User:Cal.oasis/sandbox

Article evaluation

1. Regarding the information privacy page:

Content: I thought that the introduction part was fine as it included important definitions about specific terms such as privacy and information privacy; however, I thought that the format of the page could have been better. I think that the list in the introduction is distracting because it is different from the format of the rest of the text. Additionally, I think it would be better if it was a horizontal list rather than a vertical list. Additionally, I think that the authors should introduce the different information types in the introduction part because there the main body of the article is about those. The legality portion is very small and only contains one sentence. More information could be added there. The Safe Harbor program and passenger name record issues is also distracting. I think that it should not have its own section, but can be used as an example of a information privacy problem. Otherwise, if the author would like to keep this section, explain the relevance to information privacy more explicitly.

Tone: I think that the tone is neutral. The viewpoints are neutral as well. There are sections with more information than others, but other than that, I think that the tone is okay.

Citations: In order to check the viability of the sources, I looked at the first 5 citations. Each of the links took me to the original article; however, I had trouble accessing the third citation as there was an original and archived copy. Some of the sources did not look like they were scholarly articles. For example, the fourth and fifth citation took me to websites rather than databases with scholarly articles. The fifth source is from USA Today, and I am not sure if the article is peer reviewed, therefore, it is not a good source.

Talk page: This article is part of the WikiProject Computing, Internet, and Surveillance. This page has high importance. There is discussion over phrasing of the information that makes it seem opinionated. There is also discussion about adding sections regarding different countries and their privacy protection. Additionally, there is a discussion over unavailable sources and moving the article to different pages. At the bottom, there is multiple discussions on citation use.

2. Regarding the computer security page:

Content: I think that the content of this page is very thorough. There is extensive information about the different types of computer risks, actions that can be made if your computer goes through these things, and the response to increase in computer risks. I do not have any issues with the formatting of the page.

Tone: I think that the tone for this article is neutral as well. I do not see any issues with the language used. Additionally, most of the sections are equally explained and have enough information to understand the topic.

Citations: I checked the first 5 sources listed. Each of the links takes me to the correct articles, which are all scholarly articles. I do not see any issues with the information that they have used.

Talk page: This article is part of the WikiProject Computing, networking, software, websites, computer science, hardware, computer security, computing, internet and espionage. There is talk about cleaning up grammar issues, external links, and there was a requested move as of Dec 2017; however, they have decided to not change the page.

Citation Exercise

Although there is a common belief that monitoring can increase productivity, it can also create consequences such as increasing chances of deviant behavior and creating punishments that are not equitable to their actions. Additionally, monitoring can cause resistance and backlash because it insinuates an employer’s suspicion and lack of trust.

Medical Privacy Page

For the Medical Privacy page I hope to give a larger understanding of what medical privacy is and how the concept has changed over time. I would like to give a brief overview of medical privacy prior to the industrial/technological boom and then discuss further the concept after the boom as it is very important modern society. Additionally I would like to discuss more about medical privacy within the United States and talk about different laws that were passed in order to ensure better privacy. I plan to include a list of laws that were proposed. Additionally, I plan to add more information to the state portion. I plan on focusing primarily on the United States rather than other countries.

Additionally, many laws that were proposed not passed because companies feared that they would not be able to make the same profits, so I plan to also address the viewpoint of medical privacy from businesses rather than just the individual.

Annotations:

Alpert, Sheri. 1993. “Smart Cards, Smarter Policy Medical Records, Privacy, and Health Care Reform.” The Hastings Center Report 23(6):13–23.

