Privacy and Confidentiality

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Summary: Advances in technology, including computerized medical databases, the Internet, and telehealth, have opened the door to potential, unintentional breaches of private/confidential health information. Protection of privacy/confidentiality is essential to the trusting relationship between health care providers and patients. Quality patient care requires the communication of relevant information between health professionals and/or health systems. Nurses and other health professionals who regularly work with patients and their confidential medical records should contribute to the development of standards, policies, and laws that protect patient privacy and the confidentiality of health records/information.

Background

Recent developments in technology have changed the delivery of health care and the system used to record and retrieve health information. In addition to using paper medical records, health professionals, hospitals and insurers routinely use computers, phones, faxes, and other methods or recording and transferring information. In many instances, this information - which could include medical diagnoses, prescriptions, or insurance information - is readily available to anyone (including clerical and other staff) who walks by a fax machine or logs on to a computer. This lack of privacy has the potential to undermine patients' relationships with providers and adversely affect the quality of care. Patients may also fear that the exposure of personal health information, including the results of genetic tests that are becoming increasing available, could result in the loss or denial of health insurance, job discrimination or personal embarrassment.

In keeping with the nursing profession's commitment to patient advocacy and the trust that is essential to the preservation of the high quality of care patients have come to expect from registered nurses, the American Nurses Association supports the following principles with respect to patient privacy and confidentiality:

  • A patient's right to privacy with respect to individually identifiable health information, including genetic information, should be established statutorily. Individuals should retain the right to decide to whom, and under what circumstances, their individually identifiable health information will be disclosed. Confidentiality protections should extend not only to health records, but also to all other individually identifiable health information, including genetic information, clinical research records, and mental health therapy notes.
  • Use and disclosure of individually identifiable health information should be limited.
  • A patient should have the right to access his or her own health information and the right to supplement such information so that they are able to make informed health care decisions, to correct erroneous information, and to address discrepancies that they perceive.
  • Patients should receive written, easily understood notification of how their health records are used and when their individually identifiable health information is disclosed to third parties.
  • The use or disclosure of individually identifiable health information absent an individual's informed consent should be prohibited. Exceptions should be permitted only if a person's life is endangered, if there is a threat to the public, or if there is a compelling law enforcement need. In the case of such exceptions, information should be limited to the minimum amount necessary.
  • Appropriate safeguards should be developed and required for the use, disclosure and storage of personal health information.
  • Legislative or regulatory protections on individually identifiable health information should not unnecessarily impede public health efforts or clinical, medical, nursing, or quality of care research.
  • Strong and enforceable remedies for violations of privacy protections should be established, and health care professionals who report violations should be protected from retaliation.
  • Federal legislation should provide a floor for the protection of individual privacy and confidentiality rights, not a ceiling. Federal legislation should not preempt any other federal or state law or regulation that offers greater protection.

References

  • Aronovitz, Leslie G.(1999, July 20). Testimony before the House Ways and Means Subcommittee on Health, Hearing on Confidentiality of Health Information.
  • Badzek, Laurie, MS,JD, LLM, RN, and Gross, Lauren, JD (1999). Confidentiality and Privacy: At the Forefront for Nurses. American Journal of Nursing, Vol.99, No.6. 52-54.
  • Foerstel, Karen (1999, March 13). Protecting Medical Records: Privacy vs. 'Progress'. CQ Weekly. 593-595.
  • Goldman, Janlori (1998). Protecting Privacy to Improve Health Care. Health Affairs, Vol. 17, No. 5. 47-60.
  • Hamburg, Margaret, MD (1999, July 20). Testimony before the House Ways and Means Subcommittee on Health, Hearing on Confidentiality of Health Information.
  • Hash, Michael (1999, July20). Testimony before the House Ways and Means Subcommittee on Health, Hearing on Confidentiality of Health Information.
  • Health Privacy Project, Institute for Health Care Research and Policy, Georgetown University (July 1999). Best Principles for Health Privacy, A Report of the Health Privacy Working Group.
  • Hodge, James G., Jr., JD, LLM; Gostin, Lawrence O., JD; and Jacobson, Peter D., JD, MPH (1999). Legal Issues Concerning Electronic Health Information, Privacy, Quality, and Liability. Journal of the American Medical Association. Vol. 282, No. 15. 1466-1471.
  • Koyanagi, Chris (1999, April 27). Testimony before the U. S. Senate Committee on Health, Education, Labor, and Pensions on the Confidentiality of Medical Information.
  • Serafini, Marilyn Werber (1999, October 9). Open Secrets. National Journal. 2878-2881.

Related Past Actions: 1999 Privacy and Confidentiality, House of Delegates

1995 Privacy and Confidentiality Related to Access to Electronic Data, House of Delegates

1991 Nursing and Human Immunological Virus, House of Delegates

1982 Computer-Based Patient Record and Implications for the Profession of Nursing, House of Delegates

1974 National Health Insurance, House of Delegates

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