Issues in the accessibility and confidentiality of patient records

Abstract

Traditional understandings of confidentiality are no longer sufficient to deal with the privacy issues raised by a modern health care system. Patient data are increasingly kept by large and relatively faceless institutions. Disclosure of health information is not an exception, but a matter of daily routine, not only for uses within the health care system itself, but also for various social purposes. This paper highlights a number of issues, related to these structural changes. A distinction is made between four main problem areas: basic issues, collection and keeping of data, patient access to records, disclosure of individually identifiable data. Under each heading, four issues are discussed.

KIE: Traditional guidelines regarding the fiduciary relationship between physician and patient are inadequate in a modern health care system. Today both the collection and the disclosure of health information are frequently being carried out by large institutions rather than by individual physicians. Four main problem areas resulting from this change are highlighted, and specific issues within each area are discussed. The problem areas are: (1) basic issues in the accessibility and confidentiality of patient records, (2) the collection and handling of data, (3) patient access to records, and (4) disclosure of patient data.