In Sheri Alpert’s “Smart Cards, Smarter Policy Medical Records, Privacy, and Health Care Reform”, Alpert discusses how today’s current laws do not adequately protect patient’s medical records or privacy. As a result, there has been an effort to establish better privacy mechanisms to protect people’s information.  Prior to the technological boom, many people relied on paper medium to file people’s medical data; however, nowadays their information is stored within electronic databases. However, it was more safe to have information with paper as it was harder to physically steal the data, yet now hackers are able to access large amounts of information without the owner’s knowing. Additionally, with the risk of information exposure, the relationship between physician and patient has changed as people are more reluctant to share information that has a chance of being breached. In order to reform the healthcare privacy issues, researchers are looking into the use of credit cards and “smart” cards that will allow people access to their medical information. The new “smart” card allows the storage and processing of information to be stored in singular microchip, yet people are fearful of so much information stored in a single spot that can easily be accessed. This “smart” card would include an individual’s social security number which is important piece of identification that can cause identity theft if the data bases are breached. Additionally, people will target these medical cards as they have information that can be of value to many different third parties including employers, pharmaceutical companies, drug marketers, and insurance reviewers. In response, there has been movement to create better medical privacy protection, but nothing has been officially passed. The Medical Information Bureau was created to to prevent insurance fraud, yet since it is a significant source of medical information for over 750 life insurance companies, it is very dangerous as it is a target of privacy breachers. Although the electronic filing system of medical information has increased proficiency and administration costs have been reduced, there are negative aspects to consider. The electronic filing system allows for individual’s information to be more susceptible to outsiders; even though their information is stored on a singular card, it serves as a false sense of security as it does not protect their information completely. Ultimately, there is still an issue with individual medical privacy as the confidentiality of an individual’s medical information is not guaranteed. I believe that this is a good article as it is not biased, all information is backed up by different studies and sources, and straightforward and a relatively easy read. I think it gives a good overview of the change from paper to electronic filing system of medical information and would recommend it to others. I think that this article is helpful because I can use it to talk about the shift in medical filing and how people’s privacy were changed because of it. I was unaware of how easy it is for outside parties to access my medical information from these large databases.

Etzioni, Amitai. 2000. “The New Enemy of Privacy: Big Bucks.” Challenge 43(3):91–106.

In Amitai Etzioni’s “The New Enemy of Privacy: Big Bucks”, Etzioni argues that the main danger to an individual’s privacy are private corporations because of profits from privacy-violating information. Privacy merchants are made up of two categories, one has the goal of collecting people’s personal information while the other focuses on using client’s information to market products. Privacy merchants are also able to purchase information from other companies if there is not sufficient information from their own research. A person’s privacy regarding their medical information is also very common, but people have been responding negatively and have called it “authorized abuse”. Health insurance companies nowadays collect huge amounts of personal information and keep them in large databases by requiring patients to provide more information that is needed for purposes other than that of doctors and other medical workers. Additionally, with the new technological developments, and the development of computerized records, it is easier for people to access information as many databases have been compiled into a singular place. Additionally, people’s information can be linked to other information outside of medical information. Many employers use insurance information and medical records as an indicator of work ability and ethic. Additionally, with the violation of privacy, medical research is difficult to do because people fear losing their confidentiality. The selling of privacy information can also lead employers to receive lots of money; however, this happens to many people without their consent or knowledge. Although there is a large group of people who oppose the selling of individual’s medical information, there are groups such as the Health Benefits Coalition, the Healthcare Leadership Council, and the Health Insurance Association of America that are against the new reforms for data protection as it can ruin their work. Furthermore, it is not the government that is the reason for many issues with medical privacy, but it is the large corporations that are trying to make profits off of our data. I think that this is a good article because all of the information provided is cited by multiple sources, it is not biased, and it is straightforward. I think that this article is targeted towards people who have the mindset that the government is the reason for the issues for privacy violation. It offers a great amount of information that proves that this is not the case and that it is due to corporate greed instead. I think that I will be able to use this information to showcase how and why corporations use people’s data and sell it to other third party companies.

Bradburn, Norman M. 2001. “Medical Privacy and Research.” The Journal of Legal Studies 30(S2):687–701.

In Norman Bradburn’s “Medical Privacy and Research”, Bradburn argues that an individual’s fear of having his or her medical information spread is not a privacy issue, but is a reaction to social norms and relationships between doctors and their patients. He first discusses the benefits of the technological shift of medical filing as the supposed reason for increase in fear of privacy breaching. Online filing is more efficient, accurate, affordable, and can store high volumes of data while not being bulky or hard to transport. Yet, there are negative aspects including easier access to this information. However, he believes that the real reason for the fear of the new medical filing system is due to the social norms of doctor-patient relationships and their uses of the medical information. Although levels of confidentiality are changing, individuals often feel the need to share more information with their doctors in order to get diagnosed well. But, Bradburn argues that there needs to be less of an emphasis on sharing and confidentiality in order to rid patients from their fears of information breaching. There is a common belief that the confidentiality of one’s information also only protects the doctors and not the patients, therefore there is a negative stigma towards revealing too much information. Thus it causes patients to not share vital information relevant to their illnesses. I think that this article was well written, although the concepts were harder to understand. I believe that it was very informative and gave an interesting perspective on the privacy issues within medical data collection. I think that this serves as a good counter argument, instead of technological issues that cause privacy scares, that will help broaden the information within my article. Many articles target the companies as the main reason for lack of privacy, but this offers a new perspective and discusses the relationship between doctor and patient as the main culprit of privacy fears.  

