Since the Health Insurance Portability and Accountability Act (HIPAA) passed in 2004, patient confidentiality has played a pivotal role in the healthcare industry.
Patient confidentiality refers to the right of patients to keep their records private and represents physicians’ and medical professionals’ moral and legal obligations in handling patients’ sensitive medical and personal information.
What Is Patient Confidentiality?
Healthcare providers — physicians, nurses, medical institutions, and others — who deal with patient health information are known as covered entities. They are responsible for patient confidentiality, as per HIPAA’s Privacy Rule, which states that medical professionals cannot legally share patient information without their consent.
Patient confidentiality supports the needs of both patient and physician. It protects patients from having their data misused. It also serves the physicians’ best interests. For example, doctor-patient confidentiality privileges — which assure patients that their health information is safe and only will be used for the purposes of improving health outcomes — allow doctors to establish relationships with patients based on trust and open communication, thus improving the quality of care they provide.
According to HIPAA rules, medical institutions must implement policies to protect patients’ privacy and data to meet the minimum necessary standard. This standard means that patient health information should be protected unless sharing it is essential to fulfilling a particular purpose.
Policies can include granting access to protected health information to healthcare organization members if it helps them carry out their duties more effectively, in the best interest of patient outcomes. This means restricting access and uses of the patient information to other members of the healthcare team. Additionally, procedures should be implemented to help protect electronic health records from unauthorized access, alteration, and deletion.
As more healthcare processes become digitized, information about protecting patient confidentiality will continue to change. The following resources can help individuals keep pace with evolving confidentiality practices.
- U.S. Department of Health and Human Services (HHS), Health Information Privacy — Comprehensive information about HIPAA, guidance on how to apply HIPAA during the COVID-19 epidemic, individuals’ rights, civil rights laws regarding HIPAA, and more
- Centers for Disease Control and Prevention, Confidentiality and Consent — Information about the legal and ethical concerns of patient confidentiality
- American Medical Association (AMA), HIPAA — HIPAA privacy and security resources, including articles, FAQs, and tools
The Importance of Patient Confidentiality
Patient confidentiality is necessary for building trust between patients and medical professionals. Patients are more likely to disclose health information if they trust their healthcare practitioners. Trust-based physician-patient relationships can lead to better interactions and higher-quality health visits.
Healthcare professionals who take their privacy obligations seriously, and who take the time to clearly explain confidentiality rules, are more likely to have patients who report their symptoms honestly. This makes it easier for doctors to make better-informed decisions, more accurate diagnoses, and personalized treatment plans that lead to better health outcomes.
Exceptions to Patient Confidentiality
Though HIPAA offers privacy and confidentiality protections for patients, some scenarios allow healthcare practitioners to breach patient confidentiality.
Ensuring HIPAA compliance in healthcare data requires understanding the rules. Without a firm understanding of patient confidentiality exceptions, a healthcare provider may elect not to disclose important information, even when the law allows flexibility for providing access to patient data.
Below are some examples of when physicians are legally permitted to share their patient’s health information without permission:
- Patient safety. A healthcare professional can breach patient confidentiality to protect a patient’s safety. For example, a psychologist can disclose information about a patient who talks about suicide or reveals their intent to harm someone. In cases of abuse, neglect, or violence against children, the elderly, or people with disabilities, psychologists are legally obliged to provide information to relevant authorities, according to the American Psychological Association.
- Public health. If a reported case of an infectious disease puts public health at risk, healthcare professionals must reveal the patient’s information for the well-being of the community. The HHS reports that healthcare professionals covered under HIPAA rules are “legally authorized to do so to prevent or control the spread of the disease.”
- Health outcomes. Healthcare practitioners are permitted to share information for clinical purposes, such as discussing a diagnosis with colleagues, referring patients to another facility, or speaking with a pharmacist. This can include vital clinical data if it is needed to optimize patient care.
Patient Confidentiality and Cybersecurity
Patient confidentiality is at the center of good healthcare. It helps ensure that patients feel safe in healthcare settings. With the digitization of patient records, sharing information with patients has become increasingly simple for physicians via online tools and web portals, and even social media.
