...continued from previous page As more clients and pet data become readily available at the practice level, veterinarians will be faced with challenges related to how to protect it. Ethical uses of your client and pet data As more client and pet data and information becomes readily available at the practice level, veterinarians will be faced with challenging decisions about how to use (or not use) it. A veterinarian working with Peter Alberti, CEO of Pet Cause Media, once said to him: “If only you could tell me which pet parents had money to spend with me.” Companies could easily help veterinarians use their own practice information management system (PIMS) data to identify spending habits of clients. However, some companies (e.g. Pet Cause) choose not to recommend this because their veterinary advisors point out repeatedly that doctors are obligated to make the same recommendations and provide the same options to any patient/client, regardless of their perceived ability to pay. It is unethical to selectively offer options only to those with money, and exclude people you believe don’t have the resources because of one limited data set. This goes against the veterinarian’s oath to “strive to promote animal health and welfare.”29 Ethical proposals for data usage Take control of your data. (Your clients will thank you for this). Do engage in technology! I think it’s highly dangerous for veterinarians to get left out of the technology loop.11 But do so with full knowledge and don’t agree to terms you don’t understand or are too broad with respect to data usage. Carefully read the terms and conditions and end-user license agreements (EULAs) when signing up for or licensing technology that pulls data. Discuss any data concerns with the company before choosing a partner, and ensure you ask the company representative to explain what exactly they do with your data. If they can’t, don’t do business with them.19 Look for wording along the lines of, “Data may not be shared, sold, rented, or otherwise disclosed unless appropriately de-identified and approved by the veterinary practice owner,” or “We are committed to your privacy and protecting your personal information. Our approach is simple: It is our goal to ensure the information you share with us is protected at all times. We will never share personal information or other data that identifies your clients or business without express permission.”30 Avoid open and general agreements that say the company “may access electronic records regarding the customer’s clients and their pets from customers locally.”3 Consider also a cloud-based PIMS, which can eliminate the risk of unintended or forgotten data connections and ensures the practice’s data is always backed up. Even if you have a server-based PIMS, you should always remember to “uninstall” old data connections your practice has discontinued, as many companies don’t automatically remove them, which means they still may be collecting data.18 This is another example of companies complying with the law, but not always with the ethical norm and expectations of the veterinary community when connections and data pulls continue to happen after the veterinarian thought they had discontinued using the application. Veterinary ethical issues with privacy protection “Medicine is going to become an information science. The whole health-care system requires a level of IT that goes beyond mere digitization of medical records, which is what most people are talking about now. In 10 years or so, we may have billions of data points on each individual, and the real challenge will be to develop information technology that can reduce that to real hypotheses about that individual,” says Leroy Hood, a medical futurist.6 To prove the point about big data, Google announced last year it is using 46 billion data points to predict the outcomes of hospital patients.14 Not only will we have to figure out how to use the bounty of data, but the challenge will be to ensure the individual’s privacy while using their data to help them, as well as the general population. The same challenges will be there for us in veterinary medicine. Even though we don’t have Health Insurance Portability and Accountability Act (HIPAA) requirements, we have an ethical duty to protect the privacy of individuals who entrust us with data for the sole purpose of helping them get better care for their pet. There are some trends to be aware of in privacy regulation. In a decided move toward consumer protection, the European Union passed the General Data Protection Regulation (GDPR) last May, giving individuals greater control over their data. The California Consumer Privacy Act (CCPA) of 2018 also was passed and will go into effect next year, just like GDPR.3 The trend in “consumer-driven health care” also begs the question to be asked again of veterinarians: Who owns the medical record? Legally by all state boards, the veterinarian does, but this may change, especially in California, given CCPA. The ethical dilemma is that for the sake of privacy and control, shouldn’t the consumer own their medical records and that of their pets? If so, state boards will need to catch up with the privacy acts.19 Ethical proposals for privacy Carefully read the privacy statement for the technology you are considering. Ensure the technology companies you are working with comply at least with the CCPA, if not the GDPR (for global companies). Even if you are located outside California, it is likely the technology company you are considering operates there. Regardless, California is leading a privacy trend that will be in your state soon. Legal review of privacy compliance is imperative, given the recent regulation updates. Ethically, you must consider what the client assumes you are already doing to protect their privacy and work hard to protect their data as you improve their experience. Veterinary professional organizations supporting veterinary practices could come up with a “model privacy policy” aligned with veterinary ethics related to privacy and security. continued on next page...
