The confidentiality of health information in King Faisal Specialist

Hospital and Research Centre

Table of contact:

Section I: objective and methodology

Section II: introduction and Brief history of KFSH&RC

Section III: Literature review

Section IV: data analysis and Discussion

Section V: findings

Section VI: suggestion

Section VII: conclusion

Section VIII: reference

Section I :

Objectives:

- study the police and procedures for maintaining the confidentiality.

- Assess the confidentiality effect in health information in KFSH&RC.

- Analysis the confidentiality health information.

Methodology:

The Methods for collecting information regarding the medical

information's confidentiality the method selected are:

o Interviewing the medical record staffs, manager, case

management, quality department in hospital, different
department staffs: (admission, outpatient, medical eligibility
& accept center).

o Observation and experience on the time of training.

o Search in the internet on the web King Faisal Specialist

Hospital and Research Centre sit.

Section II

Interdiction:

Today, individual health and medical data can be collected, collated,

stored, analyzed and distributed in unprecedented quantities and put
to diverse uses. Payers can not only tap patient data for claims
payment; they use it for utilization review, underwriting and coverage
decisions. Employers use health data to reduce their health care and
workers compensation costs, as well as to identify employees who
may be costly in the future. Health care providers use the data for
research, to collect reimbursement, coordinate diagnosis and
treatment, conduct quality assurance and monitor other providers.
Clinical data repositories and management systems will likely reduce
health care costs and improve patient care. So, that's why
Confidentiality is becoming a big issue.

Medical confidentiality why is it important:

• natural human desire for privacy

• fear of social embarrassment or disapproval

• fear of discrimination, stigmatization

• Information misused against patient

• builds confidence and open communication

• demonstrates doctor’s fidelity to the patient

• respects patient’s privacy, dignity and individuality

Due to this importance of confidentiality of health information I

preface my topic as the confidentiality of health information in King
Faisal Specialist Hospital and Research Centre

I select King Faisal Specialist Hospital and Research Centre

for conducting my case study. KFSH&RC was established on
450,000 sq. meters of land that was donated by King Faisal
who laid the cornerstone for the hospital in 1970 (the current
total land of the hospital is approximately 920,000 sq.
meters).

In 1973, the Government commissioned Hospital Corporation of

America (HCA) to administer and operate King Faisal Specialist
Hospital.
In 1975, King Khaled Bin Abdulaziz conducted the opening ceremony
of the then 120-bed capacity hospital, the purpose of which was to
provide tertiary care to the citizens locally avoiding the hardship and
cost of traveling abroad.

In 1978, the first cardiac surgery was initiated in the Department of

Surgery with a team from the Baylor Medical Centre, Houston, Texas,
USA, and it was the first cardiac surgery centre in the Kingdom of
Saudi Arabia.

In 1985, based on a Royal Decree, the administration and operation

of King Faisal Specialist Hospital & Research Centre was transferred
to a National team and, as such, the contract with HCA ended.

KFSH&RC Mission, Vision and Values

Mission Statement

King Faisal Specialist Hospital & Research Centre provides the

highest level of specialized healthcare in an integrated educational
and research setting.

Vision Statement

To be a world-leading institution of excellence and innovation in

healthcare.

Values
• Patient Focus: We put the needs of our patients first
• Integrity: We adhere to high ethical principles to be
truthful, transparent, equitable and trustworthy
• Quality: We strive for excellence and high quality through
creativity and innovation
• Compassion: We treat patients, families, and team
members with dignity and kindness
• Teamwork: We work well together to ensure that
knowledge and wisdom are shared for the benefit of all
 Specializes in providing medication for these
diseases:

 Cancer disease.
 Cardiac disease.
 Transplant.
 Liver disease.
 Renal disease.
 Immunodeficiency.
 Neonatal/congenital.
 Polio.
 P.IVF.

Through this case study i show the policies and procedure

following in the select King Faisal Specialist Hospital. Also, I tried
learning about type of health information and methods of release of
information so, we will have clear picture about value of confidentiality
and it is importance in King Faisal Specialist Hospital & Research
Centre provides

In this case study I would like to explain how to deal with patient
privacy by siting some cases existing in the hospital. Finally, I made
my findings and suggestions on the confidentiality aspect of health
information in King Faisal Specialist Hospital.

Section III

Literature review:
Confidentiality is commonly applied to conversations between doctors
and patients. Legal protections prevent physicians from revealing
certain discussions with patients, even under oath in court .The rule
only applies to secrets shared between physician and patient during
the course of providing medical care.
 Medical record Confidentiality requirements and the general
legal principles governing assess to patient healthcare information.
Healthcare organization and providers must be aware of the various
federal and state laws governing the Confidentiality of medical record
information.

