Showing posts with label Considerations. Show all posts
Showing posts with label Considerations. Show all posts

Tuesday, July 31, 2012

Cell Phones - Some Considerations of the Cell Phone of the Future

Cell phone technology has been moving forward at break neck speed, and sometimes we may not notice it, but think back to just a few years ago and you can see all the new feature integration and race in the marketplace - a race to "wow" consumers and get them to choose a specific device. But before we talk about the current trends in cell phones and smart phones, let's discuss the past evolution of these devices.

Since, I had one of the first mobile "cell" phones - I'd like to tell you a quick story to start out this discussion.

Cyber Law

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My first cell phones were state-of-the-art at the time, but if you saw them today, you'd laugh. One of them I actually kept; a Mitsubishi Transportable. This phone is about the size of a six pack cooler that you might take to your child's soccer game, and it was quite heavy, as I recall it is well over 10 pounds. This of course included the battery pack to power up to 3 Watt phone.

Cell Phones - Some Considerations of the Cell Phone of the Future

Remember that Ion-lithium batteries at the time were just coming off the assembly lines and were quite expensive - they did not exist in this size for anything but NASA and military usage. These original cell phones I had were nickel hydride powered, quite an inferior battery technology for modern cell phones.

The Mitsubishi Cell Phone has a strap on it so you can carry it like a purse, and I often felt really stupid carrying it, until of course it rang, and I unzipped the top, pulled out the handset on the phone and began talking. I can recall that everyone stared as if I was a secret CIA agent, was working for MI6, and my name wasn't Lance, it was really James Bond. You see, at that time not very many people had the cell phones and they were very expensive.

Another one of my first phones was a Audiovox 1000 model, which was quite large and it was mounted in my car, a car phone - cell phone. The box that ran the Cell Phone was mounted under the seat, and there was a cradle that held the headset. The headset had a cord on it just like a phone at home, before the cordless phones that is. Under the seat the box was about 3 1/2 inches high and the size of a laptop with a 17.1 inch screen.

This Cell Phone or car cell phone was wired directly to the battery with a couple of fuses. When I turned on the vehicle, the Cell Phone would automatically turn on. If I turned off the vehicle, I had to leave it on accessory with the key in the right position, unless I left the phone on which by-passed the ignition. When the phone rang and actually honked the horn, which got me into trouble a couple of times when the horn went off while I was driving behind a police car stopped at an intersection. I have a lot of stories to tell you about all those early days with the first cell phones, and you may e-mail me if you are ever interested in such experiences.

Folks today take all this for granted, as they don't realize how cumbersome the original cell phones were, or how stupid they were compared to modern day smart cell phones. Today they give you a free cell phone when you sign up for service - back then you had to pay 00 for a car cell phone, and as much as a couple hundred dollars to have it installed. It was quite a procedure, if you have a stereo system, and an XM radio put in your car at the same time, that is about how much work it took to do this. Therefore, at today's labor rates you could easily pay three or 0. That's definitely something to think about.

If I was talking to someone on the phone while the engine was running, if I turned off the car and moved the key to the accessory position I would dump the phone call, as I cut it out during that transition. However, having a cell phone in my car helped me increase my business. At the time I was only 17 years old - I had an aircraft brokerage firm and aircraft finder's service and I would work off of fees whenever an aircraft that I represented sold. I also had a small aircraft cleaning service and was able to contact customers from my vehicle on the flight line, and my crews could call me when they were done with the job as they would use the local payphone to call me.

Thus, this mobile technology allowed me to make more money, and remain more efficient than the competition. Remember at the time this was leading edge technology, it was state-of-the-art, and I had it - the competition did not. No longer was I stuck in an office, I could run my business from anywhere and it allowed me much freedom. Often people today do not realize what it was like before mobile cell phones. Anyone who is in business now over the age of 50 certainly realizes, because they remember a time when there were no cell phones.

This was a period in our nation's history where there were pay phones in every shopping center, every gas station, outside of every fast food restaurant, and people used them all the time. Business People who didn't smoke filled their ashtrays with coins so they can stop and use the pay phone. Thus, allowing them to call clients, customers, vendors, and maintain their operations in the office. When cell phones first came into play they displaced the old Motorola technology of push to talk phones, which worked off a mountaintop repeaters, these phones were very big in the military, construction industry, and all the executives with large corporations had them.

Since this was radio technology, they worked farther than the first cell phones which had to be within 10 to 15 miles of a cell tower. Today, the cell phones are less wattage than they were back then, so the average cell tower is 6 miles or less apart. Back then the cell phones worked off three Watts, and now with 3G technology the wattage is under 1 W. This is probably good for the human biosystem, as it is putting less microwave frequency radiation into your brain, there will be fewer brain tumors, brain cancer, and other issues. There have been many studies including several with the Swiss researchers which seemed to indicate that the 3 W phones were quite unacceptable for human health, and they would slowly cook your brain as one researcher said.

