Health Privacy

Personal Health Records: PHRs and Correction

One basic privacy right is the right to seek correction of personal information that is incorrect or incomplete. This is a difficult area for health records because health care providers do not like to change records, and they strongly resist removing information from a record. Often, the resistance is reasonable. For example, a preliminary diagnosis may turn out to be wrong, but the record of the diagnosis must remain in the record to explain a particular test or treatment.

Personal Health Records: PHRs and Consents for Disclosure

Under HIPAA, if a consumer wants to authorize a covered entity to disclose her records, she will usually be obliged to sign an authorization form. The HIPAA rule prescribes the content of the authorization form and its scope. That rule provides some protections because it makes it harder for a consumer to unknowingly sign a form authorizing the disclosure of health records. For example, if a consumer signs a one-sentence form authorizing anyone with records about the consumer to disclose the records to the bearer of the form, it is unlikely that any doctor or hospital would or should honor that form.

Personal Health Records: PHRs and Privacy Policies

For a non-HIPAA covered PHR, the privacy policy becomes a key document, if it is available. The privacy policy of a PHR vendor may tell consumers how the vendor plans to use personal information. It is possible that a commercial or advertising-supported PHR will do a good job of protecting its clients from uninformed or casual disclosures of personal or health information. It is also possible that a cautious client will not be able to evaluate a PHR vendor’s policy or practice.

Personal Health Records: Conclusion

PHRs that operate outside of HIPAA can negatively affect the privacy interests of consumers in various ways. The best to hope for is that a PHR will not make privacy significantly worse. However, it is not likely that even that weak standard can be met. The existence of electronically available and centralized health information outside the traditional health care system will attract new users and create new risks. The mere adding of health records to a PHR vendor’s files may undermine existing privacy protections of old records. Security is a concern for any electronic records. A consumer’s ability to control the disclosure of PHR records can easily be compromised. The consumer’s ability to correct errors in PHR records may be problematic. Advertising support may not meet a PHR’s profit goals unless at least some consumer information is available for close targeting of ads. Promised PHR privacy protections may vanish overnight if the privacy policy is changed.

World Privacy Forum files public comments regarding oversight of genetic testing

Genetic privacy | SACGHS -- The World Privacy Forum filed extensive comments with the Secretary's Advisory Committee on Genetics, Health and Society (SACGHS) regarding its draft report on genetic testing oversight, U.S. System of Oversight of Genetic Testing: A Response to the Charge of the Secretary of HHS. The World Privacy Forum requested SACGHS pay more attention in its final report to the privacy consequences of unregulated genetic testing that occurs outside the health care sector. The WPF comments note that current and proposed remedies for the misuse of genetic information tend to focus on the use of the information within the health care treatment, payment, and insurance systems. What is crucially important is to analyze how to protect genetic information in the realm of commercial collection, maintenance, use and disclosures. Another area the comments discuss is the potential for new forms of fraudulent activity related to genetic testing (Phantom genetic testing, that is, genetic tests marketed to consumers that are not even real or viable genetic tests.) The World Privacy Forum specifically recommended that the National Committee on Vital and Health Statistics be tasked with looking at this matter, that an independent pre-market assessment mechanism is created for genetic tests offered outside the clinical setting, and that privacy be expressly discussed in the overarching recommendations in the final report.

World Privacy Forum appointed to California Security and Privacy Advisory Board

Announcement | CalPSAB -- WPF executive director Pam Dixon has been appointed by California Secretary of Health and Human Services Kim Belshe to the California Security and Privacy Advisory Board. Dixon will serve as interim co-chair of the board, which is tasked with addressing health information exchange (HIE) privacy and security efforts in California. The board's meetings will be open to the public.

Briefing Paper - Responses to Medical Identity Theft: Eight best practices for helping victims of medical identity theft

Version 1: October 16, 2007 The World Privacy Forum, as part of its ongoing in-depth research into medical identity theft issues and responses, has outlined 8 best-practice responses to the crime by the health care sector. These best practices are based on interviews with victims, providers, and other stakeholders. These ...