But healthcare data breaches remain a threat. According to HIPAA Journal, 3,054 healthcare data breaches between 2009 and 2019 have led to the “loss, theft, exposure, or impermissible disclosure of 230,954,151 healthcare records.”
Therefore, physician cybersecurity is vital for protecting patient health records. Not all patients like to share information using these communication vehicles due to privacy concerns. For patients who do prefer to interact with their healthcare providers’ online tools and web portals, the good news is that more healthcare practitioners are seeing the value of investing in security technology.
The American Academy of Family Physicians reports that 69% of its members use web portal technology with secure messaging to interact with their patients. Web portals are also being used for prescription refills, appointment scheduling, and health information sharing.
HIPAA’s Security Rule of 2003 set standards for protecting patient confidentiality. It protects patient information, whether it is created by the healthcare practitioner in electronic health records (EHRs) or received in other ways. Requirements stipulated in the rule include providing safeguards — administrative, physical, and technological — to keep patient information secure.
Performing a risk assessment of current patient information systems is required by the HIPAA Security Rule and the Centers for Medicare and Medicaid Service (CMS) EHR Incentive Program. This assessment can help uncover gaps in processes and systems to reduce the potential for data breaches. Together with the Office of the National Coordinator for Health Information Technology (ONC), HHS offers a Security Risk Assessment Tool that helps guide healthcare practitioners through the risk assessment process.
Resources that provide further information about patient confidentiality and cybersecurity include the following:
- AMA, Cybersecurity in Health Care — An infographic from the American Medical Association providing key statistics about cybersecurity and patient confidentiality
- HHS, Health Sector Cybersecurity Coordination Center — Information regarding current cyber threats, alerts, and analysis
- ONC, “Understanding Electronic Health Records, the HIPAA Security Rule, and Cybersecurity” — Insights about defending against cyber attacks and patient data loss
How Healthcare Professionals Can Uphold Patient Confidentiality
Healthcare professionals can uphold confidentiality in their own practice, among colleagues, and at their medical facilities by:
- Following HIPAA guidelines. This requires keeping up to date on HIPAA rule changes to avoid penalties and legal problems. For the most updated HIPAA information, healthcare practitioners can go to HHS.gov.
- Complying with state regulations. In addition to federal HIPAA rules, healthcare practitioners need to know additional rules regarding patient confidentiality in their state. The Center for Ethical Practice provides examples of state patient confidentiality laws.
- Protecting electronic health information with safeguards and encryption. Installing firewalls and antivirus software and using strong passwords are critical steps to helping protect patient information systems. Additionally, controls should be placed to limit access to protected health information and the network. This HHS summary of the HIPAA Security Rule includes information on required safe
- Establishing facility-wide procedures and protocols for handling patient information. Maintaining patient confidentiality goes beyond the use of encrypted technology. Providing training and implementing protocols that keep patient information safe from prying eyes can help employees ensure that their facility is compliant.
The following resources provide additional information on how healthcare professionals can help ensure patient confidentiality:
- AMA, “Checklist: Protecting Office Computers in Medical Practices Against Cyberattacks” — From viruses and malware to hacking, a checklist of recommendations on keeping computers safe from cyber attacks
- HHS, HIPAA for Professionals — More information about HIPAA for those who support the needs of healthcare practitioners
- HIPAA Journal, “HIPAA Compliance Checklist 2020” — A comprehensive checklist that covered entities are required to follow to fully comply with HIPAA regulations
- ONC, “Top 10 Tips for Cybersecurity in Health Care” — Handy tips providing quick and easy information on how to keep computers and systems safe and secure
Protect the Rights of Patients, and Help Improve Health Outcomes
In a healthcare field increasingly reliant on digitization, patients worry that their medical information might be compromised. This fear can lead patients to withhold certain information from their doctors. By not disclosing critical health information, patients can hamper the efforts of the medical professionals trying to provide them with the best care possible.
Thanks to HIPAA, patient confidentiality is the law. Healthcare professionals should understand the implications of HIPAA to reinforce patient trust and improve treatment.