To belabor an analogy: What we want is a credit card statement (translation into HIN context: who got my data, when did they get it, what did they get?). What we have instead is more like Venmo’s open-to-the-world ledger of transactions (translation into HIN context: based on the digital exhaust of network-based sharing practices and policies, every network participant learns everywhere you go).

Let me spell this out: Because of how HINs operate, pretty much anyone on the network (and certainly anybody representing lots of customers, the way Particle does) gets a view into where every patient in the country is seen… just by observing their inbound queries. Every time a patient goes anywhere, a ping goes out everywhere.

“This raises an important privacy/transparency point with respect to my “Patient Trust Authority” concept paper: opting out of something like TEFCA needs to do more than just preventing responding nodes from responding. Properly opting out should mean the health system treating you should not be querying about you (i.e. telling the whole world that you are being seen).