Protect Patient Data Research Articles

Arthroplasty register for Germany.

Scientific backgroundThe annual number of joint replacement operations in Germany is high. The introduction of an arthroplasty register promises an important contribution to the improvement of the quality of patient’s care.Research questionsThe presented report addresses the questions on organization and functioning, benefits and cost-benefits as well as on legal, ethical and social aspects of the arthroplasty registers.MethodsA systematic literature search was conducted in September 2008 in the medical databases MEDLINE, EMBASE etc. and was complemented with a hand search. Documents describing arthroplasty registers and/or their relevance as well as papers on legal, ethical and social aspects of such registers were included in the evaluation. The most important information was extracted and analysed.ResultsData concerning 30 arthroplasty registers in 19 countries as well as one international arthroplasty register were identified. Most of the arthroplasty registers are maintained by national orthopedic societies, others by health authorities or by their cooperation. Mostly, registries are financially supported by governments and rarely by other sources. The participation of the orthopedists in the data collection process of the arthroplasty registry is voluntary in most countries. The consent of the patients is usually required. The unique patient identification is ensured in nearly all registers. Each data set consists of patient and clinic identification numbers, data on diagnosis, the performed intervention, the operation date and implanted prostheses. The use of clinical scores, patient-reported questionnaires and radiological documentation is rare. Methods for data documentation and transfer are paper form, electronic entry as well as scanning of the data using bar codes. The data are mostly being checked for their completeness and validity. Most registers offer results of the data evaluation to the treating orthopedists and/or hospitals, provide annual reports and publish scientific articles and/or presentations. The effects of the arthroplasty registers on clinical practice and on health political decisions in the time after the introduction of these registers are documented in some countries. The influence on cost savings for health services is also reported.DiscussionThe most important legal and ethical aspect is the patient’s data protection and, therefore, the requirement of patient’s consent. The involvement of the physicians in the data collection process is a further organisational and legal challenge. The 100% data collection, which is the aim of the registers due to their definition, should not cause disadvantages for certain groups of patients. ConclusionThe arthroplasty registers have a large medical and health-economic potential. Aspects of the patient’s data protection and the guaranteed financial support of the registers should be clarified before the introduction of a register.

Une approche pratique de l’interopérabilité entre hôpitaux et médecins traitants en Suisse

Summary Interoperability and data exchange between partners in th eh ealthcar es ector are considered one of the important domains by which to improve car ep rocesses an di nt he long ru na lso lower healthcar es ystem costs. Data exchange ensure st hat patient data are as complete as possible, thus avoiding potential treatment errors, and avoids duplicating tests if the data required are alread ya vailable. On the other hand, healthcar ed ata is as ore point with many people and strong safeguards needed to protect patien td ata against misuse, along with tools to enable the patien tt om anage his/her own data. Even if many countries have eHealth initiatives in preparation or alread yi mplemented, health dat ae xchange on al arg es cal es till has af airly long way to go, sinc et he political processes for global solution sa re often complicated. The MediCoordination project adopts ap ragmatic approach which attempts to integrate several partners in health car eo na regiona ls cale. In parallel with th ee Healt hs trateg yc urrentl yu nder development by the Swiss Confederation, the targets of MediCoordination are, in particular ,m ediumsized hospitals and external partners, with av iew to implementing concret ea dded-value scenarios of information exchange between hospitals and external medical actors.

Privacy Policies Take a Toll on Research, Survey Finds

A federal rule aimed at protecting patient data is hindering epidemiology research, adding costs and delays without enhancing confidentiality, according to a study this week in the Journal of the American Medical Association.

Basis for the implementation of digital signature in Argentine's health environment

The growth of telemedical applications and electronic transactions in health environments is paced by the constant technology evolution. This implies a big cultural change in traditional medicine and in hospital information systems' users which arrival is delayed, basically, by the lack of solid laws and a well defined role-based infrastructure. The use of digital signature as a mean of identification, authentication, confidentiality and non-repudiation is the most suitable tool for assuring the electronic transactions and patient's data protection. The implementation of a Public Key Infrastructure (PKI) in health environment allows for authentication, encryption and use of digital signature for assuring confidentiality and control of the movement of sensitive information. This work defines the minimum technological, legal and procedural basis for a successful PKI implementation and establishes the roles for the different actors in the chain of confidence in the public health environment of Argentine.

