Shifts in Health Information

To the Editor: In their Sounding Board article on shifts in health information, Mandl and Kohane (April 17 issue)1 observe that “companies providing PCHRs [personally controlled health records] are not covered entities under the Health Insurance Portability and Accountability Act (HIPAA),” but incorrectly suggest that extending HIPAA to them would improve privacy.

Publicly available PCHR systems are already prohibited from releasing information to private parties without the consent of the account holder under the federal Electronic Communications Privacy Act.2 However, HIPAA’s privacy rule provision for disclosurewithout consent for “treatment, payment, or healthcare operations” (TPO) actually eliminates privacy.

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