PRIVACY IN HEALTH CARE SYSTEM: PROBLEMS AND POSSIBLE SOLUTIONS

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

2. 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”.

3. What is “Personal Health Information”? • Personal Health Information is an object of an individual right to privacy • Information concerning the physical or mental health of 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

4. The Specific Nature of Personal Health Information • Confidentiality is central to the trust between doctor and patient • 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) • Information remains confidential after death

5. How Information Could be Disclosed ? • Access to information by a signed request • Emergency cases where information about patients is shared • 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

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

7. The Laws Regulating The Right to Privacy in Lithuania • European Convention on Human Rights and Fundamental Freedom • 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 Individual’s Personal and Secured Information Law • Penal Code and others (2 new chapters)

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

9. 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 % ) • Safety of the right to privacy is “very good” (2.4% ) • Rights to privacy were violated in the past year (2.7 %) • A lack of available information about human rights and their protection (61.6 %)

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

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

12. Results (cont’ed)

13. Results of the Study (Cont’ed) • 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: 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

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

15. Possible Solutions • 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 • Before implementing a new regulation, the government should evaluate the realistic practices • Unified forms for disclosing private information are necessary

16. What other suggestions would you recommend?

17. THANK YOU