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PubMedDate not supplied

Privacy, confidentiality, and electronic medical records.

The enhanced availability of health information in an electronic format is strategic for industry-wide efforts to improve the quality and reduce the cost of health care, yet it brings a concomitant concern of greater risk for loss of privacy among health care participants. The authors review the conflicting goals of accessibility and security for electronic medical records and discuss nontechnical and technical aspects that constitute a reasonable security solution. It is argued that with guiding policy and current technology, an electronic medical record may offer better security than a traditional paper record.

Computer Security↗

PubMed1976

Patient privacy and confidentiality at mental health centers.

The authors studied potential violations by mental health centers of individuals' rights to privacy and confidentiality by sending questionnaires to state directors of mental health programs and to mental health centers in all the 50 United States and its teritories. The questionnaires assessed the extent to which information that could identify a patient is reported to state offices; it also addressed issues of mental health center discretion in reporting information, the life span of patient files, and the access of outside agencies to mental health center files. The authors conclude that legislative action prohibiting the reporting of identifying information appears desirable.

Confidentiality↗

PubMed1980

The confidentiality of medical records: the right to privacy versus the public interest.

The confidentiality of medical records is discussed in the context of the individual's right to privacy, as yet undefinable in degree, and the often conflicting demands for access to these records for purposes considered to be in the interests of society. The proposed use of a unique personal identifying number for medical records which facilitates linkage to administrative data systems is critically examined.

Confidentiality↗

PubMed2004

Prospective study of clinician-entered research data in the Emergency Department using an Internet-based system after the HIPAA Privacy Rule.

BACKGROUND: Design and test the reliability of a web-based system for multicenter, real-time collection of data in the emergency department (ED), under waiver of authorization, in compliance with HIPAA. METHODS: This was a phase I, two-hospital study of patients undergoing evaluation for possible pulmonary embolism. Data were collected by on-duty clinicians on an HTML data collection form (prospective e-form), populated using either a personal digital assistant (PDA) or personal computer (PC). Data forms were uploaded to a central, offsite server using secure socket protocol transfer. Each form was assigned a unique identifier, and all PHI data were encrypted, but were password-accessible by authorized research personnel to complete a follow-up e-form. RESULTS: From April 15, 2003-April 15 2004, 1022 prospective e-forms and 605 follow-up e-forms were uploaded. Complexities of PDA use compelled clinicians to use PCs in the ED for data entry for most forms. No data were lost and server log query revealed no unauthorized entry. Prospectively obtained PHI data, encrypted upon server upload, were successfully decrypted using password-protected access to allow follow-up without difficulty in 605 cases. Non-PHI data from prospective and follow-up forms were available to the study investigators via standard file transfer protocol. CONCLUSIONS: Data can be accurately collected from on-duty clinicians in the ED using real-time, PC-Internet data entry in compliance with the Privacy Rule. Deidentification-reidentification of PHI was successfully accomplished by a password-protected encryption-deencryption mechanism to permit follow-up by approved research personnel.

Computer Security↗

PubMed2004

Release of test data under the 2002 Ethics Code and the HIPAA Privacy Rule: a raw deal or just a half-baked idea?

Until quite recently, many psychologists believed themselves ethically bound to fall on their swords before releasing raw test data to anyone but another qualified professional. Under the American Psychological Association Ethics Code (2002), consistent with the Health Insurance Portability and Accountability Act of 1996 Privacy Rule of 2002 (U.S. Department of Health and Human Services, 2002), test materials may still be protected, but documents containing participants' responses are ordinarily subject to disclosure. Although many may lament the cost to test security, the virtues of secrecy regarding testing are often exaggerated and its vices underestimated. Several measures, including appropriate informed consent, sensitive and detailed test feedback, offers of suitable alternatives to raw test data, copyright notices, and the use of protective orders and supervised inspection in forensic matters can still be used to maintain a reasonable degree of test security.

Codes of Ethics↗

PubMed2004

Individualized assessment moderates the impact of HIPAA privacy rules.

