Are we living an illusion that patient confidentiality exists? It has been said that in the good old days there were only 3 people in the doctor’s office: the patient, the doctor and the patients lawyer. Now there’s a whole crowd in the room: insurance companies, HMO’s, government and increasingly the computer. The above organizations can demand and usually receive access to patient records. In addition, as organizations offer their employees the health-plan-dujour in search of savings, the paper trail of patient charts on its voyage through multiple companies could subject it to multiple scrutinizations. Is patient confidentiality an illusion? What can be done to ensure confidentiality?

Patient confidentiality likely is and has been an illusion for quite sometime. First-hand knowledge of how hospitals work and a white coat can typically give access to just about any patients data. However, the inconvenience and cumbersome nature of medical records is a physical barrier to snooping.

The handwriting is clearly on the wall that patient records will someday all be online with the convenient access that this entails. It is a paradox that this access will be seen as less secure than the current paper chart confidentiality which consists of a locked door, when in fact electronic records can be made far more secure than a paper chart. However, as long as there are organizations with large databases of patient data and no economic reason for maintaining confidentiality, confidentiality will not exist. A current example of this is the recent problems with Toysmart as reported by CNN in which the bankrupt company is now trying to sell its customer data despite promises not to do so.

In an ideal world patients could pay cash only and avoid any third party prying. Similarly, a physician could own his own computer disconnected from all but in-house networks, running peer-reviewed open-source software that has been certified as being free of ‘backdoors’ (access points to a system that a third party has placed legally or otherwise). While utopian, such systems are quite possible and can be constructed such that only patient record numbers and need-to-know data are transmitted to third parties. Perhaps one day systems that don’t fulfill these criteria will be the exception.