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Bill introduced in Great Britain

  This morning a Bill entitled "Disclosure and Use of Personal Health
  Information," was introduced in Parliament.
  The Bill establishes a framework for the collection, use, and disclosure of
  persohal health information by "health service bodies" and "qualified
  health professionals," and the contractors and employees of each.  (It does
  not establish a framework that follows the information.  In other words if
  your health information ends up in the hands of someone other than a
  "health service body" or "health professional" the limitations on use and
  disclosure no longer apply.  This directly contrasts with the approach of
  S. 1360 which is to hold everyone who handles personal information to the
  obligations imposed by the bill.)  The Bill establishes a general duty to
  preserve confidentiality.  The majority of the Bill establishes exceptions
  to the general duty. The bill contains many more exceptions to consent,
  including one that allows providers to disclose information to other
  providers without patient consent, than S. 1360. The only statutorily
  imposed penalty is a £500 fine ($800).  
  This is a synopsis (mine not official) of the bill's contents.
  GENERAL RULE ON USE:  Under the Bill personal health information may only
  be used for the purpose for which it was collected or a purpose "directly
  related" to the purpose of collection.  
  EXCEPTIONS:  This rule does not apply where use for another purpose is:
  1) authorized by the patient, a court or a statute;
  2) necessary to prevent or lessen a serious and imminent threat to public
  health or safety, or the life of an individual;
  3) the information is disclosed in a form that does not identify the individual;
  4) the rule must be broken "to avoid prejudice to the maintenance of the
  law by any public body, including the prevention, detection, investigation,
  prosecution and punishment of a serious offence, or for the conduct of
  proceedings before any court or tribunal, or for any purpose authorized on
  application to the court."
  GENERAL RULE REGARDING DISCLOSURE:  It is unlawful to disclose information.
  EXCEPTIONS: This rule does not apply where:
  1) disclosure is to the individual;
  2) disclosure is authorized by the individual;
  3) disclosure is for one of the purposes for which it was obtained;
  4) general directory information and individual has not prohibited;
  5) it is "either not desirable or not practicable to obtain authorization
  form from the indivdiual concerned" and 
          a) the disclosure is directly related to collection;
          b) the disclosure is to a person nominated by the individual, or a
  socialt worker employed by a local authroity or health service body, or to
  the principal care giver or relative, and the indvidual has not prohibited;
          c) the disclosure is to an agency who can act to protect the
  interest of an individual who is unable to consent to disclosure;
          d) the information is to be used in non-identifiable form;
          e) the information is to be used for audit purpose and not
  published in identifiable form;
          f) the information is for research (approved by equivalent of an
  IRB) and will not be published in identifiable form;
          g) the disclosure is necessary to prevent of lessen a serious and
  imminent threat to public health or safety or the life of an individual;
          h) (an exception that seems to relate to transferring businesses
  between health professionals, but is unclear)
          i) the disclosure is identity, injury sustained in an accident, and
  is made to the press;
          j) the purpose of the disclosure is to identify a persons
  suitability for health education
          k) the purpose of the disclosure is: accreditation, quality
  assurance, risk management assessment (may not publish in identifiable
  form), [a confusing exception that relates to prescriptions], [another
  confusing exception that relates to monitoring mental health patients],
  investigating a complaint against a health service body;
          l) noncompliance is necessary: to avoid prejudice to the
  maintenance of the law; for court proceedings; for any purpose authorized
  by court; for disciplinary or legal proceeding against qualified health
          m) the individual is likely to become dependent upon controlled
  drugs and the disclosure is to a Medical Officer under the Misuse of Drugs
  6) between health professionals where it is necessray for care and where
  patient has not objected ***** This means disclosures between physicians
  Does NOT require Patient Consent ****
  7) in emergency circumstances;
  8) where it is not reasonably practicable to obtain the patient's consent
  GENERAL RULE ON SAFEGUARDS:  Those disclosing information must be satisfied
  that appropriate safeguards against use of the information for other
  purposes are in place.  However, in litigation the burden is placed on the
  plaintiff to prove that safeguards were not established. *** This is in
  tension with the approach under S. 1360 which holds people liable for all
  bad behavior be it negligent, intentional or malicious, and holds those who
  receive information to the same standards as those within the medical
  profession. ***
  POLICE:  The bill doesn't affect the operation of section 11 (excluded
  material) fo the Police and Criminal Evidence Act of 1984.
  to consent due to a mental disorder disclosures may occur where necessary
  for treatment, care or supervision and where the patient's guardian or
  representative, or the Mental Health Review Tribunal or responsbile medical
  officer authroizes.
  GENERAL RULE ON AUTHORITY TO DISCLOSE:  Exceptions to the General rules on
  use and disclosure must be exercised by the "consultant in charge of
  patient care" in the hospital setting; the qualified health professional.
  However, if a someone is not a qualified health professional but otains
  health infromatino, they can disclose it to a qualified helath professional
  if it is necessary to provide care to the patient.
  GENERAL RULE ON COMPLIANCE:  Health Services Bodies must establish
  compliance procedures specifying to whom requests for disclosure shall be
  referred; the qualified health professional responsible for decisions
  regarding disclosure of information for the purpose of each aspect of
  patient's health care; person who makes disclosure decisions in emergency
  situations; person who authroizes uses; the safeguards to be established to
  ensure that personal health information is used only for purpose it was
  disclosed; arrangements for maintaining records of disclosures.
  ACCOUNTABILITY AND EDUCATION: Health service body shall: educate members;
  make sure that employment contracts reflect the bill with provisions
  regarding duties of confidentiality and provisions for disciplinary action
  or dismissal; contractors are bound to protect information; collect
  statistics on # and nature of disclosures and publish the same annually.
  DEFENSE:  A defense to any breach of the act is available to a health
  service body that shows it took reasonable practicable steps to protect the
  security of information disclosed.
  DUTY TO INVESTIGATE: Health service bodies or the Health Service's
  Commissioner must investigate complaints and issue a written report to the
  patient and the the qualified health professional containing the facts and
  the propsed action to correct.
  PENALTIES:  £500 ($800) fine for violation if breached by health services
  body, their employee or contractor.
  GENERAL RULE ON ??:  [seems to limit demands for health information --
  perhaps by employers -- it isn't clear; it could be read to prohibit
  contracts to sell health information]
  Deirdre Mulligan
  Staff Counsel
  Center for Democracy and Technology
  1001 G Street, NW
  Suite 500 East
  WDC 20001
  ph 2026379800
  f  2026370968