Balancing confidentiality and care coordination: challenges in patient privacy.

BACKGROUND: In the digital age, maintaining patient confidentiality while ensuring effective care coordination poses significant challenges for healthcare providers, particularly nurses. AIM: To investigate the challenges and strategies associated with balancing patient confidentiality and effective care coordination in the digital age. METHODS: A cross-sectional study was conducted in a general hospital in Egypt to collect data from 150 nurses across various departments with at least six months of experience in patient care. Data were collected using six tools: Demographic Form, HIPAA Compliance Checklist, Privacy Impact Assessment (PIA) Tool, Data Sharing Agreement (DSA) Framework, EHR Privacy and Security Assessment Tool, and NIST Cybersecurity Framework. Validity and Reliability were ensured through pilot testing and factor analysis. RESULTS: Participants were primarily aged 31-40 years (45%), with 75% female and 60% staff nurses. High compliance was observed in the HIPAA Compliance Checklist, especially in Administrative Safeguards (3.8 ± 0.5), indicating strong management and training processes, with an overall score of 85 ± 10. The PIA Tool showed robust privacy management, with Project Descriptions scoring 4.5 ± 0.3 and a total score of 30 ± 3. The DSA Framework had a mean total score of 20 ± 2, with Data Protection Measures scoring highest at 4.0 ± 0.4. The EHR assessments revealed high scores in Access Controls (4.4 ± 0.3) and Data Integrity Measures (4.3 ± 0.3), with an overall score of 22 ± 1.5. The NIST Cybersecurity Framework had a total score of 18 ± 2, with the highest scores in Protect (3.8) and lower in Detect (3.6). Strong positive correlations were found between HIPAA Compliance and EHR Privacy (r = 0.70, p < 0.05) and NIST Cybersecurity (r = 0.55, p < 0.05), reflecting effective data protection practices. CONCLUSION: The study suggests that continuous improvement in privacy practices among healthcare providers, through ongoing training and comprehensive privacy frameworks, is vital for enhancing patient confidentiality and supporting effective care coordination.

Augmenting maternal clinical cohort data with administrative laboratory dataset linkages: a validation study.

Background: The use of big data and large language models in healthcare can play a key role in improving patient treatment and healthcare management, especially when applied to large-scale administrative data. A major challenge to achieving this is ensuring that patient confidentiality and personal information is protected. One way to overcome this is by augmenting clinical data with administrative laboratory dataset linkages in order to avoid the use of demographic information. Methods: We explored an alternative method to examine patient files from a large administrative dataset in South Africa (the National Health Laboratory Services, or NHLS), by linking external data to the NHLS database using specimen barcodes associated with laboratory tests. This offers us with a deterministic way of performing data linkages without accessing demographic information. In this paper, we quantify the performance metrics of this approach. Results: The linkage of the large NHLS data to external hospital data using specimen barcodes achieved a 95% success. Out of the 1200 records in the validation sample, 87% were exact matches and 9% were matches with typographic correction. The remaining 5% were either complete mismatches or were due to duplicates in the administrative data. Conclusions: The high success rate indicates the reliability of using barcodes for linking data without demographic identifiers. Specimen barcodes are an effective tool for deterministic linking in health data, and may provide a method of creating large, linked data sets without compromising patient confidentiality.

The role of teleradiology during COVID-19 outbreak: Saudi radiologists' perspectives.

OBJECTIVES: To evaluate the role of teleradiology during the COVID-19 pandemic from Saudi radiologists' perspectives to improve the radiology quality service. METHODS: A cross-sectional study was carried out in Saudi Arabia among radiologists working at local hospitals from October to November 2021. It contains 21 questions involved demographic information; general information on teleradiology services; and the impact of teleradiology during COVID-19. One-way ANOVA was used to compare demographic groups. Chi-square test was used to compare demographic groups regarding their distribution of responses. All tests were carried out <0.05 level of significance. RESULTS: A total of 102 radiologists participated in this study (56% males, 44% females), 58.8% of them were sub-specialized in chest radiology. Regarding the general status of teleradiology, 69.6% of participants believed that teleradiology is a helpful tool for imaging interpretation. However, 44% of them were uncertain on the impact of teleradiology on patients' confidentiality. Approximately 87% of participants agreed that there is a positive contribution of teleradiology during COVID-19, which enables decreasing risk of infection and workload. There was a significant difference between professional degrees and overall participant responses (p<0.05). Academicians agreed that it enhances radiology departments' work (mean=17.78, SD=1.86). CONCLUSION: Concerns raised on complicated cases that require physical presence of patients, cannot be performed by teleradiology. Additionally, it might provide insufficient communication with other professionals to discuss images.

