Challenges of Privacy and Confidentiality of Health Information

This report delves into the critical issues of privacy and confidentiality of health information, particularly within the Canadian healthcare system. It examines the evolution of medical records from paper-based systems to electronic health records, highlighting the benefits and challenges that nurses and healthcare professionals face. The report defines privacy and confidentiality, emphasizing their importance in fostering trust and ensuring effective patient care. It explores the impact of technological advancements, such as mobile health applications and social media, on maintaining patient data security. The discussion includes the ethical considerations, challenges, and implications for nurses, with recommendations for improving information technology safety and protecting patient data. The report also addresses the legal and ethical responsibilities of healthcare providers and the importance of patient consent in information sharing.

Running head: PRIVACY AND CONFIDENTIALITY OF HEALTH INFORMATION
Privacy and Confidentiality of Health Information
Name of the Student:
Name of the University;
Author note:

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Table of Contents
Introduction................................................................................................................................2
Background................................................................................................................................3
Definition and Scope..................................................................................................................4
Benefits and Challenges for the nurses......................................................................................5
Impact and Implications on the nurses.......................................................................................8
Recommendations......................................................................................................................8
Conclusion..................................................................................................................................9
References:...............................................................................................................................11

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Introduction
With the advancement of science and technology, the rapid spread of mobile health
applications, the increased usage of electronic medical records and the ever increasing usage
of social media within the heath care community have all created unique challenges in the
process of maintaining a duty of privacy and confidentiality of health information within the
patient-physician relationship. This further creates a place to raise a question on the medical
professionalism (Sulmasy et al., 2017). However, according to the proponents of
technological advancement in medical care, technology has improved health care practice and
has improved medical privacy and confidentiality of the patients that ever before (Kvedar,
Coye & Everett, 2014). The opponents on the other hand are of the view that although the
notion of confidentiality and privacy of the personal medical records and data are well
accepted by the patients or the general public as well as by the health professionals, detailed
practice is under potentially serious attack by the governments, which want access for
combatting the serous and fraud crimes or for improving their services’ efficiency (Wang et
al., 2017). According to many researchers, the challenges related to privacy and
confidentiality is likely to increase in the near futures with the improvement and increased
usage of online technologies. However, it is to mention that Canada is in its early stage of
managing the increasing issues of technology induced errors, which compromise the
confidentiality and privacy in the health care setting. This paper shall elaborate on presenting
a discussion paper on confidentiality and privacy of health related information and data and
its special focus would be on the Canadian health care system.
Background
In the past years, medical records were just some bunch of paper repository of data
and information, which was reviewed and used for financial, administrative, clinical and

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research purposes. Those medical records were significantly limited in terms of availability
and accessibility as they were available to only one user at a time (Springate et al., 2014).
With the same, it is also to note that those paper-based medical records were only updated
manually and therefore, there used to be delay in the process of record completing, which
used to last for four to five months or even more. Majority of the departments that kept
medical records were housed in the basements of the institutions as the weight of the papers
precluded the other locations. It was the physicians who were responsible for the
documentation and authorisation of the information and patients rarely used to see their
medical records (Alanazi et al., 2015). The other limitation of such medical records was that
they used to lack in security as their accessibility was only controlled by the doors,
identification cards and locks. Any kind of unauthorised usage to that information triggered
no such alerts and also, the fact that somebody has viewed that information was not known in
any way.
Today, with the advancement in technology, documentation processes have changed,
although their primary purpose has remained the same- supporting patient care. In modern
world, the clinical documents are scanned through electronic system immediately and are
completed within the day patients are discharged. The paper based medical records have
changed into electronic ones and became more interactive than ever before (Springate et al.,
2014). Today, there are many users, reviewers and stakeholders of the documentation and as
the government is significantly involved in the process, agencies today actively the
documentation of care. However, it is to mention that although the medical records belong to
the doctors or the health care facility, it is actually the information of the patients. According
to Ozair et al. (2015), health record refers to “not just a collection of data that you are
guarding—it’s a life”. There are a total of three main ethical priorities for the electronic

