The criticism by the Association of Community Health Councils of England and Wales (ACHCEW) of the GMC’s latest pronouncements on patient confidentiality are reported elsewhere in the BMJ (p 336). ACHCEW does have a single web page at www.nhsconfed.net/achcew/, which does not seem to be undated often, but a minimalist web presence is still worth having: it’s a handy way of publicising your address and telephone number.
Arguments about the difficulties and rewards of networked information are well rehearsed; suffice it to say that there is a continuum between convenience and ease of access and maintaining patient privacy. The best starting point for clinicians in Britain is the Caldicott report (downloadable at www.nhsia.nhs.uk/general/caldico/caldico1.htm), the recommendations of which should now be well on the way to implementation, including the appointment of data guardians and the anonymisation of clinical data to be used for administrative purposes.
Like most information technology questions, the problems are more political than technical: there are many ways to make computerised data hard to read without authorisation. Back in 1994, the NHSnet picked the X400 standard to transmit data along its network, which has the advantage of built-in security. Meanwhile, the rest of the world uses SMTP (standard mail transfer protocol), which is essentially public unless messages are encrypted and decrypted at either end. Personally, I have enough trouble reading all my own email without starting to try to read other people’s as well, but there you go.
Although “strong encryption” techniques are theoretically confined to North America by export restrictions that define the algorithms as munitions, this is essentially unenforceable. The most popular program for encrypting and decrypting email is Zimmerman’s PGP (Pretty Good Privacy), downloadable free at www.pgpi.com/.