Confidentiality Of Patient Information Research Articles

DISCLOSURE OF CONFIDENTIAL PATIENT INFORMATION AND THE DUTY TO CONSULT: THE ROLE OF THE HEALTH AND SOCIAL CARE INFORMATION CENTRE

Before disclosing confidential patient information for purposes not directly related to his or her care and treatment, there is currently a responsibility upon health professionals to consult with a patient wherever practicable. The Health and Social Care Act 2012 has diluted that responsibility to consult, at least in relation to any information that the Health and Social Care Information Centre requires health professionals to disclose. This is at odds with other moves to support an individual's involvement in decisions that affect them. Moreover, a responsibility to consult can be shown to be a procedural aspect of the fundamental right to respect for private and family life as guaranteed by Article 8 of the European Convention on Human Rights (ECHR). The scope and nature of a procedural requirement for consultation can be revealed, at least in part, by considering the case law concerning disclosure in the field of criminality information sharing. If the Health and Social Care Act 2012 is to be adequately protected from a challenge for incompatibility with the ECHR, then practicable opportunities to provide information about the intended purposes of processing, and respect for any reasonable objection to disclosure, must be recognised beyond those explicitly provided for by the 2012 Act. The Code of Practice that the Information Centre is responsible for producing represents an opportunity to guarantee adequate levels of consultation will be preserved, consistent with proposed changes to the NHS Constitution.

Patient communication, confidentiality and consent: radiology policy and practice in Europe. A survey by the European Society of Radiology.

The data collected in this article were gathered from various practising radiology departments around Europe. The focus is communication and confidentiality between patient and radiologist, specifically the ramifications of PACS and other electronic systems for the confidentiality of patient information. The differences and similarities in practice across Europe are explored. Main Messages Monitoring of access to confidential patient imaging information does not appear to have kept pace with electronic image storage systems Europe lacks a unified approach to define clear guidelines for patient confidentiality and guidance on what constitutes invasion of patient privacy Specific training in communication is not routinely incorporated into radiology training schemes

The implications of e-health system delivery strategies for integrated healthcare: Lessons from England

PurposeThis paper explores the implications that different technical strategies for sharing patient information have for healthcare workers and, as a consequence, for the extent to which these systems provide support for integrated care. MethodsFour technical strategies were identified and the forms of coupling they made with healthcare agencies were classified. A study was conducted in England to examine the human and organizational implications of systems implemented by these four strategies. Results were used from evaluation reports of two systems delivered as part of the NPfIT (National Programme for Information Technology) and from user responses to systems delivered in two local health communities in England. In the latter study 40 clinical respondents reported the use of systems to support integrated care in six healthcare pathways. ResultsThe implementation of a detailed care record system (DCRS) in the NPfIT was problematic because it could not meet the diverse needs of all healthcare agencies and it required considerable local customization. The programme evolved to allow different systems to be delivered for each local health community. A national Summary Care Record (SCR) was implemented but many concerns were raised about wide access to confidential patient information. The two technical strategies that required looser forms of coupling and were under local control led to wide user adoption. The systems that enabled data to be transferred between local systems were successfully used to support integrated care in specific healthcare pathways. The portal approach gave many users an opportunity to view patient data held on a number of databases and this system evolved over a number of years as a result of requests from the user community. ConclusionsThe UK national strategy to deliver single shared database systems requires tight coupling between many users and has led to poor adoption because of the diverse needs of healthcare agencies. Sharing patient information has been more successful when local systems have been developed to serve particular healthcare pathways or when separate databases are viewable through a portal. On the basis of this evidence technical strategies that permit the local design of tight coupling are necessary if information systems are to support integrated care in healthcare pathways.

AMA Code of Medical Ethics' Opinions on Confidentiality of Patient Information

AMA Code of Medical Ethics' Opinions on Confidentiality of Patient Information

Estimated cost of a factitious disorder with 6-year follow-up

Long-term follow up is rarely described for patients with Factitious Disorder, mainly because of the lack of access to patient's confidential information. In addition, the financial burden of multiple uses of health care system has not been examined so far. We report a 6-year follow-up for a patient with Factitious Disorder who first reported neurological then psychiatric symptoms, and investigate the cost of his detected hospitalizations.

