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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
professionals;
m) the individual is likely to become dependent upon controlled
drugs and the disclosure is to a Medical Officer under the Misuse of Drugs
Act.
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
(unconscious);
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.
GENERAL RULE ON PATIENTS WITH MENTAL DISORDERS: Where a patient is unable
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