Comparing the attitudes of physicians and non-physicians toward communicating a patient's BRCA1 mutation to a first-degree relative against a patient's wishes.

Although genetic testing can be vastly informative, it creates a dilemma if a patient does not want to disclose an abnormal genetic test to at-risk relatives. A sample of 200 participants from Nevada (100 physicians, 100 non-physicians) completed an 11-item questionnaire asking demographic information, familiarity with genetics and genetic testing, and opinions about a physician's role in a hypothetical case in which a patient does not wish to communicate her BRCA1 mutation to her sister. Although most respondents did not think the physician should notify the sister against the patient's wishes, more non-physicians (40%) than physicians (23%) contended that the physician should do so (p = 0.0119). Most respondents from both groups agreed that the physician should not have the legal duty to notify the sister, would not be morally justified in sharing genetic test results with the sister, but should have the right to notify a patient's relatives if the disease is "serious, preventable, and treatable." More non-physicians than physicians agreed that physicians should have an educational requirement on how to communicate genetic test results to patients and their family (88% vs 65%, p = 0.0002). Most physicians (70%) reported a familiarity/strong familiarity with genetic testing compared to non-physicians (33%; p < 0.0001). Future qualitative research should assess physicians' understanding of issues surrounding familial communication of genetic test results. Educational interventions to facilitate effective communication to patients and families are needed and welcomed by most physicians. Discrepancies between the attitudes of physicians and patients or the public need to be better understood and addressed.

Informed Consent In Facial Photograph Publishing: A Cross-sectional Pilot Study To Determine The Effectiveness Of Deidentification Methods.

This study determined the effectiveness of three deidentification methods: use of a) a black box to obscure facial landmarks, b) a letterbox view to display restricted facial landmarks and c) a half letterbox view. Facial images of well-known celebrities were used to create a series of decreasingly deidentified images and displayed to participants in a structured interview session. 55.5% were recognised when all facial features were covered using a black box, leaving only the hair and neck exposed. The letterbox view proved more effective, reaching over 50% recognition only once the periorbital region, eyebrows, and forehead were visible. The half letterbox was the most effective, requiring the nose to be revealed before recognition reached over 50%, and should be the option of choice where appropriate. These findings provide valuable information for informed consent discussions, and we recommend consent to publish forms should stipulate the deidentification method that will be used.

Patient Data-Sharing for AI: Ethical Challenges, Catholic Solutions.

Recent news of Catholic and secular healthcare systems sharing electronic health record (EHR) data with technology companies for the purposes of developing artificial intelligence (AI) applications has drawn attention to the ethical and social challenges of such collaborations, including threats to patient privacy and confidentiality, undermining of patient consent, and lack of corporate transparency. Although the United States Catholic Conference of Bishops' Ethical and Religious Directives for Health Care Services (ERDs) address collaborations between US Catholic healthcare providers and other entities, the ERDs do not adequately address the novel concerns seen in EHR data-sharing for AI development. Neither does the Health Insurance Portability and Accountability Act (HIPAA) privacy rule. This article describes ethical and social problems observed in recent patient data-sharing collaborations with AI companies and analyzes them in light of the guiding principles of the ERDs as well as the 2020 Rome Call to AI Ethics (RCAIE) document recently released by the Vatican. While both the ERDs and RCAIE guiding principles can inform future collaborations, we suggest that the next revision of the ERDs should consider addressing data-sharing and AI more directly. SUMMARY: Electronic health record data-sharing with artificial intelligence developers presents unique ethical and social challenges that can be addressed with updated United States Catholic Conference of Bishops' Ethical and Religious Directives and guidance from the Vatican's 2020 Rome Call to AI Ethics.

