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Should patients have to opt out of electronic records?

service, telling patients what is going to happen, the potential benefits and dangers, and most importantly how they can opt out of having their records shared.

But Dr John Halamka, Chief Information Officer at Harvard Medical School, argues that opting in is the only way to ensure confidentiality.

He discusses regional data sharing in the US and believes that patients are best served by prospectively seeking their permission to include data in the regional index. This approach acknowledges patient control and ownership of medical information.

Both opt-in and opt-out approaches have risks and benefits, he says. The key disadvantage of an opt-in system is that records populate the regional index slowly, making adoption of data sharing slow. Another is that a clinician may prescribe a drug that has an important interaction with the patient's undisclosed mental health prescriptions.

With the opt-out approach, historical records could be used to populate the regional index rapidly, but if the index is compromised, information about all institutions, including mental health providers, could be leaked. This could cause much anxiety and may affect patient confidence in the system, since they did not prospectively approve participation.

"We have only one opportunity to build a healthcare information superhighway that patients and providers can trust. We should let the patients decide if they want to drive on it," he concludes.

Two editorials also published in this issue discuss the ethics of shared electronic patient records and the need for rigorous evaluation and regulation.


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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
30-Jun-2006


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