Building Sustainable Multi-functional Prospective Electronic Clinical Data Systems

A better alignment in the goals of the biomedical research enterprise and the health care delivery system can help fill the large gaps in our knowledge of the impact of clinical interventions on patient outcomes in the real world. There are several initiatives underway to align the research priorities of patients, providers, researchers, and policy makers. These include Agency for Healthcare Research and Quality (AHRQ)-supported projects to build flexible prospective clinical electronic data infrastructure that meet the needs of these diverse users. AHRQ has previously supported the creation of 2 distributed research networks as a new approach to conduct comparative effectiveness research (CER) while protecting a patient's confidential information and the proprietary needs of a clinical organization. It has applied its experience in building these networks in directing the American Recovery and Reinvestment Act funds for CER to support new clinical electronic infrastructure projects that can be used for several purposes including CER, quality improvement, clinical decision support, and disease surveillance. In addition, AHRQ has funded a new Electronic Data Methods forum to advance the methods in clinical informatics, research analytics, and governance by actively engaging investigators from the American Recovery and Reinvestment Act-funded projects and external stakeholders.

Medicine and the Media: Balancing the Public's Right to Know With the Privacy of the Patient

The discussion surrounding the release of celebrity health information to the media is not a new issue for health care professionals to consider. The rapid dissemination of updates concerning the health of a “public person” is now available to a wide audience through Internet communication and social media systems. The “appetite” of the news organizations and the public at large to obtain “breaking news” on a medical topic of interest involving a recognized political figure, sports star, or entertainer needs to be carefully weighed against the current laws intended to protect the privacy of the individual. Minute-by-minute, no longer day-to-day, updates seem essential through a variety of media, including a mobile phone and other handheld electronic devices. Competition between news services has only increased the demand for the latest news. Regrettably, the more sensational and potentially unbelievable the health-related news story, the more likely it will be distributed faster and farther to a larger audience using contemporary electronic media. Two fairly recent events provide reason to pause and consider both the legal and the ethical standards involved in release of medical information by health care professionals. The tragic shooting of Congresswoman Gabrielle Giffords on January 8, 2011, captured the attention and concern of individuals throughout the world. She was one of 19 victims of this mass shooting, and there were 6 fatalities. Treating physicians were quick to reveal information regarding her condition to a shocked public. Regular updates on the nature of her injuries and the progress of her recovery were provided to an absorbed press trying to offer answers to a gripped national and international audience. According to separate reports, Ms Giffords’ husband, Astronaut Mark Kelly, gave the University Medical Center in Tucson, AZ, permission to disclose certain facts relevant to her progress and prognosis.1 A spokesperson for the hospital stated that any of the information released to the press would be discussed before-hand with her family.1 Despite Mr Kelly’s approval, some privacy experts remained surprised at the amount and type of health care data the press were privy to. Included were concerns of whether Ms Giffords herself would have approved of having so many medical and personal details being shared with a wide audience.1 Compared to Congresswoman Gabrielle Giffords’ extensive media exposure, the release of health information to the press surrounding the serious medical condition of Steve Jobs (CEO of Apple Inc) was far more reserved. Mr Jobs gave permission to release further information to the public several days after a Wall Street Journal article reported that he had received a liver transplant 2 months previously.2 During a June 2009 press release, the head of transplantation James D. Eason, MD, of the University of Tennessee Health Science Center, acknowledged that Mr Jobs had earlier undergone a liver transplant at that institution.3 The release detailed his progression through the United Network for Organ Sharing system as well as limited information about his present condition and prognosis.3 The report finished with a statement confirming that the “hospital respect[s] and protect[s] every patient’s private health information and cannot reveal any further information on the specifics of Mr Jobs’ case.”3 On August 24, 2011, Mr Jobs resigned his leadership position, indicating he “could no longer meet my duties and expectations as Apple’s CEO.”4 No further information was provided regarding this decision.4 The current article will explore the tort law and constitutional restrictions placed on the disclosure of information into the public forum. This will lay the framework for a discussion related to the exchange of health care information. Both ethical and legal standards are described with emphasis on the important role of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Denying a Patient’s Final Will: Public Safety vs. Medical Confidentiality and Patient Autonomy

Especially when caring for patients approaching the end of life, physicians and nursing staff feel committed to fulfilling as many patient desires as possible. However, sometimes a patient’s “final will” may threaten public safety. This can lead to severe conflicts, outweighing the physician’s obligation and dedication to care for the patient and to respect his autonomy. Yet, public safety can be threatened if confidentiality is not broken. This article provides a concise summary of the medicolegal and ethical fundamentals concerning this difficult situation. If the patient’s and others’ health and safety are at risk, physicians may (and in some countries must) break medical confidentiality and disclose confidential patient information to the police and other authorities. Physicians should be able to professionally deal with such a conflict in all patients, not only in patients with advanced illness.