A computational model to protect patient data from location-based re-identification

Health care organizations must preserve a patient's anonymity when disclosing personal data. Traditionally, patient identity has been protected by stripping identifiers from sensitive data such as DNA. However, simple automated methods can re-identify patient data using public information. In this paper, we present a solution to prevent a threat to patient anonymity that arises when multiple health care organizations disclose data. In this setting, a patient's location visit pattern, or "trail", can re-identify seemingly anonymous DNA to patient identity. This threat exists because health care organizations (1) cannot prevent the disclosure of certain types of patient information and (2) do not know how to systematically avoid trail re-identification. In this paper, we develop and evaluate computational methods that health care organizations can apply to disclose patient-specific DNA records that are impregnable to trail re-identification. To prevent trail re-identification, we introduce a formal model called k-unlinkability, which enables health care administrators to specify different degrees of patient anonymity. Specifically, k-unlinkability is satisfied when the trail of each DNA record is linkable to no less than k identified records. We present several algorithms that enable health care organizations to coordinate their data disclosure, so that they can determine which DNA records can be shared without violating k-unlinkability. We evaluate the algorithms with the trails of patient populations derived from publicly available hospital discharge databases. Algorithm efficacy is evaluated using metrics based on real world applications, including the number of suppressed records and the number of organizations that disclose records. Our experiments indicate that it is unnecessary to suppress all patient records that initially violate k-unlinkability. Rather, only portions of the trails need to be suppressed. For example, if each hospital discloses 100% of its data on patients diagnosed with cystic fibrosis, then 48% of the DNA records are 5-unlinkable. A naïve solution would suppress the 52% of the DNA records that violate 5-unlinkability. However, by applying our protection algorithms, the hospitals can disclose 95% of the DNA records, all of which are 5-unlinkable. Similar findings hold for all populations studied. This research demonstrates that patient anonymity can be formally protected in shared databases. Our findings illustrate that significant quantities of patient-specific data can be disclosed with provable protection from trail re-identification. The configurability of our methods allows health care administrators to quantify the effects of different levels of privacy protection and formulate policy accordingly.

Adopting a personal digital assistant system: application of Lewin's change theory

This paper reports a study exploring nurses' perceptions of adopting an information system using handheld computers (personal digital assistants) in their daily practice. Handheld computers have recently been used in nursing information systems for patient care, but few studies have explored their impact on users. By understanding clinicians' experiences of using this technology, strategies can be implemented to smooth the change process in adopting their use, thus achieving optimal patient outcomes. A descriptive, exploratory approach was used to study nurses' perceptions of using personal digital assistants as part of a hospital information system. A purposive sample of 15 nurses participated in one-to-one, in-depth interviews from February to March 2004. Nurses' perceptions of the adoption process were analysed using Lewin's force field theory of change as a framework. Nurses initially resisted using the personal digital assistant system (unfreezing stage), then came around to using it (moving stage), and finally adopted the system in their daily practice (re-freezing stage). However, an anticipatory stage also occurred and this could serve as a feedback mechanism to improve the system for current and future use. Educational programmes should be provided and strategic planning should be done in the early stage of implementing a policy to adopt new technology. In addition, the adoption process and learning period could be shortened by improving the system's content design. During this transition stage, dual charting should be used as a backup only for a limited time to avoid adding extra work to nurses' already heavy workload. Finally, the concept of confidentiality should be reinforced and stressed early in the educational programme to protect patient data, which can easily be accessed in computerized systems.

Managing hospital databases: can large hospitals really protect patient data?

Between 1998 and 2003 a number of European countries, the UK, Canada, Australia and the US all introduced data privacy legislation that sought to comply with the European Data Privacy Directive of 1995 in protecting the privacy of individuals undergoing treatment in large hospitals. In 2004 we find that hospital administrators within these jurisdictions are still struggling to find ways to implement and maintain hospital databases while complying with the given legislation - where compliance seems to require a whole new approach to database management. This research examines the UK Data Protection Act 1998 and considers whether current database management systems allow the EU Directives contained in the Act to be followed in practice. It finds a number of recurrent problems with hospital systems that would make compliance with the Act difficult. These findings have significant implications for hospital information systems development and design.

Safety and security of patient data on the Internet

Patient data transferred by the Internet is inherently insecure. All medical workers should have a basic understanding of security risks and what steps ought to be taken to protect patient data.

Protecting Patient Data Confidentiality in the Healthcare Environment

Protecting Patient Data Confidentiality in the Healthcare Environment