Difficult to uphold patient confidentiality with electronic record system

The reader is assured from the Integrated Health Information Systems' letter that, with the implementation of the National Electronic Health Record (NEHR) system, patient confidentiality and personal data protection will continue to be upheld "no different from today" (Electronic health records key to better and safer care; Dec 13).

As a doctor, I would like to point out two important aspects where this may not be possible in practice.

First, a patient presently has the right not to mention prior illnesses when he consults his doctor.

For example, a patient seeing the doctor for conjunctivitis may not want to bring up previous treatment for drug addiction or psychiatric disease.

Whether this decision disadvantages him or not is irrelevant. Under the principle of medical ethics called "autonomy", the patient retains the right to control the information he shares with his doctor.

Second, the patient rightfully expects the doctor to keep private all details revealed in medical confidence.

These are entered into and remain in the clinic's records. Without his permission, the doctor cannot mention them to others - not even other doctors.

This privacy is his right under the principle of confidentiality.

Exceptions do exist. For example when there is risk to public health from specific infectious diseases, but these are clearly identified by law and regulations.

Can this possibly remain unchanged when the NEHR is implemented?

Once entered into the computer record, the patient's entire medical past will be visible to any doctor he consults in the future, even details he considers sensitive or irrelevant.

Moreover, if he cannot stop his doctor from uploading "embarrassing" personal data, like a positive test result for a sexually transmitted disease, onto his NEHR record, he will have lost privacy control over information or data arising from this consultation.

Things will clearly not be the same as they are today.

I have no doubt that the NEHR has potential for enormous good.

But regarding matters of control over personal privacy and confidentiality, it would be simplistic to say that "this will be no different from today".

It would be preferable to educate the public on the benefits and on what every individual will have to sacrifice for this.

Finally, patients should have the right to refuse to have his details keyed into a permanent computerised record if he so wishes, whether or not doctors agree with his reason.

Lee Pheng Soon (Dr)