Student nurses' views regarding disclosure of patients' confidential information

Background : Nurses have a moral duty to maintain the confidentiality of patients’ information. Challenges to maintaining confidentiality often arise because of competing moral claims of the patient, his/her family members and doctors. Methods : A qualitative, descriptive and contextual study was conducted to explore and describe the views of student nurses regarding the disclosure of patients’ information. Sampling to select 17 student nurses in their final year of nursing training was adopted purposefully. Data were collected by means of focus group and individual interviews, and then analysed using the Tesch descriptive analysis method. Results : Two themes emerged from analysis of the data, reflecting the participants’ views regarding the disclosure of confidential patient information. The themes were: maintaining the confidentiality of patients’ information, and factors influencing the disclosure of information. Conclusions : The findings indicate that student nurses are aware of the challenges inherent in practice, where patients’ confidentiality might sometimes be compromised.

Knowledge of ethical obligations amongst dental house officers and final year dental students.

Objective: To assess graduating dental students and house officers' perception as regards to protection and management of patient's clinical information.
 Method: This descriptive cross-sectional survey among the entire graduating dental students and house officers in a Teaching Hospital in the Southern part of Nigeria was conducted between August and September, 2010. The self-administered questionnaire sought answers to required patient information, patient information management, handling of patient, legal obligation to patient and the communication channel between patient and a third party.
 Result: The overall response rate was 87.6%. Out of the 85 respondents, 61 (71.8%) and 24 (28.2%) were dental students and house officers respectively. House Officers exhibited significantly better knowledge of identifiable patient information, confidentiality of patient information, taking custody of hospital care notes and mode of release of detailed information concerning child care to non-attending father than the dental students (P<0.05 ). House officers also exhibited better, though, not-significant knowledge in release of information about HIV- infected husband to the spouse than dental students. Dental students exhibited better knowledge in data storage area, release of patient information to colleagues and police than the House officers.
 Conclusion: There was overall poor knowledge on the protection of patient data and relevant clinical information. However, experience in dental practice appeared to have resulted in the differences noted in the protection and management of patient's clinical information among graduating dental students and house officers.

AMA Code of Medical Ethics' Opinions on Confidentiality of Patient Information

AMA Code of Medical Ethics' Opinions on Confidentiality of Patient Information

On the acoustics of operating rooms.

Designing modern operating rooms to meet al.l design criteria can be a challenge. Creating a sterile, well‐lit, temperature and humidity appropriate environment for medical operations typically takes precedence over the acoustics of the operating room. The sterile, washable operating room surfaces are commonly hard and reflective, offering little sound absorption. These surface finishes result in strong discrete reflections, increased background noise, and reduced speech intelligibility. Code mandated energy efficiency and ventilation requirements coupled with the owner‐driven desire for economical mechanical systems can result in excessive HVAC noise, adding to background noise levels. Yet, speech intelligibility and speech privacy levels are expected to be superb to minimize errors due to miscommunication and to prevent the unintentional spread of confidential patient information. The acoustical challenge is to design operating rooms to control noise and to enhance room acoustics without affecting the performance of other systems. Speech intelligibility and impulse response measurements from modern hospital operating rooms and design strategies will be discussed.

Quality in health care and globalization of health services: accreditation and regulatory oversight of medical tourism companies

Patients are crossing national borders in search of affordable and timely health care. Many medical tourism companies are now involved in organizing cross-border health services. Despite the rapid expansion of the medical tourism industry, few standards exist to ensure that these businesses organize high-quality, competent international health care. Addressing the regulatory vacuum, 10 standards are proposed as a framework for regulating the medical tourism industry. Medical tourism companies should have to undergo accreditation review. Care should be arranged only at accredited international health-care facilities. Standards should be established to ensure that clients of medical tourism companies make informed choices. Continuity of care needs to become an integral feature of cross-border care. Restrictions should be placed on the use of waiver of liability forms by medical tourism companies. Medical tourism companies must ensure that they conform to relevant legislation governing privacy and confidentiality of patient information. Restrictions must be placed on the types of health services marketed by medical tourism companies. Representatives of medical tourism agencies should have to undergo training and certification. Medical travel insurance and medical complications insurance should be included in the health-care plans of patients traveling for care. To protect clients from financial losses, medical tourism companies should be mandated to contribute to compensation funds. Establishing high standards for the operation of medical tourism companies should reduce risks facing patients when they travel abroad for health care.

