| 2009 is a year of hope and change. However, it is | | | | Medical databases are desirable because they |
| not certain that change will be positive when | | | | usually contain the information necessary to |
| rushed through congress at break-neck speed. | | | | perpetrate identity theft. Additionally, there are |
| The economic stimulus bill that President Obama | | | | many recorded incidents of hospital record |
| just signed includes legislation that will establish a | | | | systems made available on the internet through |
| national computerized medical records database | | | | poor server configuration or administrative error. |
| that will contain data on every citizen. In addition, | | | | The government has a lackluster history regarding |
| the legislation will force physicians to adopt | | | | computer security. The Federal Information |
| electronic medical records (EMRs) that meet | | | | Security Management Act (FISMA) was enacted |
| government standards and specifications. | | | | to improve security, but its success has been |
| There are three main problems with this new | | | | marginal. |
| legislation. First, it eliminates patient choice | | | | The government will use Medicare and Medicaid |
| regarding disclosure of their medical records. | | | | reimbursements to force physicians to adopt an |
| Second, it creates a high-value target for online | | | | EMR that meets government specifications. |
| criminals. Third, it eliminates freedom of choice for | | | | Although we do not know what those |
| physicians. | | | | specifications will involve, they will probably be of |
| A national database containing data on "every | | | | a "one size fits none" nature. Specifications |
| American" by definition proscribes patient choice. | | | | designed by committees tend to change rapidly |
| Although the legislation states participation is | | | | and be unnecessarily complex. Implementing |
| voluntary, it does not contain any measures for | | | | medical records is a difficult task without being |
| opting out of the system. Furthermore, the | | | | forced to adopt an overly expensive and complex |
| database will be used for biosurveillance, public | | | | system. |
| health, as well as research purposes. It is unclear | | | | While there is certainly a need to encourage |
| what "biosurveillance" means at this time. | | | | physicians to adopt EMRs, the current strategy of |
| However, it is clear that any citizen in this data | | | | implementation through legislation has many |
| base will have no control over their records. | | | | problems including patient privacy, security of |
| Online databases of medical information have | | | | medical information, and freedom of choice. |
| traditionally been high-value targets for e-criminals. | | | | |