Chapter 5

Confidentiality and the Management

of Health Care Information
Confidentiality: A Principle with Qualifications
(slide 1 of 4)
• Any breach of confidentiality is invasion of
privacy
• Expectation of patient-provider relationship
• Arrived at and defended using the four
systematic approaches to ethical decision
making
Confidentiality: A Principle with Qualifications
(slide 2 of 4)
• Utilitarian
– Health care conducted under agreement of
confidentiality
– Practitioners who breach trust in violation of
agreed-on expectation
• Duty-oriented
– Privacy viewed as person’s right
– Confidentiality is professional’s duty
Confidentiality: A Principle with Qualifications
(slide 3 of 4)
• Virtue ethics
– Patient confidentiality mainstay of health care
practice
– Forms virtue from the “good practitioner”
• Protective privilege of confidentiality is limited
where health and safety of others involved
Confidentiality: A Principle with Qualifications
(slide 4 of 4)
• Harm principle: requires health care providers
refrain from acts or omissions that would
foreseeably result in harm to others, especially
in cases in which individuals vulnerable to the
risk
Invasion of Privacy Tort Actions
(slide 1 of 2)
• Misappropriation: deals with unpermitted use of
a person’s name or likeness for another’s benefit
or advantage
• Intrusion: involves intrusion upon another’s
solitude or seclusion
Invasion of Privacy Tort Actions
(slide 2 of 2)
• Public disclosure of private facts: involves
publicity of objectionable nature of private
information
• Presenting someone in a false light to the public:
involves publication of information that leads to
the public regarding the plaintiff falsely
Common Legal Reporting Requirements

• Child abuse
• Drug abuse
• Communicable disease
• Births and deaths
• Injuries with guns or knives
• Blood transfusion reactions
• Poison and industrial accidents
• Misadministration of radioactive materials
Modern Health Care and Confidentiality (slide 1 of 2)

• Patient record accessible to physicians and

technical and administrative staff who generate
and handle patient data
• Access to patient information exacerbated by
use of computerized information systems
Modern Health Care and Confidentiality (slide 2 of 2)

• Prior to enactment of HIPAA and the Privacy

Rule there was no unifying federal privacy act
for medical records
Health Insurance Portability and Accountability Act (slide 1 of 3)

• Encourage use of electronic transmission of

health information
• Provide safeguards to protect security and
confidentiality of the information
Health Insurance Portability and Accountability Act (slide 2 of 3)

• Protect and enhance rights of consumers by

providing them access to their health information
and controlling inappropriate use of information
• Improve quality of health care in U.S. by
restoring trust in health care system
Health Insurance Portability and Accountability Act (slide 3 of 3)

• Improve efficiency and effectiveness of health

care delivery by creating a national framework
for health privacy protection
• HIPAA rules affect virtually all health care
records
Medical Record

• Property of hospital or clinic

• Patient has legal interest and right to information
• Record is confidential
• Access limited to patient, authorized
representatives, attending physician, hospital
staff members who have legitimate interest
Medical Record Maintenance (slide 1 of 2)

• If correction is significant, someone designated

in facility’s policy should review correction to
determine it meets policy requirements
• Health care practitioners should only make
changes within scope of practice for their
specialty
Medical Record Maintenance (slide 2 of 2)

• Draw single line to cross out incorrect entry,

enter correction, error initialed and dated
• Mistakes should not be erased or unreadable
• If legal suit threatened, no changes in medical
record without consulting risk management
Institutional Review Boards (IRBs)

• Attempt to balance potential risk to patient

against potential benefits of research
– Results presented to protect anonymity of
patients
– Only those involved in study have access to
raw data
– Safeguards to protect patient’s privacy
– Same obligation to patient confidentiality
Human Subject Research (slide 1 of 4)

• Protocol that sets forth explicit objectives

• Formal procedures designed to reach objectives
• Researchers may conduct both invasive and
noninvasive procedures
Human Subject Research (slide 2 of 4)

• Basic ethical principles in planning research

protocol involving human subjects:
– Autonomy
– Beneficence
– Nonmaleficence
– Confidentiality
– Justice
Human Subject Research (slide 3 of 4)

• Human subject research generally requires:

– Risks to subjects minimized by using
procedures consistent with sound research
design that do not unnecessarily expose
subjects to risk
– Risks to subjects reasonable in relation to
anticipated benefits
– Selection of subjects is equitable
– Continues…
Human Subject Research (slide 4 of 4)

• Human subject research generally requires

(continued):
– Informed consent sought and appropriately
documented from subject or subject’s legal
representative
– Provision for monitoring data collected to
ensure safety of subjects
– Provision for protection of privacy and
maintenance of confidentiality of collected data
Institutional Review Boards (slide 1 of 2)

• Ensure satisfactory compliance with appropriate

research standards
• Review research protocols prior to
implementation
• To protect rights and welfare of human subjects
Institutional Review Boards (slide 2 of 2)

• Research: systematic investigation designed to

develop or contribute to generalizable
knowledge
• Human subjects: living individuals whom
investigator conducting research obtains:
– Data through intervention or interaction with
individual
– Identifiable private information
Conclusion

• Confidentiality acknowledges a respect for the

individual’s right to privacy as guaranteed by our
legal system and our cultural values
• Promise of confidentiality provides a bond
between practitioner and patient that allows for a
full and honest disclosure of information