Medical Records

How can any regulation be called a "privacy rule" when it permits sharing Americans' most personal medical information with 800,000 or so health, business and government entities? Even a hospital gown offers more privacy, and this widespread access to medical records should leave patients with a different sort of chill running up the spine. How can they be open about their medical needs if traditional doctor-patient confidentiality has been eroded? Medical privacy rules put in place in 2003 under HIPPA - the Health Insurance Portability and Accountability Act of 1996 - can make it harder to send someone flowers in the hospital, or check on their condition, than limit access to patient records.

Was it only April? That's when Bush administration officials were touting their new federal privacy rules as a major advance in safeguarding Americans' personal medical data. By winter, though, Attorney General John Ashcroft's Justice Department was battling to obtain the medical records of patients in Philadelphia, Chicago, New York and elsewhere who underwent a controversial late-term abortion. Justice lawyers offered this startling rationale for their records request: Given "modern medical practice" and the involvement of third-party health insurers, they said, "individuals no longer possess a reasonable expectation that their histories will remain completely confidential.

Conservative radio commentator Rush Limbaugh got a birthday present yesterday from an unlikely new friend - the American Civil Liberties Union. The ACLU wants to join the fray in Limbaugh's right-to-privacy battle with Palm Beach County, Fla., prosecutors over his medical records, which were seized a month ago from four doctors as part of an investigation into Limbaugh's prescription drug use. Prosecutors, meanwhile, filed to dismiss the...

Imagine this scene next fall: Monday Night Football reporter Melissa Stark is poised to report on the quarterback's injury - a body slam just witnessed by millions of TV viewers. But then hulking host John Madden breaks in breathlessly and announces, "Holy cow, Melissa, that information is private by federal law!" That's as silly as this potential scene at your family doctor's office: Staff clearing away cutesy bulletin-board photos and community news items about patients.

Despite strong opposition from the health-care industry, the Bush administration announced yesterday that it will implement the first federal standards to protect the privacy of patients' medical records. While the Bush administration intends to make some revisions to the rules - which originally were offered in the Clinton administration's final weeks - the regulations will limit the use and exchange of patient information by health-care professionals, employers, insurers and others.

Each side in the debate over better safeguards for the privacy of medical records had its horror stories. From folks urging better protections came stories of purloined patient files - even psychotherapy notes only a mouse-click away from dozens of prying eyes at a Boston HMO. From the health-care industry, insurers and drug makers came claims that patient care might be hurt. They said new rules requiring patients' consent to release health data might even stop a frail retiree from sending her neighbor around to the drugstore for critically needed medicine.

The Clinton administration has erred on the side of protecting patients' privacy in its new regulations to safeguard the confidentiality of Americans' medical records. That's good preventive medicine for a health-care woe that most patients hardly consider when they visit their doctor or hospital, or fill out a lengthy insurance form. In a digital age, the challenge is how to keep private medical records private. Since Congress directed the White House to come up with privacy guidelines in 1996, debate over the issue has been contentious, if low-profile.

Dr. Bartholomew Tortella no longer has to locate a vacant computer terminal to get the results of tests that measure the depth of an accident victim's shock. Instead, the chief of trauma and surgical critical care at Hahnemann University Hospital can find the information on his wireless Palm VIIx personal digital assistant. And having the facts at hand can be crucial in determining the best method for resuscitating the victim, he said. Tortella is participating in a wireless experiment at MCP Hahnemann University.

So who do you think knows about that embarrassing little medical problem you may have had recently? Your doctor, of course. And the nurse. The receptionist who faxed your health insurance claim form knows. So, too, the health insurance worker who typed the information into the company's giant computer banks. Depending on your little medical problem, local and state health departments probably know. And if the federal government is paying for treatment through Medicare, Medicaid, Social Security disability or Workers' Compensation, the bureaucrats know, too. Other insurance companies could know if your file is sent to the Medical Information Bureau, a central database containing the medical records of 15 million residents of the United States and Canada.

You can't get blood from a stone. But you can get blood from a stoned driver. Even without a search warrant, said the state Superior Court. Joanne M. Barton tried to make a test case out of the issue, but this week she was notified that the appeal of her drunken-driving conviction has gone down the tubes. Barton's blood was drawn at a Lancaster County hospital after she was injured in a car crash on Jan. 1, 1995. It confirmed that she had been intoxicated while driving.