Anonymous Living Liver Donation: Donor Profiles and Outcomes

There are no published series of the assessment process, profiles and outcomes of anonymous, directed or nondirected live liver donation. The outcomes of 29 consecutive potential anonymous liver donors at our center were assessed. We used our standard live liver assessment process, augmented with the following additional acceptance criteria: a logical rationale for donation, a history of social altruism, strong social supports and a willingness to maintain confidentiality of patient information. Seventeen potential donors were rejected and 12 donors were ultimately accepted (six male, six female). All donors were strongly motivated by a desire and sense of responsibility to help others. Four donations were directed toward recipients who undertook media appeals. The donor operations included five left lateral segmentectomies and seven right hepatectomies. The overall donor morbidity was 40% with one patient having a transient Clavien level 3 complication (a pneumothorax). All donors are currently well. None expressed regret about their decision to donate, and all volunteered the opinion that donation had improved their lives. The standard live liver donor assessment process plus our additional requirements appears to provide a robust assessment process for the selection of anonymous live liver donors. Acceptance of anonymous donors enlarges the donor liver pool.

Electronic Medical Archives: A Different Approach to Applying Re-signing Mechanisms to Digital Signatures

Electronic medical records can be defined as a digital format of the traditionally paper-based anamneses, which contains the history of a patient such as his somewhat illness, current health problems, and his chronic treatments. An electronic anamnesis is meant to make the patient's health information more conveniently accessible and transferable between different medical institutions and also easier to be kept quite a long time. Because of such transferability and accessibility of electronic anamneses, we can use less resource than before on storing the patients' medical information. This also means that medical care providers could save more funds on record-keeping and access a patient's medical background directly since shown on the computer screen more quickly and easily. Overall, the service quality has seemingly improved greatly. However, the usage of electronic anamneses involves in some concerned issues such as its related law declaration, and the security of the patient's confidential information. Because of these concerns, a secure medical networking scheme is taking into consideration. Nowadays, the administrators at the medical institutions are facing more challenges on monitoring computers and network systems, because of dramatic advances in this field. For instance, a trusted third party is authorized to access some medical records for a certain period of time. In regard to the security purpose, all the electronic medical records are embedded with both of the public-key infrastructure (PKI) cryptography and the digital signature technique so as to ensure the records well-protected. Since the signatures will be invalid due to the revocation or time expiration, the security of records under this premise would turn into vulnerable. Hence, we propose a re-signing scheme, whose purpose is to make a going-expired digital signature been resigned in time, in keeping with the premise of not conflicting with the laws, morals, and privacy while maintaining the security of the electronic medical records.

A matter of conscience: confidentiality in practice

Maintaining the confidentiality of patient information can be a complex responsibility. In this article, Glenys Bridges explains the basics of confidentiality, and why it is an important part of professionalism for the dental team.

Patient confidentiality and mental health. Part 2: dilemmas of disclosure

The article is the second in the series examining some of the issues relating to patient confidentiality and mental health. It explores the situations in which confidential patient information may be disclosed by nurses. First, disclosure with consent is considered. Second, disclosure where it is in 'the public interest' is explored. Third, those situations in which disclosure may be required by statute are discussed. The article concludes by suggesting that the whole area of confidentiality is ripe for reconsideration and perhaps statutory reform.

Professionalism in Anesthesiology

Professionalism in Anesthesiology

Summary of: Clinicians' knowledge and practice of data protection legislation and information management

Aims The aim of this study was to review current legislation and guidance on information governance and to audit clinicians' management of confidential patient information and knowledge of published guidelines in a teaching hospital. Materials and methods A questionnaire was developed based on published Department of Health, General Dental Council and National Health Service guidance. This was then piloted and distributed to clinicians to complete. Results A review of the current guidance revealed many confusing and unclear areas. However, clinicians' knowledge of information governance was generally good, with an overall correct response rate of 73%. Conclusions All clinicians have an ethical and legal obligation to protect confidential patient data and to be aware of their responsibilities. Local guidelines need to be clarified to help clinicians to manage patient data effectively.

Clinicians' knowledge and practice of data protection legislation and information management

The aim of this study was to review current legislation and guidance on information governance and to audit clinicians' management of confidential patient information and knowledge of published guidelines in a teaching hospital. A questionnaire was developed based on published Department of Health, General Dental Council and National Health Service guidance. This was then piloted and distributed to clinicians to complete. A review of the current guidance revealed many confusing and unclear areas. However, clinicians' knowledge of information governance was generally good, with an overall correct response rate of 73%. All clinicians have an ethical and legal obligation to protect confidential patient data and to be aware of their responsibilities. Local guidelines need to be clarified to help clinicians to manage patient data effectively.