After attending December’s RSNA meeting in Chicago, it is apparent that radiology is well into a digital information revolution.

This revolution, complicated by the impending implementation of the Health Insurance Portability and Accountability Act (HIPAA) privacy rules, will change how radiology does business, with the added burden of maintaining confidentiality along with getting a good, accurate study.

However, as exciting as the digital revolution will be for radiology, there is a dark side that could overshadow both the technology and the HIPAA regulations that are fueling innovation. Over the last 12 months, in response to the September 11 terrorist attacks in New York and the District of Columbia, the Defense Advanced Research Projects Agency (DARPA) has quietly implemented its Total Information Awareness (TIA) system. Administered by DARPA’s Orwellian-sounding Information Awareness Office (IAO), TIA will allow the federal government access to dozens of electronic databasesincluding health care’sin the ongoing search for possible terrorists operating in the United States.

Though, on the face of it, the TIA system, with its promise of increased security, seems like a good idea, critics of all political leanings, from Sen Charles Shumer (D-NY) to conservative columnist William Safire to the Cato Institute, have weighed in with grave misgivings about the terrorist-hunting program.

At a December 12 briefing about TIA sponsored by the Cato Institute, Robert Levy, a senior fellow with the libertarian think tank, outlined a host of potential problems with the system including the misuse of database information, the possibility of “false positives,” and the targeting of innocent citizens. The threat from TIA to individual privacywhich the more public and commonsensical HIPAA is designed to protectis staggering.

So, what does this mean for radiology and radiologists, health care and health care administrators? While the new technology showcased at December’s RSNA meeting will make life easier and better for clinician and patient with more accurate records and greater efficiency, it also creates a bigger role and responsibility for radiology in the lives of patients. Not only will radiologists be expected to cater to health care needs, but they will be in a position to take an activist role in helping to ensure that patient privacy is not sacrificed because of vague threats from a small band of possible terrorists.n

Chris Wolski
Associate Editor
[email protected]