Medical Law

Privacy, Confidentiality, and Health Research

By William W. Lowrance
Cambridge University Press June 2012

Specifications

ISBN-13
9781107020870
Publisher
Cambridge University Press
Publication
June 2012
Format
Hardback , 202 pages
Jurisdiction
International ? Countri(es) for reference only

Details

The potential of the e-health revolution, increased data sharing, database linking, biobanks and new techniques such as geolocation and genomics to advance human health is immense. For the full potential to be realized, though, privacy and confidentiality will have to be dealt with carefully. Problematically, many conventional approaches to such pivotal matters as consent, identifiability, and safeguarding and security are inadequate. In many places, research is impeded by an overgrown thicket of laws, regulations, guidance and governance. The challenges are being heightened by the increasing use of biospecimens, and by the globalization of research in a world that has not globalized privacy protection. Drawing on examples from many developed countries and legal jurisdictions, the book critiques the issues, summarizes various ethics, policy, and legal positions (and revisions underway), describes innovative solutions, provides extensive references and suggests ways forward.

• Analyzes current problems, reviews practical solutions and proposes new approaches

• Reviews and comments in a concise manner

• Discusses the intersections between privacy and research

Table of Contents

Preface and acknowledgments
xiii
1       Introduction
1
Health research as a public-interest cause
1
Privacy protection as a public-interest cause
3
Health data vulnerability
4
The challenges
4
2       Data, biospecimens, and research
7
A few essential notions
7
The e-health revolution
10
Data and databases
11
Biospecimen collections
13
Public research resource platforms
18
Degrees of sensitivity
18
Data and biospecimen ownership
22
What is research, anyway?
24
3       Privacy, confidentiality, safeguards
29
Privacy
29
Confidentiality
33
Safeguards
34
4       Broad privacy and data protection regimes
35
The plethora of controls
35
Two sorts of regimes
36
Early concerns about computers and privacy
36
The OECD privacy principles
38
Council of Europe Convention 108
40
The European strategy
40
The US approach
47
The Canadian strategy
48
Australia, Japan, APEC
49
5       Healthcare, public health, and research regimes
52
Healthcare and payment regimes
52
Public health regimes
53
Human-subject protection regimes
54
Clinical trial and product postmarketing regimes
57
Other, specialized laws and regulations
59
Research ethics review systems
60
“Rules” thickets in four countries
62
6       Consent
67
Consent as it is applied now
69
Legitimately sought, meaningfully informed, willingly granted
71
The casting of consent
74
Right to withdraw
78
Community engagement
79
Searching for research candidates
80
Research without consent
81
Some reflections
84
7       Identifiability and person-specific data
87
“Personal data”
87
Identifiers
92
De-identification for research
93
Ways non-identified data can become identified
96
Retaining the possibility to re-identify
98
The HIPAA Privacy Rule approach
99
Key-coding
104
Identifiability terminology
105
Identifiable to whom?
107
No personal data: no human subject?
108
Some reflections
109
8       Genetics and genomics
111
Genetics/genomics
112
GWAS
114
EHR-driven genomic discovery
115
Genotype-driven recruitment
115
Notice and consent
116
Genetic and genomic identifiability
118
The Personal Genome Project
121
Some reflections
122
9       Safeguards and responsibilities
125
Operational safeguards
125
Formal responsibilities
126
Stewardship
129
Data and biospecimen retention
129
Security
130
Privacy risk assessment
131
Requests for non-research access
132
Enforcement and sanctions
135
10      Data sharing, access, and transfer
138
Data sharing
138
Access
140
The two basic modes of access
140
Access agreements
141
Terms of restricted access
142
Privacy-preserving data linkage
146
Extremely restricted access
149
Oversight and governance
151
International transfer
152
Some reflections
156
11      Ways forward
158
Bibliography
160
Index
176
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