Monday, September 12, 2011

Health Information Technologies – Potentials and Threats to Privacy

An American has no sense of privacy. He does not know what it means. There is no such thing in the country.

George Barnard Shaw (1856-1950), Speech in New York

If the right of privacy means anything, it is the right of the individual, married or single, to be free of unwarranted government intervention.

William Joseph Brennan Jr. (1906- 1991), Eisinstadt v. Baird (1972)

September 12, 2011 - This week the Sunday edition of the New York Times contained three articles that caught my attention.

• “Court Case Asks if “Big Brother” Is Spelled GPS.

• “Tracking Vital Signs, Without the Wires.”

• “In Case You Wondered, A Real Human Being Wrote This Column”

GPS Surveillance

The GPS (Global Positioning Satellite) addresses the propriety and legality of planting GPS devices in suspect’s cars to track their activities. It asks the question; do such uses of the GPS have Orwellian Big Brother overtones? One judge says such use makes the Big Brother approach “seem clumsy”; another judge writes “1984 may have come a bit later than predicted, but it’s here to stay"); Yet another opines, “Technology has progressed to the point where a person who wishes to partake in the social, cultural, and political affairs of our society has no realistic choice but to expose to others, if not to the public as a whole, a broad range of conduct that would previously have been demme4d unquestionably private.”

Epidermal Electronic Monitoring

The second article on wireless technologies describes a new field “epidermal electronics,” mHealth, wherein researchers attach mobile devices to the skin to monitor vital signs, in such conditions as cardiac rhythm disturbances. Electronic monitoring could reduce medical costs, as proven by a large study of patients with congestive heart failure and chronic obstructive lung disease. These patients showed a 25% drop in bed days of care, and 19% drop in hospital admissions. Hospitals, the article goes on to say, “Have some fear about the financial implications.”

Algorithms as Translators of Data into Narratives

The third article – on how programmers have been able to translate financial data in readable narratives. Computers, it turns out, given the proper algorithms, can write some pretty decent prose. This research now goes under the name of “Narrative Science.” This is not the same speech recognition, which may make EHRS more useful and readable. Oren Etzoni, a computer scientist at the University of Washington, says “The quality of the narrative produced is quote good” and sees this application as pointing to “the increasing sophistication in automatic language understand and now, language generation.”

Will this application spill over into the practice of medicine? It already has. The use of the Instant Medical History, now more than 10 years old is widely used. Clinical algorithms in the Instant Medical History take age, gender, chief complaint, and symptoms, supplied by the patient from a home computer or a laptop in the reception room, into account and types out the medical history in the form of a narrative before the patient enters the exam room.

Does this threaten privacy? It might if someone hacks into the doctor’s EHR or the patient’s home computer. But is also enhances productivity, saving, on average, 6 minutes for each patients, and it adds to the comprehensiveness and accuracy of the patient’s medical history.

Tweet: IT advances include surveillance of suspects with GPS, skin devices monitoring vital signs, algorithms translating data into narratives.

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