Luckily, for the cell phone industry they were able to bury most of these problems and objections, as well as the studies that the Swiss did. Although, there were studies here in the United States, you would be hard-pressed to find those research studies and data on brain tumors, brain cancer, and their relation to the cell phones that people used. In fact, if you go to Google Scholar today you will be hard-pressed to find anything that would suggest that the cell phones could cause such horrible conditions. This of course is all still up for debate, but we try not to talk about it.

Perhaps, by going to 3G wireless, and lower wattage the mobile cell phone industry dodged a bullet of huge class-action lawsuits, and we may never know the damage we had caused. Nevertheless, as we talk about Six Sigma efficiency in corporations, or using modern management techniques in small businesses, no one can deny that increasing communication speed and reliability is by far a factor in the increase productivity in the 80s and 90s due to cell phones.

At the time I was literally running 1000 to 1200 minutes per month and although that service was much cheaper than the other choices such as the Iridium Satellite Phones, non-cell phone mobile units, as they did not use cell towers, rather satellites - you can imagine the costs of the original cells. They did not have an unlimited plan and once over your minutes, you paid the premium for each minute on that cell phone, my bill was usually 0 to 800 or more.

The other mobile phones at the time were not cell tower-based phones, they were push-to-talk and came in a brief case - it was considered quite James Bond at the time. And this was back in the 1970s, and I remember this, because I started my business when I was 12 years old washing airplanes at the local airport. Many of the businessmen who owned corporate jets had these types of phones. They were basically for the rich and famous, and business person. They didn't work everywhere and you had to have pretty much line of sight to the nearest tall mountain, and that mountain had to have a repeater on top of it, which was hardwired into telephone lines, and the rest of the system worked with ground lines.

All this is very interesting, and we must consider that many folks today have never been alive when there were no cell phones. They have no clue how hard it was to run a business back in the days when there really was no mobile communication. The same repeater systems on top of the mountains that Motorola owned or which used Motorola hardware, also controlled the pagers. These pager systems were quite popular with people on call, such as doctors, and service personnel. Two-way radios, which work basically the same as the two-way push to talk briefcase phones, were used through a dispatcher for companies very often.

Later, just as cell phones came into play, someone came up with the idea of 1.5 way and two-way pagers. Instead of a one-way pager, someone who had what they call an "alpha mate" device could page someone and ask them a question (using a text message) on that page and the recipient could press a button for yes or no, Y. or N. and that information would be relayed to the dispatcher. People actually got pretty good at communicating this way. And you could send text type messages for the user of the pager to read. In reality these were the first text type messages, so the concept of having a mobile device and using text messaging is not all that new.

Two-way text messaging via cell phones is merely a re-introduction of that similar technology. Once people had cell phones they didn't need to use the text pagers anymore, and that technology was leapfrogged as the price of the cell phone services was lower, as competition increased between companies like Sprint and AT&T. There were many other regional smaller players, but they eventually got bought up by the big boys.

The cell phone industry grew so fast in the late 80s and early 90s, that eventually there was coverage everywhere. Then something really weird happened, the promise of 3G wireless came into play, and folks started switching to that new system. I can tell you this - my first cell phones were much more powerful and worked much better than the cell phones of today.

Occasionally, I had a call dropped and there were not as many service areas, yes there were more dead zones, but the signal was much more powerful because it was 3 W, and since it ran off my car battery or a large battery pack in a small carry case, it had ample power to maintain that strong signal.

Today, when I use my AT&T cell phone, I am often cursing because the service is so bad, I wonder why I am even paying for it. In fact, the loss of productivity from dead zones, and the cell phone calls dropping, I feel as if AT&T should be paying me. Apparently, I am not alone many people feel the same way. Nevertheless, the 4G wireless is on the way and everyone will be switching to that so that they will have Internet access allowing them to do e-mails, twitter, video, and real-time text messaging without the use of ground lines

A good many folks do not know of a time when there was no email or internet. And most people who are in business today, who are under 50 years old do not remember a time when we didn't have fax machines, the reality is that fax machines came into play about the time of the first cell phones. Mind you, there was still no Internet, no e-mail, and although ARPANET was being used by the military, and by think tanks, research centers, and top universities, it wasn't really available to the public in the way we have it now.

