As efforts to implement electronic medical records escalate, so do the debates about patient privacy and the potential for commercial exploitation of the technology.
Computerized files are seen as a way to improve care and save tens of billions of dollars in health costs, but doctors and advocacy groups have raised concerns about the risks of exposing detailed personal health information. In particular, doctors worry that insurance and drug companies could manipulate the records to affect decisions on patient treatment.
MedChi, which represents more than 22,000 Maryland physicians, recently announced that it was the first medical society in the nation to pass a resolution calling for state-level legislation to ensure that doctors retain responsibility for treatment decisions and that medical records are made available on a neutral platform that does not advance any commercial interests.
"As we implement the system, we want to make sure the data remains the patient's data and is private," said Gene Ransom, MedChi's chief executive officer.
The establishment of electronic medical records is a major part of national health care reform. The Obama administration set aside nearly $19 billion in stimulus money to establish electronic records for all Americans by 2014. The records would include a patient's history as well as guidelines and the latest medical research and treatments for diseases.
Health officials acknowledge that privacy issues will arise with digitized records.
"In the electronic arena, there is a need for more oversight and constraint," said Rex Cowdry, executive director of the Maryland Health Care Commission.
Privacy of patient medical records has long been a concern of the health industry and government. The federal Health Insurance Portability and Accountability Act sets guidelines on what information can be shared.
There are risks even with paper record keeping. But electronic records shared among many medical institutions heighten that risk because the data becomes more widely available, and computer systems could be hacked.
"Their private records could end up in the hands of someone they don't want to see it," said Melissa Goemann, legislative director of the Maryland chapter of the American Civil Liberties Union. "People could steal records and try to get Social Security numbers. There are all kinds of invasion-of-privacy issues."
Some of the policies the state is considering would enable patients to limit which doctors see their electronic medical records or to opt out of the system altogether.
"A person could call up and say, 'I don't want any of my information queried, even if I am in the emergency room,' " said Cowdry of the Maryland Health Care Commission.
The commission's policy group is also looking at ways to ensure the identity of those authorized to use the system. It would likely require more than a user name and password to sign into the system.
But concerns persist.
MedChi is worried about electronic systems owned by insurance and drug companies that would feed into the state exchange. The medical society wants to prevent insurance companies from using the records to bolster arguments for denying treatment because of costs. MedChi wants state legislation aimed at preventing drug and insurance companies from influencing medical care.
For instance, an electronic system owned by a drug company might recommend its drugs for treatment of certain ailments, the doctors' group contends. It recommends that clinical information available to the exchange be provided by a third party or academic institution.
The group also wants immediate responses from insurance companies on prior-authorization requests to prescribe certain medications or perform procedures -- a process that now can take days but that could be accelerated with electronic medical records.
"We need to make sure we protect the privacy of the patients and that the recommendations the doctors are getting are represented in an unbiased fashion," said David Hexter, an emergency physician at a Baltimore community hospital and president of MedChi.