Quality improvement spreadsheets and AI privacy: what a GP clinical audit sheet gives away in ChatGPT or Claude.

Practices run quality improvement work from spreadsheets: an export of every patient with diabetes, their latest results and whether they are due for review. The practice manager or a nurse uploads the sheet to ChatGPT or Claude to find the overdue patients, chart the results or fix a formula. The sheet is a clinical register for a whole cohort, with identifiers. This page marks a routine audit sheet and shows how the same work is done on Ermos inside the practice.

The quality improvement spreadsheet

Exported from the clinical software by the practice manager or a nurse to plan recalls and track quality measures, then shared by email, which is how it reaches an AI tool.

An invented spreadsheet. All patients are fictional. Hover or tap any highlighted item for the analysis; the full list is below.

What leaves the practice

1. 1
   Patient names

   A name on a list titled for diabetes is already a diagnosis. The names were collected in providing a health service, so they are held as health information under section 6FA. Privacy Act guide.

2. 2
   Dates of birth

   With the names, enough to identify each patient with certainty. Privacy Act guide.

3. 3
   Aboriginal and Torres Strait Islander status

   Racial or ethnic origin is sensitive information under section 6(1) of the Privacy Act. Privacy Act guide.

4. 4
   HbA1c and kidney results

   Laboratory values against every named patient in the cohort. Health information, which is sensitive information. Patient data guide.

5. 5
   Smoking status

   A health behaviour against each name. Patient data guide.

6. 6
   Last review dates

   When each patient was last seen, and which ones have dropped out of care.

7. 7
   The notes column

   Free text with the most candid detail: a lost job, an alcohol history, an eating disorder kept to the GP, a carer at home. The column most likely to cause harm. Patient data guide.

8. 8
   The review formula

   A date test with no patient information in it. The formula can be shared; the sheet it sits in cannot.

9. 9
   Other tabs and file properties

   The workbook carries a second tab covering every chronic disease patient, plus any hidden columns, comments and properties such as the author. Uploading the file sends all of it.

What happens in Frontier Models (ChatGPT, Claude)

• The whole document is transmitted to the provider’s servers. On personal plans the user cannot choose where it is stored or processed, and for the major providers that has generally meant outside Australia, under that country’s legal process. Some business plans offer storage in Australia, but the provider still receives the content.
• On consumer tiers, prompts can be retained and used to train future models.
• The provider’s staff and systems can reach the content under the provider’s own policies.
• Once sent, the practice no longer controls it. Retention and deletion happen on the provider’s terms.

The same document on Ermos

Part of AI data leakage in general practitioner (GP) practices. See how this works in practice: Care plans on Ermos.

Common questions