World Privacy Forum gives keynote speech to AHIMA on medical identity theft; outlines 8-point best-practice responses to the crime

Medical identity theft | AHIMA -- Executive director Pam Dixon spoke to thousands of AHIMA delegates in Philadelphia sharing the latest information on medical identity theft and outlining 8 best practice responses to the crime for the health care sector. Dixon specifically asked for the creation of national guidelines for helping medical identity theft victims, the ability for victims to set red flag alerts in their health care files, that providers train and have dedicated personnel to help medical identity theft victims, "john and jane doe" file extractions, a focus on addressing insider access to patient information, risk assessments specifically for medical identity theft, and educational efforts. The information in the speech was based on the latest World Privacy Forum research in the area of medical identity theft.

World Privacy Forum outlines 8 best practice responses to medical identity theft for the healthcare sector

Medical identity theft | Best practice responses -- The World Privacy Forum has outlined 8 best practice responses to medical identity theft for the health care sector. The best practice responses are based on research the Forum is conducting for its second report on medical identity theft, and is a work in progress. The 8 best practice responses were presented to AHIMA delegates October 9; the Forum is soliciting and accepting feedback on the 8 best practices.

Public Comments: World Privacy Forum files comments on CMS plan to allow release of patients' protected health information from Medicare database in some circumstances; benefits do not outweigh the risks

Medicare - CMS -- The World Privacy Forum filed extensive pubic comments on the substantive changes to the Medicare database release policy that the Centers for Medicare and Medicaid Services (CMS) has proposed in a System of Records Notice. As it currently stands, CMS is planning to release the individually identifiable protected health information of patients in the Medicare database to third parties in some circumstances. CMS has not established strong enough checks and controls on its release policy, and it has not explained how it is able to do this under HIPAA. The comments state that CMS has an obligation to explain how each routine use in its new policy is consistent with the authority in the HIPAA privacy rule. If a routine use allows disclosures that are broader than those permitted by HIPAA, then the routine use must be narrowed so that it is consistent with HIPAA. The comments also note that nothing in the CMS notice discusses substance abuse rules and other legal restrictions of the protected health data. The World Privacy Forum asked CMS to specify that the qualifications of any data aggregators who may potentially receive the data exclude any entity that sells other consumer data for any general business, credit, identification, or marketing purpose.

Update: World Privacy Forum's NHIN Timeline updated to reflect changes in AHIC

NHIN update -- The National Health Information Network, or NHIN, is part of a major undertaking to digitize and network the health care sector. From electronic health records to multi-state health information hubs, the U.S. government's goal is to modernize and move health care information from paper to digital. The Department of Health and Human Services is the primary mover behind this initiative, which is complex and multi-faceted. The World Privacy Forum keeps a chronology of NHIN events as a public service. The NHIN timeline has been updated to reflect changes in AHIC, a group that is charged in part with ensuring privacy and confidentiality in the NHIN and other aspects of health care modernization. AHIC is set to transition to a "public-private partnership," a move that will need to be watched closely to ensure robust consumer involvement.

World Privacy Forum requests adoption of a "no stakeholders left behind" policy in AHIC successor plans

AHIC successor | health care privacy -- The World Privacy Forum offered public comments on HHS' American Health Information Community (AHIC) successor plans, urging that HHS adopt a "no stakeholders left behind" policy as it forms the new public/private AHIC. The Forum's analysis of the AHIC Successor White Paper concluded that the current succession plans lack processes and checks that would ensure meaningful consumer participation, and that the AHIC successor plans as they currently stand do not bode well for a robust role for privacy or consumer groups in the new AHIC. Specific issues the World Privacy Forum discussed in its comments included fee structures, membership, handling conflicts of interest, stakeholder issues, privacy and identifiability issues, and the need for the new AHIC to achieve credibility.

World Privacy Forum and EFF submit comments on AHRQ plan for national healthcare database

AHRQ / databases | medical privacy -- In June, the Agency for Healthcare Research and Quality (AHRQ) published a request for information about its plan to create a "public/private" national database of healthcare information tentatively called the "National Health Data Stewardship entity." WPF and EFF raised questions about ownership and management of the proposed database (Would this database fall under HIPAA? Would it fall under the Privacy Act of 1974?), questions about identifiability of patients in the database, and suggested that a full-time, independent privacy officer should be established for the program from the inception of the planning stages. The comments also discussed the numerous questions relating to data security (including medical identity theft) and data quality, as well as consent, access, and opt-out procedures for patients that the proposed national database raises.