The right to intimacy of minors in the practice of pediatric endocrinologists.

Nowadays, the subjectivity of each person and respect for their rights, especially the right to privacy and personal dignity, are strongly emphasized. The right to intimacy is derived from the former. This right is guaranteed by numerous laws, including the Constitution of the Republic of Poland. The protection of the right to intimacy is particularly important in the case of people who, due to their capacity or age, cannot effectively protect themselves against its violation. This problem is exacerbated in case of patients who, while in medical facilities, must submit to their regime and are hence seriously exposed to the possibility of encroachment on their intimacy. The protection of minor patients is increased in this respect. This paper discusses the sources of the right to intimacy, both domestic and international, and indicates the areas where it may be violated. The violations of the right to intimacy may take psychological and physical forms. In the former aspect, the encroachment on intimacy may include disclosure of sensitive data protected by medical confidentiality. This paper explains the subject matter of medical confidentiality and what exceptions apply to minors. In turn, the encroachment on intimacy in the physical form includes, among others, the involvement of bystanders during providing health services. This paper presents regulations permitting such assistance of medical workers, relatives, and other persons, as well as students.

Alcohol and the Law.

In the intersection of alcohol ingestion with the law, medical ethics, and public safety, physicians are often unsure about how to proceed. Physicians' primary focus should be on patient education with an ethical and legal duty to warn the patient of the adverse effects of alcohol. Warning third parties of potential harm related to alcohol-related impairment may involve a breach of patient confidentiality; therefore it should only be undertaken after careful analysis suggests that the risk for significant harm exceeds the burden that results to the patient from warning others. The law remains vague in this area.

[Health privacy in the age of digital networks]. / Gesundheitsdatenschutz in vernetzten Zeiten.

Digitization in the health sector embodies opportunities and risks. These consist of patient and data confidentiality. Vulnerability of data concerning integrity and availability can lead to financial losses and to damage of the health of data subjects. Those risks must be tackled by privacy or data protection law. For this purpose we have the European Data Protection Regulation as a comprehensive legal framework and a harmonizing bracket.This framework contains regulations on consent, purpose binding and data transfer, on rights of the data subject, technical and organizational measures and procedural arrangements. Recently, codes of conduct and certification schemes have been added as instruments. The frame of privacy law is completed by the law on medical products and information security regulations.Unfortunately, German legislation did not grip the opportunity of the European regulation to modernize, tighten and harmonize national privacy law in the health sector. This led to a lack of clarity, particularly because of the parallel applicability of privacy law and professional law. Central issues - for instance concerning transparency for data subjects, official supervision, analytics and processing for research purposes - remain dysfunctional. The German legislation should adjust those deficits. Corporations and the chambers for health professionals could and should also be active for this concern.

Postoperative Home Monitoring After Joint Replacement: Feasibility Study.

BACKGROUND: We conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time. OBJECTIVE: The primary outcome was the mean percentage of successful wireless transmissions from home of blood pressure levels, heart rate, oxygen saturation levels, and pain scores until postoperative day 4 with a feasibility target of ≥90%. METHODS: Patients with an expected length of stay ≤1 day, age 18-80 years, Revised Cardiac Risk Index ≤ class 2, and caretakers willing to assist at home were eligible. Patient satisfaction, as a secondary outcome, was also evaluated. Wireless monitoring equipment (remote patient monitoring, Telus Canada) was obtained and a multidisciplinary care team was formed. RESULTS: We conducted the study after obtaining Research Ethics Board approval; 54 patients completed the study: 21 males, 33 females. In total, we evaluated 9 hips, 4 hip resurfacing, 26 total knees, and 15 hemi-knees. The mean transmission rate was 96.4% (SD 5.9%; 95% CI 94.8-98.0). The median response to "I would recommend the Remote Monitoring System program to future patients" was 4.5 (interquartile range 4-5), with 1 being "strongly disagree" and 5 "strongly agree." At 30 days postop, there was no mortality or readmission. CONCLUSIONS: This is an evolving new paradigm for postoperative care and the first feasibility study on monitoring biometrics after primary hip or knee replacement. Postoperative home monitoring combines current technology with real-time support by a multidisciplinary transitional care team after discharge, facilitating postsurgical care with successful wireless transmission of vitals. The postoperative home monitoring implementation is, therefore, generalizable to other surgical discharges from hospitals. TRIAL REGISTRATION: ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/71ugAhhIk).

