Confidentiality

Protecting and
providing information
Group 5
1.Introduction: Pre-amble
Health Professions Act, 1974 (Act No. 56 of 1974), gives
health care practitioners’ (HCP) certain rights and
privileges.
HCP must however meet the standards of competence,
care and conduct set by the HPCSA.
HCPhold information about patients that is private and
sensitive and should not be disclosed to others without
justification.
HCP ensure that clerks, receptionists, and other staff
respect confidentiality in their performance of their duties.
There are guidelines regarding confidentiality and
obtaining consent for information disclosure.

2. Definitions from the National Health Act

Anonymised data - data from which the patient cannot be
identified.
Consent - consent for the provision of a specified health service
given by a person with legal capacity.
Express consent - is expressed orally or in writing.
Health care personnel (HCP) - health care providers and health
workers
Patients are referred to as “users”.
Personal information - information about people that health
care practitioners learn in a professional capacity and from which
individuals can be identified.
Public interest - mean the interests of the community as a
whole, or individuals or a group within the community.

3.Patient's right to
confidentiality
The National Health Act (Act No. 61 of 2003) clearly
states that all patients have a right to privacy .
Rule 13 of the Ethical Rules of the HPCSA: Practitioner
may make known of information regarding a patient only
in terms of a Statutory provision, at the instruction of a
court, in the public interest, with the express consent of
the patient, with the written consent of a guardian of a
minor under the age of 12 years.
In the case of a deceased patient with the written
consent of the next of kin or the executor of the
deceased’s estate
Disclosures in the public interest would include but not
be limited to situations where the patient or other
persons would be prone to harm because of risk related
contact.
4. Retaining Confidentiality

Medical practitioners should

keep all patient information
confidential in order to
maintain the patient's trust.
Without confidentiality certain
information may be ommitted
by the patient which could
negatively affect patient care.
Should a health care practitioner need
to provide information on a patient the
following should be done:
Patients should give consent to the
disclosure of information.
Patient's information should remain
anonymous where unidentifiable
data will serve a purpose
Disclosure of the patient's
information should be kept to a
minimum

5. Protecting Information

All health care providers should

ensure that the personal information
of their patients is protected from
improper disclosure. Improper
disclosure may unintentional,
however it is the health care
professional's responsibility to
ensure that information remains
private.

6. The right of patients to personal information

The National Health Act states that health care

Patients have the right to information
regarding what health care services are
available to them as well as information
regarding any condition or disease that they
are suffering from. Health are providers
should also respect if a patient doesn't want
to receive detailed information regarding
their health
providers should inform patients on the
following:
The patients health status.
The relevant diagnostic procedures and
treatment options that are available to the
patient.
The benefits, risks costs and consequences
of treatment options.
The implications, risks and obligations
should the patient exercise their right to
refuse treatment.
8. DISCLOSURE OF INFORMATION OTHER THAN FOR TREATMENT OF INDIVIDUAL PATIENTS

Obtaining consent for disclosure

Principles
HCP have a duty to protect the privacy of
patients and respect their autonomy
Consent for disclosure is essential, one
needs to understand what to do with the
obtained information and what to do when
the information cannot be obtained.
It is also important to know when it is
impractical to seek consent for disclosure of
information
Obtaining consent where the disclosure will have personal consequences for patients:
- Where patients might be personally affected by disclosure.
- HCP must make sure that patients are given enough information for decision making.
- HCP should explain how much information will be disclosed and to whom.
- If a patient withdraws consent the HCP should first attempt to persuade the patient.
- If consent cannot be obtained, the consequences of disclosure should be explained to the
patient
Obtaining consent where disclosure is made for research, education, training ,
efficient administration of health audit purposes:
- Use identifiable data with informed consent.
- Only relevant information is revealed
- Where de-identified information can serve a purpose, it is incumbent that the HCP de-
identifies the data as soon as possible.
- HCP should not allow access to the information for studies without obtaining consent.
Disclosure in the public interest:
-In cases where patients withhold consent, personal information can be disclosed in public
interest where the benefits to an individual or society of the disclosure outweigh the public and
the patient's interest in keeping the information confidential.
- Practitioner must weigh the possible harm against the benefits that are likely to arise.