Fast forward to today and now no one goes anywhere without a cell phone. Social researchers have noted fewer people wearing wrist watches. They don't need a wristwatch because that is a standard feature on all cell phones now. Of course, this doesn't help companies like Rolex who are catering to the young up-and-coming BMW crowd, if you look around you will see that most young executives don't even wear a watch and most of our younger generation doesn't wear a watch either.

It seems that the wrist-watch replaced the pocket watch, and the cell phones seem to be replacing just about everything. These days people use their cell phone or smart phones to do their e-mails, and these same phones act like a PDA, no one carries day planners anymore, although a few people do, myself included perhaps out of habit from using a day planner from the time I was 12 years old in my business until I was in my mid-40s. Perhaps, I am giving away my age, but sometimes old habits die hard.

Today with many laptop notebooks, PDAs, and smart phones, it seems none of that other stuff is needed. Including your human memory say many psychologists, who argue that this technology is causing the human brain to rewire itself differently because there are different needs to get along in the world. After all, all your best friends are on the speed dial and you don't have to remember phone numbers anymore. And all your contacts and information is on your smart phone, in your e-mail program, or on your laptop.

Cyber security analysts worry that if the system crashes or God forbid an electro-magnetic pulse, neutron bomb, or nuclear device is set off high in the atmosphere it could destroy all the electronic equipment, including all the cell towers, your laptop, your television, your refrigerator, and your smart phone. Where will you be then, and can you rely on your memory and the brain you are born with to carry on your daily endeavors - scary thinking, but perhaps we need to address this as we consider the evolution of cell phones.

Today, our cell phones have changed the entire dynamics of our society. There are unspoken etiquette issues of cell phone use in public. There are rules when we can use our cell phones and when we can't. Issues such as driving with a cell phone and the number of auto deaths which occur while people are driving and talking on the phone at the same time. There have been major disasters caused by texting while driving a bus or conducting a train.

The reality is that as our technology has evolved, it is evolving much faster than the human brain can to take it all in. Due to the multitasking required in our society to get along and the high pace and productivity that jobs require, many brains cannot cope or adapt fast enough. And this seems to be a problem, if some people are not able to make the switch, but they attempt to, sometimes while driving with disastrous results.

Our smart phones are becoming super cell phones that have more and more features, such as the ability to store music like the iPod, and vast amounts of data like our electronic PDAs. These devices are getting more high-tech each and every year and they are feature rich. Many have five to ten gigabytes of information storage now. One recent study in the cell phone industry noted that 90% of the people who own cell phones have never used all the features, and do not know how to program them, or even that they exist on their cell phone. Most people don't even care, they use the features they want and none of the others.

This is a common problem with new technologies, and it is something that happened with that Beta and VHS recorders. What's that old joke, there are tons of features on your video recorder at home, but no one knows how to use them, and before we all learned that we need to learn to use these features, the VHS video recorder is out in the new DVDs are here. Now cable companies offer boxes which can record multiple shows so you can watch later or pause a live TV program while you go to the bathroom, or go to the kitchen to get something to eat. Some allow you to use your cell phone to do remote programming too.

These are all things common challenges which are encountered and similar problems with any new personal tech devices which become mass consumer products. Cell phones and our current smart phones are no exception. It's hard to say the future what types of new features in our cell phones will have. The sky is the limit, and the imagination and demand for more features and greater technology is readily apparent. The early adopters of such cell phone and smart phone technologies are willing to spend big bucks to have all-in-one devices. Therefore, these trends will continue.

Just to give you an example of some of the crazy ideas people come up with for future smart phones let me tell you a little quick story.

Our on-line Think Tank came up with a plan to produce a PhD or Personal Health Device, which tracks your diet - on your cell phone. How it worked was quite simple, when you are at the grocery store, you would scan all the items that you bought, and they would go into storage inside your smart phone. Each time you ate one of those items you would simply select what you ate, and punch in the number of servings and you would calculate and keep track of your calories, fat content, and recommended daily allowances in the major five food groups.

The smart phone would have a scanner system on it, later subsequent versions of this smart phone and personal health device would be able to scan products via RFID tags. Your phone could tabulate and even recommend what you should eat, how many more miles you should jog, and what you would need to maintain your diet to meet your personal health goals, and weight loss program. Sounds crazy doesn't it, yes, it does, but the venture capitalists like the idea. So too, do companies that produce high tech smart phones today, as everyone is looking to get a jump on the competition.

GPS systems by way of smart phones or cellular high-tech phones is quite possible (now available), and you don't even need satellites to do it. If you are within the realm of several cell towers your location can be triangulated quite quickly, which pinpoints your exact location within 10 feet. Ah ha, you see the problem in this too; What about privacy you ask? That's a good point and that is another issue that people are quite concerned about with all this new high-tech personal smart phone innovations.