In this comment, I express appreciation of Erard's (this issue) review, and urge psychologists to continue to protect test security. I disagree with Erard's belief that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is salient for nonhealth forensic issues. I then review some ways in which individualized assessment practices can moderate the negative impact of the HIPPA privacy rules. Assessors can use tests as a ground forjoint exploration of the client's experience, behavior, and their contexts. Clients may later ask for a review of test data and collaborative life findings, but they rarely are interested in acquiring test records. Attorneys, after discovering that assessment conclusions are based largely on events/contexts provided by the client and others, are less interested in acquiring test records that the psychologist used as tools rather than as evidence for conclusions.

Confidentiality↗

PubMed1984

The conflict of patient privacy and the Freedom of Information Act.

The purpose behind the Freedom of Information Act was to permit greater access by the public to information held by the federal government. In promoting this democratic ideal, little attention was focused on a potential problem that this access to government-held information might cause: violation of another individual's right to privacy. This article examines a recent case in which these two goals came into conflict.

Civil Rights↗

PubMed2003

Learning from experience: privacy and the secondary use of data in health research.

Health services research must continually address the question: Under what conditions may data not collected specifically for research, such as primary medical data, be re-used for research without compromising the privacy of the data-subjects? For secondary use of data in research there are basically three options. Option A: Use personal data with consent or other assent from the data-subjects. To make this both fairer and more practical, in many circumstances broader construals of consent, or permission or approval, need to be explored and instituted. Option B: Anonymise the data, then use them. For many studies, this is the most practical and desirable option. The craft of anonymisation, including reversible anonymisation, or key-coding, needs to be developed and more fully supported under law. Option C: Use personal data without explicit consent, under a public interest mandate. Whether and how the data should be anonymised will depend on the situation. Public health mandates and protections deserve to be clarified, strengthened and extended for a variety of surveillance, registration, clinical audit, health services research and other types of investigation. Safeguards are an integral part of the research promise to the public, offer crucial reassurance and should be emphasised. For health services research, databases are core resources, and their stewardship must be cultivated.

Access to Information↗

PubMed2000

Current developments in Canadian privacy and information law: implications for telehealth.

An appropriate legal regime protecting privacy of personal information is an important element in assuring public confidence in telehealth initiatives while at the same time avoiding undue restrictions or difficulties for those implementing these technologies. In Canada there are several sources of legal protection of personal information but there is increasing emphasis on legislation. A bill recently passed by the Canadian House of Commons is expected have a significant impact on the way personal information, including health information, is handled in the private sector.

Canada↗

PubMedDate not supplied

Privacy: a key nursing concept.

This article discusses how intrusion of territory and personal space produces anxiety and feelings of depersonalisation in hospitalised clients. The implications of privacy as applied to nursing contexts are also examined. Finally, there is a brief discussion of the use of space by staff in terms of status and function.

Humans↗

PubMed2004

[Community health agents and patients' privacy].

This is an exploratory study on views of various social players in the Brazilian Family Health Program, concerning the right to privacy in the relationship between users of the program and community health agents (CHA). The following healthcare professionals were interviewed: heads of basic healthcare units, physicians, nurses and community health agents, working at health units in the city of Sao Paulo, Brazil, in 2002. Healthcare professionals and managers agreed that limits should be placed on access by CHAs to certain user information, including diagnosis. The study showed that frequent contact between users and CHAs results in users' disclosure of their health conditions to CHAs prior to consulting other professionals in the healthcare team. This generates the following ethical issue: Is there any specific scope of confidentiality between the CHA and users over information that should not be disclosed to other team members?

Brazil↗

PubMed2006

Patient privacy and conflicting legal and ethical obligations in El Salvador: reporting of unlawful abortions.

Postabortion care providers who breach patient confidentiality endanger women's health and violate ethics. A 1998 abortion ban in El Salvador likely spurred an increase in the number of women investigated, because many women were reported to legal authorities by health care providers. Having analyzed safeguards of confidentiality in laws and ethical guidelines, we obtained information from legal records on women prosecuted from 1998 to 2003 and identified factors that may lead to reporting through a survey of obstetrician-gynecologists (n=110). Although ethical and human rights standards oblige providers to respect patients' privacy, 80% of obstetrician-gynecologists mistakenly believed reporting was required. Most respondents (86%) knew that women delay seeking care because of fear of prosecution, yet a majority (56%) participated in notification of legal authorities.