Definition

Confidentiality is the right of an individual to have personal,

identifiable medical information kept private. Such information should
be available only to the physician of record and other health care and
insurance personnel as necessary

The Purpose of Confidentiality

Need to ensure privacy and protection of personal records and data

in an environment of electronic medical records and third-party
insurance payers.

Description

Patient confidentiality means that personal and medical information

given to a health care provider will not be disclosed to others unless
the individual has given specific permission for such release

TYPES OF INFORMATION IN THE MEDICAL RECORD

(Administration, clinical, identification data)

 Patient identification data

 Physical examination

 Progress note

 Lab reports

 Discharge summary

 …etc
  AHIMA grouped these information into :
Confidential non-confidential

↕ ↕

• Patient address patient name

• All clinical data dates of service

outpatient or inpatient

Important responsibilities of health information

professional are:
1. protecting the confidentiality interest of the patient

2. Responding to legitimate demands for information.

3. forbid unauthorized use of medical record.

The major reason for increase demand of health

information:
1. Method of payment of care (Medicaid, Medicare).

2. Increase computerization.

3. The mobility of the population.

Methods of release of information:

1. Direct release.

2. Verbal release (emergency situation).

3. Photocopy.

4. Abstracting information.
(all these facts leads to a situation in which keeping confidentiality of medical
information is challenge to health information management professional).

Section IV

Analysis & Discussion of data

Part 1.Medical Records Dept. & Functions

The medical Record serves as a tool for continuity of care for the
patient, protects the legal and financial interest of the patient, health
care providers and facility. The Medical Record plays a fundamental
role in medical research, education of health care provider, public
health studies and quality review. The contents of the Medical Record
are confidential.

Mission:

The mission of Medical Records is to provide quality patient

information ta all authorized users of medical record.

Goals:

 Maintain comprehensive clinical information on all hospital

patients.

 Ensure the quality of patient information.

 Make patient information available as timely as possible.

 Protect patient information services in a courteous and user-
friendly manner.

 Deliver patient information services efficiently.

 Provide an atmosphere for training and development of staff

and students of medical record.

Medical Record Organizational Structure in KFSH

:Table showing the staff distribution
Processing = 5 Coding = 4 loose report = 3

supervisor= 3 Tem leader = 4 Filling = 24

R.O.I=8 Manger = 2 Secretary = 4

:Function of M.R dept. in KFSH&RC

• Processing :
 The records of discharged patients are assembled and analyzed
by following proper guidelines. Any deficiencies identified are
entered in the deficiency system.

• Coding :
For diagnosis, research and study purposes all records are coded
with ICD-10-AM codes.

• Incomplete records:
Records are processed and physicians are insisted for timely
completion as it is essential for continuity of care in compliance
with the hospital policies and procedures.

• Medical Transcription :
All dictated reports are prioritized based on the status and
transcribed in a timely manner to provide continuity of care.

• Records Review :
To assist reviewers for research and study and other retrospective
reviews, records are made available.

• Filing
All complete medical records are filed in this area. Records are
retrieved for admission, emergency and any patient appointments
to various clinics. File area is staffed for 24 hours/ day and 7
days /week for ongoing patient care.

• Release of Information :
Information such as copies of reports, sick leave statements,
sitter/escort statements, visit statements, birth and death notices
are released upon proper authorization as per hospital policy.

Part 2.The confidentiality of health information in King Faisal

Specialist Hospital and Research Centre

For assessing the level of confidentiality of health information I,

 1. Studied the Policies and Procedures of the hospital in maintaining
the confidentiality.

2. Assessed the level of confidentiality of health information by

conducting a sample study on patients who demand maximum
protection of privacy of their health information.

Policies for keeping confidentiality

1) Any physician or new worker or any employee renew his

contract with king Faisal Specialist hospital needed to read and
agree to the confidentiality statement.

2) When the doctor wants any file he should write a request

to the manager of the medical records department should sign
it. After that the manager of medical record department has to
agree it.

3) Patients are never to be sent to the medical record department

for their records.

4)Medical records are never leave anywhere in the hospital

except in the medical records department.

5) Records are never to be left unattended in open areas where

they can be taken or ready by unauthorized persons.

6) Records are never to be locked in offices, desks, etc. where

they will be unavailable for patient care.
 7) Physician has the right to copy any report that they dictate. The
physician then assumes responsible for safeguarding that copy
from unauthorized access.

As a legal security measure, Consent from patient is taken before

treatment.

To give consent, patient must be able to -

• Understand in simple language what the medical treatment is.