Google Phone and social networking connections appear to be on horizon. That is to say, linking your smart phone with all of your social networking friends, but apparently Google got into a little bit of a problem and noted that many people are not ready for that just yet. In fact, many people who are friends on social networks and make connections, have no intention of ever meeting these people in real life, and therefore they aren't really friends. And since you don't really know anything about those connections or friends on your social networking site, the last thing you want them to do is know exactly where you are within 10 feet.

That should appear to be obvious, and in the future it may not be such a big deal, but people are still a little paranoid and they like to have their privacy. Meanwhile, we read more and more articles about social networking gone bad. That is to say people using social networks to stalk other people, and this also concerns parents who have teenagers, who use social networks on a daily basis, and some that use them on an hourly basis, and a good many who seem to be texting every few minutes.

One recent study of cell phone users was able to have a 93% predictability of where a person might be based on the patterns determined by their cell phone, and when it was connected to any given local cell tower. The study found that most people stay within 6 miles of their homes. These patterns of predictability are a reality in our society and how we operate as individuals - nevertheless this brings up all types of issues that have attracted the attention of the Electronic Freedom Foundation, and it also touches on the issue of privacy and paranoia, it catches people off guard.

Then there is the new trend with smart mobs using their smart phones, and having fun with and meeting up in various places all at the same time. Although these schemes are used for fun, entertainment, and socializing, these same types of smart mobs have the power to destabilize a society or civilization. Consider if you will the use of technology in Tiananmen Square - should governments be worried about your smart phone technology, or the future of 4G wireless cell phones? They probably should be concerned with it, especially if it is used by a foreign government to provide mass protests against what would be a normal stabile government.

In other words it has uses in warfare, the CIA, in bringing down corrupt regimes which are enemies to United States. But rest assured - the same thing could happen in the United States where perhaps a communist rogue nation state decided to have protests in the United States in our major cities on Mayday. It could easily happen especially with our own technology being used against us, due to all the interconnectivity that it offers.

Does this mean that our government has to find a way to turn off all the cell phones in case of something like this happening? Do they need a device to turn off certain cell phones from the system, while leaving first responders cell phones activated for communication? And what about hackers, which might be able to send out tens of thousands of bogus text messages, or call masses of people into a trap, or stage a riot?

These are all questions we need to answer and we need to understand that the same technology we create to improve our productivity, our society, and help us in our daily lives with our families and friends can also be used against us.

And what happens when our smart phones become smarter than us? Some believe, as I do, that they already have. Most of the smart phones today have artificial intelligence systems within them, for instance a text messaging program which guesstimates which keys you are going to press next or what you are trying to say and it offers you suggest is so you can fill in the blank. Making your texting very quick. This is very similar technology that Google uses when doing a search and offer suggestions as you are typing to save you time. This is just one form of artificial intelligence in our smart phones and cell phones today.

There are many cell phones that allow you to use speech recognition to dial phone numbers, search your databases, or navigate the screens on your cell phone. The newest smart phones will be able to tell you when you are in proximity to a Starbucks and then give you GPS directions to find that location. This has big implications for retailers, advertisers, and consumers alike. They will begin to know your patterns and habits. All these technologies are available now and we will see them in the near future. Your cell phone will even become a payment device, hooked to your credit card information. All this technology exists today.

But what about the technologies which are just over the horizon?

We've recently seen at Comdex and CES shows the first generations of projection cell phones, that is to say video conference enabled cell phones which allow you to project to the other party onto the nearest wall or onto a table so you can watch. This will obviously be followed by the Holographic cell phones, which were similar to those that we saw in the Star Wars trilogy.

All these things will be available in the next five years, and you will most likely have them if you buy one of the high-tech cell phones in the near future. At first these technologies will cost a lot extra, but those prices will come down as the number of units built goes up and as more Chinese also purchase their first cell phone, adding another billion people who own such devices, therefore bringing the cost down for everyone - significantly!

By the year 2025 your cell phone will be a brain chip inside of your head, and you can think that you'd like to contact someone and it will dial the number and contact them. By 2050 you will be able to do thought transfer via the small devices, brain implant - perhaps smaller than a dime. And people born after that will never know what time were "thought transfer" did not exist, just like right now there are many people who have never known a time when mobile phones didn't exist. And since Moore's law also seems to apply to the cell phone and smart phone industries we can expect a size reduction as well as a power reduction to run this technology.

