Some level of secrecy is also in the interests of private institutions, for whom the corporate data store has competitive value. Security is harder still. Security regimes also require a clear sense of the privileges appropriately accorded to various classes of users. Even inside care-providing institutions, large numbers of persons may need access to records. Balancing security provisions while promoting easy access for appropriate uses is a challenge.
Minimalism is perhaps the hardest principle of the four.
It is the conjunction of socially-valued ends set against individual risk that forms the core problem of information fairness, particularly in health care, and particularly in the United States. Individuals may value privacy for its own sake, being loath to have intimate details of their lives available to any and all comers. This is particularly true of the intimate details contained in a health record. More critically, in a society where personal information disclosures may have adverse consequences, such as in loss of insurance or employment, privacy has a clear instrumental value. While research and public health surveillance may benefit particular individuals in the long run, the link is tenuous, and not nearly as compelling in one's decision calculus as the individual risks.