Data Protection & Confidentiality Flashcards
What is the consequentialist argument for maintaining confidentiality?
- Impact on patient (e.g. breach may upset them, affect trust + make them less likely to share info in future)
- Impact on others generally (e.g. loss of public trust so less effective care for many)
- Impact on specific others (e.g. harm of non-disclosure)
What other reasons are there to maintain confidentiality?
- Respect for autonomy: self-determination includes determining how info about oneself is used, how or whether its shared
- Virtue ethics: promise-keeping + trustworthiness are virtues
- Other duties: duty of care (data shared within healthcare team but not beyond) + patient-dr relationship
We must make sure any personal information that we hold or control is effectively protected at all times against 3 things, what are they?
- Improper access
- Disclosure
- Loss
When can you share a information about a patient’s care?
CONSENT (implied or explicit)
When is implied consent be sufficient?
- Data being accessed to support a patient’s direct care
- Info available to patients about how data will be used + how they can object
- No reason to believe they would object
- Satisfied that anyone you disclose info to will understand it is given to them in confidence, treating it accordingly
When should you seek explicit consent before sharing a patients information?
If you suspect a patient would be surprised to learn about how you are accessing or disclosing their personal information
What are some examples of uses of information not directly relevant to a person’s medical care when you should seek consent?
Research Certain types of audit (e.g. financial or local clinical) Public health Education Health service planning
When can you disclose personal information for secondary purposes without gaining consent?
- Required by law
- Approved through a statutory process that sets aside common law of confidentiality
- Justified in public interest
- Not appropriate/practicable to obtain consent
BUT consent should always be sought where possible
____ information will normally be sufficient for secondary purposes.
Anonymised - only disclose identifiable info if there is a legal basis for breaching confidentiality
When is data considered anonymised?
- Does not directly identify any individual
2. Unlikely to allow any individual to be identified through combination with other data
What must be considered when anonymising information?
Different types of data will have different levels of re-identification risk e.g. small vs large dataset - bare in mind context and who you are showing data too
What is pseudonymised data?
There will be a way of linking the data back to original records using a unique patient identifier - data management and de-identification process by which personally identifiable info fields within a data record are replaced by 1 or more artificial identifiers (pseudonyms) i.e. CODED info
What can you do as a researcher to avoid breaching confidentiality?
Get patients to contact you directly so they volunteer their information voluntarily - cannot then tell clinician who has agreed to be involved in trial w/o consent
When deciding whether the public interest in disclosing information outweighs patient’s and public interest in keep it confidential, you must consider:
- Potential harm/distress to patient arising from disclosure
- Potential harm to trust in Drs generally
- Potential harm to others if info is not disclosed
- Potential benefits to individual/society arising from info disclosure
- Nature of info to be disclosed + views expressed by patient
- Whether harms can be avoided or benefits gained w/o breaching patient’s privacy or with min intrusion
Who has to approve the disclosure of identifiable information in research cases?
Research Ethics Committee (REC)
Give a few examples of notifiable diseases that must be disclosed.
Acute meningitis Anthrax Botulism Cholera Food poisoning Malaria Plague Rabies TB Whooping cough
Who should report notifiable diseases and to who?
- Duty microbiology to hospital infection control
- Diagnosing clinician to local health protection team, then to PHE via a form (notify urgent cases by phone within 24hrs)
Why do notifiable diseases have to be disclosed?
- Legislation - Public Heath (Infectious Diseases) Act 1988
2. PHE regulations - Health Protections Regulations (2010)
What does the GMC guidance state are the secondary purposes for disclosing patient information?
- Report concerns about patients to DVLA/DVA
- Records for financial/administrative purposes
- Report gunshot/knife wounds
- Info about serious communicable diseases
- Info for insurance, employment + similar purposes
- Info for education + training purposes
- Respond to criticism in press
What is the General Data Protection Regulation (GDPR)?
Data protection framework that applies in all EU member states described as most important change in data privacy regulation in 20 years - GMC guidance on confidentiality now been updated to reflect it
What 2 laws should generally be considered together?
- The new Data Protection Act (2018) that was enacted to supplement some sections of the GDPR
- GDPR itself
What are the 6 key principles of the General Data Protection Regulation (GDPR)?
Data must be:
- Processed fairly, lawfully + in a transparent manner in relation to data subject
- Collected for specified, explicit + legitimate purposes + not further processed for other purposes that are incompatible
- Adequate, relevant + limited to what is necessary in relation to purpose of data processing
- Accurate + kept up to data
- Kept in form that permits ID of data subjects for no longer than necessary for purpose
- Processed in way that ensures appropriate security of data including protection against unauthorised/unlawful processing + against accidental loss, destruction or damage using technical/organisational measures
How can health records be accessed?
- GDPR: allows access for all living individuals - NHS trusts have 1 month to respond to request
- Access to Health Records Act 1990: allows access to health records of deceased people
Who may access health records?
- Patients
- Person with parental responsibility of child (if not contrary to competent child’s wishes)
- Power of attorney if patient lacks capacity
- Executor of will/dependents for deceased patient’s records
- IMHAs or IMCAs
- Police by court order
- Solicitors with data subjects consent
Does a request to access health records have to be granted?
No
When should access to health records be declined?
- When access is likely to cause serious harm to physical/mental health or condition of data subject or any other person
- When data would reveal identity of another person (does not apply to health professionals involved in care of data subject unless disclosure would cause THEM serious harm)
What policy must be follow as Warwick Medical School students?
- Be aware of obligations with regard to University policy on data protection + corresponding policies in NHS trusts they are working in
- We owe duty of confidence to patients too
- Follow protecting patient sensitive info on Moodle or Community handbook