Bibliography

1. Bradburn, Norman M. 2001. “Medical Privacy and Research.” The Journal of Legal Studies 30(S2):687–701.
2. Twight, Charlotte. 2002. “Health and Human Services ‘Privacy’ Standards: The Coming Destruction of American Medical Privacy.” The Independent Review 6(4):485–511.
3. Etzioni, Amitai. 2000. “The New Enemy of Privacy: Big Bucks.” Challenge 43(3):91–106.
4. Alpert, Sheri. 1993. “Smart Cards, Smarter Policy Medical Records, Privacy, and Health Care Reform.” The Hastings Center Report 23(6):13–23.
5. Sobel, Richard. 2007. “The HIPAA Paradox: The Privacy Rule That’s Not.” Hastings Center Report 37(4):40–50.
6. Etzioni, Amitai. 2000. “The New Enemy of Privacy: Big Bucks.” Challenge 43(3):91–106.
7. Peter H. W. Van Der Goes. 1999. “Opportunity Lost: Why and How to Improve the HHS-Proposed Legislation Governing Law Enforcement Access to Medical Records.” University of Pennsylvania Law Review 147(4):1009–67.
8. Hiller, Mare D. and Lee F. Seidel. 1982. “Patient Care Management Systems, Medical Records, and Privacy: A Balancing Act.” Public Health Reports 97:332–45
9. Zittrain, Jonathan. 2000. “What the Publisher Can Teach the Patient: Intellectual Property and Privacy in an Era of Trusted Privication.” Stanford Law Review,52:1201–50.
10. Gostin, Lawrence, James Hodge Jr. , and Lauren Marks. 2002. “The Nationalization of Health Information Privacy Protections .” Tort & Insurance Law Journal 37:1113–38.
11. Parver, Corrine. 2006. “Lessons From Disaster: HIPAA, Medicaid, and Privacy Issues- The Nation's Response to Hurricane Katrina.” Administrative Law Review 58:651–62.
12. Everett, Margaret. 2007. “The ‘I’ in the Gene: Divided Property, Fragmented Personhood, and the Making of a Genetic Privacy Law.” American Ethnologist 34(2):375–86.
13. Woody, Robert W. 2002. “HEALTH INFORMATION PRIVACY: THE RULES GET TOUGHER.” Tort & Insurance Law Journal, vol. 37, no. 4, pp. 1051–1076.
14. Wieczorek, Susan M. 2010. “FROM TELEGRAPH TO E-MAIL: PRESERVING THE DOCTOR-PATIENT RELATIONSHIP INA HIGH-TECH ENVIRONMENT.” ETC: A Review of General Semantics, vol. 67, no. 3, pp. 311–327.
15. Knapp, John A., and Michael J. Rothman. 2004. “RECENT DEVELOPMENTS IN INSURANCE REGULATION.” Tort Trial & Insurance Practice Law Journal, vol. 39, no. 2, pp. 511–531.
16. Lengwiler, Martin. 2006. “Insurance and Civil Society: Elements of an Ambivalent Relationship.” Contemporary European History, vol. 15, no. 3, pp. 397–416.
17. Hickerson, Kristina A.K. 2001. “CONSUMER PRIVACY PROTECTION: A CALL FOR REFORM IN AN ERA OF FINANCIAL SERVICES MODERNIZATION.” Administrative Law Review, vol. 53, no. 2, pp. 781–801.
18. Hosek, Susan D., and Susan G. Straus. 2013. “Privacy of Individual Health Information.” Patient Privacy, Consent, and Identity Management in Health Information Exchange: Issues for the Military Health System, RAND Corporation, Santa Monica, CA; Arlington, VA; Pittsburgh, PA, pp. 19–30
19. Zielezienski, J. Stephen, and Catherine I. Paolino. “INSURANCE PRIVACY AFTER GRAMM–LEACH–BLILEY — OLD CONCERNS, NEW PROTECTIONS, FUTURE CHALLENGES.” Tort & Insurance Law Journal, vol. 37, no. 4, pp. 1139–1179.
20. Peter H. W. Van der Goes, Jr. 1999. “Opportunity Lost: Why and How to Improve the HHS-Proposed Legislation Governing Law Enforcement Access to Medical Records.” University of Pennsylvania Law Review, vol. 147, no. 4, pp. 1009–1067.
21. Miller, Amalia R., and Catherine Tucker. 2009. “Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records.” Management Science, vol. 55, no. 7, pp. 1077–1093.
22. Gostin, Lawrence, O., et al. 2002.  “THE NATIONALIZATION OF HEALTH INFORMATION PRIVACY PROTECTIONS.” Tort & Insurance Law Journal, vol. 37, no. 4, pp. 1113–1138.
23. Butera, Adam. 2002.  “HIPAA PREEMPTION IMPLICATIONS FOR COVERED ENTITIES UNDER STATE LAW.” Tort & Insurance Law Journal, vol. 37, no. 4, pp. 1181–1211.
24. Hodge, James G. 1999. “THE INTERSECTION OF FEDERAL HEALTH INFORMATION PRIVACY AND STATE ADMINISTRATIVE LAW: THE PROTECTION OF INDIVIDUAL HEALTH DATA AND WORKERS' COMPENSATION.” Administrative Law Review, vol. 51, no. 1, pp. 117–144.

