BKPRMDIN.RVW   980508

"Personal Medical Information", Ross Anderson, 1997, 3-540-63244-1,
U$45.00
%E   Ross Anderson ross.anderson@cl.cam.ac.uk
%C   175 Fifth Ave., New York, NY   10010
%D   1997
%G   3-540-63244-1
%I   Springer-Verlag
%O   U$45.00 800-777-4643 fax: 201-348-4505 wborden@springer-ny.com
%O  http://www.amazon.com/exec/obidos/ASIN/3540632441/robsladesinterne
%P   250 p.
%T   "Personal Medical Information: Security, Engineering, and Ethics"

The papers contained in this work were presented at a conference held
in Cambridge, UK, in June of 1996.  Those attending were from medical,
legal, activist, legislative, and data security backgrounds.  Most of
the material comes from the UK and German experience.

The first paper examines the purpose and ownership of medical
information: does the data belong to the patient or the NHS (National
Health Service) and what implications does ownership have on policy
regarding health information.  This question is complicated by the
requirement for aggregated details in order to provide the proper
quality of service.  In Germany, a "smart" card is being developed for
patient information and billing purposes and the debate and various
options for the card is described in the second essay.  Chapter three
looks generically (and in rather jargon laden manner) at the
distinctives of medical information systems.  During rationalization
of the medical information systems of the German Democratic Republic
(GDR, East Germany) and the Federal Republic of Germany (West Germany)
the value of a central repository for cancer information was noted,
along with the danger of invasion of privacy in such consolidated
systems.  The possibility of a distributed information system in which
patient information is held locally, but made available for non-
identifying epidemiological research is discussed in paper four.  The
review of the use of information systems by general practitioners, in
chapter five, is general and anecdotal, rather than analytical.

The British Medical Association (BMA) has produced a policy paper on
the security and confidentiality of patient information.  The sixth
essay takes issue with aspects of the BMA paper with particular
respect to acute care.  Implementation of the policy in a multi-
practitioner practice in Yorkshire is noted in chapter seven.  The BMA
policy is used as a case study for medical ethics analysis in chapter
eleven.  Chapter twenty closes off the book with an update on the
policy.

Paper number eight is a somewhat simplistic view of a confidential
patient information architecture modelled on an ideal patient ward. 
Unfortunately, it fails to account not only for real world situations,
but also for many important uses of medical information.  Although
titularly involved with risk assessment, chapter nine is essentially a
statement of medical ethics in opposition to the surveillance of
patients used by for-profit managed care operations.  With the
introduction of information technologies, wholesale modification of
institutions and systems is being undertaken, often with untoward
consequences.  The aim of essay ten is to propose a model for re-
engineering that makes responsibility central to the enterprise in
order to avoid confidentiality problems.  While the many see patient
information as primarily business related, chapter twelve looks at the
needs for data as a resource for research and treatment.  Electronic
commerce tools are used to ensure confidentiality of patient
information transfer in paper thirteen.  Similarly, public key
encryption is examined for the establishment of confidential auditing
of medical payments in essay fourteen.  Chapter fifteen is a very
brief case study of the use of smart cards for medical data.  The
philosophical review of medical ethics in chapter sixteen has only
tenuous connections to technology.  Only an abstract is included for
presentation seventeen.  Chapter eighteen is a review of privacy
policy in the United States.  Nineteen is a case study from New
Zealand.

While the quality of the papers is uneven, the variety of viewpoints
is extremely valuable.  Although there is a significant bias in favour
of patient confidentiality, some of the needs for sharing of
information are at least raised.

copyright Robert M. Slade, 1998   BKPRMDIN.RVW   980508