Privacy in Healthcare

Dr. Nicole GoldaPGY 5 Urology

Have you: – actually read through the privacy contract

before signing it to obtain EPR access?

– shared your login/password with a resident or medical student?

– brought patient information home? Or emailed patient information?

– left your ERP logged in at a nursing station or in the OR?

– misplaced your patient list?

– discussed patient info in a public place or in front of patient’s family members?

Why is privacy important? Patients entrust us with their care and private health info

only for the purpose of treating them Protecting privacy matters because if patients felt their

information would not be kept private, they would with-hold information, ultimately affecting their care

Canadians appear to be concerned about the privacy of their health information. A recent online survey of 1002 Canadian patients indicated that 43.2% have withheld or would withhold information from their health care provider because of privacy concerns, while 31.3% of Canadian patients have or would postpone care over privacy concerns, and 42.9% would seek care outside their communities for the same reason

Privacy Laws Primer:

PHIPA: Personal Health Information Privacy Act Provincial law - took effect Nov 1, 2004 Governs:

collection, use and disclosure of personal health information (PHI), for health care and secondary purposes

entrenched patients’ privacy rights:access PHIcorrect PHIrestrict use & disclosure of their PHInotified if PHI stolen or lostchallenge an organizations’ privacy

practices

‘Privacy’ is not a new issue in health care… so why do we need privacy laws?

Modern healthcare relies on electronic patient-care systems i.e., EPR, PACS

EPR increases the scope of info available to health practitioners = better health care

Privacy risks are inherent in EPR environmentie. cannot lock down EPR so users can only

access info for patients assigned to them

Important that you only access info if required to complete

your job

Key Issues: #1 Access to Information

Access only the information/records needed to take care of your patients

Just because you have access to EPR, does not mean you can access any record, even if it is kept confidential

This includes your own record and that of your family, colleagues etc. – you cannot even look up your colleagues birthdates/demographic info

Audits Privacy Office audits EPR to determine

compliance:on request of a patient/SDM - to investigate

complaintson randomly selected patients/staff/affiliateshigh profile patients; staff deaths

If a breach occurs, the hospital is required by law to inform the patient of any unauthorized access

Access to your own records

Ex. Your throat is sore and an ER doctor sends a swab. Later that night you call microbiology to ask them if your culture is positive- can they give you the information?

Who can access your results?A. Check yourselfB. ER doctorC. ER residentD. Collegue if you give them permission

Patients have the right to access their health information (with some exceptions)

Residents who are also patients must access information same as other patients e.g. through Health Records

Key Issues: #2 Information Security

Do not share your login information You are responsible for any activity that occurs under your login

Log out of your network application when you are finished!

Do not ask another resident to access information on patients if they are not providing the patient care

Do not access information using someone else’s login

Log out of the network application when you are finished– NEVER leave an access open and unattended

Keeping patient info secure Store electronic confidential information on

hospital network, not on local/hard drives or portable devices

If you are required to store confidential information on a hard drive or portable device it MUST be either de-identified or encrypted

Ensure you have proper approval prior to collecting patient information in a database or other application (REB approval)

Never leave confidential information unattended- ie. patients lists after rounds

Dispose of lists in confidential bins

Encryption of Files

Keeping patient info secure Ex. Post on Facebook- “on call at St. Mike’s

and sick trauma came in last night on call and got to go to OR!” Is this OK since the patient is not identified?

Do not post confidential information on personal or public web pages, e.g. blogging, other social networks, Internet messaging

Do not take photographs, video record and/or sound record patients unless you have the appropriate consent – even if the photo/video/sound is ‘de-identified’

What about teaching rounds?

Case Studies – If education is being provided to colleagues

who provide the patient care, express consent from the patient is not required

– If education is being provided to those who do not provide care e.g. Grand Rounds, the information must be “de-identified” OR you must obtain express consent from the patient

Key Issues: #3 Communicating confidential information

Select the most secure method of sending hard copy and transmitting electronic confidential information

if you need to send confidential information either de-identify the info, encrypt the file or send in a secure manner– e-mail is not a secure manner of sending outside the organization/ outside the secure system

designating e-mails sent within the secure system as “confidential” – subject line

Cannot all be avoided, minimize the risk by:– Not discussing PHI in public places,

e.g., elevators, hallways, cafeteria, etc.– Not using your cell to discuss PHI in public places.– Speaking softly when another patient is nearby

(e.g., double rooms, ICUs, etc).– In clinics, speak to your patients in private rooms,

not in the waiting room.– Keep charts, mail, test results, etc in protected

areas.– If necessary for patient care and safety, limited

disclosure may be made (e.g., identifying a patient as being on precautions).

Incidental Disclosure

Inappropriate disclosure – watch where you discuss confidential information

Privacy Breaches

When PHI is collected, used, disclosed or disposed in a was that does not comply with the Act.

Most common:– Unauthorized collection (patient not looking after, no

consent)– Unauthorized disclosure: loss (leave pt list in public

place), theft (laptop stolen), mistake (fax/letter sent to wrong person)

– Unsecure disposal (unshredded file left in garbage)

Privacy breaches are happening daily:– Residents are unaware they are doing anything

wrong– Residents don’t know what you can and cannot

do

Consequences of a Privacy Breach

If you violate the law, you may face:– Fines for an offence and/or a lawsuit for

damages– Civil litigation– Loss of appointment or affiliation within a

hospital– Report to CPSO – disciplinary proceedings

If prosecuted and convicted of an offense:– Hospital or physician could ne fined up to

$250K or $50K respectively

A breach of privacy may entitle affected individuals to sue you for damages for:– Actual harm a breach caused, or– Mental anguish (up to $10K)

What should I do?

Scenario #1:Q: I am approached in the hallway by someone who

asks me if I know what room a patient is in. I saw the patient’s name on the unit I just left. What should I do?

A: Refer the person to the nurses’ station, information desk, or hospital operator. You do not know whether the patient has requested any restrictions.

Is this okay?Scenario #2:Q: I hear about a very unusual case in the OR. I am an

ortho resident and the patient is being operated on for ambiguous genitalia. I read some of the clinic notes in EPR. Is this okay?

A: No. While it might be argued that educational benefit can be gained by reviewing unusual cases, access to patients’ records in this type of situation is not appropriate. Electronic records are monitored for inappropriate access. If this patient is not under your service, you could be flagged for inappropriate access

Is it okay?Scenario #3:Q: My friend was admitted yesterday after collapsing

during a bike ride. I am very concerned about her progress and would like to visit her but I don’t know which room she is in. Is it okay if I look up the information in the computer system?

A: No. Using your access privileges to look up any information for any patient when there is no need to know based on your responsibilities in the hospital is a violation of patient confidentiality.

Is it okay?Scenario #4:Q: Giving handover to the staff and next resident on

call via:- Email?- Text message?- What if do not use patient name but initials?

A: No. Unless txts are going through hospital security system (hospital blackberry’s) then its not secure. Cell phone provider has access.

Who is at fault?Scenario #5:Q: On morning rounds EPR is logged in under

resident A’s login. Resident B places an order for a patient. Orders the wrong medication.

A: Resident A is accountable for resident B’s actions

References

CPSO http://www.cpso.on.ca/ Information and Privacy Commissioner of

Ontario http://www.ipc.on.ca/ Ontario Hospital Association (Physician’s

Toolkit) http://www.oha.ca/ Hospital Privacy Office

Questions?Comments?Thank you