Abstract
The purpose of this paper is to explore different health care professionals' discourse about privacy - its definition and importance in health care, and its role in their day-to-day work. Professionals' discourse about privacy reveals how new technologies and laws challenge existing practices of information control within and between professional groups in health care, with implications not only for patient privacy, but also for the role of information control in professions more generally. The authors conducted in-depth, semi-structured interviews with n=83 doctors, nurses, and health information professionals in two academic medical centers and one veteran's administration hospital/clinic in the Northeastern USA. Interview responses were qualitatively coded for themes and patterns across groups were identified. The health care providers and the authors studied actively sought to uphold the protection (and control) of patient information through professional ethics and practices, as well as through the use of technologies and compliance with legal regulations. They used discourses of professionalism, as well as of law and technology, to sometimes accept and sometimes resist changes to practice required in the changing technological and legal context of health care. The authors found differences across professional groups; for some, protection of patient information is part of core professional ethics, while for others it is simply part of their occupational work, aligned with organizational interests. This qualitative study of physicians, nurses, and health information professionals revealed some differences in views and practices for protecting patient information in the changing technological and legal context of health care that suggest some professional groups (doctors) may be more likely to resist such changes and others (health information professionals) will actively adopt them. New technologies and regulations are changing how information is used in health care delivery, challenging professional practices for the control of patient information that may change the value or meaning of medical records for different professional groups. Qualitative findings suggest that professional groups in health care vary in the extent of information control they have, as well in how they view such control. Some groups may be more likely to (be able to) resist changes in the professional control of information that stem from new technologies or regulatory policies. Some professionals recognize that new IT systems and regulations challenge existing social control of information in health care, with the potential to undermine (or possibly bolster) professional self-control for some but not necessarily all occupational groups.
Highlights
Expectations of privacy and confidentiality in medical care are rooted in core professional ethical standards across a variety of health professions
What reasons do health care providers give for protecting patient privacy and who do they think is primarily responsible for the privacy of patient information? Second, how do they protect privacy in practice, i.e., what kinds of actions do they take to ensure patient privacy while delivering health care? Third, how do recent changes, both the introduction of information and communication technologies (ICTs) and new legal requirements, affect their professional control of patient information? We explore these questions to examine whether and how different professional groups in health care use the discourse of professionalism to accept, resist and/or justify changes to the control and use of patient information in health care
Patient privacy: definitions and responsibility We asked participants to describe what privacy is in medical care and why it is important to patients
Summary
Expectations of privacy and confidentiality in medical care are rooted in core professional ethical standards across a variety of health professions. Even newer “professional” occupations such as the American Academy of Professional Coders (2014), an organization that certifies health information specialists who work with medical records, have a code of ethics that includes protecting patient privacy and confidentiality. Professions and information control Much of the vast literature on professions centers on the ability to interpret, define, and manipulate information within their jurisdictions (Abbott, 1988; Larson, 1977; Parsons, 1954) Such “information control” is a source of professional expertise, and of professions’ authority and status in client relationships, and of the ability to delineate, negotiate and protect professional and occupational boundaries (Freidson, 1970a, b; Starr, 1982; Turner, 1995). How do professional groups talk about information control as part of their profession? Does the discourse of information control differ across professional groups?
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