9. PUTTING THE
PRINCIPLES INTO PRACTICE

Disclosure after the patient's death

HCP are obligated to keep personal information confidential after death.

Information remains confidential depending on the circumstances which
may lead to disclosure. Whether that information is already public
knowledge or can be anonymised.
HCP should also consider whether the disclosure of information may
cause distress to, or be of benefit to, the patient's partner or family.
There are several circumstances in which HCP may be asked to
disclose information about patients who have died:
- To assist in connection with an inquest
- As part of a clinical audit, education, research (approval from ethics
committee)
- On death certificates - honestly and fully completed
- To obtain information relating to public health surveillance that is approved
by a research ethics committee. Anonymised information should be used,
unless
identifiable data is essential to the study.
Difficulties may arise when there is a conflict of interest between parties
affected by the patient's death.

Disclosure to protect the patient

and others

Disclosure without consent maybe

justified where failture to do so may
expose the patient or others to risk
or death or serious harm.
 Disclosure which benefit patient directly
Monitoring public health and the safety of medicines and devices
- Professional organisations and Government regulatory bodies that
monitor the public health or the safety of medicines and devices rely on
information from patients' records for their effectiveness in safeguarding
public health.
- If personal information is needed, consent should be given.
- If patients are not competent to give consent, HCP should consider
whether disclosure would be justified in public interest.
Administration and financial audit
- Financial and other administrative data should be recorded seperately
from clinical information and should be anonymised when provided.
-Only relevent parts of financial records should be provided.
Medical research
- Where research projects depend upon using identifiable information the
data can anonymised and this should be drawn to the attention of a
research ethics committee.
Disclosures where health care Publication of case-histories and photographs
- HCP must obtain expressed consent from patients before publishing
practitioners have dual personal information about them to the media
responsibilities
In some instances, health care providers have
contractual obligations to third parties, such as
companies or organizations, as well as obligations to
patients. This occurs when practitioners provide
occupational health or medical services for an
employee, are employed by and
organisation/company and work in armed forces or Disclosures where health care
correctional services. practitioners have dual
responsibilities
If a health care provider is required to disclose
information regarding a patient to a third party, they
must:
Inform the patient on the purpose of disclosure
and the extent of the infomation being disclosed.
Have written consent regarding the disclosure
from the patient.
Present only factual, unbiased information.
Patients have the right to view any information
before it is disclosed to the third party.

Children and other patients who may lack

competence to give consent
If patients refuse to give consent and HCP are
convinced that it is essential, they may disclose
relevant information to the appropriate
authority.
The National Health Act Provides that if no
person has been legally appointed to give
consent then consent can be given depending
on the order of precedence.
Patients should be informed that their
information will be given, even without their
consent
Disclosure of information to others providing
care
Patients should be made aware that personal information
will be shared with the MDT with reason.
Practitioners cannot treat patients safely without having
relevant information.
Referral: If patients have consented to therapy the patient is
assumed to have given implied consent.
HCP need to ensure that person's receiving personal
information are respectful and information remains
confidential - legal duty of confidentiality.
Confidentiality in emergency situations: The HCP may
disclose personal information without consent and explain to
the patient after the emergency.

Disclosure in connection with judical or other statutory

proceedings
HCP may disclose personal information to statisfy specific
statutory requirements - notifiable disease or suspected abuse.
HCP must disclose relevant information if informed to do so by
a judge or presiding officer of court.
HCP may not disclose information to a lawyer or police officer of
the court without consent except in certain circumstances - to
protect the patient, incompetency or the death of the patient.
HCP may disclose information to statutory regulatory bodies in
exceptional cases - in the interest of justice and safety.
If HCP disclose information in any situation, they should be able
to explain and justify their reasoning.

Electronic processings of information

Arrange security for the protection of personal
information when stored, sent or received by fax,
computer or email.
HCP should take authoritative professional advice on
how to secure personal information if necessary.
HCP should ensure that fax machines and computer
terminals are in secured areas so data cannot be
intercepted or seen by others.
HCP should note that personal information sent vial
email have a higher chance of being intercepted.