Powerful tool with manageable risks

I am concerned that the April editorial by Dr Ladouceur¹ will leave the impression that when medical data are stored or moved electronically, they cannot be protected, or that clinicians must avoid these technologies to provide appropriate protection. Fortunately, neither is the case.

While physicians are data custodians and have a fiduciary duty to protect clinical information, we are not the owners. Patients own their data.² Consequently, patients can be our partners in deciding what risks to their data are acceptable. Using this approach, if a physician wanted to send a picture of a patient’s skin lesion to a specialist by e-mail, that physician could explain the risks of the electronic data transfer to the patient and seek his or her consent. If consent were provided and the data were compromised, there would be a degree of protection for the provider in the same manner as for a procedure for which informed consent was obtained, but an adverse outcome occurred.

It is also important to consider the overall structure of health information systems in Canada. Unlike in the Snowden scenario described in the editorial, our system for electronic management of health information is much less mature. This results in it being highly decentralized, with limited linkages between the disparate systems. As a result, a Snowdenlike attack would be exceptionally complex to carry out and thus much less likely. It also creates an opportunity for us to build privacy protection into the system as it matures. This approach is called privacy by design and is a robust method that can be applied throughout the life cycle of electronic medical information systems.³

While threats to clinical information held and moved in electronic systems certainly exist, they can be mitigated through thoughtful application of policy, procedures, and protective measures. Accomplishing this is essential, as medical information technology is a powerful tool in the practice of safe, effective, and patient-centred family medicine.

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