Medical Images are Safe - an Enhanced Chaotic Scrambling Approach.

The patient data confidentiality is one of the vital security aspects in e-Health and m-Health services. In particular, providing confidentiality to the patient's medical image is essential and the protection approaches have to be explored in-depth due to the rapid progress in the technologies of teleradiology and PACS. In this study, the pseudo random number generators (PRNGs), namely, the linear congruential generator (LCG) and XOR shift generator (XSG) are improved and combined with improved logistic 2D coupled chaotic map to provide enhanced chaos based encryption. The proposed scheme encrypts the Digital Imaging and Communication in Medicine (DICOM) images to protect the patient confidentiality during the storage and transfer in radiological information system (RIS). The cipher image was measured with various security analyses and tested with different test suites to prove its randomness.

Applying CHAID algorithm to investigate critical attributes of secured interoperable health data exchange.

With enhanced interoperability in healthcare environment the exchange of electronic health records (EHRs), both intra and inter organisations, has increased manifold. Sharing of the EHR creates room for illegal disclosures and confidentiality breaches. Interoperable healthcare is a complex system with many independent components. To design a secured framework for such a system, one need to understand the most important security attributes and predict various dependencies among them. The security attributes selected for statistical analysis are taken from the real-time study of patient-doctor relationship existing in any hospital or clinic. Hospitals with functional EHR-systems are the prerequisite of this study. The dependencies in the obtained data are generated through classification technique, chi-squared automatic interaction detection (CHAID). The decision tree obtained is analysed and verified using regression. The paper enabled the identification of the salient feature controlling which would maximally reduce security threats while sharing EHRs in interoperable healthcare environment.

Respecting patient confidentiality.

Nurses face a particular challenge in respecting the confidentiality of patients in a world where information is quickly shared and where information about illness can be sensitive. We have a duty of care towards patients. That duty includes maintaining privacy (protecting them from undue intrusion), and confidentiality (by the discreet management of information about themselves that they share with us). Legislation on confidentiality comes from different sources and should be interpreted in the clinical setting. This article summarises the principal requirements set out in the legislation and directs readers to questions and tools designed to help them explore the extent to which patient confidentiality is respected where they work.

Abortion in Chile: the practice under a restrictive regime.

This article examines, from a human rights perspective, the experience of women, and the practices of health care providers regarding abortion in Chile. Most abortions, as high as 100,000 a year, are obtained surreptitiously and clandestinely, and income and connections play a key role. The illegality of abortion correlates strongly with vulnerability, feelings of guilt and loneliness, fear of prosecution, physical and psychological harm, and social ostracism. Moreover, the absolute legal ban on abortion has a chilling effect on health care providers and endangers women's lives and health. Although misoprostol use has significantly helped to prevent greater harm and enhance women's agency, a ban on sales created a black market. Against this backdrop, feminists have taken action in aid of women. For instance, a feminist collective opened a telephone hotline, Linea Aborto Libre (Free Abortion Line), which has been crucial in informing women of the correct and safe use of misoprostol. Chile is at a crossroads. For the first time in 24 years, abortion law reform seems plausible, at least when the woman's life or health is at risk and in cases of rape and fetal anomalies incompatible with life. The political scenario is unfolding as we write. Congressional approval does not mean automatic enactment of a new law; a constitutional challenge is highly likely and will have to be overcome.

Preparing medical legal reports and dealing with lawyers.

In preparing reports or records for patients in personal injuryThe term 'personal injury' includes cases involving automobile accidents, slip and falls, defective products and medical malpractice. litigation certain basic information will be necessary. Most of that information is often provided in the basic chart without the need for a written report. Ensure that when providing records or discussing the patient's care and treatment with an attorney that your are providing records in a timely manner to the attorney for the patient and that you are not discussing the case with counsel for your patient's opponent. When in doubt, call the patient's attorney and ask them what information is needed.