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On Wed, 18 Sep 1996, Timothy C. May wrote:

> On a related note, I read an article yesterday about the proposed new
> Health Data Base, with all encounters with any medical institution or any
> health care provider of any sort being cross-linked and cross-referenced.

Scary. The benefits for the singular patient would be very marginal.
Epidemiologic research would become easier, with lots of opportunities
for the publish-or-perish academic medical crowd, but we already
know that smoking etc is bad for us. The real agenda is of course
to make life easier for the insurance business, our would-be employers
and the State.

> the master index was born....Only people with a 'security ticket'--such as
> doctors, insurers, scientific researchers or police with a proper
> warrant--are supposed to be able to see the clinical details....Kathy Ganz,
> director of the New Mexico Health Policy Commission, said, "Rights to
> privacy are genuine concerns, but they will need to be balanced against
> notions of common good."

The specialized software industry is currently flooding the medical
community with applications for all sorts of patient-related info.
It started with the small units (offices, with a single or a handful
doctors etc), which are already doing a lot of their record-keeping
on digital media, often with lousy security. Now the turn has come to
the big hospitals, which need heavily customized implementations of
the basic product they will choose. Athough most serious products
have proper authentication routines (including smartcards; especially
nurses seem to be totally unable to handle passwords above the
my_cat's_name level), the overall availability of patient data will
rise enormously with digital storage. The trend in the US is for
large companies to take over more and more of the big hospitals
(in Sweden almost all hospitals are owned by the 'public', with
a trend towards bigger and bigger integrated 'regions') mandating
larger and larger databases. So even without an outspoken decision
the Grand National Health Database is worming itself upon us.

> Pretty chilling, eh? As we all know, once such medical, dietary, and
> genetic data bases are established, the likelihood of privacy-invading
> use is near unity.

It certainly is. And cryptography can not do that much about it since
it's primarily a problem of user integrity.