Outline

In the introduction I will keep the definitions and explanation of medical and health privacy. In addition to electronic medical records, I will also include PCMS (patient care management systems). There I will give a brief overview of what they are. I will also include background on HIPAA as it is one of the most important medical privacy laws in the United States. I will additionally add a sentence description regarding each country I will discuss in the article - Australia, Canada, Turkey, UK, US, New Zealand, and the Netherlands.

History of Medical Privacy

Change from paper filing systems to electronic system of filing

• The benefits and problems of such changes

What are the responses from the public from these various changes

Protected Health Information (PHI)

• Definition
• Reasons for lack of privacy within this specific field

Patient Care Management Systems (PCMS)

Definition

Benefits of PCMS

Problems with PCMS

Important Laws

HIPAA (link to the HIPAA page)

• Definition
• Goals
• Limitations
  • Katrina
    • Explain what happened in this natural disaster and how it showed how weak medical privacy laws are
• Effects
• Public response

Genetic Privacy Act

• Definition (Oregon)
• Goals
• Limitations
• Property debate
• Effects
• Public Response

Medical privacy standards by country

Australia

I am planning on restructuring this section. In the beginning I will include a brief overview of these eHealth system and then divide the page by laws (governance), safety measures, and certain issues. But in the issues portion, I will format it so that there are no more bullet points and questions, but rather reads more fluidly.

Canada

• laws within Canada regarding Medical privacy
  • provisions to ensure the security
• Discussion regarding Medical privacy - opinions from the public and desires for what should be done in order to improve it

Turkey

• laws within Turkey regarding Medical privacy
  • provisions to ensure the security
• Discussion regarding Medical privacy - opinions from the public and desires for what should be done in order to improve it

United Kingdom

• laws within UK regarding Medical privacy
  • provisions to ensure the security
    • Government Gateway - NHS (National Health Service)
• Discussion regarding Medical privacy - opinions from the public and desires for what should be done in order to improve it

United States

• Brief overview of medical privacy
• California Specific Laws
• Privacy and Electronic Health Records
• Medical data outside of HIPAA

New Zealand

• laws within New Zealand regarding Medical privacy
  • provisions to ensure the security
    • Health information Privacy Code
• Discussion regarding Medical privacy - opinions from the public and desires for what should be done in order to improve it

Netherlands

• laws within Netherlands regarding Medical privacy
  • provisions to ensure the security
    • Nationwide system for exchange of medical information
• Discussion regarding Medical privacy - opinions from the public and desires for what should be done in order to improve it

Discussion

Any possible solutions to these issues

Any final thoughts on overall issues with medical privacy

Medical Privacy Draft

Medical privacy or health privacy is the practice of maintaining the security and confidentiality of patient records. It involves both the conversational discretion of health care providers and the security of medical records. The terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility. Modern concerns include the degree of disclosure to insurance companies, employers, and other third parties. The advent of electronic medical records (EMR) and patient care management systems (PCMS) have raised new concerns about privacy, balanced with efforts to reduce duplication of services and medical errors.

