medical privacy medical privacy medical privacy, or health privacy, is the practice of maintaining the security and confidentiality of patient records. it involves both the conversational discretion of health care providers and the security of medical records. the terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility, and to modesty in medical settings. modern concerns include the degree of disclosure to insurance companies, employers, and other third parties. the advent of electronic medical records (emr) and patient care management systems (pcms) have raised new concerns about privacy, balanced with efforts to reduce duplication of services and medical errors. most developed countries including australia, canada, turkey, the united kingdom, the united states, new zealand, and the netherlands have enacted laws protecting people's medical health privacy. however, many of these health securing privacy laws have proven less effective in practice than in theory. in 1996, the united states passed the health insurance portability and accountability act (hipaa) which aimed to increase privacy precautions within medical institutions. history of medical privacy the history of medical privacy traces back to hippocratic oath that postulates the secrecy of information obtained when helping a patient. prior to the technological boom, medical institutions relied on the paper medium to file individual medical data. nowadays, more and more information is stored within electronic databases. research shows that it is safer to have information stored within a paper medium as it is harder to physically steal data, whilst digital records are vulnerable to access by hackers. in order to reform the healthcare privacy issues in the early 1990s, researchers looked into the use of credit cards and smart cards to allow access to their medical information without fear of stolen information. the "smart" card allowed the storage and processing of information to be stored in a singular microchip, yet people were fearful of having so much information stored in a single spot that could easily be accessed. this "smart" card included an individual's social security number as an important piece of identification that can lead to identity theft if databases are breached. additionally, there was the fear that people would target these medical cards because they have information that can be of value to many different third parties including employers, pharmaceutical companies, drug marketers, and insurance reviewers. in response to the lack of medical privacy, there was a movement to create better medical privacy protection, but nothing has been officially passed. the medical information bureau was thus created to prevent insurance fraud, yet it has since become a significant source of medical information for over 750 life insurance companies; thus, it is very dangerous as it is a target of privacy breaches. although the electronic filing system of medical information has increased efficiency and administration costs have been reduced, there are negative aspects to consider. the electronic filing system allows for individual information to be more susceptible to outsiders; even though their information is stored on a singular card. therefore, the medical card serves as a false sense of security as it does not protect their information completely. patient care management systems (pcms) with the technological boom, there has been an expansion of the record filing system and many hospitals have therefore adopted new pcms. pcms store large amounts of medical records, and hold the personal data of many individuals. these have become critical to the efficiency of storing medical information because of the high volumes of paperwork, the ability to quickly share information between medical institutions, and the increased mandatory reporting to the government. pcms have ultimately increased the productivity of data record utilization and have created a large dependence on technology within the medical field. it has also led to social and ethical issues because basic human rights are considered to be violated by the pcms, since hospitals and health information services are now more likely to share information with third-party companies. thus, there needs to be a reformation to specify which hospital personnel have the access to medical records. this has led to the discussion of privacy rights and created safeguards that will help data keepers understand situations where it is ethical to share an individual's medical information, provide ways for individuals to gain access to their own records, and determine who has ownership of those records. additionally, it is used to ensure that a person's identity is kept confidential for research or statistical purposes and to understand the process to make individuals aware that their health information is being used. thus, a balance between privacy and confidentiality must be kept in order to limit the amount of information disclosed and protect patients' rights by safeguarding sensitive information from third parties. electronic medical records (emr) sample view of an electronic health record in action. electronic medical records are a more efficient way of storing medical information, yet there are many negative aspects of this type of filing system as well. hospitals are willing to adopt this type of filing system only if they are able to ensure that the private information of their patients is sufficiently protected. researchers have found that u.s. state legislation and regulation of medical privacy laws reduce the number of hospitals that adopt emr by more than 24%. this is due to decreasing positive network externalities that are created by additional state protections. with increases in restrictions against the diffusion of medical information, hospitals have neglected to adopt the new emrs because privacy laws restrict health information exchanges. with decreasing numbers of medical institutions adopting the emr filing system, the u.s. government's plan of a national health network has not been fully recognized. the national network will ultimately cost us$156 billion in investments, yet in order for this to happen, the u.s. government needs to place a higher emphasis on protecting individual privacy. many politicians and business leaders find that emrs allow for more efficiency in both time and money, yet they neglect to address the decreasing privacy protections, demonstrating the significant trade-off between emrs and individual privacy. privacy and electronic health records (ehr) the three goals of information security, including electronic information security, are confidentiality, integrity, and