Chapter Five

Confidentiality and the Management of

Health Care Information
• Respecting a patient’s confidence is an ethical duty
• The requirement that we respect a patient’s privacy is a
legal obligation
• American common law provides sanctions against the
unwarranted disclosure of a patient’s private affairs

Confidentiality
• The principle of confidentiality can be defended using
any of the decision-making formats:
• Utilitarian defense
• Duty defense
• Virtue ethics defense

Confidentiality – A Clear Duty

• Consider the Prosenjit Poddar case:
• To whom did the practitioners owe a duty, to their real
patient, or to the potential victim?
• Harm principle
• Was the court decision right?
• Legal reporting requirements

Confidentiality – A Principle
with Qualifications
Confidentiality
 All patient information must be kept
confidential and shared only with the
appropriate staff involved in the care of the
patient.

• Keep records out of sight, so night workers and

other patients cannot view it.
• Do not discuss the case with anyone outside the
medical office. 5
• Legal reporting requirements:
• Child abuse
• Drug abuse
• Communicable disease
• Injuries with guns or knives
• Blood transfusion reactions
• Poison and industrial accidents
• Misadministration of radioactive materials

Confidentiality – A Principle
with Qualifications (continued)
• Modern health care creates a “right to know” and
“legitimate interest” situation for many outside the direct
patient care service

Confidentiality in
Modern Health Care
Confidentiality
 The following information may be
disclosed without authorization:
• Medical researchers • Work related conditions
• Emergencies that may affect employee
• Funeral Directors/Coroners health
• Disaster Relief Services • Judicial/administrative
• Law enforcement proceedings at the patient
• Correctional Institutions request or as directed by a
• Abuse and Neglect subpoena or court order
• Organ and Tissue Donation
Centers
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• Modern information technology creates multiple avenues
for information acquisition, making security a real
problem
• Has modern health care made the principle of
confidentiality a “decrepit concept?”

Confidentiality in
Modern Health Care (continued)
• Health Insurance Portability and Accountability
Act
• Dual goals for HIPAA legislation
• Highlights of legislation:
• Consumer control over health information
• Rules for medical record release and use
• Increased security of personal health information

HIPAA Legislation
and Requirements
Confidentiality Issues (cont.)

• August 21, 1996 is the date the U.S. Congress

HIPAA was passed
• Two main sections of the law:
• Title I: Health Care Portability
• Title II: Preventing Healthcare Fraud and
Abuse; Administrative Simplification; Medical
Liability Reform

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Confidentiality Issues
 Use and Disclosure are two important concepts under
HIPAA that must be understood.
Information is used when it moves within an organization.
Information is disclosed when it is transmitted between or among
organizations.
Examples of Use Examples of Disclosing
• Sharing • Release
• Employing • Transfer
• Applying • Provision of access to
• Utilizing • Divulging in any manner
• Examining
12
• Analyzing
Medical Law and Ethics
Confidentiality Issues (cont.)
HIPAA will allow the provider to use health care
information for:

reatment Providers are allowed to share information

in order to provide care to patients.

Providers are allowed to share information

ayment in order to receive payment for the
treatment provided.

Providers are allowed to share information

perations to conduct normal business activities, such
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as quality improvement.
• Goals
• Basic principles involved
• Patient benefit/risk calculations:
• Sound design minimizes risk
• Risks are reasonable in relation to benefit
• Subject selection equitable

Human Subject Research

• Patient benefit/risk calculations (continued):
• Informed consent
• Appropriate monitoring
• Privacy and confidentiality protection
• A problematic past
• Review Jewish secretary case

Human Subject Research

(continued)
• IRB – foundational materials:
• Nuremberg Code of 1947
• Helsinki Declaration of 1964
• The Belmont Report of 1979
• U.S. Department of Health and Human Services Title 45 of
2001

Human Subject Research

(continued)
• Modern health information data systems threaten to
undermine principle of confidentiality
• Legitimate interest guide
• Duty to warn

Key Concepts
• HIPAA legislation:
• Cost containment
• Protection of privacy
• Legal reporting requirements:
• Child abuse
• Drug abuse
• Communicable disease

Key Concepts (continued)

• Legal reporting requirements (continued):
• Injuries with guns and knives
• Blood transfusion reactions
• Poison and industrial accidents
• Misadministration of radioactive materials

Key Concepts (continued)