Confidentiality and Data Protection in Health Care

INFORMATION GOVERNANCE IN HEALTH CARE
5/24/2020Vaileth Mdete

Information Governance
‘’Information governance defined as an organization wide framework for managing information
throughout its lifecycle and for supporting the organization’s strategy, operations, regulatory, legal, risk,
and environmental requirements.”
The American Health Information Management Association (AHIMA)
Information Governance .
Information governance (IG) in health care is defined as the structures, policies, and relevant
procedures initiated and adhered to by hospitals, health care providers and medical insurance companies
to collect, organize, utilize and secure data.
It is the way in which health and health care information, in particular the personal and sensitive
information relating to people (such as patients and employees), is handled. It aims to balance facility of
use with security of health information.

IG principles
Despite the diversity in the healthcare industry, information across the various types of organizations
can be governed using eight principles: accountability, transparency, integrity, protection, compliance,
availability, retention, and disposition. These principles can be adopted in any organization within the
healthcare industry
 Principle of accountability: There must be an information governance structure and a qualified
accountable person also enable auditing as a means of demonstrating the organization is meeting
its obligations to both internal and external parties.
 Principle of transparency: Information governance will be conducted in an open, verifiable
manner.
 Principle of integrity: Information management will maintain the reliability of the data.
 Principle of protection: All information will be kept secure.

 Principle of compliance: The information governance program will follow all applicable laws,
standards or policies.
 Principle of availability: The information governance strategy will ensure data is accessible to
stakeholders.
 Principle of retention: Information will be stored as long as necessary based on legal, financial,
operational or other requirements.
 Principle of disposition: Any information the organization no longer needs will be disposed of in a
safe and legal manner.

Importance of IG in healthcare
 Maintain the confidentiality, privacy and security of patients’ personal
information and electronic health records (EHR)
 Increases operational efficiency and effectiveness
 Improves quality of care and patient safety
 Streamline strategic planning and predictive data analytics
 Increase operational efficiency
 Reduces costs
 Improves population health
 Reduces risk

Challenges facing IG in healthcare industry
 Expanding numbers of electronic systems/applications in use within and
across organizations,
 Growing volume and variety of data and information,
 Expanding uses of healthcare information,
 Proliferation of medical devices creating data for which reliable integration
into systems/applications is essential,
 State of interoperability across devices and systems, and
 Reliability of shared and exchanged information

Types of patients personal information
 Confidential information - Confidential information is information that
patients and service users disclose in confidence to staff who are providing
their health and care – they expect that information to be treated
confidentially. It can include names and addresses, as well as a person’s
sensitive personal information – for example, health and care information.
Other information can also be confidential information, such as employee
references and some commercial information (for example, about the
organisation).

 Personal information - Information about someone is 'personal' when it identifies an
individual. It may be about living or deceased people, including patients, service users and
members of staff. A person’s name and address are clearly personal information when
presented together, but an unusual name may, by itself, might enable an individual to be
identified. Personal information may be recorded in hard copy or digital form – for
example, photographs, videos/DVDs, whiteboards, health and care records, personnel files,
on a computer – or it may be information simply known by others (such as the care team).
Key identifiable information includes:
 patient’s name, address, full post code, date of birth;
 pictures, photographs, videos, audio-tapes or other images of patients;
 number and local patient identifiable codes;
 anything else that may be used to identify a patient directly or indirectly. For example,
rare diseases, drug treatments or statistical analyses which have very small numbers within
a small population may allow individuals to be identified.

 Sensitive information - As mentioned above, all health and care information
is sensitive, but patients and service users may consider particular types of
information to be highly sensitive, for example, information relating to their
mental or sexual health.

 Anonymised information - This cannot be personal or confidential. This
information does not identify an individual and cannot reasonably be used to
determine their identity. Anonymisation requires the removal of name,
address, full post code and any other detail or combination of details that
might support identification, either by itself or when used with other
available information. Anonymised information does not identify a person, so
it cannot be personal or confidential. This is information which does not
identify an individual directly, and which cannot reasonably be used to
determine identity. Anonymisation requires the removal of name, address,
full post code and any other detail or combination of details that might
support identification

 Pseudonymised information - Pseudonymised information is
information in which an individual’s identity is disguised by
using a unique identifier (that is, a pseudonym). This does
not reveal their ‘real world’ identity, but allows the linking
of different data sets for the individual concerned . This is
like anonymised information in that in the possession of the
holder it cannot reasonably be used by the holder to
identify an individual. However it differs in that the original
provider of the information may retain a means of
identifying individuals. This will often be achieved by
attaching codes or other unique references to information
so that the data will only be identifiable to those who have
access to the key or index.

