Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Med Ethics. 2024 Jan 23;50(2):84-89. doi: 10.1136/jme-2023-109574.
Patient online record access (ORA) is spreading worldwide, and in some countries, including Sweden, and the USA, access is advanced with patients obtaining rapid access to their full records. In the UK context, from 31 October 2023 as part of the new NHS England general practitioner (GP) contract it will be mandatory for GPs to offer ORA to patients aged 16 and older. Patients report many benefits from reading their clinical records including feeling more empowered, better understanding and remembering their treatment plan, and greater awareness about medications including possible adverse effects. However, a variety of indirect evidence suggests these benefits are unlikely to accrue without supplementation from internet-based resources. Using such routes to augment interpretation of the data and notes housed in electronic health records, however, comes with trade-offs in terms of exposing sensitive patient information to internet corporations. Furthermore, increased work burdens on clinicians, including the unique demands of ORA, combined with the easy availability and capability of a new generation of large language model (LLM)-powered chatbots, create a perfect collision course for exposing sensitive patient information to private tech companies. This paper surveys how ORA intersects with internet associated privacy risks and offers a variety of multilevel suggestions for how these risks might be better mitigated.
患者在线记录访问(ORA)在全球范围内普及,在一些国家,包括瑞典和美国,患者可以快速访问他们的完整记录,访问程度得到了提升。在英国,从 2023 年 10 月 31 日起,作为新的英格兰国民保健制度(NHS)全科医生(GP)合同的一部分,向 16 岁及以上的患者提供 ORA 将成为强制性要求。患者报告说,阅读他们的临床记录有很多好处,包括感到更有权力、更好地理解和记住他们的治疗计划,以及对药物有更多的认识,包括可能的不良反应。然而,各种间接证据表明,如果没有互联网资源的补充,这些好处不太可能实现。然而,通过这些途径来增加对电子健康记录中存储的数据和注释的解释,会在将敏感患者信息暴露给互联网公司方面带来权衡。此外,临床医生的工作负担增加,包括 ORA 的独特要求,再加上新一代大型语言模型(LLM)驱动的聊天机器人的易于获取和功能,使得将敏感患者信息暴露给私人科技公司的风险达到了顶峰。本文调查了 ORA 与互联网相关的隐私风险的交叉点,并提供了各种多层次的建议,以更好地减轻这些风险。
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