Confidentiality in a multidisciplinary team is still very important as in a one on one doctor patient relationship. The sharing of the information should be limited to the other members of the team and  only for the benefit of the patient. In todays world, the medical insurance seems to have become part of the team. Is it beneficial to the patient? If not beneficial to the patient why should they not seek consent to access information from the patient. The Medical Insurance have become very strong because they hold the purse. They can tell the patient the funds are not available etc, so the relationship is skewed.

A very good question indeed.

Apart from the challenges to maintain confidentiality in health information, there are other challenges. One big challenge is the difficulty in integrating medical records of different service providers to maintain continuity of patient records. Furthermore, within health care services, a lot of the time , electronic record maintenance can lead to problems such as duplication of records and inefficient management of databases such that it becomes difficult to have clean data at finger tips necessary for health care provision. Maintenance of Unique Medical Record Number (UMRN) or similar for each patient record is crucial but may often be overlooked. Retention of records and proper storage of hardcopy of medical records is another common problem faced by many health care institutions. It really depends on the institution, health system and the country as there are many variations.

Hi All…

Excellent question…this falls within the envelope of Medical Informatics which I personally feel needs to be more explored and a fertile area of research.

The field of Medical informatics holds so much promise for Healthcare. Imagine being able to predict future instances/behaviours of disease, viruses, epidemics and patient health etc etc all based on past and current medical data. It is mind-blowing and exciting for both healthcare and the world.

Relating to your current questions, Yes, confidentiality remains a key ethical principle in Healthcare. However, Information Systems these days cater for expert security and ‘identity management’. So that shouldn’t really be an issue…..Relating to the Hippocratic Oath and other confidentiality protocols, healthcare professionals need to realise that there is a vast difference between ‘intentional breach of confidentiality’ and ‘unintentional breach of confidentiality”…

Let me explain…intentional breach means that information is poorly stored and accessible to anyone etc who operates the Medical Information System on a daily basis…this can therefore be leaked…in this instance security measure are pivotal which current Information systems can provide………….

Unintentional breach means that a ‘hacker’ or ‘bribed database admin’ etc got hold of the information. This is beyond anyone’s control. Furthermore, this can happen in instances where Information Systems are not even used.. eg. Anybody can break into a doctor’s office and break open the filling cabinet and steal/view records. Information Systems provides far greater security and recovery. Furthermore, records can never get lost.

I therefore think the Healthcare system, per country’ needs to re-evaluate their protocols and strategies….Information systems are made up of both PEOPLE and TECHNOLOGY….in regard to your question, it’s the PEOPLE aspect that needs to be looked at.

Particularly in our case, Malawi. I find that one of the main concern is lack of skill and motivation of the operational health staff to collect and feed the systems with the data appropriately. This in turn leads to senior management not having enough data to make their decisions on. This of course could be a problem at senior levels as I have a doubt  on the abilities of senior managers in querying the database enough to get deep knowledge the data may have. 

Security of medical information and avoidance of unauthorized data access - due to proposed their cloud computing. E.g. personal and medical data sets of Polish patients shouldn't be acquired, stored, and processed abroad. Cause: not only national safety of soldiers and government/parliament members data sets, but possible unauthorized access of e.g. insurance companies, headhunters, shops, banks to our personal data. Is there possible for bank to regret credit based on genetic profile of the client showing increased risk of cancer?

This is a very important question and it is not well handled or understood at the practical health service level. There are many guidelines and differing legislation that trip to define the societal values regarding secondary use of health information.

That, ie secondary use, is usually what we are talking about wrt confidentiality, as it is normally accepted that sharing amongst a health care team is purely to support the best patient care. As you state, the societal benefits to be gained from sharing and aggregating and analysing health data are potentially immense, but there are many barriers and confidentiality is just one.

Integration of siloed systems is another important barrier as mentioned above. Although the technology to effect integration exists and has been well adopted outside health, the complexity of health data and the health system takes health care data integration to another level. The flexibility required in health due to rapid changes in models of care and health technologies is also difficult to accommodate in traditional enterprise integration systems.

Another critical problem is the political wrangle that results from attempts to share data. This is because custodians and service directors recognise the power of information and there is an inherent reticence to potentially give others control, especially if the  culture is competitive rather than collaborative.

Then there is the skills shortage in data sciences at the health service level, which is required to facilitate the sharing and use of information to support  quality improvement, service management decision making and research to identify best treatment options.

A simple tool to help service level custodians was the topic of a workshop presentation that might be of interest here https://www.researchgate.net/publication/263849488_Governance_ofClinical_Information_Access_Confidentiality_and_Secondary_use_A_Practical_Framework_for_Clinical_Services

Conference Paper Governance of�Clinical Information Access, �Confidentiality ...

Susan,

I totally share your view that at a very practical health service level, practitioners grapple with this pertinent issue.

Healthcare remains complex with often diverse and disparate stakeholders that strong affiliations and professional accountability--that is remote to their immediate practice space. Further, information has become a kind of subaudition of status and control within the hierarchy in health services.

Thank you for sharing your publication.

Anayo,

I read your paper with interest and I fully endorse your statement above that "information has become a kind of subaudition of status and control within the hierarchy in health services.". Unfortunately I have experienced this to be a major stumbling block in realising the potential of clinical data and information systems to improve care and improve health system quality. Have you seen much research on this in the medical (or other) literature? I would be grateful for any relevant references you could suggest - many thanks...

Susan,

Apologies for the belated response.

Unfortunately, I am yet to come across a research that looks at the issue specifically; although clinicians encounter this obstacle on a fairly regular basis, which you alluded in your post. Silo-working continues to be a major problem in health services.

I suppose internal politicisation of information sharing and management which impacts optimal care is a subject worth exploring--as part of a research collaborative effort. I welcome your thoughts.

I imagine such research would require a survey structure to elicit perceptions from clinicians regarding exchange of information. We did something like that on a very small scale in the paper looking at integration of clinical data, although this was in regard to secondary use of database stored clinical data, rather than sharing of information firsthand for rather than immediate clinical patient care (https://www.researchgate.net/publication/229152400_Investigation_of_decision_making_issues_in_the_use_of_current_clinical_information_systems) . I would think there might be quite a difference between primary use of clinical data and secondary uses, although I would hypothesise that the holder of information could still use that to shift power in a clinical team, as this effect has been documented in the management literature on teamwork.

Article Investigation of decision making issues in the use of curren...

Here is a post that may also be of interest in regard to the politicisation of data; it mentions many conundrums surrounding data democratisation, may of these can be addressed by good Information Governance processes, but this is still not a common occurrence in the clinical environment from my observations.

http://lawrenceserewicz.wordpress.com/2011/09/21/the-dark-side-of-open-data-politicized-data/

http://lawrenceserewicz.wordpress.com/2011/09/21/the-dark-side-of-open-data-politicized-data/