In other words, your biosystem will be able to power up your brain cell phone chip, just as it does your current human brain which works on about a maximum of 20 W. of energy, and you will be able to have an eyelid screen, so you can close one eye, and surf the Internet. It's hard to say what the Comdex and CES Show in Las Vegas in the year 2025 will look like, it is probably impossible to pinpoint what these shows will look like in the year 2050. In fact, there may not be shows at all, you may be able to experience these trade shows in your holographic living room, video gaming center.

Walking the virtual halls of the trade show using your avatar and talking to other avatars explaining all the new technologies that are available for you might be the new reality albeit an Augmented or fully Virtual Reality. That appears to be where we are going, although it's hard to imagine considering where we are today. Nevertheless, I can assure you people in the 1950s could not really have imagined the way in which our smart cell phones have evolved in the present period.

Currently, there seems to be a very big push in the larger cities like Atlanta and Dallas, Los Angeles and Seattle, Boston and New York, Miami and Houston towards the 4G wireless, obviously this will continue. That is the full broadband Internet surfing on your smart phone, the ability to watch TV while driving in a car on your cell phone. And next comes the ability to project that TV onto any screen or flat surface that is nearby or available. The technology is getting more robust, it's getting smaller, it's getting smarter, and you have to decide how far you want to go with it.

Perhaps, I should write a quick eBook on this topic and explain chapter by chapter, the evolution of this ominous communication technology, and the future of smart phone personal tech devices. Let me know if you know any interested potential co-authors.

At the current pace we are moving, and at the speed in which we are interfacing with the Internet, social networks, e-mail, and television, it's hard to say exactly what you will be carrying around in the future in your purse or pocket, but I daresay it will be something that is truly incredible, and in the next 10 years it will be hardly imaginable from this point in time to know exactly what it will be, or what it might be able to do. I hope you will please consider all this. And contact me if you'd like to discuss this further at the Online Think Tank.

Cell Phones - Some Considerations of the Cell Phone of the Future

Lance Winslow is a Cell Phone Technology Writer, and specializes in Futuristic Topics and Personal Technologies such as smart phones, cell phones, and mobile technologies. Learn more about your options with various Cell Phone Plans. Please visit http://www.calling-plans.com.

Note: All of Lance Winslow's articles are written by him, not by Automated Software, any Computer Program, or Artificially Intelligent Software. None of his articles are outsourced, PLR Content or written by ghost writers.

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Sunday, May 20, 2012

Ethical Considerations of Privacy and Cyber-Medical Information

In 1818, British author Mary Shelley's tale of Dr. Frankenstein's infamous creation startled and captivated a receptive audience. Just as the macabre, but resourceful, doctor created life from non-life that terrorized the local countryside, we have created a "cyberspace monster" that "lives" and knows no boundaries. It may not actually terrorize us, but we are likewise captivated by it. It profoundly influences and impacts our everyday activities, but it is also out of control and has spawned many controversial issues involving free speech, censorship, intellectual property, and privacy. The free market and society norm may, in some measure, be capable of regulating these issues and eventually help allay many of our concerns. A major and controversial concern that requires additional discussion is safeguarding the confidentiality of private medical information.

Expectations of Privacy and Private Medical Information

Cyber Law

According to attorney and privacy law specialist, Ronald B. Standler, "Privacy is the expectation that confidential personal information disclosed in a private place will not be disclosed to third parties, when that disclosure would cause either embarrassment or emotional distress to a person of reasonable sensitivities" (Standler, 1997). Another theorist, Ruth Gavison, defines privacy as "the limitation of others' access to an individual with three key elements: secrecy, anonymity, and solitude." Secrecy or confidentiality deals with the limits of sharing knowledge of oneself. Anonymity deals with unwanted attention solitude refers to being apart from others (Spinello, 2003). Basically, we want to protect the integrity of who we are, what we do, and where we do it. Regardless of our definition, the right of privacy usually concerns individuals who are in a place reasonably expected to be private. Information that is public record, or voluntarily disclosed in a public place, is not protected.

Ethical Considerations of Privacy and Cyber-Medical Information

The open architecture of the modern phenomenon that we call the Internet raises very unique ethical concerns regarding privacy. Information is sent effortlessly over this vast global network without boundaries. Personal information may pass through many different servers on the way to a final destination. There are virtually no online activities or services that guarantee absolute privacy. It is quite easy to be lulled into thinking your activity is private when actually many of these computer systems can capture and store this personal information and actually monitor your online activity (Privacy Rights Clearinghouse, 2006). The Net's underlying architecture is designed to share information and not to conceal or protect it. Even though it is possible to develop an adequate level of security, with an acceptable risk level, it is at enormous cost and considerable time.