Many countries - including Australia, Canada, Turkey, the United Kingdom, the United States, New Zealand, and the Netherlands - have enacted laws that try to protect people's privacy. However, many of these laws have proven to be less effective in practice than in theory.

History of medical privacy

Prior to the technological boom, many people relied on paper medium to file people’s medical data; however, nowadays their information is stored within electronic databases. Research showed that it was safer to have information with paper as it was harder to physically steal the data, yet now hackers are able to access large amounts of information without the owner’s knowing.

In order to reform the healthcare privacy issues in the early 1990's, researchers looked into the use of credit cards and “smart” cards that would allow people to access to their medical information without fear of stolen information. The “smart” card allowed the storage and processing of information to be stored in a singular microchip, yet people were fearful of having so much information stored in a single spot that can easily be accessed. This “smart” card includes an individual’s social security number which is an important piece of identification that can cause identity theft if the data bases are breached. Additionally, there was a fear that people would target these medical cards as they have information that can be of value to many different third parties including employers, pharmaceutical companies, drug marketers, and insurance reviewers.

In response, there was a movement to create better medical privacy protection, but nothing has been officially passed. The Medical Information Bureau was thus created to prevent insurance fraud, yet since it is a significant source of medical information for over 750 life insurance companies, it is very dangerous as it is a target of privacy breachers. Although the electronic filing system of medical information has increased proficiency and administration costs have been reduced, there are negative aspects to consider. The electronic filing system allows for individual’s information to be more susceptible to outsiders; even though their information is stored on a singular card, it serves as a false sense of security as it does not protect their information completely.

Emergence of the Insurance System

The emergence of insurance was part of the growing democratic movement of the working-class movement. However, the idea of traditional insurance policies was soon taken over by corporate and social insurance companies who wanted to take advantage of individuals. This ultimately caused many individuals to lose the social assistance they needed from the government. This marginalization of individuals ultimately shaped many of the institutions of civil insurance practices.

In the nineteenth century, insurance policies were not as formal as they currently are, instead there was an ambivalent relationship between democratic institutions and civil policies. Society was primarily characterized by principles of democracy and elitism which in theory should underline equality. However, power was concentrated among the elite, causing a feeling of mutuality and exclusivity. Therefore, many of the policies that should have created inclusivity ultimately caused people to be marginalized. Realizing this was an issue, there was a call for inclusivity and sociability which led to new cautions regarding medical privacy and ability to access an individual’s information.

As a result, during the twentieth century, there was a change in within the insurance industry which caused a new development of medical policies on how to handle people’s medical information. There was a shift from being selective to broadening the qualifications of being able to receive insurance help. With the end of exclusiveness within the insurance market, the government started to regulate the market more and thus emerged the fear of lack of privacy. Ideas of transparency thus caused many people to become wary of privacy violation rights. This led to modern day advocacy groups that argued for larger protections and regulations of insurance companies. As a result, in today's society, the government plays a large role in enforcing these roles within society. Since then, the government has had the role of enforcing these regulations to protect individual’s information and data.

Patient care management systems (PCMS)

With the technological boom, there has been an expansion of the record filing system and many hospitals have therefore adopted new patient care management systems (PCMS). These have become critical to the efficiency of storing medical information because of high volumes of paperwork, the ability to quickly share information between medical institutions, and the increased mandatory reporting to the government. PCMS have ultimately increased the productivity of data record utilization and have created a large dependence on technology within the medical field. Yet, it has also led to social and ethical issues because of the basic human rights that could be a casualty for this expansion of knowledge. Hospitals and health information services are now more likely to share information with third party companies. Thus, there needs to be reform to specify the rules of the hospital personnel who have the access to medical records. This has led to the discussion of privacy rights and created safeguards that will help data keepers understand situations where it is ethical to share an individual’s medical information, provide ways for individuals to gain access to their own records, determine who has ownership of those records, ensure that a person’s identity is kept confidential in research or statistical purposes, and the process to make individual’s known that their health information is being used. (This sentence looks too long, maybe try to break it down?--MYYY) Additionally, a balance between privacy and confidentiality must occur in order to limit the amount of information disclosed and keep the occupations of physicians in check by constricting the information flow.

