Last Updated 16 Jun 2020

Confidentiality Notes

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Ethical theories and principles that are related to confidentiality are- confidentiality is one of the most basic principles in health care practice and it is the most long-standing ethical dictum in health care codes of ethics. It is the practice of keeping harmful, shameful, or embarrassing patient information within proper bounds. The right to privacy gives legal standing to this ethical principle. ). a reliable test for who among team members should be given certain types of information is need to know basis.

It is necessary for one to adequately perform ones specific job responsibilities- meaning that by giving the information does it provide the adequate caring response that is required for the patient) Immediate aims of confidentiality are to: 1. Facilitate the sharing of sensitive information with the goal of helping the patient 2. Exclude unauthorized people from such information 3. Discern need to know information from mere interest when deciding what to share.

Confidentiality serves as one cornerstone for the solid foundation of a trusting health professional-patient relationship that should be built AMA principles of medical ethics states that:- a physician shall respect the rights of patients, of colleagues and of other health professionals and shall safeguard patient confidences within the constrains of the law. This provides a conflict when a physician knows that some secret may be harmful for the patient and yet are bound to keep it.

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Breaking Confidence- Legal exceptions to the standard of practice that confidences must be kept, except with the patient’s consent or at the patient’s request to break it include * An emergency in which keeping the confidence will harm the patient * Patient is incompetent or incapacitated and a third party needs to be informed for decision making for the patient * Third parties are at a risk for harm (eg. Sexually transmitted diseases, child or other abuses) * Request for commitment or hospitalization of a psychiatrically ill patient * A serious risk that any others may be harmed (a terrorist threat) Eventually breaking of confidence always enlists at least one harm and for health professionals it is to minimize the harm 6 step process in confidentiality situations 1. Step 1- Gather relevant information- 2. Step 2 &3- identify the type of ethical problem and the ethics approach to analyze it 3. Step 4- Explore the practical alternatives 4. Step5- Complete the action 5. Step 6- Evaluate the process and outcome

Ethical principles or elements that support confidentiality are * Beneficence * Nonmaleficence or fidelity * Right to autonomy Key character trait is trustworthiness kindness, compassion, and courage to help with the challenging situations. Patient care information systems (PCIS)- is a computerized systems of record of patients that are permanently kept in an electronic form Health information managers- (also known as the gatekeepers of medical records) are key members of the health care team.

Their primary role is the responsibility for designing and maintaining the system that facilitates the collection, use and dissemination of health and medical information. They ensure that the medical records are correct and kept in privacy and are only given to the health professionals that have the right to see them. They ensure that the records are not abused or released to unauthorized persons. Medical record is an extremely useful document for the health professionals * Can be found both in paper and electronic form They are systematic accounts of a patient’s encounter with a health provider * They serve as a repository of information * Generated by and contributed to by many providers in various health delivery settings * EHR- Electronic health record is an electronic record of patient health information, they often include patient demographics, progress notes, problems, medications, relevant social history, medical history, vital signs, laboratory data and diagnostic reports guidelines that are applicable when recording patient information 1. Questionable information should be clearly labeled as questionable 2. True information that is not relevant to should not be recorded 3. All information should be handled among health professionals with regard for the privacy and dignity of patients Confidentiality finally comes down to each professional being vigilant about the flow of patient information, guided by the goal of using information to help the patient.

Patient privacy- Health Insurance Portability and Accountability Act (HIPAA) of 1996 * This act imposed considerable new constraints on the use and disclosure of a patient’s personal clinical information * Major goal of HIPAA is to ensure that an individual’s health information is properly protected while allowing the glow of information needed to promote high-quality care * This set of regulations are called the New Federal Medical Privacy Rule- basic intent is to control the use or disclosure of “protected health information” * One area that this rule strongly affects is the handling of information for purposes of research.

It has also been interpreted to mean that information about patients (including family members) cannot be released * A “covered entity” is defined as a health plan, data processing company, health care professional, or hospital The Health Information Technology for Economic and Clinical Health Act- * Parts of this act expanded and strengthened the privacy laws that protect patient health information originally outlined under HIPAA. Provides additional provisions regarding privacy and security breaches, reporting of breaches, accounting of disclosures, restrictions of disclosures for sales and marketing purposes, and monetary penalties associates with HIPAA violations.

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