Confidentiality and privacy of personal health information is critical to acceptance of NHIN

"ACP strongly believes in the goal of widespread adoption and use of health information technology to improve quality of care," Michael H. Zaroukian, MD, PhD, FACP, told the National Committee on Vital and Health Statistics subcommittee on Privacy and Confidentiality at their hearing on "Consumer Controls for Sensitive Health Records."

Dr. Zaroukian is a member of ACP's Medical Informatics Subcommittee and Medical Director of the Michigan State University (MSU) Internal Medicine Clinic and the University's Chief Medical Information Officer. He spoke with the subcommittee by phone.

"Control of content and access by individuals to clinical information are critical issues that will greatly influence acceptance and use of the National Health Information Network (NHIN)," Dr. Zaroukian continued. "The impact of policies adopted and implemented to address these complex concerns could be substantial with respect to the accuracy, reliability and usability of information exchanged electronically."

Dr. Zaroukian responded to a June 2006 report to Health and Human Services Secretary Leavitt that raised questions about the practical implications of policy decisions regarding an individual's right to control access to his or her personal health record through the NHIN.

"Individuals should be able to access their health and medical data conveniently, reliably and affordably," Dr. Zaroukian recommended. "Further, individuals should be able to review which entities and providers have accessed their personal health information."

Dr. Zaroukian suggested that the NHIN use role-based access models to determine the level of information provided to any entity accessing a personal health record. A role-based model would use privacy algorithms such as the title of the requestor, role of the requestor, and source and type request to determine the level of clinical information provided. This model would also allow for privacy of mental health therapy notes, but would represent all of a patient's medications and allergies to show the essential elements of the medial record.

Dr. Zaroukian concluded by saying that the effectiveness of the NHIN will be determined by the degree to which patients and providers trust the system. "Individuals and their health care providers will need to trust that the information provided is complete, accurate and the best available representation of clinical data for the purpose identified. Anything short of these objectives will undermine the efforts to use the NHIN to achieve the quality improvements and cost savings many have projected."