Disclosing Health Information Part II

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Disclosing Health Information Part II

• Disclosing Without Consent

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You May Disclose Without Consent (Learn these)

• To other custodians for authorized uses
• Some of these authorized uses of health
  information include more to follow later
• Providing health services
• Determining eligibility to receive a health
  service
• Providing health service provider education
• Conducting research

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Disclosing to Custodians for Authorized Uses
Without Consent

• Example A rheumatololgists office calls a
  dermatologists office to request health
  information on a patient being treated for
  scleroderma. The dermatologist was not aware
  that the patient was going to see a
  rheumatologist.
• Does the dermatologist require the patients
  consent prior to sending the requested health
  information to the rheumatologist?

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Disclosing to Custodians for Authorized Uses
Without Consent

• No. Under the Health Information Act, the consent
  of the patient is not required to send his or her
  health information to another custodian for an
  authorized use in this case the authorized use
  is providing a health service.
• The dermatologist may send the information to the
  rheumatologist without consent from the patient,
  if he or she is comfortable doing so (the
  dermatologist is not obligated under the Act to
  disclose)

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You May Disclose to Other Custodians for
Authorized Uses Without the Consent of the
Patient

• However, the dermatologist may choose to have a
  policy that requires patient consent before such
  a disclosure, or that the patient be notified
  when such a disclosure is made, but the HIA does
  not require this.

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You May Disclose to Other Custodians for
Authorized Uses Without the Consent of the
Patient

• If the dermatologist is not familiar with the
  physician, or not comfortable with a verbal
  request from the physicians office, he or she
  could ask for the request to be sent in writing
  on clinic letterhead.

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You May Disclose Without Consent

• To other custodians for authorized uses
• Authorized uses of health information (contd)
• Carrying out any purpose authorized by an
  enactment of Alberta or Canada
• For internal management purposes, including
  quality improvement, billing, etc.
• Conducting investigations, discipline proceedings
  relating to the members of a health profession or
  health discipline

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You May Disclose Without Consent

• You may disclose without consent to a person
  responsible for providing continuing treatment
  and care to the patient
• Example You could provide health information to
  a family member who will be caring for the
  patient at home, or a home care nurse. (It is
  ideal to obtain consent of the patient first, if
  possible.)

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You May Disclose Without Consent to Those
Providing Continuing Care

• You could also disclose without consent to a
  physiotherapist that the patient will be seeing
  as part of their ongoing treatment.

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You May Disclose Without Consent to Those
Providing Continuing Care

• Note that if the physiotherapist is paid by
  Alberta Healthcare (partly or fully, directly or
  indirectly), he or she would also be considered a
  custodian. He or she would also be using the
  information for an authorized use (providing a
  health service), so in this case, for two
  reasons, consent would not be required.

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You May Disclose Without Consent

• You may disclose without consent general
  information to family members or those believed
  to have a close personal relationship with the
  patient, on the location, presence, condition,
  diagnosis, prognosis, progress of the individual
  on the day on which the disclosure is made, if it
  is not against the express wishes of the
  individual.

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How are We Supposed to Know the Express Wishes of
the Patient?

• You are not legally required to ask every patient
  about whether they particularly do not want
  certain people to be informed about their
  condition.
• However, use common sense, particularly in the
  case of divorce, or health conditions of a
  particularly sensitive nature. Try to clarify
  with the patient before disclosing.

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Disclosing to Family or Friends

• You should be making a reasonable effort to
  verify the identity of those requesting
  information on family members, and a reasonable
  effort to verify their relationship with the
  patient.
• Reasonable Fair, proper, just, moderate,
  suitable under the circumstances. Fit and
  appropriate to the end in view

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Disclosing to Family or Friends

• One way is to ask for ID, or ask them questions
  about the patient that only family members or
  those close to the patient, would know. Make a
  notation of steps taken to verify
  identity/relationship.
• Check with the patient first if possible.
• Be especially careful with patients who are well
  known in the community.

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Disclosing General Information to Family or
Friends

• It is a judgement call as to whether it is
  appropriate to disclose to those with a close
  personal relationship with a patient.
• Note that the Health Information Act itself never
  obligates you to disclose health information.

