Michele Gomez remembers the precise second when she realized the issue. It was the autumn of 2022. Gomez (who, like me, is a household doctor and abortion supplier in California) had just lately offered a digital medicine abortion to a affected person from Texas. The affected person had flown to her mother’s home in California, the place she had her appointment, took her mail-order medicines, and handed the being pregnant. Again in Texas, she grew to become involved about some ongoing bleeding and went to the emergency room. The bleeding was self-limited; she required no important medical interventions. Gomez discovered all this the next morning. “I sat down at my laptop and noticed her word from the ER. And I believed, ‘Oh God, if I can see their word, then they have to have the ability to see my word”—a word that included prescriptions and directions for the medicine abortion. For weeks afterward, she waited for a name, fearing Texas regulation enforcement would come after her—or worse, after her affected person.
An unlimited system of digital networks—referred to as Well being Info Exchanges, or HIEs—hyperlink affected person information throughout 1000’s of well being care suppliers across the nation. With the clicking of a mouse, any physician can entry a affected person’s information from some other hospital or clinic the place that affected person has obtained care, so long as each places of work are related to the identical HIE. In a rustic with no nationwide well being system and a whole bunch of various digital medical document (EMR) platforms, the HIE undeniably promotes environment friendly, coordinated, high-quality medical care. However such interconnectivity comes with a serious trade-off: privateness.
Affected person privateness has at all times been a paramount worth in abortion care, and the stakes have solely gotten increased after the Dobbs determination. I’m amongst many involved abortion suppliers asking for swift motion from EMR firms, who’ve the ability to construct technical options to guard our sufferers’ digital well being info. If these firms aren’t keen to construct such protections, then the regulation ought to drive them to take action.
Though it’s not spelled out within the Structure, the Supreme Courtroom has traditionally interpreted a number of amendments to indicate a “proper to privateness,” most famously within the case of Roe v. Wade. By grounding the Roe determination within the 14th modification’s Due Course of clause, the Supreme Courtroom successfully wrapped a proper to privateness across the feminine physique and its capability for being pregnant.
Over the 50 years following Roe, the web got here alongside, after which the digital medical document and the HIE. Alongside this rising connectivity and portability, the federal authorities enacted a sequence of legal guidelines to guard well being info, together with the Privateness Act of 1974 and elements of the Well being Info Portability and Accountability Act (HIPAA) of 1996. However HIPAA is not primarily a privateness regulation; its foremost goal is to facilitate the switch of well being information for medical and billing functions. Many sufferers don’t understand that beneath HIPAA, medical doctors are permitted (although not at all times required) to share well being info with different entities, together with insurance coverage firms, well being authorities, and regulation enforcement.
HIPAA does embrace some privateness provisions to guard “delicate” info. Sure substance use therapy information, for instance, are seen solely to designated suppliers. Legislation enforcement is prohibited from accessing these information with no court docket order or written consent. Entry to abortion information may be equally restricted, however with a technical catch: These restrictions apply solely to sure information, referred to as “visit-specific” info, such because the textual content of the physician’s word. Different information, referred to as “patient-level” info—together with ultrasound photos, consent kinds, and medicines—stay discoverable. If, for instance, a affected person travels to California and is prescribed mifepristone and misoprostol—the usual routine for medicine abortion—these medicines will seem in her document again in her dwelling state. Any cheap individual can assume what occurred at that go to, even with out studying the word.
