Confidentiality and the Management of Health Care Information

8/8/2019 Confidentiality and the Management of Health Care Information

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Confidentiality and theConfidentiality and the

Management of Health CareManagement of Health CareInformationInformation


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ConfidentialConfidentialy Adjectivey Define as

y spoken, written, acted on, etc., in strict privacy or

y

secrecy; secret: a confidential remark.

y indicating confidence or intimacy;

y imparting private matters: a confidential tone of voice.

y having another's trust or confidence; entrusted with secretsor private affairs: a confidential secretary.


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The Patients Bill of RightsThe Patients Bill of Rights

y The patient has a right to every

consideration if privacy concerning his

own medical care program. Case

discussion, examination, and treatmentare confidential and should be conducted

discreetly. Those not directly involved in

his care must have the permission andrecords pertaining to his care should be

treated as confidential.


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Confidentiality in a Utilitarian PointConfidentiality in a Utilitarian Point

of Viewof Viewy The long term consequences of making public any

personal information gained as a result ofpractitioner/patient relationship would have a chillingeffect upon the truth telling in that relationship.

y Normally health care practice is under the a tacitagreement of confidentiality, practitioners who breachthis trust are in violation of an agreed-uponexpectation. ( esp. cases on psychotherapy)

y If the patient has lost confidence and fails to discusspersonal issues with the practitioner the amount of carewill be severely limited.


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Confidentiality in a Duty OrientedConfidentiality in a Duty Oriented

PerspectivePerspectivey Personal privacy is a basic right, not only inprofessional practice but also in law.

y Ex. Disclosure of patients private affairs,

unauthorized use of a persons photo, orexploitation of a persons name. These things areconsidered to be grounds of invasion of anindividuals right to privacy.

y The medical duty to protect the confidentiality ofpatients could be basis of our general rights ascitizens to be free from invasion of privacy.

y Privacy as a persons right while confidentiality isthe professionals duty.


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Vantage Point of Virtue EthicsVantage Point of Virtue Ethics

y Confidentiality has been corporate with the healthcare practice and forms one of the virtue that onewould expect from a good practitioner

y Confidentiality a critical principle and regardlessof the specialty the good practitioner cannot beviewed as an inconsiderate in regard to protectionpatients confidences and privacy.

y Practitioners shares information with each other

but does not take in forms of conversation incafeterias, or with friends at a party.


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TarasoffTarasoff CaseCase

y Prosenjit Podder a young man that was

committed and evaluated by the health

care practitioner because of the potential

danger to a woman namedTatiana. Andwas realeased after he convinced that he

is in a rational state of mind.

y Tatiana - murdered by Prosenjit


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Courts DecisionCourts Decision

y Court recognized that a practitioner mighthave in a tempting to predict whetherstatements made by a patient would

actually be carried out.

y The court ruled that the specialist wouldbe held to the standard of reasonablepractice; and where the standard indicateda foreseeable danger to another, a duty towarn was created.


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y The protective privilege of confidentiality isLIMITED where the SAFETY of OTHERS isINVOLVED.

y

Breaching of trust of confidentiality is recognized andALLOWED by the Principles of Medical Ethics of theAmerican Medical Association which states that:

y A physician may not reaveal the confidencesentrusted to him in the course of medical attendance. .. Unless he is required to do so by the law or unlessbecomes necesarry in order to protect the welfare ofthe individual or of the community.


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ConfidentialityConfidentiality

Secrets: On the Ethics of Concealment andSecrets: On the Ethics of Concealment and

Revelation byRevelation by SisselaSissela BokBok1. Keep all clients records secure.2. Consider carefully the content to be entered into the record.

3. Release information with the written consent and fulldiscussion of the information to be shared, except whenrelease is required by the law.

4. Use professional judgement deliberately reagardingconfidentiality when the client is a danger to self or others.

5. Use professional judgement deliberateley when decidinghow to maintain the confidentiality of a minor. The right of

parents/guardian must also be considered.

6. Disguise clinical material when used professionally forteaching and writing.


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Harm PrincipleHarm Principle

y Bok feels that the privilege of confidentialityis limited by this principle.

y The principle requires the healthpractitioners refrain from acts that wouldforeseeable result in harm to others.

y Modified by Level of Vulnerability.y Case of a married man withHIV positive.The risk to community at large is minimal

while the risk is regards to discrimination,deprivation of rights and occupational andsocial harms are GREAT.


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Confidentiality and Genetic ScienceConfidentiality and Genetic Science

y Employment, Insurance are affected.

y The issues of confidentiality with right to

know?

y Ex. A teenager who were tested to be (+)

in HD, could the information be kept in

the spouse. Parent who were tested

positive should they keep it on hischildren.


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CASE STUDY: Confidentiality vs. ACASE STUDY: Confidentiality vs. ARightTo KnowRightTo Know


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Modern Health Care andModern Health Care and

ConfidentialityConfidentialityy Early 1900s 85% of direct medical care services weredelivered by the physicians.Today 80% of direct patient careis provided by allied health and nursing professionals.

y The patient record is not only accessible to the physiciansbut also to the host technical and administrative staff who

generate andhandle t

he patient data.

y The access of insurance companies, public health agencies,employers, federal state and local government, attorneys andlaw enforcement agencies, media.

y Third Party Payers (insurers/utilization reviewers) they mayfavor safety, truth and knowledge rather than the value ofpatient privacy.


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Legal Perspective to Medical RecordLegal Perspective to Medical Record

AccessAccessCommon Legal Reporting Req.

y Child abuse

y Drug abuse

y Communicable Dxs.

y Injuries with guns or knives

y BT reactions

y Poison and industrial accidentsy Misadministration of Radioactive Materials


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Any physician, hospital administrator and personnelengaged in examination, care, and treatment ofpersons..

Having reasonable cause to believe that a child knownto them in their professional or official capacity maybe an abused child or neglected child shallimmidiately report or case a report to be made.

The privilegad quality of communication between anyprofessional person required to report and his parentsor client shall not apply to situations involving abusedor neglected annd shall not constitute grounds forfailure to report as required by this Act.


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Legitimate InterestLegitimate Interest

y Medical record goes far beyond medical

information and contains personal data of

a financial and social nature.

y The exact specification of who has a

legitimate interest is a great concern to

health care practitioners.


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For Professional EducationFor Professional Education

y Medicine, nursing, allied health, psychology,

social services, or any professional groups

involved in patient care.


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Administrative FunctionsAdministrative Functions

y Limited amounts of information as

needed for the administrative functions

such as admission, discharges, billing,

compiling census data.


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Duly appointed quality of careDuly appointed quality of care

AuditorsAuditorsy Governmental third party payers and

professional review organization have

legitimate access to patient record.


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Institutional Review Boards (IRBs)Institutional Review Boards (IRBs)

y To balance the potential risk to the patient agains the

potential benefits of the research.

1. The research should not be presented in such a fashion

as to protect the anoniminity of the patients.

2. Only those involved in the study will have the access

to the raw data.

3. safeguards to protect the patients privacy will be

party of the research protocol.

4. The same level of obligation to maintain patient

confidentiality in the practice of health care is

expected in the conduct of medical reasearch.

Confidentiality and the Management of Health Care Information

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