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Duty to Protect Health Information

• There was a case in Calgary in which a member of
  the press phoned a hospital and pretended to be a
  patients brother, and subsequently published
  general information on the status of the patient.
  Remember, you have a duty to protect health
  information.
• You are required to make a reasonable effort to
  confirm you are disclosing to the correct
  individual. (Check with the patient first if
  possible.)

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Duty to Protect Health Information

• Remember, only those who are involved in the care
  of a patient should have access to that patients
  health information.

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Duty to Protect Health Information

• This also means that staff should not be looking
  up information on their family, friends or other
  people they know unless it is directly related to
  their work duties.

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Duty to Protect Health Information

• Staff and medical residents in Toronto were
  disciplined in 2002 for accessing information on
  Brian Mulroney and Pat Quinn (coach of the
  Toronto Maple Leafs) when they were in hospital.
  Those who were disciplined were not involved with
  the care of these individuals.

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Mature Minors

• Parents do not always have an automatic right to
  the health information regarding their children,
  unless the child is too young to understand.

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Mature Minor

• Someone who is under 18 but understands the
  nature of a right or power, and the consequences
  of exercising that right or power, would be
  considered a mature minor under the Act.

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Mature Minors

• If a patient is a mature minor, and you have any
  reason to believe they do not want their health
  information disclosed to their family, or it is
  of a particularly sensitive nature, ask them.
• Make a notation in the chart if this is the case,
  and make sure all staff are aware of the
  patients wishes.

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You May Disclose Without Consent

• To police investigating a life-threatening injury
  to the patient if it is not against the express
  wishes of the patient
• Example If a patient has been shot, the injury
  is life-threatening, and the patient does not
  object to having health information disclosed to
  the police, then the custodian may disclose.
• But

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Disclosing to Police to Investigate a
Life-Threatening Injury If not against express
wishes of patient

• What if the patient is unconscious and does not
  have the opportunity to express their wishes
  regarding a disclosure?

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Disclosing to Police to Investigate a
Life-Threatening Injury If not against express
wishes of patient

• As long as the injury is life-threatening, the
  information may be disclosed to the police to
  investigate that injury if the patient is
  unconscious or otherwise unable to express their
  wishes. If you are in
  any doubt, you do not have to
  disclose under HIA, however.
  
  

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Disclosing to Police to Investigate a
Life-Threatening Injury If not against express
wishes of patient

• However, should the police provide you with a
  warrant to provide information on the patient,
  the HIA would allow you to disclose in order to
  comply with another enactment of Alberta or
  Canada.

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You May Disclose Without Consent

• To any person to avert or minimize imminent
  danger to the health or safety of any person
• Example If you have a patient who drives a bus
  for a living, and feel he is beginning to
  experience early signs of Alzheimers disease and
  should not be driving, what should you do?

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Disclosing to avert or minimize a danger to
health or safety of someone

• You need to evaluate whether the danger to the
  patient, or the public, is imminent. If it is,
  then you may notify whoever would avert or
  minimize the danger, such as the Motor Vehicles
  Division, the patients employer, or the police.

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You May Disclose Without Consent

• To comply with a subpoena, warrant, or court
  order
• Only disclose what the warrant, court order or
  subpeona requires you to disclose. If it is an
  arrest warrant, that does not authorize you to
  disclose health information.

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You May Disclose Without Consent

• To comply with another enactment of Alberta or
  Canada.
• Example Legislation such as the Child
  Protection Act prevails, and you are still
  obligated under this legislation (not HIA) to
  notify authorities of any suspected child abuse
  or neglect.

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You May Disclose Without Consent

• The Public Health Act requires disclosure
  regarding people with notifiable infectious
  diseases.
• The HIA allows for such disclosures.

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Quiz

• Some patients receive vouchers for transportation
  from rural Alberta into Edmonton for medical
  visits. The agency which provides the vouchers
  calls the doctors office to confirm that they
  have attended their appointment.
• Can the doctors office state whether or not the
  patient attended his or her appointment without
  the patients permission?

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Quiz - Answer

• No, the patient must give their written consent
  before the doctors office can disclose whether
  or not the patient attended their appointment
  (this is individually identifying health
  information).
• The agency should have the patients sign a
  consent form stating they consent to have the
  doctors office confirm with the agency if they
  attended their appointments when the patients are
  provided with the vouchers.

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Disclosing

• You can move onto the third set of slides on
  Disclosing Health Information