PRIVACY IN HEALTH CARE SYSTEM: PROBLEMS AND POSSIBLE SOLUTIONS Tautvydas Jankauskas M.D. Rita Baneviciene M.D. Darius Petraitis Egle Kalinauskiene M.D. Kaunas 2 nd Clinical Hospital, Lithuania

The Hippocratic Oath vis a vis Confidentiality I swear to fulfill, to the best of my ability and judgment, this covenant: “And about whatever I may see or hear in treatment, or even without treatment, in the life of human beings – things that should not even be blurted out outside – I will remain silent, holding such things to be unutterable”.

What is “Personal Health Information”? Personal Health Information is an object of an individual right to privacy Personal Health Information is an object of an individual right to privacy Information concerning the physical or mental health of the individual Information concerning the physical or mental health of the individual Information concerning any health service provided to the individual Information concerning any health service provided to the individual Information concerning the donation by the individual of any body part or any bodily substance Information concerning the donation by the individual of any body part or any bodily substance

The Specific Nature of Personal Health Information Confidentiality is central to the trust between doctor and patient Confidentiality is central to the trust between doctor and patient Diagnosis and results of tests, history of diseases and treatment Diagnosis and results of tests, history of diseases and treatment Most intimate aspects of the individual’s life (family history, relationships, sexual behavior, substance abuse, mental status) Most intimate aspects of the individual’s life (family history, relationships, sexual behavior, substance abuse, mental status) Information remains confidential after death Information remains confidential after death

How Information Could be Disclosed ? Access to information by a signed request Access to information by a signed request Emergency cases where information about patients is shared Emergency cases where information about patients is shared Disclosure of information indirectly: education, research, monitoring and epidemiology, public health surveillance, administration Disclosure of information indirectly: education, research, monitoring and epidemiology, public health surveillance, administration Disclosure without patient consent: instances where safety of the individual would supersede the need for confidentiality Disclosure without patient consent: instances where safety of the individual would supersede the need for confidentiality

Possible Consequences of Improper Disclosure of Medical Information Inaccuracies or improper disclosure may threaten: Obtaining insurance coverage Obtaining insurance coverage An individual’s personal and financial well being An individual’s personal and financial well being Negatively affect an individual’s social status Negatively affect an individual’s social status

The Laws Regulating The Right to Privacy in Lithuania European Convention on Human Rights and Fundamental Freedom European Convention on Human Rights and Fundamental Freedom The Constitution of the Lithuanian Republic (The right to privacy became constitutional in 1992). The Constitution of the Lithuanian Republic (The right to privacy became constitutional in 1992). The Civil Code of the Lithuanian Republic (The concept of privacy affective July, 2000) The Civil Code of the Lithuanian Republic (The concept of privacy affective July, 2000) The Individual’s Personal and Secured Information Law The Individual’s Personal and Secured Information Law Penal Code and others (2 new chapters) Penal Code and others (2 new chapters)

Laws Regulating the Right to Privacy in Healthcare System Laws Regulating the Right to Privacy in Healthcare System Healthcare Law Healthcare Law Patient’s Right and Compensation for the Loss Law Patient’s Right and Compensation for the Loss Law Donor Organ and Transplant Law Donor Organ and Transplant Law Mental Health Care Law Mental Health Care Law Biomedical Research Ethics Law Biomedical Research Ethics Law Policies and bills signed by the health care minister Policies and bills signed by the health care minister

Patients’ Rights to Privacy in Lithuania Results according to the study “Human Rights in Lithuania 2001”: The right to privacy is considered as one of the urgent problems in Lithuania (1.9 % ) The right to privacy is considered as one of the urgent problems in Lithuania (1.9 % ) Safety of the right to privacy is “very good” (2.4% ) Safety of the right to privacy is “very good” (2.4% ) Rights to privacy were violated in the past year (2.7 %) Rights to privacy were violated in the past year (2.7 %) A lack of available information about human rights and their protection (61.6 %) A lack of available information about human rights and their protection (61.6 %)

Problems to Privacy in Health Care System Patients are not aware about their rights to privacy Patients are not aware about their rights to privacy Clinical staff do not follow the Hypocrite Oath Clinical staff do not follow the Hypocrite Oath The assumption of privacy depends on social norms, established models and practices The assumption of privacy depends on social norms, established models and practices The privacy laws sometimes are dysfunctional The privacy laws sometimes are dysfunctional The clinical staff are not well-protected by the insurance coverage The clinical staff are not well-protected by the insurance coverage

The Research Study in Kaunas 2 nd Clinical Hospital 2005 Goal : to identify the attitude towards privacy Method : anonymous questionnaires with multiple answers Questionnaires responded : A. patients (210) A. patients (210) B. clinical staff (210) B. clinical staff (210) Distributions in the following departments : ob/gyn, infectious communicable diseases, sexually transmitted diseases, internal diseases

Results (cont’ed)

Results of the Study (Cont’ed) Confidential information should be disclosed: Confidential information should be disclosed: - By a health care provider (patients 55.8 % ); by a nurse (patients 23.5 % ) - By the chief of the department (62.4 % patients) The information about the inpatient stay can be provided via phone: The information about the inpatient stay can be provided via phone: staff 19.8 % patients 29 % staff 19.8 % patients 29 % The information used for the education purposes is not confidential and can be used with the patient’s verbal agreement The information used for the education purposes is not confidential and can be used with the patient’s verbal agreement

In Summary Lack of available information Lack of available information In health car reform quality and access to health care are prioritized In health car reform quality and access to health care are prioritized The right to privacy is new in Lithuania – misinterpreted and unidentified The right to privacy is new in Lithuania – misinterpreted and unidentified Laws do not always reflect patients’ and medical personnel’ view about privacy Laws do not always reflect patients’ and medical personnel’ view about privacy

Possible Solutions Patient education in an understandable manner (Attractive brochures, advertising stands and other educational materials) Patient education in an understandable manner (Attractive brochures, advertising stands and other educational materials) The internal hospital policies should reflect the principles of the patients’ rights to privacy The internal hospital policies should reflect the principles of the patients’ rights to privacy Before implementing a new regulation, the government should evaluate the realistic practices Before implementing a new regulation, the government should evaluate the realistic practices Unified forms for disclosing private information Unified forms for disclosing private information are necessary are necessary

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