Electronic Medical Records (EMR)

Electronic medical records (EMR) are a more efficient way of storing medical information, yet there are many negative aspects of this type of filing system. Hospitals are willing to adopt this type of filing system, yet only if they are able to ensure the protection of patient information. Amalia Miller and Catherine Tucker found that state legislation and regulation of medical privacy laws reduce the amount of hospitals that adopt EMR by more than 24%. This is ultimately due to the decreasing positive network externalities that are caused by state protections. With increases in restrictions against the diffusion of medical information, hospitals have neglected to adopt the new EMR’s because of the privacy laws that restrict health information exchanges. With the decreasing amounts of medical institutions that are adopting the EMR filing system, the federal government’s plan to have a national health network will be stopped. The national network will ultimately cost the US $156 billion in investments, yet in order for this to happen, the government needs to place higher emphasis on protecting individual medical privacy. Many politicians and business leaders find that EMR’s allow for more efficiency in both time and money, yet they neglect to address the decreasing privacy protections. Thus, this research shows that there is a significant trade off between EMR’s and individual privacy.

Third party issues

One of the main danger to an individual’s privacy are private corporations because of the profits they can receive from privacy-violating information. Privacy merchants are made up of two groups - one tries to collect people’s personal information while the other focuses on using client’s information to market company products. Privacy merchants also purchase information from other companies, such as health insurance companies, if there is not sufficient information from their own research. Privacy merchants target health insurance companies because, nowadays, they collect huge amounts of personal information and keep them in large databases. They often require patients to provide more information that is needed for purposes other than that of doctors and other medical workers. Additionally, people’s information can be linked to other information outside of the medical field. For example, many employers use insurance information and medical records as an indicator of work ability and ethic. The selling of privacy information can also lead employers to receive lots of money; however, this happens to many people without their consent or knowledge. Although there is a large group of people who oppose the selling of individual’s medical information, there are groups such as the Health Benefits Coalition, the Healthcare Leadership Council, and the Health Insurance Association of America that are against the new reforms for data protection as it can ruin their work and profits. Furthermore, it is not the government that is the reason for many issues with medical privacy, but it is the large corporations that are trying to make profits off of our data.

Effects of changing medical privacy laws

Physician-Patient Relationships

Patients want to be able to share medical information with their physicians, yet they worry about potential breaches that can release financial information and other confidential information and with that fear, they are wary of who may have access. In order to ensure better protection , the government has created frameworks for keeping information confidential - some of which include being transparent about procedures, disclosure and protection of information, and monitoring of these new rules to ensure that people’s information is not affected by breaches.

Effects of Technological Advances regarding physician-patient relationships

Recently physicians and patients have started to use email as an additional communication tool for treatment and medical interactions. This way of communication is not “new”, but its effects on doctor patient relationships has created new questions regarding legal, moral, and financial problems. Ultimately, the use of email has caused changes between physicians and their patients and, ultimately, the future of health care. The American Medical Informatics Association (AMIA) has characterized medical emails as way to communicate “medical advice, treatment, and information exchanged professionally”; yet, the “spontaneity, permanence, and information power characterizing” role is significant because of the unknown affects. However, the use of emails allow for increased access, immediate aid, and increased interactions between patients and their doctors. There are many benefits and negative aspects of using emails; doctors feel a new sense of negative responsibility to respond to emails outside of the office, but also find benefits with facilitating rapid responses to patient’s questions. Additionally, the use of email between physicians and their patients will continue to grow because of the increasing use of the Internet. With the Internet, patients are able to ask for medical advice and treatment, yet issues regarding confidentiality and legal issues come up. Ultimately, emails between a physician and patient are supposed to be used to supplement face to face interactions, not for casual messages. If used properly, physicians could use emails as a way to supplement interactions and provide more medical aid to those who need it immediately.

Traditional beliefs on doctor-patient relationship that spur fear

Although many people believe that the technological changes are the reason for fear of sharing medical privacy, there is a new theory that has caused people to believe that it is the institutional ideals between doctors and their patients that are causing the fear of sharing medical privacy information. Although levels of confidentiality are changing, individuals often feel the need to share more information with their doctors in order to get diagnosed well. However, there is an argument for a smaller emphasis on sharing and confidentiality in order to rid patients from their fears of information breaching. There is a common belief that the confidentiality of one’s information also only protects the doctors and not the patients, therefore there is a negative stigma towards revealing too much information. Thus it causes patients to not share vital information relevant to their illnesses.