• Its purpose and why it is being proposed.

• Understand its principal benefits, risks and alternatives.

• Understand in broad terms what will be the consequences of

not receiving the proposed treatment.

• Retain the information for long enough to use it and weigh it in

the balance in order to arrive at a decision.

Who is ‘competent’ (has capacity to consent)?

• People over 16 presumed to be competent unless there is

evidence to the contrary.Under 16years are only considered
competent if they have sufficient intelligence and understanding
to understand fully what proposed. Parent is can consent on
behalf of anyone under 18 who cannot understand the details
and purpose of the consent.

• If someone over 18years lacks competence in

understanding , no one can consent on their behalf - decision to
be made by medical team ‘in the best interests of the patient’;
consulting relatives considered good practice to help medical
team to make decisions in such cases.
In a hospital ,Health Information has to be released in different
situations.

1. with patient’s consent

2. for benefit of patient

3. when required by Law

4. medical research, audit, registries

1-Disclosure with patient’s consent:

• Should be attempted at all times possible

• Patient understands nature &effects of disclosure

• Reports to 3rd parties(insurance, employer) must always

be with consent - written consent

• Husband/ wife/ family cannot be implied

• Consent should be written, original , addressed to a

named doctor

• Clear indication of reason & material

• Informed vs Valid Consent - capacity, voluntary

2-Disclosure for patient’s benefit:

• In time of emergency.

• Patient is incompetent – mental disorder.

• Implied consent when care is shared among

professionals - only necessary information for effective care of
patient.
 • For the benefit of patients care.

• To prevent harm to patient - epilepsy, child abuse.

3- Disclosure required by Law:

• When patient need subpoena.

• After the receipt of a formal request and depending on the

situation.

5- Disclosure for medical audit, research, registries:

• approved by ethics committee

• ensure no harm to patient

• delink patient’s identifiable data

• registries operated under principle of medical

confidentiality

• where feasible get consent or inform patient

Access to information – in the hospital, health professionals can

access the health information for patient benefit and treatment.

• doctors

• nurses

• medical staff

• health care team

There is a chance to loose confidentiality in cases of "ethical
dilemmas/special situations":

• Company/Management care

Must have an authorized person in any committee and

everything done with signature of head departments.

• Police & Prisons Doctor

All most they need a reports, cause of death, date of

appointment and if he/she comes to clinic or not " show or not"
because that's help them. Of course we will help the police and
try to save patient privacy as much as we can.

Usually physician progress not is important for answer the

police doctor's question.

Sometimes, patient refused counseling or discussing with other

health professional because of the fear of confidentiality so, they
must reassure the patient and reduces patient anxiety.

A chance of losing confidentiality of health information in hospital

setting. It mainly depends on the number of persons handling the
medical record. ?

Processing Coding Maine files

area
 Incomplete

chanceto loosconfidentialityin M.Rdept

6

3 Expon. (chance to
loos…
nfpO
N

2
e
rs.o

0
process IC coding FA
Medical Record dept.

The medical record department has the most responsibility to keep

privacy of information but the chance of loose information it different
as the graph show it is increase in the File Area and decrease in the
process department depend on number of person.
 • Electronics Medical Records systems

Getting the password, the employees in the hospital can open

and use the system to collect the information or VIP patient or
celebrities.

chanceto loosconfidentialityin the ward

8
7
6
5
4
3 Expon. (chance to loos
ne
rs N
.fp
o

confidentiality)
2
1
0
cleark nurses physicon other medical
staff
healthcare team

The inpatient medical record can be taken from department to the

ward and it is handled from different worker in the ward like physician,
nurse…etc and with more handled the chance of loose it increase as
the graph is show the loose is increase from other medical staff and
decrease from the clerk depend on number of person in each
department.

Diagram show the chance to loos confidentiality in

ONE outpatient medical record

Record can be taken to the clinic some day and it still until the
treatment of patient and it transport through the clinic department so,
the chance of loose is increase as the graph show it is increase in the
laboratory and decrease in the physician.
Assement of the level of confidentiality of health information in
KFSH

Medical confidentiality is critical in the cases of:

• sexual history & STD

• adolescent sexuality

• alcohol & drug dependence

• psychiatric conditions

• marginalized persons

All police and procedure are correctly followed for these

situations.

Medical confidentiality -principles of disclosure

• Medical confidentiality is not absolute

• Disclosure - to proper authorities- need to know

• not beyond what is required or relevant

• reason for disclosure documented in the medical records

• inform patient that such disclosure is required

 In my case study I would like to discuss some cases from
this hospital to highlight the strict follow up of policies for
health information confidentiality in the hospital. To assess
the level of confidentiality of patient information, I gave the
following questions to the physicians handling these special cases.

