37 - Balancing Privacy & Convenience

Balancing Privacy and Convenience
Access Privacy Authentication Digital rights Identifier Identity Identity card Online privacy Electronic Health Records e-Security Health management Health policy Standards REGULATION
Mon, 05/10/09 - patrickcallioni

On 14 September 2009, the Minister for Human Services, Chris Bowen MP, released a discussion paper to engage with industry on government payment and information services. This will take the Government into territory that was once earmarked for the Coalition’s Access Card, which was killed by the Rudd Government soon after it took office. And a good thing too, because the Access Card was a disaster in the making. It would have been outrageously expensive and would have curtailed, unnecessarily as we will see, our rights to privacy and anonymity. Also, as it was designed, it would not have worked, because it focused on the average citizen as the suspected perpetrator of fraud. Anyone who has worked in health and welfare will tell you that fraud and malpractice are the prerogative of a relatively few service providers who think they are above the law and who generally get away with it.

Here is my modest contribution to the Minister’s request for input.
Managing personal data in Australia, as in other developed economies, is a complex problem or, rather, a set of interrelated, complex problems. Structuring an approach capable of resolving these problems is not an easy thing to do and no country in the world seems to have the complete solution. However, there are lessons to be learned from scanning the environment, to see if parts of the solution already exist. The model I propose (below) draws on the concept of an electronic service broker, as the foundation for an integrated approach to the management of personal health data and information. The model is predicated on these guiding principles:
The Commonwealth Government should be responsible for the provision of a national framework of trust, covering privacy, security and authentication.
The management of personal (health) data should not be a service provided exclusively by government.
The Commonwealth Government should have the responsibility to regulate the collection, management and access to personal data.
The individual should control his/her data, by setting parameters for access.
National data standards should apply (covering both technical and management requirements).
National privacy standards should apply.
Protection of individual rights established by these principles should be universal.
Access to data by service providers should be universal and ubiquitous (subject to 2).
Risk and risk management should be scalable.
A model to manage health data
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Individual recipients of services are not shown in the diagram, as the model envisages the individual as the person who controls the flow and access to his/her data, rather than as a user of data. To protect the interests of individual citizens and of users of the system in general, a national regulator would oversee the system, giving effect to the principles underpinning a National framework of trust: protecting privacy, ensuring security, and enabling authentication. The regulator would oversee the operations of the data brokers, issue licences, conduct audits, impose sanctions and so on. The regulator could be an industry specific regulator or an existing regulator whose mandate could be adapted to this purpose. For example, the role of the Privacy Commissioner could be redefined to suit, though in that case one probably would split the licensing and watchdog roles.
The individual (citizen/client/customer) would choose the data manager and, within the national standards, would prescribe the depth and breadth of access to personal data. The individual would be able to choose the public data broker or a private broker to hold and manage his/her personal data. The public broker would provide a universal service. That service would be free to the user or impose a minimal cost on the user. The public broker would ensure that everyone in Australia has the level of privacy protection mandated by Parliament and would facilitate fair and equitable access to government services through the management of personal data. In Australia the public broker could be the Health Insurance Commission (“HIC”).
As for the process of establishing identity and entitlement, I suggest the following:
rather than replacing existing cards, we should make those cards interoperable. This can be done cheaply, by using magnetic strips, rather than smartcards. Alternatively, the Medicare card could be used as the card of choice, gradually replacing all the others. The existing Medicare card could do this, with one change, adding a photograph;
we should place an authenticated photograph on a plastic card – a basic card, with no chip. The photograph could be authenticated using the process that is used for passport issue; if it is good enough for a passport, it is good enough for a services card (this is how the French do it). This would be much cheaper and less intrusive than the process envisaged for the Access Card;
the new plastic cards with photographs would be issued gradually, as existing cards need to be replaced, allowing for faster progress with groups that are considered to present a higher risk or have a special need.
by using plastic cards with magnetic stripes, new readers would not be required. Health practitioners and pharmacies, for example, already have these;
to validate transactions (and lessen the risk of fraud), health practitioners should also be issued with a card, with a PIN. Most practitioners already have a unique identifier with Medicare Australia. In a surgery or pharmacy, the citizen, having established identity through the photo, would then confirm identity and entitlement by swiping the card though a reader, linked to the relevant back end system. Lastly, the doctor or pharmacist would swipe his/her card and enter the PIN, which would validate that a service has been provided and would prompt appropriate payments/reimbursements to occur automatically;
this would reduce drastically the likelihood of duplicate or non-existent claims and would accord with the experience a citizen would have in a shop or in a bank, increasing the likelihood of client acceptance of the new process;
once everyone has got used to doing thing this way, a more sophisticated device, such as a smartcard could be introduced – if the evidence supports the need for it;
this way, citizen acceptance would be high, the risk of fraud would be reduced significantly, the system would work much more efficiently, the risk of failure of reform would be much lower, and the cost of reform would be much lower.
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Patrick Callioni is a former senior public servant, with the Queensland and Australian Governments, and is now the Managing Director of consulting company, Enterprise Intelligence Pty Ltd, which specialises in helping business to do business with government and vice-versa. www.enterpriseintelligence.net.au His book Compliance Regulation and Financial Services is available at Amazon