Confidentiality
The practice of keeping harmful, shameful or embarrassing information within proper bounds
- confidentiality is a duty
- confidentiality is an obligation, an ethical issue, self imposed by a profession
- practice* and duty*
- confidentiality is important because someone has confided private information to us -> ability to trust
Privacy
A privilege (a right)
- a legal issue invoked (or relinquished) by the patient that requires the professionals to not disclose information
- the right to privacy gives legal standing to the ethical principle of confidentiality
- law that upholds the practice of confidentiality
Violations of confidentiality
Involved disclosure of someone’s private information that they voluntarily imparted in confidence and trust when there was an implicit promise not to divulge that information without their permission
Violations of privacy
Involve the unauthorized disclosure of someone else’s private information (unauthorized access, use or disclosure of procreated health information)
Trust
Always involves a relationship
- confidentiality serves as one cornerstone for building a solid relationship with patient
- breaking the confidence undermines their ability to trust
Modern difficulties with maintaining confidentiality
Professional “need to know” other MDs RNs, therapists, etc.
- communication hazards:
- phone/answering machines
- fax
- copy machines
- electronic medical records
When can you share private patient information with other health professionals
Need to know basis
- when it is directly related to the patient care
- do they need this information to provide the most caring response to the patient
- different from what a colleague might find interesting or unusual
- has no bearing on the case at all
Why do we uphold patients confidence
- build trust in the patient provider relationship
- maintain the patient dignity
- uphold justice
How to uphold justice
Through moral choices that measure the rights of the people involved
- seeking to cause the least amount of damage
- is this the right thing to do?
Special problems in confidentiality
Confidentiality is likely to be lost in return for:
- Insurance coverage
- an employment opportunity
- your application for government benefits
- an investigation of health and safety at your work site
Exceptions to obligation for confidentiality
- patient threatens to harm self
- patient threatens harm to others
- when required by law (state specific):
- communicable disease
- occupational diseases
- wounds of violence
- suspected abuse
- loss of consciousness
Special problems in confidentiality
Confidentiality is likely to be lost in return for:
- insurance coverage
- an employment opportunity
- your application for govenremenr benefits
HIPPA privacy rule
- health insurance portability and accountability act (HIPPA)
- 1996
- required department of health and human services (DHHS) to issue privacy regulations governing individually identifiable health information
who is covered by HIPPA
- applies to covered entities
1. a health plan
2. health care clearing house
3. health care provider who transmits any health information in electronic form in connection with a transaction
health plan
means an individual or group plan that provides or pays the cost of medical care
health care clearing house
-the term health care clearing house means a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements
health care providers
every health care provider regardless of size who electronically transmits health information in connection with certain transactions, is a covered entity
-privacy rule covers a health care provider whether it electronically transmits these transactions directly or uses a billing service or other third party to do so on its behalf
health information
- term health information means any information, whether oral or recorded in any form or medium, that:
- is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse
- related to the past, present, or future:
- physical or mental health or condition of an individual
- provision of health care to an individual
- payment for the provision of health care to an individual
individual identifiable health information
- any information including demographic information collected form an individual that:
- is created or received by a health care provider, health plan, employer, or health care clearinghouse
- related to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and identifies the individual with respect to which there is a reasonable basis to believe that the information can be used to identify the individual
individually identifiable health information
- name
- address
- social security number
- phone number
- medical record number
- email address or URL
- diagnosis
- test results
- photographs
- physician notes
- health plan information
protected health information (PHI)
- any individually identifiable health information held or transmitted by a covered entity or its business associate in any form or media whether electronic, paper, or oral
- privacy rule excludes from protected health information:
- employment records that a covered entity maintains in its capacity as an employer
- education and certain other records subject to, or defined, in the family educational rights and privacy act (FERPA)
de-identified health information
there are no restrictions on the use or disclosure of de-identified health information
- neither identifies nor provides a reasonable basis to identify an individual
- there are two ways to de-identify information:
- formal determination by a qualified statistician
- removal of specified identifiers of the individual and of the individuals relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual
18 elements to de-identify elements
- names
- social security numbers
- telephone numbers
- fax numbers
- all geographic subdivision smaller than state, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code,
- all elements of dates (except year)
- electronic mail addresses
- medical record numbers
- health plan beneficiary numbers
- account numbers
- certificate/license numbers
- vehicle identifiers and serial numbers, including license plate numbers
- device identifiers and serial numbers
- web universal resource locators (URLs)
- internet protocol (IP) address numbers
- biometric identifiers, including finger and voice prints
- full face photographic images, other comparable images or image which can readily identify the individual
- any other unique identifying number, characteristic or code
general principle for uses and disclosures
-A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual’s PHI may be used or disclosed by covered entities.
-A covered entity may not use or disclose PHI, except:
▪ As the Privacy Rule permits or requires
▪ As the patient or the patient’s representative authorizes in writing
