Elna King cringes every time she sees her medical information going into a laptop computer or a wireless device. She has left two doctors who wouldn't take her seriously about protecting her privacy in an electronic world.

A retired computer security specialist with the Army Medical Command in San Antonio, King says she doesn't see anything wrong with electronic medical records but thinks too many aren't secure.

“They think everybody should be able to look at anything — that it's important. It's not true,” King said.

But Congress is preparing to pump $20 billion over the next two years into increasing the exchange of medical records electronically to make for better diagnoses and to cut waste from the system.

That makes some people nervous because while the latest ache or pain is a frequent water-cooler conversation, medical records are considered sacrosanct and many Americans are uneasy about them falling into the wrong hands.

Insurance companies, however, consider stringent privacy requirements a hindrance to money-saving technology.

Duplication of expensive tests and critical decisions made without enough information are making the health care system “unsustainable and on a collision course to disaster,” said Deven McGraw, director of the Health Privacy Project at the Center for Democracy & Technology.

Information-rich health care via electronic records could help turn that around, she said, but “people don't trust that their information is not going to be misused.”

Last week, the House Energy and Commerce Committee passed a bill on health information technology that included more stringent patient privacy protections than exist under current legislation. The Senate Judiciary Committee is to hold a hearing on the same issues today.

The Health IT spending is part of the broader American Recovery and Reinvestment Act meant to stimulate the economy.

Health insurance companies have much to gain from electronic medical records and their exchange among doctors, hospitals and insurance companies.

“Investing in health information technology will make the health care system safer, more efficient and more effective,” said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans. “Patients need the peace of mind of knowing that their personal health information is protected.

“However, if Congress enacts provisions that inhibit the secure exchange of health information, it will turn back the clock on efforts to coordinate patient care, improve health care quality, promote prevention and wellness, conduct comparative effectiveness research and streamline health care administration,” Ignagni said in a written statement.

But Democrats and Republicans alike have been insistent on privacy protections.

U.S. Rep. Joe Barton, R-Ennis, was one of 3,000 people who had personal health information stolen when a laptop was swiped last spring from a National Institutes of Health researcher. Barton, the ranking member on the House Energy and Commerce Committee, was one of the participants in an NIH heart study.

The thief wasn't after the data, but these kinds of stories don't sit well with the public.

“If there's not a high level of trust in privacy, the patient may be reluctant to give the physician the information that could be important,” said Paul Parks, executive director of the Ecumenical Center for Religion and Health. The San Antonio-based organization trains business and medical professionals on bioethics issues.

Parks' 6-month-old grandson was in a San Antonio hospital for five days on a recent visit and saw three pediatricians, none of whom communicated with the infant's regular doctor in another city.

That brought home the need for electronic medical records and the sharing of them to Parks, but he says the gap between effective information movement and the public trust is still large.

Surveys have found that consumers' top concerns are use of their medical information by an employer, discrimination by insurance companies if they are trying to buy insurance on their own, and having their information used for marketing purposes, health privacy advocate McGraw said.

The House version of the bill includes privacy protections that require some sort of encryption of medical data, an audit trail of who sees it and the prevention of doctors and pharmacists from taking money to market medication to patients. When it comes to security, McGraw says the technology industry is creating effective tools to keep medical data secure, but policies in place now allow too many people to see the patient information.

“The whole issue is really a balance between providing the highest quality of care and protecting the patient's privacy,” said John Wisniewski, CEO of the 4,200-doctor Bexar County Medical Society. “I think the physicians would like to see both sides of the issue succeed.”

Medicare and Medicaid payment incentives to participating doctors and hospitals are expected to speed adoption of a standard record, and physicians would be eligible for $40,000 to $65,000 from the federal government for showing they are using health information technology in a meaningful way.

Baptist Health System in San Antonio is in the process of putting electronic medical records in place so health care workers can more easily collaborate on patient care, but information safety is still the key concern when it comes to sharing outside the hospital system, said Susan Deleo, Baptist's regional compliance officer.

“E-mail is a dangerous entity. The Internet is a dangerous entity. And so is any hand-held device because they get lost,” Deleo said.

She said Baptist wants to be competitive when it comes to using technology to enhance quality care but it has to take more precautions than ever.

“People who are over 70 have a very hard time understanding how the information might be used and the 20-somethings arecomme ci, comme ça (so-so) about it,” said King, the retired computer security specialist. “I personally haven't been hurt by it, but I don't want to take a chance.”