Confidentiality is a major concern for many people inside and outside the health care professions. When you’re dealing with an electronic health record, accessible by various practitioners, how is the confidentiality of these records guaranteed?

Even the CIA can’t protect their system 100 percent of the time. There’s a tradeoff to this. But we’ve done a lot of work to develop very secure infrastructures to protect the information, and if you look at the core specifications that support the nationwide health information network, they are comparable to what we see in the banking industry, as far as keeping one’s money safe.

Does that mean somebody can’t hack it? No. But one of the things we’ve tried to do as much as possible is to create federated systems. That is, we don’t build huge repositories of data. We build patient records on the fly as we need them. When you talk about a continuity of care record, if I go and ask for information on a particular patient, it will go to all the community sources and assemble it on the fly for me. So rather than have somebody hack into a repository that has 100,000 or a million records in it, we try to federate, or decentralize, everything and assemble them on an as-needed basis.

So what’s centralized is the way the patterns of information are stored and accessed, and what’s decentralized is the data itself.

Correct. We have master patient indexes at a community level that point us to your records.

Does that mean that if I am seeing a patient, and I have the proper code to gain access to their electronic health record including the treatments of other practitioners …

The proper consents have to be in place. Then, it remembers you, it remembers what you looked at.

So I can’t take someone’s psychiatric records and post them on the World Wide Web.

First off, psychiatric records for the most part are set aside. They’re protected by a whole other set of laws. Although it does get a little dicey when you talk about the medications they’re on, because those are more readily accessible. But the psychiatric notes are a far-away set-aside. But you could, if you are an unscrupulous physician and you have consent to enter that system, you could do that. But if you did, it would probably be the last time you practiced.

What other aspects of the new law should our readers know about?

Another leg of this bill is a major push to upgrade quality. We’re going to see quality reporting done and we’re going to see the transparency that everyone has tried to avoid for so many years. That could be an opportunity for the chiropractors to step up, to show the efficacy of chiropractic treatment. Electronic records allow quick access to large amounts of data for researchers to use in determining effectiveness. It’s far more difficult to do this by just pulling paper charts. This is a chance to shine. Most medical professions that I am working with are terrified of having their quality data reported.

My sense is that chiropractors would welcome such scrutiny. Of several dozen randomized controlled trials comparing spinal manipulation to other treatments or placebo, none have shown chiropractic to perform worse than what it was compared to, and a substantial majority have shown it to be superior.

That’s why I think this is a real opportunity.

Daniel Redwood, DC, the interviewer, is Editor-in-Chief of Health Insights Today.