Privacy and Public Health at Risk : Public Health Confidentiality in the Digital Age

[...]when probed, one quarter of state public health agencies reported at least 1 security breach in the previous 2 years,17 and a similar proportion of health care information executives and security officers reported attempted or successful intrusions into their companies' electronic information systems within the previous year.18 These incidents are probably underestimated, given the increasing extent to which public health agencies have been operating and transmitting information electronically in recent years, although the data to confirm an increasing trend (such as comparative studies of breaches in the pre-electronic and electronic eras) are lacking. Patients may also be increasingly wary of breaches as reports of identity theftfrom illicitly obtained identifiable health information become more common.19 As perceived risks of privacy or security breaches increase, patients might avoid care.20,21 Such behavior could harm an individual's health (e.g., forgoing tests or treatment to avoid collection of personal health information),20,21 as well as the public's health (e.g., avoiding treatment for a contagious disease as a result of fearing an invasion of privacy).20 Certain information, including HIV/AIDS surveillance information and mental health or substance abuse data, is particularly sensitive and often receives greater confidentiality protection under the law22; some states and localities have enacted "superconfidentiality" laws for these diseases.23 However, placing restrictions on data acquisition, use, and disclosure also poses risks, particularly if these restrictions impede acquisition of key surveillance data that would otherwise be used to prevent disease, investigate causation, or identify and enable interventions to protect an exposed population.20 THE MIXED BLESSING OF THE DIGITAL AGE Improved information technology benefits many areas of public health including health care delivery, surveillance, research, and education.24 Electronic patient information offers many advantages over paper records.