Medical records are among the most personal forms of information about an individual and may contain medical history, lifestyle details (such as smoking or participation in high-risk sports), test results, medications, allergies, operations and procedures, genetic testing, and participation in research projects.The protection of this private medical information falls under the area of medical ethics. The realm of medical ethics is to analyze and resolve ethical dilemmas that arise in medical practice and biomedical research. Medical ethics is guided by strict principles or standards that address: Autonomy, Beneficence, Nonmaleficence, Fidelity, and Justice (Spinello, 2003). The principle of Autonomy includes a person's right to be fully informed of all pertinent information related to his/her healthcare. A discussion of medical ethical principles and patient rights leads us to further discuss legislation designed to maintain and protect these cherished rights.

Access to Private Medical Information and the Health Insurance Portability and Accountability Act of 1996

Since 400 B.C. and the creation of the Hippocratic Oath, protecting the privacy of patient medical information has been an important part of the physician' code of conduct. Unfortunately, many organizations and individuals not subject to this strict code of conduct are increasingly requesting this private information.Every time a patient sees a doctor, is admitted to a hospital, goes to a pharmacist, or sends a claim to a healthcare plan, a record is made of their confidential health information. In the past, all healthcare providers protected the confidentiality of medical records by locking them away in file cabinets and refusing to reveal them to anyone else. Today, we rely on "protected" electronic records and a complicated series of laws to maintain our confidential and private medical records.

Congress duly recognized the need for national patient record privacy standards in 1996 when they enacted the Health Insurance Portability and Accountability Act HIPAA). This act was effective April 14, 2003 (small health plans implementation date was April 14, 2004) and was meant to improve the efficiency and effectiveness of the nation's healthcare system. For the first time, federal law established standards for patient medical record access and privacy in all 50 states. The act includes provisions designed to save money for health care businesses by encouraging electronic transactions, but it also required new safeguards to protect the security and confidentiality of that information (Diversified Radiology of Colorado, 2002).

There are three essential parts to HIPAA: Privacy, Code Sets, and Security. The Security section is further subdivided into four parts: Administrative Procedures, Physical Safeguards, Technical Security Services (covering "data at rest"), and Technical Security Mechanisms (covering "data in transmission").

PRIVACY:

The intent of the HIPAA regulations is to protect patients' privacy and allow patients greater access to their medical records. The Act specifically addresses patients' Protected Health Information (PHI) and provides patients with greater access to and modification of their medical records. Prior to providing patient services, the Covered Entity must first receive the patient's consent to share PHI with such organizations as the insurance billing company, the billing office, and physicians to which the patient may be referred. Individuals must be able to access their records, request correction of errors, and they must be informed of how their personal information will be used. Individuals are also entitled to file formal privacy-related complaints to the Department of Health and Human Services (HHS) Office for Civil Rights.

CODE SETS:

Under HIPAA, codes are standardized to improve safety and security of health information. According to these new standards, a code set is any set of codes used for encoding data elements, such as tables of terms, medical diagnosis codes, procedure codes, etc.

SECURITY:

The security section is divided into four major parts:

1. Administrative, which requires documented formal practices, the execution of security measures to protect data, policies and procedures regulating conduct of personnel in protecting data, security training, incident procedures, and termination policies.

2. Physical Safeguards relate to the protection of physical computer systems, network safeguards, environmental hazards, and physical intrusion. One must consider computer screen placement, pass code protection, and computer locks to control access to medical information.

3. Technical Security Services refers to PHI stored on the computer network and how it is securely stored and accessed. Those using the PHI must be logged on and authenticated. An audit trail of authenticated access will be maintained for 6 years.

4. Technical Security Mechanisms refers to PHI transmitted over a communication network such as the Internet, frame relay, VPN, private line, or other network. PHI transmitted over a communication network must be encrypted.

There are also some noticeable shortcomings to HIPAA. The act did little to actually make health insurance more "portable" when an employee changes employers. Also, the Act did not significantly increase the health insurers' accountability for wrongdoing with provisions that are often difficult to monitor and enforce. There is also much confusion for patients, as well as healthcare providers, in regard to the interpretation of the act (Diversified Radiology of Colorado, 2002).

Other Laws, Regulations, and Decisions Regarding Private Medical Information

Besides HIPAA, there are important state regulations and laws, and federal laws and legal decisions, concerning the privacy and confidentiality of medical information (Clifford, 1999):

The Privacy Act of 1974 limits governmental agencies from sharing medical information from one agency to another. Congress declared hat "the privacy of an individual is directly affected by the collection, maintenance, use and dissemination of personal information ...," and that "the right to privacy is a personal and fundamental right protected by the Constitution of the United States ..." (Parmet, 2002).

