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mation while increasing others. A 1994 Institute of Medicine report32 recommends that federal preemptive legislation be enacted to establish uniform requirements for the preservation of confidentiality and the protection of privacy rights for health data about individuals. A more recent OTA report33 identifies the issues of privacy and confidentiality as particularly important areas in dealing with health information. The report suggests that if there is little confidence that electronic medical information systems will protect them, providers and patients will be unwilling to use them. The report concludes that Congress may wish to establish federal legislation and regulation to protect medical information, as well as electronic data standards for storage and transmission of medical information.
As these reports recognize, legal regulation of medical privacy cannot focus solely on the doctor-patient relationship or the site at which the information is processed or stored. Moreover, an individual's own control over his or her health information cannot be complete because these data are essential for the modern distribution of health care services. In the computer age, health data pass through an increasing number of professional settings and organizations. The processing of personal information already plays a critical role in the provision, regulation, and financing of health services by government and private entities. Beyond the traditional doctor-patient relationship and the provision of health services in hospitals, a variety of public and private organizations now use personal health data. Moreover, health care reform will further increase the extent to which health care data are applied and shared. As part of this process, greater use will be made of information technology in an attempt to control costs and increase the quality of care.
In preparing and implementing laws and policies to provide privacy, policy makers cannot ignore the possibility that individuals may be discriminated against on the basis of specific illnesses or conditions they have or that sensitive or adverse information may be used against an individual's economic interests in some way. For example, an employer may refuse to hire or promote an individual with a long and expensive history of medical claims (or with the prospect of probable expensive or chronic medical problems in the future based on family history). Policy makers must assume that such discrimination is likely to continue in the
Institute of Medicine. 1994. Health Data in the Information Age: Use, Disclosure, and Privacy, Molla S. Donaldson and Kathleen N. Lohr (eds.). National Academy Press, Washington, D.C.
Office of Technology Assessment. 1995. Bringing Health Care On line: The Role of Information Technologies. U.S. Government Printing Office, Washington, D.C.