Last week, Microsoft announced a new PHR (Patient Health Records) system called HealthVault. HealthVault is a web-based portal that enables end-users to upload their health records on the web. Unfortunately, what people don’t realize is that HealthVault and similar PHR systems are not subject to or governed by law. When the Health Insurance Portability and Accountability Act (HIPAA) was enacted, we did not envision that private software firms would eventually want to create databases for our health records. As a result, HealthVault and other PHR systems are not subject to the same privacy and security laws to which traditional medical records are subject to in the United States because they are not “covered entities” as specified in the HIPAA.
Over the course of the past 7 years, researchers at ThePrivacyPlace.org have evaluated over 100 privacy statements for financial and healthcare web portals. In addition, we focus on evaluating the extent to which the privacy of sensitive information is protected in these systems as well as the extent to which system comply with relevant regulations.
Even though physicians and the press are excited about the introduction of these new PHR systems , there are questions that I urge the public to ask before entrusting their sensitive health records to any PHR system. My concerns are based on a careful evaluation of the HealthVault privacy statements [2, 3]. Microsoft appears to have sought the counsel of physicians who believe that patient consent is the best indicator of privacy protections. Unfortunately, most physicians do not understand the subtleties buried within healthcare privacy statements within the context of the software that implements those statements. For this reason, I now list three primary questions that one should ask before entrusting their health records to HealthVault or any other PHR system:
Will your health information be stored in other countries without appropriate legal oversight, skirting many of the protections afforded by the HIPAA?
The HealthVault privacy statement explicitly states that your health records may be off-shored to countries that do not afford the same privacy protections for sensitive information that we do in the United States. In particular, if information is disclosed or altered, do you have any legal recourse or remedy?
Will your health care records be merged with other personal information about you that was previously collected within the context of non-health related services?
Within the context of HealthVault, the answer to this question is yes. Microsoft explicitly states that they will merge the information they have previously collected from you via non-health related services with your HealthVault information. Moreover, it is unclear what information Microsoft already has about us other than our names and contact information and precisely what information third parties may access. Furthermore, we don’t know if that information is accurate or complete. Thus, use of the merged information may not be what we expect.
Are the access controls to your health records based not only on your consent, but also on the principle of least privilege?
Although HealthVault requires patient consent for any accesses and sharing of your health records, access controls leave the door wide open for data breaches. HealthVault enables individuals to grant access to other people and programs that can further grant read/write access to your health record. The only safeguard is a history mechanism to provide an accounting of accesses if you suspect that your information has been breached after the fact. A better approach would be for Microsoft to proactively enforce contractual obligations via audits and monitoring mechanisms.
The hype surrounding HealthVault’s privacy protections among those in the medical community must be balanced with the reality of the information security and privacy practice expressed in its public privacy statements. It is critical to address these privacy concerns in the design of PHR systems before we deploy them with vulnerabilities that will ultimately lead to yet another rash of data breaches.
 Steve Lohr. Microsoft Rolls Out Personal Health Records, New York Times, 4 October 2007.
 Microsoft HealthVault Search and HealthVault.com Beta Version Privacy Statement, October 2007.
 Microsoft HealthVault Beta Version Privacy Statement, October 2007.