World Privacy Forum responds to June 2007 NCVHS recommendations to the Secretary of HHS regarding health care information at non-HIPAA covered entities

Medical privacy | NCVHS | HIPAA -- The World Privacy Forum has sent a letter to Dr. Simon P. Cohn, Chairman of the National Committee on Vital and Health Statistics, supporting the Committee's formal conclusion that all entities that create, compile, store, transmit, or use personally identifiable health information should be covered by a federal privacy law. More needs to be done about health care data that is left unprotected by HIPAA. The Forum's letter included a discussion of two HHS programs that operate outside of HIPAA: FDA RiskMAPS, and the National Institutes of Health, which is not a covered entity under HIPAA.

World Privacy Forum testifies at FDA advisory committee hearing on the iPledge program; requests attention to privacy issues

iPledge Program | FDA -- The World Privacy Forum testified before the Dermatologic and Ophthalmic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee of the Food and Drug Administration regarding privacy issues related to iPledge, a mandatory program for patients taking the drug Accutane or isotretinoin generics. The FDA has stated that the program, which it requires four drug manufacturers to have in place, does not fall under HIPAA. The program collects substantive amounts of patient information. The Forum urged the FDA to set privacy standards for all RiskMAPs in general, and to resolve privacy issues in the iPledge program specifically. The Forum requested that all marketing provisions of the iPledge program privacy policy be removed, that patients be expressly informed the program does not fall under HIPAA, and that patients be given a printed copy of the iPledge program privacy policy, among other requests.

World Privacy Forum requests that the new National Disaster Medical System protect all patient information to standards at least equal to HIPAA

National Disaster Medical System | Privacy Act of 1974 -- The World Privacy Forum has filed public comments with the Department of Health and Human Services requesting that its new National Disaster Medical System protect all patient information to at least the baseline protections that HIPAA affords, including the HIPAA security and privacy protections. Currently, the new system does not do this, even though the system is housed at HHS, the agency which promulgated the HIPAA standards. The National Disaster Medical System currently contains overbroad routine uses which could potentially result in significant privacy and even public health issues. For example, public health information will not be able to be disclosed under the National Disaster Medical System as the system is currently organized. Additionally, some of the current routine uses in the system would authorize disclosures that would be illegal under HIPAA. For example, Congressional disclosure of a HIPAA record requires a written authorization, something the new system does not require.

The FDA needs to set privacy standards to protect patients in drug risk programs

FDA privacy standards - RiskMAPs - World Privacy Forum executive director Pam Dixon testified at an FDA/AHRQ joint public workshop about the need for the FDA to set robust privacy standards for drug risk minimization programs, which are put in place for drugs the FDA has determined to be high risk in some way. Drug risk minimization programs (like the iPledge program for the acne drug Accutane) are not typically covered by HIPAA, and some programs have a privacy policy that allows marketing use of patient information collected as part of the risk program. This kind of marketing activity would not be allowable if the programs fell under HIPAA, and Dixon's testimony stated that patients in these programs should have the same kinds of privacy protections as HIPAA covered programs, and that marketing activities involving patient information should not be allowable in these programs.

World Privacy Forum files public comments and recommendations on pharmacogenomics privacy: all patient-specific PGx research should require certificates of confidentiality

information will expand greatly in the future. In public comments filed with the National Institutes of Health on pharmacogenomics (PGx) research, or research using genetic information to create highly personalized medicine, the World Privacy Forum recommended that all research activities that involve any type of patient-specific genetic information be required to have certificates of confidentiality, whether that information appears identifiable or not. The WPF also urged the NIH to require strong data use agreements to protect individuals' privacy. The WPF also urged NIH and the Department of Health and Human Services to reinstate the position of "privacy advocate" so as to provide oversight in this area.

Update: World Privacy Forum's National Health Information Network Timeline

National Health Information Network -- Recently, the first live prototypes of the NHIN were demonstrated in Washington, D.C. This was a milestone event in the development of the planned network. The National Health Information Network is an ambitious project the U.S. government undertook in 2004 to digitize and network patient health records across the nation. This project raises challenging confidentiality, privacy, and security issues.

