Privacy, Dignity, Respect

“Privacy is not only a means to an end. It is an independent good that individuals use to maintain control over their personal lives. In the case of health care, though, privacy is very much a means to improving medical outcomes. People who know they can trust the health care system are more likely to seek full treatment. In this way, privacy has concrete benefits for each individual, and for society as a whole.” – Privacilla.com

Patient privacy is commonly defined as the right of patients to determine when, how and to what extent their health information is shared with others. It involves maintaining confidentiality and sharing identifying data, only with healthcare providers and related professionals who need it in order to care for the patient. This identifying data is known as protected health information (PHI).

Privacilla,  a web- based project which aims to bring forward the concept of “privacy” as a public policy issue expounds on my sentiments best. According to them, doctors make the best decisions about treatment if they have access to all relevant information in their patients’ medical histories. However, some illnesses may have some stigma attached to them. Because of this, patients may avoid treatment if they are not confident that whatever they say, whatever examinations that will be done as well as its results will remain private. This being so, patients who seek consult may withhold important information out of concern for their privacy. This may prevent patients from receiving full and appropriate treatment.

The driving question asks us, “What policies are in place to protect the Filipino patient’s privacy and confidentiality of health information?”

 

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Our big medical centers who have been evaluated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have policies and systems in place. JCAHO is an independent, not-for-profit organization, which accredits and certifies health care organizations and programs in the United States as well as in other countries. JCAHO accreditation is recognized as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. Once JCAHO surveyors evaluate an organization, they expect its staff to know the organization’s mission, the organization’s policies for protecting confidentiality, what efforts each department is making to improve patient privacy and confidentiality, and how each area’s function relates to all of these.

Even our PhilHealth covers patient privacy in several portions of their Benchmark Manual for hospital accreditation. I was able to obtain hospital policies which included the following: a policy on records keeping and management, a policy regarding access to medical records, a policy on borrowing of medical records by physicians and representatives, a policy on medical records confidentiality, as well as a policy on confidentiality of records used for quality improvement. With these policies, hospital staff know who can have access to patient information, the security measures needed for handling patient health information, the limits of quality improvement measures regarding use of patient data as well as the proper procedures for destroying patient health information.

In most hospitals, these policies are in place. However, implementation is another thing altogether. The reading material provided for this assignment provides a stark picture of the reality in Philippine hospitals. The Cebu case was a sad reflection of how far hospital personnel stray from their mission of health care. Even a president of the country is not spared from the prying and intruding eyes of media caused by an unnecessary disclosure of her past medical treatments . The rise of social media offers a challenge to the issue of patient privacy.

From all these, we, as healthcare professionals should remember:

  • Carefully handle patients’ health information to protect their privacy
  • Decide what personal health information can be shared with others
  • Decide how that information can be shared, and with whom it may be shared
  • Not have information about patients discussed in areas where others could overhear
  • Not post personal information nor medical treatments of patients online
  • Carefully handle patients’ health information to protect their privacy
  • Keep the information in patients’ individual records as accurate as possible
  • Recognize that privacy also refers to the right to have physical privacy (eg. curtains closed)

Patient confidentiality and privacy are important aspects of the healthcare industry. Our patients trust us. It is only right that we maintain their trust by maintaining their right to privacy. More than patient privacy though, we should recognize our patients as persons who deserve to get the treatment they need in an environment which fosters dignity and respect.

Reference:
1. The importance of medical privacy. Article. Privacilla webpage. Accessed thru: http://privacilla.org/business/medical/medicalimportance.html
2. Joint Commission on Accreditation of Healthcare Organizations. JCAHO website. Accessed thru: http://www.jointcommission.org/
3. Antonio, Marcelo. Health Information Privacy in the Philippines. Accessed thru: http://aehin.hingx.org/Share/Details/2044

Building the foundation for sustainability

In my previous blog, I talked of people, the economy, technology and structures. I think those same factors address the problem of sustainability of a health information system in a developing country such as the Phillipines.

Sustainability

“What are the challenges of sustainability for health information in developing countries?”

Sustainability of a health information system in the country faces several challenges. Change from the status quo is difficult for most people, this is so with leaders who are reluctant to embrace new ideas, new technology as well as end users who are resistant to anything that alters their daily routine.  More people who are trained in IT are needed to diffuse their knowledge to more people as well as augment the meager IT workforce in health informatics that we presently have. The  problem could be further compounded by the “brain drain” which may happen with ASEAN integration.

The economy of the Philippines has been on the upswing for several years and this bodes well for the IT industry and health information services in particular. This provides a better environment for new technologies to prosper and enables more opportunities for the gains of this growth to trickle down to branches of government, businesses and eventually to ordinary people. At present, only 4 percent of GDP is allocated to health care. Since the Department of Health is spearheading the move for a unified health information system for the country, more sources of funding would be needed. An assessment of the current state of the various health information systems, noted to be fragmented, has already been done and moves have been initiated to improve on its capabilities.

In order to sustain the shift towards a unified health information system for the country, a solid foundation must be built. This can only happen if we have a single road map to track to, a single blue print to follow which eHealth governance for IT espouses. All capacity building that ensues must look to this blueprint for strategic alignment, IT value delivery as well as resource and performance management. We must also have leaders who are enablers working with vision, passion and commitment. However, it should not be only one group or one department of government working for this goal, it should be all the stakeholders in the health and IT industry. Multiple sectors must be involved and have a claim to ownership of this blueprint for sustainability. Widespread acceptance ensures alignment with strategy, a consensus of IT processes needed, the steps necessary for its implementation and desired outcome.

Reference:

1. Kimaro HC & Nhampossa JL. The challenges of sustainability of health information systems in developing countries: comparative case studies of Mozambique and Tanzania. J Health Informatics in Developing Countries 2007;1(1):1-10 http://www.jhidc.org/index.php/jhidc/article/viewFile/6/34