The Alcohol and Drug Abuse Act, passed in 1988, establishes confidentiality for records of patients treated for alcohol or drug abuse (only if they are treated in institutions that receive federal funding).

The Americans with Disabilities Act, passed in 1990, prohibits employers from making employment-related decisions based on a real or perceived disability, including mental disabilities. Employers may still have access to identifiable health information about employees for reasonable business needs including determining reasonable accommodations for disabled workers and for addressing workers compensation claims.

Supreme Court decision in Jaffee v. Redmond: On June 13, 1996, the Court ruled that there is a broad federal privilege protecting the confidentiality of communication between psychotherapists and their clients. The ruling applies to psychiatrists, psychologists and social workers.

Freedom and Privacy Restoration Act of 1999: Designed to prohibit the creation of government unique medical ID numbers.

Managed Care and Cyber Threats to Private Medical Information

The introduction of the Internet and the advances in telecommunications technology over the last two decades allows us to access vast amounts of medical information, regardless of time, distance, or remoteness, with relative ease. This cyber access to medical information has profoundly changed how healthcare providers treat patients and offer advice. No longer are there barriers to the efficient exchange of health information and critical life-saving medical information. In addition to the many benefits of cyber access to medical information, there are also serious threats to our personal privacy and our medical information.

The intense interest for the protection and privacy of medical information is driven by two major developments. The first is the growth of electronic medical record keeping that has replaced paper records. A report from the National Academy of Sciences states that the healthcare industry spent between and billion on information technology in 1996 (Mehlman, 1999). This was the year that the Health Insurance Portability and Accountability Act was passed with most of the expenditure attributed to converting hard-copy information to electronic formats.Electronic medical records (EMRs) present a significant threat to maintaining the privacy of patient-identifiable medical information. This medical information can be retrieved instantaneously by anyone with access and passwords. Although hard-copy medical information can be easily copied, electronic records are much more easily copied and transmitted without boundaries.

The second major development that concerns the privacy of patient information is the overall growth of managed care organizations. There is a demand for an unprecedented depth and breath of personal medical information by an increasing number of players. In contrast to traditional fee-for-service healthcare, the provider of care and the insurer can be the same entity. In this situation, any medical information in the possession of the provider is also known to the insurer. This is common in all forms of managed care, but most evident in closed-panel HMOs. This sharing of information increases the fear that the insurer may use the data to limit benefits or terminate insurance coverage (Mehlman, 1999).

Some managed care companies are reporting private medical information to an extreme in requiring providers to report to case managers within twenty-four hours any case that is considered a high risk potential for the client, a second party, the employer, or the managed care company. Examples include such things as possible danger to self or others, suspected child abuse, potential threats to national security or the client organization, client's request for records, complaint about Employee Assistance Program services or threat of a lawsuit, and potential involvement in litigation including confession or knowledge of criminal activity. No mention is made concerning client privacy or rights regarding the release of this information. Nothing is also said about what will be done with the information that is shared (Clifford, 1999).

Another issue with managed care companies is the large volume of data processed and the carelessness in handling medical information. A salient example deals with lost records as noted in a 1993 survey sample of San Francisco Bay Area psychologists. In this survey, 59% of reports were mailed or faxed to wrong persons, charts accidentally switched, or proper authorization not obtained (Clifford, 1999).

Maintaining and Protecting Electronic Private Medical Information

In order to maintain and protect valued private medical information, we must always be vigilant and proactive. Basic steps can be taken prior to using electronic information sharing. For example, when signing a "Release of Information" form, read everything carefully. If not clearly understood, ask questions. Also, remember that HIPAA grants you the right to request that your healthcare provider restrict the use or disclosure of your medical information. Make sure those who ask for information are properly identified and authorized to collect this information. Finally, make sure that the person collecting information uses at least two "identifiers" to ensure proper identification of patient (e.g. name, last four of social security number, address, telephone, number, birth date etc.

When dealing with electronic and computerized medical information, the situation gets more tenuous and much more complex. Secure networks and websites, passwords, firewalls, and anti-virus software, are unquestionably the first steps in a plan of protection. Passwords must be complex, using numbers, letters, and cases, yet also easily remembered. To maintain security, experts suggest that passwords be changed every 90 days or if they are believed to be compromised. In addition, any private medical information sent on the NET or non-secure networks should be encrypted. Encryption (64 or 128 bit) is translating information into a secret code where a key or password is required to read the information.