Case No. 1

A 17 year- old male under chemotherapy. He's lost his hair and
became very lean.

He doesn't want to see his friends and relatives because he lost his
self-confidence.

Q1: Which would be the most appropriate next step?

A: open time of the visit. ( make it clear )

B: Says to all that he's dealing with chemotherapy.

C: No one will be allowed to visit and don't tell anyone about

chemotherapy without the patients permission.

Q2: The patient refuses parental involvement or counseling. Would it be

appropriate to breach confidentiality in this situation?

A: Yes.

B: No.

Answers: Q1= C. Q2=B.

 Discussion - :
Q1.If the answer is A or B, we can say that the confidentiality of
treatment or health information is not maintained. But the answer
from physicians is C. (Any person is not allowed to visit and never
disclose to anyone about chemotherapy).

Q2.If the answer is A it means without patients permission parents

are allowed to involved the patients privacy is breached. As the
answer from physicians is B .It means in any of these situations,
breach of confidentiality is not considered appropriate.
The answer shows that Patient privacy interest is highly
considered if he is an adult and in a conscious state.

Case No. 2

A 35 year old male. He is concerned about the possibility of

having HIV, and requests testing. After receiving a positive result he
states he cannot and will not tell his wife of his status.

Q1: Which would be the most appropriate next step?

A: Respect the patient's wishes.

B: Counsel the patient in respect to the importance of notifying his

sexual partner of his HIV status.

C: Tell his wife he is HIV positive without discussing this with the
patient first.
 Q2: Should confidentiality be breached if he refuses other options?

A: Yes.

B: No.

Answers: Q1= B. Q2= A.

Discussion
Q1: if the answer is A or C the physician not keep the confidentiality
in correct way because there are no interest about patient care and
prevent from the disease. So, when the physician not tells his wife the
disease transfer to this healthy wife. But the answer from physicians
is B so, it is mean the physician interest of the patient privacy, respect
his want and prevent of disease

Q2: If the answer is B it means without patients cannot breach the

information with that the disease can spread to his healthy wife and it
is wrong. As the answer from physicians is A .It means in any of
these situations, breach of confidentiality is considered appropriate
and essential
The answer shows that Patient privacy interest if it not dangers to
other person.
In KFSH&RC patient are aware about their privacy rights. Every
patient accepts in KFSH&RC or gets an appointment the employee
give the patient a Patients' Bill of Rights. Because they believe that
outstanding patient care begins with the establishment of a
partnership between the patient and the staff at KFSH&RC.

Section V:

Findings
• Confidentiality is strictly maintained with policies and
procedures.

• Policies and procedures regarding confidentiality are

implementing with all staff.

• Release of health information is controlled under rules and

policies.

• The system is new and having some errors.

• For releasing health information to 3rd party the procedure are

following strictly.

• Patients are aware about their privacy rights.

Section VI:

Suggestion

Add some suggestions to improve confidentiality of information.

• Employee shall get update training on new systems.

• If there are still errors that means the software is damaged so,
it's better to install new program.

• A culture of professionalism can effect in confidentiality of

medical information.

• Loose talk in corridor and gossips can be avoided among staff.

• Doctors should not view MR of patient’s not under their care.

• All Staff should keep professional decency for

not viewing health information unnecessary.

Section VII:

Conclusion

• All medical information that doctors acquire as part of the

professional practice is subject to the Duty of Confidentiality

• Confidentiality of health information is not absolute in a

hospital.

• Disclosure should only occur with consent, for benefit of

patient.

• Confidentiality come's very importance when patient treat in

specialist health care providers more than other hospital
 • The relation between Confidentiality & handing
record:

Section VIII:

Reference:

1. Medical Record, privacy & Confidentiality Copyright 1996-97 William L. Manning

except as otherwise noted. All rights reserved. No copyright claimed to original
government works. Last Updated by Bill Manning 8/03/97
2. MEDICAL CONFIDENTIALITY Dr. T Thirumoorthy SMA Centre for Medical
Ethics and Professionalism. September 13 2001.

3. http://en.wikipedia.org/wiki/Confidentiality#Medical_confidentiality

4. Medical records and the law book by: William and others American Health
Information Management Association
5. Lecture from the college (ethic).

6. Worker in Medical Record dept. (Mohammed khan, Aali al otiaby,

Mohammed amer).

7. Worker in Case Management dept. (Yasser al mousry).

8. Ethical Principles, Consent and Confidentiality by Richard Dawson.

9. http://bportal.kfshrc.edu.sa/wps/portal/bportal/!
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