Successfully reported this slideshow.

Chapter05

992 views

Published on

Published in: Health & Medicine, Technology
  • Be the first to comment

  • Be the first to like this

Chapter05

  1. 1. Chapter Five Confidentiality and the Management of Health Care Information
  2. 2. Confidentiality <ul><li>Respecting a patient’s confidence is an ethical duty </li></ul><ul><li>The requirement that we respect a patient’s privacy is a legal obligation </li></ul><ul><ul><li>American common law provides sanctions against the unwarranted disclosure of a patient’s private affairs </li></ul></ul>
  3. 3. Confidentiality – A Clear Duty <ul><li>The principle of confidentiality can be defended using any of the decision-making formats: </li></ul><ul><ul><li>Utilitarian defense </li></ul></ul><ul><ul><li>Duty defense </li></ul></ul><ul><ul><li>Virtue ethics defense </li></ul></ul>
  4. 4. Confidentiality – A Principle with Qualifications <ul><li>Consider the Prosenjit Poddar case: </li></ul><ul><ul><li>To whom did the practitioners owe a duty, to their real patient, or to the potential victim? </li></ul></ul><ul><ul><li>Harm principle </li></ul></ul><ul><ul><li>Was the court decision right? </li></ul></ul><ul><ul><li>Legal reporting requirements </li></ul></ul>
  5. 5. Confidentiality – A Principle with Qualifications (continued) <ul><li>Legal reporting requirements: </li></ul><ul><ul><li>Child abuse </li></ul></ul><ul><ul><li>Drug abuse </li></ul></ul><ul><ul><li>Communicable disease </li></ul></ul><ul><ul><li>Injuries with guns or knives </li></ul></ul><ul><ul><li>Blood transfusion reactions </li></ul></ul><ul><ul><li>Poison and industrial accidents </li></ul></ul><ul><ul><li>Misadministration of radioactive materials </li></ul></ul>
  6. 6. Confidentiality in Modern Health Care <ul><li>Modern health care creates a “right to know” and “legitimate interest” situation for many outside the direct patient care service </li></ul>
  7. 7. Confidentiality in Modern Health Care (continued) <ul><li>Modern information technology creates multiple avenues for information acquisition, making security a real problem </li></ul><ul><li>Has modern health care made the principle of confidentiality a “decrepit concept?” </li></ul>
  8. 8. HIPAA Legislation and Requirements <ul><li>Health Insurance Portability and Accountability Act </li></ul><ul><ul><li>Dual goals for HIPAA legislation </li></ul></ul><ul><li>Highlights of legislation: </li></ul><ul><ul><li>Consumer control over health information </li></ul></ul><ul><ul><li>Rules for medical record release and use </li></ul></ul><ul><ul><li>Increased security of personal health information </li></ul></ul>
  9. 9. Human Subject Research <ul><li>Goals </li></ul><ul><li>Basic principles involved </li></ul><ul><li>Patient benefit/risk calculations: </li></ul><ul><ul><li>Sound design minimizes risk </li></ul></ul><ul><ul><li>Risks are reasonable in relation to benefit </li></ul></ul><ul><ul><li>Subject selection equitable </li></ul></ul>
  10. 10. Human Subject Research (continued) <ul><li>Patient benefit/risk calculations (continued): </li></ul><ul><ul><li>Informed consent </li></ul></ul><ul><ul><li>Appropriate monitoring </li></ul></ul><ul><ul><li>Privacy and confidentiality protection </li></ul></ul><ul><li>A problematic past </li></ul><ul><li>Review Jewish secretary case </li></ul>
  11. 11. Human Subject Research (continued) <ul><li>IRB – foundational materials: </li></ul><ul><ul><li>Nuremberg Code of 1947 </li></ul></ul><ul><ul><li>Helsinki Declaration of 1964 </li></ul></ul><ul><ul><li>The Belmont Report of 1979 </li></ul></ul><ul><ul><li>U.S. Department of Health and Human Services Title 45 of 2001 </li></ul></ul>
  12. 12. Key Concepts <ul><li>Modern health information data systems threaten to undermine principle of confidentiality </li></ul><ul><li>Legitimate interest guide </li></ul><ul><li>Duty to warn </li></ul>
  13. 13. Key Concepts (continued) <ul><li>HIPAA legislation: </li></ul><ul><ul><li>Cost containment </li></ul></ul><ul><ul><li>Protection of privacy </li></ul></ul><ul><li>Legal reporting requirements: </li></ul><ul><ul><li>Child abuse </li></ul></ul><ul><ul><li>Drug abuse </li></ul></ul><ul><ul><li>Communicable disease </li></ul></ul>
  14. 14. Key Concepts (continued) <ul><li>Legal reporting requirements (continued): </li></ul><ul><ul><li>Injuries with guns and knives </li></ul></ul><ul><ul><li>Blood transfusion reactions </li></ul></ul><ul><ul><li>Poison and industrial accidents </li></ul></ul><ul><ul><li>Misadministration of radioactive materials </li></ul></ul>

×