Further security is provided by using privacy enhancing P3P frameworks, filtering software (e.g. MIMESweeper), message authentication codes "(MACs), and "digital signatures." The Platform for Privacy Preferences Project (P3P) is a technological framework that uses a set of user-defined standards to negotiate with websites regarding how that user's information will be used and disseminated to third parties (Spinello, 2003). This P3P architecture helps define and improve cyberethics, improves accessibility, improves consistency, and increases the overall trust in using cyberspace. MACs utilize a common key that generates and verifies a message whereas digital signatures generally use two complementary algorithms - one for signing and the other for verification.

There has also some creative technology proposed for maintaining and protecting private medical information. In October 2004, the "VeriChip" was approved by the FDA for implantation into the triceps of patients. The chip is about the size of a grain of rice and is inserted under the skin during a 20-minute procedure. This invisible chip stores a code that can scanned to further release a patient's private medical information. This code is then used to download encrypted medical information. The procedure cost is about 0-200 (MSNBC, 2004).

Another more commonly used medical information tool is the "smart card," a credit card sized device with a small-embedded computer chip. This "computer in a card" can be programmed to perform tasks and store important information. During an emergency, paramedics and emergency rooms equipped with smart card readers can rapidly access potentially life-saving information about a patient, such as allergies to medication, and chronic medical conditions. There are different types of smart cards: memory cards, processor cards, electronic purse cards, security cards, and JavaCards. These cards are tamper-resistant, can be PIN protected or read-write protected, can be encrypted, and can be easily updated. These unique features make smart cards advantageous for storing personal medical information and are popular throughout the world. In Germany and Austria, 80 million people have the capability of using these smart cards when they visit their doctor (Cagliostro, 1999).

There is also a recent proposed government plan to create a national system of electronic health records (EHRs). Details include the building of a National Health Information Network that will electronically connect all patients' medical records to providers, insures, pharmacies, labs, and claim processors. The sharing of vital information could improve patient care, include more accurate and timely substantiation of claims, and be an asset to public health in emergencies. The goal is to have it operational by 2009. Even with laudatory goals of saving money, making medical care more efficient, and decreasing drug reactions and interactions, there are still inherent dangers to this national plan. There are valid concerns that pharmaceutical companies may attempt to market a new drug or device for your specific medical condition. There are also strong worries of exploitation and abuse of personal data. Who will monitor access to the information? There are also concerns that lenders or employers may rely on private medical information to make business decisions. Then there is always the ever present fear of hackers and pranksters retrieving your personal information. There are still so many questions unanswered (Consumer Reports.org, 2006).

In conclusion, we are now stuck with a "Cyberspace Monster" and all of its advantages and shortcomings. When we use cyberspace, we can have no expectations of privacy and we must accept a level of risk. Therefore, when transmitting and sharing private medical information, we must be always aware to take precautions in safeguarding our privacy as much as possible by using secure networks, P3P architecture, passwords, firewalls, encryption, message codes, digital signatures, and devices like smart cards and "VeriChips." Medical records are among the most personal forms of information about an individual, but we are challenged to find a balance between society's interest in protecting medical confidentiality and the legitimate need for timely access to critical medical information especially with fears of influenza pandemics and bioterrorism. When this information is transferred into electronic format, we have heightened concerns about maintaining and protecting this private data. With managed care, there is a demand for an unprecedented depth and breath of personal medical information by an increasing number of players. While the HIPAA provisions are a welcomed start in protecting our private medical information, we must remain vigilant of the ever increasing need to protect this special information.

References:

Cagliostro, C. (1999) Smart card primer.

Clifford, R. (1999) Confidentiality of records and managed care legal and ethical issues.

Consumer Reports.org (2006). The new threat to your medical privacy.

Diversified Radiology of Colorado (2002) History: HIPAA general information.

Mehlman, M. J. (1999) Emerging issues: the privacy of medical records.

MSNBC (2004) FDA approves computer chip for humans.

Parmet, W. E. (2002) Public health protection and privacy of medical records.

Privacy Rights Clearinghouse (2006) Internet privacy resources.

Spinello, R. A. (2003) CyberEthics: Morality and law in cyberspace. Jones and Bartlett Publishers, Sudbury, MA

Standler, R. B. (1997) Privacy law in the USA.

Ethical Considerations of Privacy and Cyber-Medical Information

Mr. Klemens is an accomplished author, writer, and practicing pharmacist. He has authored a book on integrative medicine (Mountains and Rivers: Complementing your Healthcare with Alternative Medicine, ISBN: 1-4033-8672-2) and numerous articles in local, national, and international magazines, and web sites. Topics include integrative medicine, Oriental medicine, herbs and supplements, health and fitness, Scottish culture, and leadership and ethics. He is also listed in the Marquis Who's Who in America, a member of Clan Gregor, and is a Fellow of the Society of Antiquaries of Scotland.

http://www.writers.net/writers/22138

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