The Hippocratic bargain and health information technology.
The shift to longitudinal, comprehensive electronic health records (EHRs) means that any health care provider (e.g., dentist, pharmacist, physical therapist) or third-party user of the EHR (e.g., employer, life insurer) will be able to access much health information of questionable clinical utility and possibly of great sensitivity. Genetic test results, reproductive health, mental health, substance abuse, and domestic violence are examples of sensitive information that many patients would not want routinely available. The likely policy response is to give patients the ability to segment information in their EHRs and to sequester certain types of sensitive information, thereby limiting routine access to the totality of a patient's health record. This article explores the likely effect on the physician-patient relationship of patient-directed sequestration of sensitive health information, including the ethical and legal consequences.
Rothstein
Mark A
MA
Health Policy and Law at the University of Louisville School of Medicine, LA, USA.
D003219:Confidentiality / Q000941:ethics* / Q000331:legislation & jurisprudence; D057286:Electronic Health Records / Q000941:ethics* / Q000331:legislation & jurisprudence; D006625:Hippocratic Oath; D006801:Humans; D033181:Information Dissemination / Q000941:ethics / Q000331:legislation & jurisprudence; D010817:Physician-Patient Relations / Q000941:ethics*; D014481:United States
J Leg Med. 2007 Oct-Dec;28(4):487-501
18066975
Can Fam Physician. 1989 Apr;35:921-6
11650274
JAMA. 2006 Jun 28;295(24):2882-5
16804155
Am J Bioeth. 2007 Mar;7(3):38-45
17366232
Med Care. 1981 Mar;19(3):310-5
7218896
Ann Emerg Med. 2005 Jan;45(1):53-9
15635311
BMJ. 2003 Apr 5;326(7392):725-6
12676824
North Carol Law Rev. 1984 Jan;62(2):255-94
16100795
Yale J Health Policy Law Ethics. 2002 Spring;2(2):299-323
12669316
Ann Intern Med. 1989 Mar 15;110(6):482-4
2919852
N Engl J Med. 1982 Dec 9;307(24):1518-21
7144818
J Am Geriatr Soc. 1990 Nov;38(11):1183-7
2246454
Fed Regist. 2003 Feb 20;68(34):8334-81
12596712