Bioethics Blogs

The Latest Challenge to Health Privacy: Health Care Consolidation

The American health care industry is undergoing a transformation in several respects, including the substantial integration and consolidation of health care providers. Three of the leading ways in which this is taking place are through mergers of hospitals and health systems, development of accountable care organizations (networks of providers that share responsibility for coordinating patient care), and hospitals purchasing physician practices. There has been considerable discussion about the effects of consolidation on health care cost and quality, but there has been virtually no discussion about the significant effects of consolidation on health privacy.  

A brief example involving a hospital purchasing a physician practice will illustrate how health care consolidation threatens health privacy. Assume that you received mental health treatment from a psychiatrist in private practice, and your mental health records were stored at your psychiatrist’s office and not disclosed without your authorization. Further assume that a local hospital subsequently purchased your psychiatrist’s practice. When you later visit the hospital’s emergency department for treatment of a sprained ankle sustained in the company softball game, the physicians and nurses access your integrated electronic health record (EHR), including records from all of the hospital-owned practices. As a result, your mental health records, which you assumed were confidential, are now accessible by the physicians and nurses treating your ankle.  

Eventually, the interoperability of EHRs will permit health information exchanges (HIEs) or comparable entities to aggregate individual health information stored by various providers. It is not clear, however, whether individuals will have the ability to opt out of participating in an HIE or to segment certain sensitive information.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.