Full Project – The challenges facing confidentiality of patients health information and how to improve on it

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Chapter One

INTRODUCTION

Background of the Study

Confidentiality of patients’health information is one of the most important pillars of medicine. Protecting the private details of a patient is not just a matter of moral respect, it is essential in retaining the important bond of trust between the health practitioner and the patient.

Confidentiality is a professional duty or promise between a health practitioner and his or her patient that places restrictions on the disclosure of information provided by the patient as part of the care and treatment given by the practitioner.

Confidentiality is recognized by law as privileged communication between two parties in a professional relationship such as with a patient and a physician, nurse, health information manager and other clinical professionals (Brodnik etal, 2012).

Patients’health information confidentiality is deeply embedded in the Hippocratic Oath. The “Oath of Hippocrates” was adopted roughly in the fourth century B.C. It still remains a recognized medical ethics. It states thus:

“Whatsoever things I see or hear concerning the life of men, in my attendance on the sick and even apart therefrom which ought not to be noised about, I will keep silence thereon counting such things to be as sacred secrets”.

Dilemmas around confidentiality arise when the principles of confidentiality conflict with other ethical principles such as avoiding harm to other patients. When a confidential information about a patient is breached or disclosed to a third party, it can lead to many problems.

There is an increasing problem emanating from poor keeping of patient’s health information. The awareness has led to several ethics both at the national and state level on confidentiality of health records with particular reference to solid training and development of health information managers, the dismissal and termination of unqualified staff from their posts and recruitment and employment of qualified staff.

According to McWay (2013), breach of confidentiality occurs when data or information provided in confidence to a health practitioner is disclosed to a third party who is not on the health team without the patient’s consent.

Healthcare providers also owe patients a common duty of confidentiality in relation to information obtained as part of the treatment. The duty is based on contract law and also on “fiduciary duty” of an individual practitioner to his or her patient.

Confidentiality is recognized by law as a privileged communication between two parties. There are so many challenges facing the confidentiality of patient’s health information. They include; the release of patient’s health information without his/her consent, staff are not well-oriented on ethics guiding confidentiality and health records are not computerized.

A response to the challenges is information governance, described as the strategic management of enterprise wide information including policies and procedures relating to health information confidentiality and security; this includes the role of stewardship (Washington, 2010).

Health information managers are uniquely qualified to serve as health information stewards with an appreciation of various interests in that information and knowledge of the laws and guidelines speaking to confidentiality and security. The role of the steward encompasses not only ensuring the accuracy and completeness of the records, but also protecting its privacy and security.

This study addresses directly security measures and steps that need to be taken to protect the privacy of the health information and support professionals in holding that information sacred.

Statement of Problem

Patient confidentiality means that personal and/or medical information given to a healthcare provider will not be disclosed to outsiders unless the individual has given specific permission for such release. Confidentiality is one of the core elements of effective medical practice. It requires health care providers to keep a patient’s personal health information private.

Patients routinely share personal information with healthcare providers. If the confidentiality of patient’s information is not protected, trust in the physician-patient relationship would be diminished. Creating a conducive environment by respecting patient privacy encourages the patient to seek care and be as honest as possible during the course of a health care visit. Because the disclosure of personal information could cause professional or personal problems, patients rely on physicians to keep their medical information private.

However, the release of patient’s health information without the patient’s consent has led to many problems such as suing the hospital to court by the patient. Many healthcare organizations are embarking on implementing Electronic Health Records (EHR), while there are currently no national incentives for doing so. The primary reason is for the enhancement of health information safety and confidentiality.

The implementation of ‘EHR’ is a new territory for many health information managers, hence, not all managers are able to operate the system; this is why it is important for health information managers to attend workshops on Information Communication Technology (ICT) (Onuoha, 2017). Inadequate or lack of computer and other ‘ICT’ devices will bring down the quality of patient’s health information confidentiality as it can be accessed by unauthorized individuals when it is in paper-based format.

