Digitalization of Medical Records, Privacy and Digital Engagement: New Insights for the HIPAA (Health Insurance Portability and Accountability Act)

Digitalization of Medical Records, Privacy and Digital Engagement: New Insights for the HIPAA (Health Insurance Portability and Accountability Act) One of the most promising aspects of digital technologies has been electronic medical service delivery. Digital technologies empowered healthcare providers as well as ordinary people to coordinate, to search helpful information and to share their expertise. Transaction cost runs low and digital transition of health service has exploded, from websites set up by hospitals to dedicated online health sites, such as Web MD or Digital Diagnostics, and data broker firms, such as Acxiom. Yet notice a paradox: Hasn’t this rapid digitalization brought out privacy challenges which fundamentally thwart the transformation of medical practices? Public intellectuals and health officials acknowledged the significance of protecting privacy in medical system. This goes back to the Hippocratic Oath by which doctors pledge for the confidentiality of patients’ records. Maintaining privacy plays a critical role in enhancing, not only the use of health-related technologies, but also health outcomes because worried people may avoid the health system. Still, few studies examined the posited relationship between privacy and health-related use of new technologies. Neither do we know the impact of a sense of privacy on individual health outcomes. Understanding relevant dimensions of health privacy and their impacts is important, when considering increasingly algorithm-based and data-driven medical practices. In this vein, the need for (1) updating the outmoded 1996 HIPAA and (2) developing effective policy responses addressing potential privacy threats is paramount. The objective of this study is to address these issues, entwined in health privacy, public perceptions and behavior, and policy implications. We identified sociodemographic factors affecting privacy surrounding health data and explored the notion of health privacy as a capital resource that is quintessential on the use of health-related digital technologies. To this end, we attended to discrete and multifaceted indicators of health privacy when examining its consequences, using the 2014 Health Information National Trends (HINTS) Survey (n = 3,212). Findings revealed three key dimensions of health privacy capital — awareness of privacy, attitude toward the importance of data sharing, and confidence in the ability to maintain privacy — and showed positive relationships between privacy capital and engagement as well as outcomes concerning health-related digital technology. Analysis suggests that the development of health privacy capital is susceptible to sociodemographic disparities and that its impact remains influenced by sociodemographic status. This suggests useful policy insights. First, simply providing assurance over the safe transfer of medical data between two entities (as in the HIPPA) will not prompt everyone to bridge the socio-demographic divide. Rather, new policy initiatives must be accompanied by the understandings of people’s digital engagement, i.e., how people understand their privacy issues and how they can protect privacy when they use digital technologies. Second, the HIPAA is not meant to regulate data practices beyond the traditional context of doctors-patients; neither is it designed to allow people to restrict the flow of sensitive data into advertisers, data brokers, or/and third parties with commercial interest. Therefore, extending the HIPAA into digital technologies will require insights about how and where the dividing line in people’s abilities to engage in health-related technologies occur.