Controversies regarding HIPAA

Contrary to the popular belief, the Health Insurance Portability and Accountability Act (HIPAA) does not provide strong medical privacy protections as it only provides regulations that disclose certain information. The government authorizes the access of an individual’s health information for “treatment, payment, and health care options without patient consent” (41). Additionally, HIPAA rules are very broad and do not protect an individual from unknown privacy threats and a patient would not be able to identify the reason for breach due to inconsistent requirements. Because of limited confidentiality, HIPAA facilitates the sharing of medical information as there is little limitation from different organizations. Information can easily be exchanged between medical institutions and other non-medical institutions because of the little regulation of HIPAA - some effects can include job loss due to credit score sharing or lead to loss of insurance. Additionally, doctors are not required to keep patients information confidential and that patient consent is now optional. Patients are often unaware of the lack of privacy they have as medical processes and forms do not explicitly state the extent of how protected they are. Physicians believe that overall, HIPAA will cause unethical and non-professional mandates that can affect a person’s privacy and therefore, they in response have to provide warnings about their privacy concerns. Because physicians are not able to ensure a person’s privacy, there is a higher chance that patients will be less likely to get treatment and share what their medical concerns are. Individuals have asked for better consent requirements by asking if physicians can warn them prior to the sharing of any personal information. Patients want to be able to share medical information with their physicians, yet they worry about potential breaches that can release financial information and other confidential information and with that fear, they are wary of who may have access. In order to ensure better protection, the government has created frameworks for keeping information confidential - some of which include being transparent about procedures, disclosure and protection of information, and monitoring of these new rules to ensure that people’s information is not affected by breaches. Although there are many frameworks to ensure the protection of basic medical data, many organizations do not have these provisions in check. HIPAA gives a false hope to patients and physicians as they are unable to do anything about the eroding privacy protections and are not able to protest against them; patients and providers have very little rights regarding their medical privacy rights and physicians cannot guarantee those. In order to solve these problems, there needs to be a reform that acknowledges that an individual's privacy rights cost more than they are shown.

In 2000, there was a new surge to add new regulations which included the following goals: to protect individual medical information by providing secure access and control of their own information, improving healthcare quality by creating a better sense of trust within consumers, third party organizations, and healthcare professionals, and improve the efficiency of the medical system through new rules and regulations put forth by the local governments, individuals, and organizations. The implementation of these new goals was complicated by the change in administrations (Clinton to Bush), and so it was difficult for the modifications to be successfully implemented. HIPAA, in theory, should apply to all insurance companies, services, and organizations, yet there are some exceptions to who actually qualifies under these categories. For example, life insurance companies are not considered part of these groupings because they do not fit the specific qualifications of what constitutes a health organization/company. Additionally, there are strict rules of what constitutes health information whether it is regarding information authorization, consent, types of treatment, health care operations, and payment. Yet, within each category, there are specific restrictions that are different in every category. Thus, there are no universal laws that can be easily applied that are easy for organizations can follow. As a result there is a lack of implementation of these new policies. Additionally, there are new patient rights that call for better protection and disclosure of health information. Yet, like the new rules regarding insurance companies, the enforcement of the legislation is limited and not effective. A common issue with all of these new rules is that they are often broad and very complex. Therefore it is difficult for many organizations to ensure the privacy of these people. Enforcing these new requirements also causes companies to spend many resources that many companies are not willing to completely use and enforce, which will ultimately lead to further charges of medical privacy invasion.

HIPAA and Hurricane Katrina

HIPAA does not protect the information of individuals as the government is able to publish certain information when deemed necessary; the government is exempted from privacy rules regarding national security. HIPAA additionally allows the authorization of protected health information (PHI) in order to aid in threats to public health and safety as long as it follows the good faith requirement - the idea that disclosing of information is necessary to the benefit of the public. The Model State Emergency Powers Act (MSEHPA) gives the government the power to “suspend regulations, seize property, quarantine individuals and enforce vaccinations” and requires that healthcare providers give information regarding potential health emergencies (656). In regards to Hurricane Katrina, many people in Louisiana relied on Medicaid and their PHI was subsequently affected. People’s medical privacy rights were soon waived in order for patient’s to get the treatment they needed; additionally, many patients were unaware that their rights had been waived. In order to prevent the sharing of personal information in future natural disasters, a website was created in order to protect people’s medical data. Ultimately, Katrina showed just how unprepared the government was in face of a national public health scare and the changes that are necessary to protect people’s information.

