Comments

Health Affairs encourages readers to engage in discussion via comments on our Web site.

• To RESPOND to a particular article: Click on the link "Submit a response to this article" in the box at the top right-hand corner of the article.
• To READ responses to a particular article: Click on the link "View responses" in the box at the top right-hand corner of the article.

Comments to:

Arnold Milstein Health Information Technology Is A Vehicle, Not A Destination: A Conversation With David J. Brailer Health Affairs, March/April 2007; 26(2): w236-w241. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

Comments:Submit a response to this article

Comments published:

Brailer Reveals His Opposition To Privacy In HIT

Deborah C. Peel, MD   ( 21 February 2007 )

Brailer Reveals His Opposition To Privacy In HIT 21 February 2007
Deborah C. Peel, MD, Chair Patient Privacy Rights Send comment to journal: Re: Brailer Reveals His Opposition To Privacy In HIT dpeelmd{at}patientprivacyrights.org Deborah C. Peel, MD	David Brailer is frank about his view of the patient's right to privacy in the electronic health system. He does not want patients to control access to their medical records. (1) He does not think we have a theoretical foundation for national health policy. We do. The AMA Code of Medical Ethics should be the moral and theoretical core of all health policy; it puts the needs of patients ahead of everyone else’s, at the center of the practice of medicine. Medicine will always be a cottage industry. At the granular level, it is only two people: a doctor and a patient. The trust between patient and physician determines if the patient will give his/her physician any information at all or even be willing to participate in the massive "health care system." (2) Although he sees privacy as the “defining issue of health information sharing,” Brailer does not agree that patients' right to control access to their medical records should be restored. He says that “settling old scores over HIPAA will not make personal health records more protected or give consumers more control over health information.” In fact, the only way consumers can have any control over their health information at all is to restore their right to medical privacy and their right of consent. (3) His view is that HIT will give consumers control by “informing their decisions about their health and who treats them.” Being informed about health and who treats you is neither privacy nor control. Knowing all about your personal health information but being unable to stop any of the over 600,000 health-related covered entities, businesses, and government agencies from legally accessing your records---as the Amended HIPAA Privacy Rule allows---is not control. (4) He favors “voluntary standards” for privacy. That’s what we have now: The marketplace has been deciding what privacy rights Americans will have. The market operates as if we are living in the Wild Wild West and as if 200+ years of state law, common law, constitutional law, the physician-patient privilege, and medical ethics do not exist, enabling corporations to freely steal, aggregate, sell, and data-mine the nation's medical records (our personal property). The marketplace has decided that Americans will not have any medical privacy, yet over 60% of the public wants the government to set privacy standards (Westin Poll). The public knows that the marketplace will never “voluntarily” give up using and selling medical records. When did Dr. Brailer last work with patients, and how did he forget the Hippocratic Oath? Does he really want a national HIT system that is not based on medical ethics and violates patients' privacy? My patients simply will not participate in any treatment or take a medication if their medical records or prescriptions can be used by employers and insurers to harm them. Consumers want the HIT system to be built with 'smart' technology that will guarnatee ironclad privacy protections and their right to consent up front before any disclosures are made. Consumers want all the benefits of HIT and privacy. No one should be forced to choose between having privacy or having health care.