Patients information uses
 The management of patient records
 Communication concerning your clinical, social and supported care;
 Ensuring the quality of your care and the best clinical outcomes are
achieved through clinical audit and retrospective review;
 Participation in health and social care research; and
 The management and clinical planning of services to ensure that
appropriate care is in place for our patients today and in the future.

Measures to PROTECT patients
information
 Read, understand and comply with your organisation's policy and procedures.
 Recognising that confidentiality is an obligation for all staff, external
contractors, and volunteers.
 Recording patient information accurately and consistently;
 Keeping patient information private;
 Keeping patient information physically and electronically secure; Store your
digital assets securely when not in use. Report any lost or stolen digital asset
to the police immediately. Ensure that digital assets and passes are handed
back if you are leaving the organisation.
 Disclosing and using information with appropriate care.
 Follow your organisation’s incident management procedure.

Patients rights in relation to their information
 To be told what personal information is being used for.
 To see and have a copy of personal information.
 To have objections to processing considered in some circumstances
 Have inaccuracies corrected
 Object to direct marketing
 Restrict the processing of their information

Healthcare Provider responsibility on patients information
 Check that patients have seen the available information leaflets
 Make clear to patients when information is recorded or health records are
accessed
 Make clear to patients when information is or may be disclosed to other
 Check that patients are aware of the choices available in respect of how
their information may be used or shared
 Check that patients have no concerns or queries about how their
information is used
 Answer any queries personally or direct patients to others who can answer
their questions or other sources of information
 Respect the right of patients to have access to their health records
 Communicate effectively with patients to help them understand

Principles of data protection
Principle 1 – Fairly and Lawfully Processed.Personal data can only be
processed fairly and lawfully if the individual concerned (data subject) gives
their permission, or the processing is necessary for legal or contractual
reasons.
Principle 2 – Processed for limited purposes.Personal data should not be used
except for the purpose in which it was given. Data should not be disclosed to a
third party, without the prior consent of the data subject, unless legally or
contractually obliged to do so.
Principle 3 – Adequate, relevant and not excessive.Only data relevant to the
purpose should be collected.
Principle 4 – Accurate and up to date.All reasonable steps should be taken to
ensure that data held is accurate and up to date. For example a change of
address or telephone number etc.

 Principle 5 – Not kept for longer than is necessary
All out of date or redundant data should be destroyed in a secure and
confidential manner.
 Principle 6 – Processed in accordance with the rights of the data subject.
Data subjects can access personal information held about them through the
Subject Access Request procedure under the Data Protection Act. Data Subjects
also have the right to request changes to their data and to prevent processing
which is likely to cause damage or distress to themselves or anyone else. There
are exceptions to these rights such as in the prevention and detection of a crime.
 Principle 7 – Be protected
Security and confidentiality measures should be in place to protect personal data.

Caldicott principles of confidentiality
 The Caldicott Principles were developed in 1997 and revised in 2013 in United
Kingdom following a review of how patient information was handled .Principles
that healthcare providers should follow to ensure that information that can
identify a patient is protected . Since then, when deciding whether there is a
need to use information that would identify an individual, a healthcare
provider is advised to use the following Principles as a test.

Caldicott Principles:
Principle 1: Justified purpose(s) .Every proposed use or transfer of personal confidential data within or
from an organisation should be clearly defined, scrutinised and documented, with continuing uses
regularly reviewed, by an appropriate guardian.
Principle 2: Necessity. Don't use personal confidential data unless it is absolutely necessary.Personal
confidential data items should not be included unless it is essential for the specified purpose(s) of that
flow. The need for patients to be identified should be considered at each stage of satisfying the
purpose(s).
Principle 3: Use the minimum personal confidential data. Where use of personal confidential data is
considered to be essential, the inclusion of each individual item of data should be considered and
justified so that the minimum amount of personal confidential data is transferred or accessible as is
necessary for a given function to be carried out.
Principle 4: Strict access . Access to personal confidential data should be on a strict need-to-know
basis.Only those individuals who need access to personal confidential data should have access to it, and
they should only have access to the data items that they need to see. This may mean introducing
access controls or splitting data flows where one data flow is used for several purposes.

