Professor of Law, University of Miami School of Law. This paper had a long gestation for a piece concerning the Internet, during which I accumulated debts to an unusually large number of helpful readers, more than I dare list here. Previous drafts also benefited from discourse at the Georgetown University Law Center (2ooi), a Stanford Law School faculty colloquium (2ooo), the conference on Culture & the Humanities (Winston-Salem, 1999), andunder another titlethe I7th IVR World Congress: Challenges to Law at the End of the 2oth Century (Bologna, 1995) and the Law and Society Association Annual Meeting (Toronto, '995). Caroline Bradley has had to put up with it from the start, and for that and everything else, no thanks suffice.
Robert Wood Johnson Foundation's Project HealthDesign included funding of an ethical, legal and social issues (ELSI) team, to serve in an advisory capacity to the nine design projects. In that capacity, the authors had the opportunity to analyze the personal health record (PHR) and personal health application (PHA) implementations for recurring themes. PHRs and PHAs invert the long-standing paradigm of health care institutions as the authoritative data-holders and data-processors in the system. With PHRs and PHAs, the individual is the center of his or her own health data universe, a position that brings new benefits but also entails new responsibilities for patients and other parties in the health information infrastructure. Implications for law, policy and practice follow from this shift. This article summarizes the issues raised by the first phase of Project HealthDesign projects, categorizing them into four topics: privacy and confidentiality, data security, decision support, and HIPAA and related legal-regulatory requirements. Discussion and resolution of these issues will be critical to successful PHR/PHA implementations in the years to come.
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