Oregon-Specific Laws

The Oregon GPA (Genetic Privacy Act) states that “an individual’s genetic information is the property of the individual”. The idea of an individual’s DNA being compared to property occurred when research caused an individual’s privacy to be threatened. Many individuals believed that their genetic information was “more sensitive, personal, and potentially damaging than other types of medical information.” Thus, people started calling for more protections. People started to question the anonymity of DNA within research studies and argued that the identity of a person could be exposed if research was shared. As a result, there was a call for individuals to treat their DNA as property and protect it through property rights. Therefore, individuals can control the disclosure of their information without extra questioning and research. Many people believed that comparing one’s DNA to property was inappropriate, yet individuals argued that property and privacy are interconnected because they both want to protect the right to control one’s body.

Many research and pharmaceutical companies showed opposition because they were worried about privacy issues within their work. Individuals on the other hand wanted the right to privacy for their own DNA and continued to support the act. Yet, with the opposition, lawmakers created a compromise that kept the property clause but also included provisions that would allow research to be done without much consent. Additionally, a committee was created to study the effects of the act and how it affected the way it was analyzed and stored. After the study, researchers found that the act benefited many individuals who did not want their privacy being shared with others and therefore the law was officially implemented in 200

Connecticut Legislation

In order to solve HIPAA issues within Connecticut, state legislatures tried to create better provisions to protect the people living within the state. One of the issues that Connecticut tried to solve were issues with consent. Within the consent clause, health plans and health care clearinghouses do not need to receive consent from individuals because of a general provider consent form with gives healthcare providers permission to disclose all medical information. The patient thus does not get notification when their information is being shared afterwards. Connecticut, like many other states, thus tried to protect individual’s information from disclosure of information through additional clauses that would protect them from businesses initiatives. In order to do so, Connecticut legislature passed the Connecticut Insurance Information and Privacy Protect Act, which provides additional protections of individual medical information. If third parties neglect to follow this law, they will be fined, may face jail time, and may have their licenses suspended. Yet, even in these additional provisions, there were many holes within this legislation that allowed for businesses agreements to be denied and subsequently, information was compromised. Connecticut is still working to shift its divergent purposes to creating more stringent requirements that create better protections through clear provisions of certain policies.

Peer-review

PandaFantasy: Regarding the lead, I think the first section gives a great overview of the rest sections of this article. Although in terms of content, the lead clearly states the structure, which is really straightforward and comfortable to follow, the problem is that the style of the language is not the same as what I read in most wikipedia pages. What I find really amazing is that this article is rich in content for each section, even though it is supposed to be the first draft! Regarding the tone, most of the sentences are based on some reliable sources, and the balance of each part is good. As for the shortcoming of this article, personally speaking, the content should be condensed slightly, or be divided into different parts with corresponding subheadings. Another way to make it more convenient to go through is dividing the whole part of the section into three or four paragraphs logically, making it easier for readers to find the main idea of the section quickly. For example, take the "controversies of HIPAA" part, the content is unbiased and reliable, combining different opinions of different kinds of people, but I think it would be better if it contains three parts: one about the lack of strong medical protections in the law and the reasons; another one about the possible effects of this: the last is what the government has done and what should be improved. All in all, though not perfect, this article is abundant in content and has lots of advantages.

Mrzy732993: Nice Job! It's so impressive to see that you've already got so much work done in the first draft! I read through the draft very carefully, and it's hard for me to find out spelling or grammar mistakes (I helped corrected 3-4 small mistakes). Also, the language is neutral and easy to understand, so you did really well on interpreting the technical terms to the general readers. I particularly like your lead sections because it precisely covers everything in your outline and there is no redundant sentence. The references also look pretty good now. Try to start adding some hyperlinks next week! Although you haven't started working on all the sections, the balance of section length looks good for now. The sources all come from academic journals so I feel they're very reliable when I look through them!

One advice would that since the headings look a little confusing now, you can do some small adjustments. Like in your first draft, there are only the lead section and the "history of medical privacy" selection, but you actually have covered many other things, such as laws or relevant controversial, but now they are all under the "history of medical privacy" section. I think it's just a small problem with the use of headings and sub-headings, and it's very easy to fix that!

One thing I really want to learn from you is how you break a big topic into small sections. For example, in the law section, you created smaller sections regarding its definition, goals, effects, and limitations. This is a very good way to structure the article since the readers can easily follow. In general, very good job and keep going!