Abortion, Illegal↗

PubMed2005

Privacy vs usability: a qualitative exploration of patients' experiences with secure Internet communication with their general practitioner.

BACKGROUND: Direct electronic communication between patients and physicians has the potential to empower patients and improve health care services. Communication by regular email is, however, considered a security threat in many countries and is not recommended. Systems which offer secure communication have now emerged. Unlike regular email, secure systems require that users authenticate themselves. However, the authentication steps per se may become barriers that reduce use. OBJECTIVES: The objective was to study the experiences of patients who were using a secure electronic communication system. The focus of the study was the users' privacy versus the usability of the system. METHODS: Qualitative interviews were conducted with 15 patients who used a secure communication system (MedAxess) to exchange personal health information with their primary care physician. RESULTS: Six main themes were identified from the interviews: (1) supporting simple questions, (2) security issues, (3) aspects of written communication, (4) trust in the physician, (5) simplicity of MedAxess, and (6) trouble using the system. By using the system, about half of the patients (8/15) experienced easier access to their physician, with whom they tended to solve minor health problems and elaborate on more complex illness experiences. Two thirds of the respondents (10/15) found that their physician quickly responded to their MedAxess requests. As a result of the security barriers, the users felt that the system was secure. However, due to the same barriers, the patients considered the log-in procedure cumbersome, which had considerable negative impact on the actual use of the system. CONCLUSIONS: Despite a perceived need for secure electronic patient-physician communication systems, security barriers may diminish their overall usefulness. A dual approach is necessary to improve this situation: patients need to be better informed about security issues, and, at the same time, their experiences of using secure systems must be studied and used to improve user interfaces.

Communication↗

PubMed1984

An experiment in privacy protection.

During investigation of toxic shock syndrome in New South Wales, record keepers were requested not to disclose the identities of subjects. Nevertheless, many record keepers disclosed these identities to the investigator. Covering letters giving extra stress to privacy protection had no special effect. The extent of disclosure appeared to be greater for record keepers who either are infrequently approached for research data or lack the facilities to prepare non-identified abstracts of personal information. These record keepers may benefit from education about their responsibilities.

Biomedical Research↗

PubMed1990

Privacy Act of 1974; matching program--HCFA. Notice of a matching program--the Internal Revenue Service (IRS), the Social Security Administration (SSA), and HCFA--disclosure of IRS taxpayer identity and filing status information to be matched with SSA earned income information for Medicare beneficiaries and their spouses.

As required by Section 6202 of the Omnibus Budget Reconciliation Act of 1989 (OBRA 1989), Public Law 101-239, the Department of Health and Human Services is providing public notice that the IRS and the SSA will disclose certain information regarding the taxpayer identification and filing status and the earned income of Medicare beneficiaries and their spouses for HCFA's use in identifying Medicare secondary payer (MSP) situations. This will enable HCFA to seek recovery of identified mistaken payments that were the liability of another primary insurer or other type of payer. The matching report set forth below is in compliance with the Computer Matching and Privacy Protection Act of 1988 (Pub. L. No. 100-503).

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1990

Privacy Act of 1974; computer matching program--HCFA. Notice of a matching program--HCFA's Health Insurance (HI) Master Record and information from four Railroad Retirement Board (RRB) systems of records.

The Department of Health and Human Services is providing public notice that the RRB agrees to disclose information concerning Medicare eligible railroad retirees to HCFA. The matching report set forth below is in compliance with the Computer Matching and Privacy Protection Act of 1988 (Pub. L. No. 100-503).

Aged↗

PubMed1990

Privacy Act of 1974; system of records--HCFA. Amendment of an existing system of records.

In accordance with the requirements of the Privacy Act of 1974, we are proposing to amend our system of records entitled, "Payments for Interns and Residents," HHS/HCFA/BPO No. 09-70-0524. The amendment will expand the information contained in the system to include the information on interns and residents required in 42 CFR 413.86 (Direct Graduate Medical Education Payments). We have provided information about this amendment in the "Supplementary Information" section below.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1991

Electronic mail and privacy: setting your company's policy.

In setting a privacy policy, a company must consider not only its interest and the interests of its employees, but also the interests of third parties, including suppliers, customers, law enforcement agencies, and others who may have a legal right to or interest in accessing company records, including electronic mail.

Civil Rights↗