 Principle 5: Responsibility awareness. Everyone with access to personal
confidential data should be aware of their responsibilities. Action should be
taken to ensure that those handling personal confidential data - both clinical
and non-clinical staff - are made fully aware of their responsibilities and
obligations to respect patient confidentiality.
 Principle 6:Comply with the law.Every use of personal confidential data must
be lawful. Someone in each organisation handling personal confidential data
should be responsible for ensuring that the organisation complies with legal
requirements.
 Principle 7: The duty to share information can be as important as the duty to
protect patient confidentiality.Health and social care professionals should
have the confidence to share information in the best interests of their
patients within the framework set out by these principles. They should be
supported by the policies of their employers, regulators and professional
bodies

Legal framework of confidentiality in
Tanzania
 Three primary sources embody the legal framework relating to
confidentiality in medical practiceTanzania .
 Constitution of United Republic of Tanzania
 HIV and AIDS (Prevention and Control Act of 2008
 Employment and Labour relation Act of 2003

In addition to these laws the ministry of health issued other official
guidelines that promote health information privacy .
 The Standard Operating Procedure for HIV testing and Counseling
 National Guideline for the prevention of Mother to Child Transmission
 National Guideline for the Management of National Aids Control Program

Constitution
 The United Republic of Tanzania’s Constitution grants citizen a general right to
the right of privacy of his own person his family and of his matrimonial life
that includes respect and protection of his residence and private
communication .To protect the right to privacy the state authority shall lay
down legal procedures regarding the circumstances manner and extent to
which the right to privacy… may be encroached upon without prejudice to the
provision of this Article .

HIV
 The act set consent based testing requirement and protect the confidentiality
of HIV/AIDS test results specifically as well as medical confidentiality .
 Section 17(1)HIV and AIDS(Prevention and Control)Act of 2008 states that:
 “All health practitioners ,workers , employers , recruitment agencies ,
insurance companies ,data recorders ,sign language interpreters ,legal
guardians and other custodian of any medical records , files ,data or test
results shall observe confidentiality in handling of all medical information and
documents particularly the identity and status of persons living with HIV and
AIDS “

Employment and Labour relation Act of
2003
 Section 101(1) of Employment and Labour Relation Act of 2003 states
that:
“Subject to subsection (2), it is an offence for any person to disclose any
information relating to the financial or business affairs of another person
if that information was acquired in the performance of any function or
the exercise of any power under this Act.”
5/24/2020
Vaileth Mdete

Penalties
 Section 46 of HIV and AIDS(Prevention and Control)2008 states that:
 “Any health practitioner or any person referred to under section 16 and 17 who
(a) breaches medical confidentiality ; or
(b)unlawfully discloses information regarding HIV and AIDS status of any person commits an offence
and on conviction shall be liable to a fine of not less than five hundred thousand shilling and not
exceeding one million shillings or to imprisonment to a term of not less than six month and not
exceeding twelve month or both.

Penalties………..
 Section 102(4) of ELRA of 2003 impose the penalty for the breach of
confidentiality
“(4) Any person convicted of any of the offences referred to in sections 27, 28,
45(3) and 101 shall be sentenced to a fine not exceeding one million shillings”

Exceptions for confidentiality
 The law of Tanzania provide some exceptions for confidentiality for practitioners:
 Section 101(2) of ELRA states that confidentiality does not apply if the information is disclosed in
compliance with this act.
(a) to enable a person to perform a function or exercise a power under this Act;
(b) in accordance with any written law;
(c) for the purpose of the proper administration of this Act;
(d) for the purposes of the administration of justice.

 Section 18 of HIV and AIDS (Prevention and control)Act of 2008 state that:
“The medical confidentiality shall not be considered breached in .
(a)complying with the reportorial requirements in conjunction with the
monitoring and evaluation programmes
(b)informing other health practitioners directly involved or about to be
involved in the treatment or care of a person living with HIV/AIDS.

Confidentiality and Data Protection in Health Care

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