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health records and they are- data integrity and availability, security and finally, privacy and
confidentiality.
Definition and Scope
It is to mention that privacy and confidentiality is an overlapping, but not identical
principles. These two are essential to the relationship between patients and physicians as they
not only foster the sense of trust, but at the same time, also deliver an effective and long
lasting care. Both the terms are defined differently by different people. Ohlhausen and
Okuliar (2015) in their research study have defined privacy as “the right “to be let alone”.
According to Waldman (2014), it is “the right of individuals to keep information about
themselves from being disclosed to others; the claim of individuals to be let alone, from
surveillance or interference from other individuals, organizations or the government”. It is to
mention that the data and information that are shared as an outcome of clinical relationship is
regarded as confidential and they should be protected. These information or data can take
many different forms including progress notes, diagnoses, laboratory results, identification
data and treatment provided. They can be stored in many media like electronic files, paper,
video etc. However, in this context, it is to mention that the information from which the
patient’s identity cannot be ascertained, for instance, the number of patients suffering from
breast cancers in a particular hospital, do not fall under this category. According to Ozair et
al. (2015), the information about patients should be released to others only with the patient’s
consent or if allowed by the law. Also, this information can only be released to the physicians
for treatment or any other administrative purposes without the authorization of the patient.
With the same, it is to note that every patient has the legal, federal and state rights to see,
obtain a copy of and amend that information in his or her medical record.

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It is to note that privacy protection is a critical issue for the Canadians. Research
studies demonstrate that many of the Canadian patients even withhold their serious health
related information due to their privacy concerns. The main objective of this paper is to
assess the privacy and confidentiality of health information related concerns within the
Canadians as a whole. The nurses or the health care system have a leading role to play in this
regard. As the profession of nursing is continuously growing, so does the usage of
technology. Many advancement in technology have taken place and been integrated into
nursing practice. This is further creating the importance of exercising nursing informatics
competency for the nurses. According to Yue et al. (2015), the fundamentals of nursing
information are knowledge, data and information. In turn, one gets the building blocks of
nursing communication, which is an accepted language for similar kind of concepts, while
ensuring confidentiality, privacy and security of health information.
Benefits and Challenges for the nurses
The expectations of privacy and confidentiality in the medical setting are rooted in the
core professional ethical standards across a huge range of health professions. For instance, in
each of its iterations throughout the history, the Hippocratic Oath among the physicians
includes their commitment towards protecting patient’s privacy and confidentiality.
According to Stablein (2016), in the updated version, the oath takers state that- “I will respect
the privacy of my patients, for their problems are not disclosed to me that the world may
know”. The nurses also have a code of ethics called- the Nightingale Pledge. Improvement in
technologies in the medial practice has both the benefits as well as challenges in terms of
maintaining patients’ privacy and confidentiality.
Benefits- With the emergence of online communication, shared electronic health
records, mobile applications, social media and big data, the nurses, patients and physicians

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can use and share personal health information of the patients in new and innovative manners.
The traditional model, known as the “paternalistic model” on the physician and patient
relationship used to involve a bidirectional flow of data and information (Borza, Gavrilovici
& Stockman, 2015). Notwithstanding this fact, the ease of which the patients now can access
their medical information from the alternative sources via internet and the usage of social
media within the health care community has completely redefined the way in which
information is being communicated from the physicians, doctors or nurses to the patient and
vice versa. The traditional paper based medical records have changed into electronic ones and
became more interactive than ever before. Today, there are many users, reviewers and
stakeholders of the documentation and as the government is significantly involved in the
process, agencies today actively review the documentation of care. Furthermore, it is also to
note that online communication and usage of social media for this purpose are pervasive in
the Canadian society. Many nurses and physicians have embraced this opportunity of
maintaining interconnectivity, which the social media affords, while implementing their own
processes of privacy for reflecting the new type of date collection, storage and uses.
Increasing number of modern patients seek for getting health care information from the
online platforms. This form of communication poses a very unique set of opportunities for
the nurses and physicians. It increases their reach and improves patient engagement (Mesko
et al., 2017).
Challenges- However, all the above visible benefits have raised new challenges for
clinical practise, particularly in terms of the ways the expanded access of data are navigated
via the usage of new technologies. It has also raised a challenge in terms of maintaining
patients’ privacy and confidentiality (Beeson et al., 2016). It is to note that in many of the
cases, the nurses or the physicians might not be the primary custodian of the health records of
patients once their health records are collected. The clinics or institutions might also have the

