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If the United States moves to a national healthcare database, medical information will need to be accessed by hospitals, medical clinics, mental health clinics, pharmacies, medical researchers, government health care organizations and other medical institutions. The real question is: Who will decide what information should be accessed? Once the policy decision is made, how will the CISO enforce it?
There are some technological complications related to protecting the data. If the government opts to let the user manage who has access to data, how is that process enabled via technology? Would there be a national health care portal that allows an individual to define who can access certain portions of their data or would the national, state, and/or health care institution negotiate that access?
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Data protection of the medical information requires use of encryption and a key or keys. All encryption that is used to protect data requires a root key. In the financial-services industry, many banks have their own root key so there is no national financial services root key. But a national database of individual medical data would require a root at the national level and potentially even globally. The root has the ability to access all information, thus giving the institution that owns the root great power.