Health information managers are not oriented on the ethics and policies guiding confidentiality of patient’s health information. When health information managers do not go for orientation they do not know when and the procedures in disclosing patient’s health information and to make sure that when dispensing healthcare that patient’s health information is kept in confidence. Poor security measures in the health records library can equally expose patient’s health information to unauthorized third parties because there no restrictions to who can enter and access patient’s health information stored within.

Objective of the Study

The general objective of this study is to examine generally the challenges facing the confidentiality of patients’ health information and how to rectify them.

However, the specific objectives are;

To find out if releasing a patient’s health information without his or her consent will lead to a patient suing the hospital.

To determine if lack of ‘ICT’ facilities exposes the patient’s health information to unauthorized third parties.

To ascertain if non-orientation of health information managers on the ethics and policies guiding the confidentiality of patients’ health information exacerbate the cases of wrongful disclosure.

To determine how poor security measures would expose patients’ health information stored in the medical records library.

Research Questions

For the purpose of this study, the following research questions aided the researcher in carrying out this research exercise, to wit:

Does releasing a patient’s health information outside consent lead to a patient suing the hospital?

Does lack of ‘ICT’ facilities expose the patients’ health information to unauthorized third parties?

Does non-orientation of health information managers on the ethics and policies guiding the confidentiality of patients’ health information exacerbate the cases of wrongful disclosure?

What effect does poor security measures have on the confidentiality of patient’s health information stored in the medical records library?

Research Hypothesis

In this study, the researcher attempted the test of the following research hypothesis:

Hypothesis One

HO: There is no significant relationship between quality patient health informationand the release of patients’ information outsidepatients’ consent.

HI: There is a significant relationship betweenquality patient health information and the release of patients’ information outsidepatients’ consent.

Hypothesis Two

HO: There is no significant relationship between quality patient health information and non-orientation of health information managers on the ethics and policies guiding the confidentiality of patients’ health information, lack of ‘ICT’ facilities as well as poor security measures.

HI: There is a significant relationship between quality patient health information and thenon-orientation of health information managers on the ethics and policies guiding the confidentiality of patients’ health information, lack of ‘ICT’ facilities as well as poor security measures.

Scope of Study

This study is restricted to finding out the challenges facing confidentiality of patients’ health information and how to rectify them. The study is also directed specially to the staff of Health Information Management Department, Nnamdi Azikiwe University Hospital, Nnewi.

Significance of the Study 

This study is of immense importance to every Head of Department of Health Information Management as it will drive him or her to organize orientation programme or seminar/workshop for new employees on the importance of Nigerian Health Records Code of Ethics for Medical Records Practitioners regarding confidentiality.

This study creates awareness to other health professionals giving them the knowledge on how to handle patients’ health information and also put confidentiality above every other thing.

Most especially, this project is of benefit to health information managers as it will keep them in line knowing that information is power and when tampered with, it can affect the medical progress of the patient.

Operational Definition of Terms:

Breach of Privacy: Is the loss of unauthorized access to, or disclosure of personal information such as health information of a patient to a third party.

Confidentiality: Is a professional duty or promise between a health practitioner and his or her patients which places restrictions on the disclosure of information provided by the patient as part of the care and treatment given by the practitioner.

Consent: Is a process of getting permission before conducting a healthcare intervention on a patient or for disclosing health information.

Health Information Manager: Is a health care professional who has administrative control of a health record.

Health Record: A documented account, whether hardcopy or electronic form of a patient’s health, illness and treatment during each visit or stay at a health facility.

Patient: Any person who receives health services at to who as a result, a professional owe a duty of care.

Privacy: Refers to the right of a patient to have their personal health information safeguarded from loss, misuse and unauthorized disclosure.

Security of Health Information: Refers directly to protection, specifically to the means used to protect the privacy of health information and support professionals in holding that information in confidence.

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Full Project – The challenges facing confidentiality of patients health information and how to improve on it