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responsibility towards this information and for this reason, they play a crucial role in ensuring
that they are protected. However, there responsibilities are challenged by the rapidly
changing usage and adoption of the new technologies like the medical or health records.
O’Mahony et al. (2014) too in this context have opined that the medical records of the
patients are compiled together for assisting the nurses, physicians and the other health care
professionals in the treatment process. Still, they get vulnerable to certain privacy breaches
when these data and information get exposed to the secondary uses like research studies,
quality assurance, epidemiological studies, education etc. In Canada, many efforts have been
made by different organisations like Canada’s Health Informatics and Health Canada
Organisation. Still, the services that are aimed at ensuring improvement in the health
information technology safety remained poor at national level.
As the modern information management and stewardship have had to evolve as a
response to the emerging technology, the different parameters of the medical records have
grown highly ambiguous. Due to the proliferation of a range of health information technology
like the electronic heath records, the concern regarding their safety and quality has been
raised. According to the Canada Health Infoway, health information technology is a tool that
often reduces the patient safety instead of improving them (Rudin, Tang & Bates, 2014).
Meeks et al. (2014) too are of the view that if such technologies are not designed, maintained
and implemented in effective manner, it can result in some intended results like breaches of
patients’ privacy and technology-induced errors. Furthermore, the use of social media or
other online platforms for communication on the one hand is improving patient engagement
and health professionals’ reach, while on the other hand, is blurring the boundaries that are
required to be kept in between one’s professional and personal life.

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Impact and Implications on the nurses
One of the core features of the profession of nursing is the potential of controlling
patient’s information. For this reason, anything that change or challenge that control has
significant implications for the nursing professions- for the professional relation with clients,
for the inter- and intra- professional relationships and for the professional identity. For
instance, the research studies on the introduction of new technologies in the medical practice
have find that they often spur the inter-professional conflict and the challenge prevailing in
the organisational routines and intra-professional practices. According to Singh and Sittig
(2015), the current widespread diffusion of new communication technologies and information
into the health care have created a change in the process in which information are
disseminated and managed. This has implications for the “professional control of
information”. With the same, due to the access to information and data in the health care is
based on the interactions in different professional groups within and around the socio-
technical organisations, the information and communication technologies might challenge the
information control of different professional groups and this would further cause high
possibilities for change along with some additional disruptions. As opined by Davis Giardina
et al. (2014), nursing professional in the modern age of information would be based on their
own professions that aids to the ethical use of information technology and also on the inter-
professional balance of power in a specific site of practice. It is also to note that it is very
important to take into consideration the ethical and professional aspects of serious medical
challenges for gaining a good understanding on the role of professionalism and the way it is
getting changed with the passage of time.

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Recommendations
As a result of the above analysis, it is clear that privacy protection is a critical issue
for the Canadians. Many of the Canadian patients found to be withholding their serious health
related information due to their privacy concerns. Both nurses and the health care system
have a leading role to play in this regard. There needs to be development of in the existing
reporting system, which is not effective enough to report on human errors. Development in
the reporting system would help the nurse and the other health professionals to report about
the human errors that are the result of usage of health information technology, anonymously.
Furthermore, health information technology in the country is not effective enough.
Literatures too have claimed that modern technology has created unique challenges in the
process of maintaining a duty of privacy and confidentiality of health information within the
patient-physician relationship. They have focused on the use of clinical flags, medication
alerts, better reporting and tracking of the diagnostic testing, consultation and availability of
patient data. Hence, it is recommended that there should be a collaborative approach for
improving the health information technology safety standards in the country in order to make
sure that the present and future usage of medical records information is respectful and
accurate of the patient privacy. It should involve nurses, health system and government.
Government should introduce some national uniform guidelines on appropriate access of, use
of and disclosure of the personal health data as this would allow the presence of data stewards
for advancing their research while respecting the rights to privacy of the patients.
Moreover, from the above analysis of the literatures it is evident that the use of social
media is blurring the boundaries that are required to be kept in between one’s professional
and personal life. This is creating a challenge for the doctors and nurses. Therefore, the health
care institutions should develop some set of policies that would outline the different ways for

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preventing and decreasing the privacy breaches’ impact related to social media
communication. They should include tracking mechanism for helping in balancing the
present obligation to privacy with the evolution of technology.
Conclusion
Hence, from the above analysis it is clear that confidentiality and privacy of health
related information and data in the Canadian health care system is not efficient enough.
Technology, social media and ineffective use of existing health information system are
posing great challenges in terms of privacy and confidentiality of patient’s records. The
growth of technology will never stop and it would continue to evolve in its own way.
Similarly, the traditional parameters of the patient-physician relationship too would
continuously evolve. The professional and ethical obligation for protecting patients’ privacy
should always remain paramount at the attainment of technology use. Just banning the use of
online communication or social media sites would never eliminate these risks and also, would
never provide any benefit to the patient care outcomes. Canadian health care institutions
should develop some stringent policies, which outline the ways of preventing or reducing the
impacts of privacy breaches related to online communication and social media. Also, the
nurses and other health professionals who choose to communicate with the patients through
online medium or through the social media platform should always keep in mind that they are
still governed by the same professional and ethical standards that are paramount.

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