World Privacy Forum testifies on genetic privacy and consumer data marketing issues

Genetic privacy | SACGHS -- The World Privacy Forum gave testimony to the Secretary's Advisory Committee on Genetics Health and Society regarding privacy issues stemming from direct-to-consumer advertising and consumer-initiated genetic testing. The World Privacy Forum noted that a great deal of consumer health data circulates outside the protections of HIPAA, and a substantial market for this kind of consumer health data already exists. Genetic data about consumers that is acquired outside the clinical context and is not subject to the protections of HIPAA (for example, through consumer-initiated genetic testing) will likely not be any more protected than other forms of consumers' health-related information from the current demands of the market. However, the consequences of leakage of genetic information about consumers into the marketing stream could have potentially negative consequences for both those consumers and their blood relatives. The World Privacy Forum urged the committee to include specific recommendations about privacy in its upcoming report to the Secretary, and also urged the committee to work with other federal agencies to set up a pre-market oversight structure that includes significant and meaningful privacy protections for genetic testing occurring outside of the protections of HIPAA.

World Privacy Forum comments about the ethical, legal, and social implications of using genetic health care data in electronic health records

Genetic Privacy -- The World Privacy Forum filed public comments with the Department of Health and Human services in response to an HHS request for information regarding the use of patients' genetic data for research, health care, and for use in electronic health records. The World Privacy Forum is requesting that HHS use all Fair Information Principles in any personalized health care projects, and is requesting that a formal ELSI (ethical, legal, and social implications) committee be set up to oversee any projects, among other requests.

President's Identity Theft Task Force: World Privacy Forum requests that medical identity theft be added to task force agenda

Identity Theft -- The World Privacy Forum filed comments and recommendations with the President's Identity Theft Task Force. The task force's draft report and recommendations did not include or contemplate medical identity theft solutions for victims; the WPF has requested and recommended that this be corrected. Medical identity theft victims need more help, more recourse, and agency attention.

World Privacy Forum Requests That CMS Bring Its Medicare Part D Data Activities Under HIPAA and Require Certificates of Confidentiality to Protect Patient Privacy

Medical privacy | Medicare Part D -- In comments filed with the Centers for Medicare and Medicaid Services, the World Privacy Forum requested that CMS give effect to data restrictions that Congress has expressly included in the law. WPF also requested that CMS include in its standard agreements for use of CMS data a requirement that the recipient obtain a certification of confidentiality for all identifiable CMS data. WPF also requested that CMS perform a regulatory impact analysis and publish a system of records notice.

World Privacy Forum Comments on "Red Flag" Guidelines for Identity Theft, Requests Addition of Medical Identity Theft to Red Flag Rule

Identity theft | medical identity theft -- The World Privacy Forum filed comments with the Federal Trade Commission, the Treasury, and other federal agencies today regarding the joint draft rule on "Red Flags" for identity theft. In its comments, the World Privacy Forum requested that medical identity theft be added to several aspects and portions of the proposed rule. Adding medical identity theft to the rule is essential to help close gaps in protection for consumers and to encourage health care providers to attend to victims' challenges and needs regarding medical identity theft.

Public Comments: July 2006 - WPF comments on draft report "Policy Issues Associated with Undertaking a Large U.S. Population Cohort Project on Genes, Environment, and Disease.

The collection of DNA material from 500,000 to 1,000,000 or more individuals as part of a large U.S. medical research project raises many challenging ethical, legal, and privacy issues. An advisory committee reporting to the Office of the Secretary of Health and Human Services ( the Secretary's Advisory Committee on Genetics, Health and Society) has published a detailed analysis of the issues such a project would raise in a draft report. The committee's final report and policy recommendations will be submitted to the Secretary of HHS. The World Privacy Forum has submitted public comments on the draft report; the comments include key policy recommendations. The Forum's recommendations include the need to provide protection from compelled disclosure of information, the necessity for a full-time project privacy officer with enforcement power, and the need for a far-reaching and robust privacy policy that exceeds the requirements of HIPAA, among other recommendations.