As a new member of the Institutional Policy Review Team, you are seeking information about institutional, professional, and personal ethical standards and dilemmas with respect to privacy of medical information, professional and personal ethical standards of Law and Tort Liability.
Please response to the following questions:
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My understanding of this question is that it is asking for information with respect to privacy of medical information, in terms of institutional, professional, and personal ethical standards and dilemmas (e.g. the three specific questions below) and professional and personal ethical standards of Law and Tort Liability. It is less clear, though, if the second tort liability
question is referring to all malpractice suits or only those related to privacy of medical records.
First, let's look at the threats and protections (ethical and legal) to medical record privacy with respect to medical information and then apply the information to the three questions.
Threats to Medical Record Privacy
· Administrative Actions. This includes errors that release, misclassify or lose information. This includes compromised accuracy, misuse by legitimate users, and uncontrolled access.
· Computerization. While in some situations computerization increases privacy protection (for example, by adding passwords to sensitive areas), it may also decrease privacy protection for the following reasons.
o Computerization enables storage of large amounts of data in small spaces. Thus when an intruder gains access, it is access not just to certain discrete amount of data, but to larger collections, and perhaps keys to even further information.
o Networked information is accessible from anywhere at any time, allowing a larger number of people access. This increases the possibility of mistakes or other problems such as misuse or leaks of data.
o New databases and different types of data sets are more easily created. This both drives demand for new information and makes possible its creation.
o Information is easily gathered, exchanged and transmitted. Thus potential dissemination theoretically limitless.
· Access by unrelated parties.
o Insurance companies. They may either check records before approving treatment or who may check records before extending coverage.
o Drug companies. These companies may have deals with doctors and hospitals, and who may use the list for marketing. (Consumer Reports)
For example, PCN (Physician's Computer Network) has access to the patient records of 41,000 doctors, which is about 10% of office-based doctors in the United States. By participating in the PCN, a doctor requires a doctor to view promotions from drug manufactures. In addition, PCN reserves the right to copy information from the computer to is won and to sell if to other companies. Of course, this can only be aggregate data, but may include ages, diagnoses, treatments, and prescriptions.
Most policies that consumers fill out have an authorizations to release information to the insurance company. Most insurance policies sold in the U.S. and Canada also give notice that a report may be filed with the Medical Information Bureau (MIB), which is financed and run by the insurance industry to detect fraudulent applications. Of course, not everyone is included in the MIB database.
· Court subpoenas. Often a patient will be unaware when her or his records have been subpoenaed. Even worse, unnecessary information is often included when the records are not adequately screened.
Legislative Risks to Medical Record Privacy
· A national medical records data bank without adequate privacy safeguards.
E.g. Medical ID cards: These are problematic because of the backup databank necessary. They may also be a first step toward a national ID card. (Source: http://epic.org/privacy/consumer/med_record.html).
o The privacy portion of the Hippocratic Oath: "Whatsoever I shall see or hear in the course of my intercourse with men, if it be what should not be published abroad, I will never ...
Referring to health care legal liability issues, this solution discusses malpractice law suites against hospitals and physician, as well as the laws of tort liability and malpractice suits against physicians under Medicare and Medicaid.