availability. organizations are attempting to meet these goals, referred to as the c.i.a. triad, which is the "practice of defending information from unauthorized access, use, disclosure, disruption, modification, inspection, recording or destruction." in a 2004 editorial in the washington post, u.s. senators bill frist and hillary clinton supported this observation, stating " need...information, including access to their own health records... at the same time, we must ensure the privacy of the systems, or they will undermine the trust they are designed to create". a 2005 report by the california health care foundation found that "67 percent of national respondents felt 'somewhat' or 'very concerned' about the privacy of their personal medical records". the importance of privacy in electronic health records became prominent with the passage of the american recovery and reinvestment act (arra) in 2009. one of the provisions (known as the health information technology for economic and clinical health act) of the arra mandated incentives to clinicians for the implementation of electronic health records by 2015.privacy advocates in the united states have raised concerns about unauthorized access to personal data as more medical practices switch from paper to electronic medical records. the office of the national coordinator for health information technology (onc) explained that some of the safety measures that ehr systems can utilize are passwords and pin numbers that control access to such systems, encryption of information, and an audit trail to keep track of the changes made to records. providing patient access to ehrs is strictly mandated by hipaa's privacy rule. one study found that each year there are an estimated 25 million compelled authorizations for the release of personal health records. researchers, however, have found new security threats open up as a result. some of these security and privacy threats include hackers, viruses, and worms. these privacy threats are made more prominent by the emergence of "cloud computing", which is the use of shared computer processing power. health care organizations are increasingly using cloud computing as a way to handle large amounts of data. this type of data storage, however, is susceptible to natural disasters, cybercrime and technological terrorism, and hardware failure. health information breaches accounted for the 39 percent of all breaches in 2015. it security costs and implementations are needed to protect health institutions against security and data breaches. health screening cases although privacy issues with the health screening is a great concern among individuals and organizations, there has been little focus on the amount of work being done within the law to maintain the privacy expectation that people desire. many of these issues lie within the abstractness of the term “privacy” as there are many different interpretations of the term, especially in the context of the law. prior to 1994, there had been no cases regarding screening practices and the implications towards an individual's medical privacy, unless it was regarding hiv and drug testing. within glover v eastern nebraska community office of retardation, an employee sued her employer against violating her 4th amendment rights because of unnecessary hiv testing. the court ruled in favor of the employer and argued that it was unreasonable search to have it tested. however, this was only one of the few precedents that people have to use. with more precedents, the relationships between employees and employers will be better defined. yet with more requirements, testing among patients will lead to additional standards for meeting health care standards. screening has become a large indicator for diagnostic tools, yet there are concerns with the information that can be gained and subsequently shared with other people other than the patient and healthcare provider third party issues one of the main dangers to an individual's privacy are private corporations because of the profits they can receive from selling seemingly private information. privacy merchants are made up of two groups - one that tries to collect people's personal information while the other focuses on using client's information to market company products. subsequently, privacy merchants purchase information from other companies, such as health insurance companies, if there is not sufficient information from their own research. privacy merchants target health insurance companies because, nowadays, they collect huge amounts of personal information and keep them in large databases. they often require patients to provide more information that is needed for purposes other than that of doctors and other medical workers. additionally, people's information can be linked to other information outside of the medical field. for example, many employers use insurance information and medical records as an indicator of work ability and ethic. the selling of privacy information can also lead employers to make much money; however, this happens to many people without their consent or knowledge. within the united states, in order to define clear privacy laws regarding medical privacy, title 17 thoroughly explains the ownership of one's data and adjusted the law so that people have more control over their own property. the privacy act of 1974 offers more restrictions regarding what corporations can access outside of an individual's consent. states have created additional supplements to medical privacy laws. with hipaa, many individuals were pleased to see the federal government take action in protecting the medical information of individuals. yet when people looked into it, there was proof that the government was still protecting the rights of corporations. many rules were seen as more of suggestions and the punishment for compromising the privacy of its patients were minimal. even if release of medical information requires consent, blank authorizations can be allowed and will not ask for individuals for additional consent later on. although there is a large group of people who oppose the selling of individual's medical information, there are groups such as the health benefits coalition, the healthcare leadership council, and the health insurance association of america that are against the new reforms for data protection as it can ruin their work and profits. previous controversies, such as google's "project nightingale" in 2019 have demonstrated potential holes in regulations of patient data and medical information. project nightingale, a joint effort between google and the healthcare network ascension, saw to the selling of millions of patients'