Legal and Ethical Aspects of HIM Ch 11

Components of a Valid Court Order Authorizing Disclosure

1) Limit disclosure to those parts of the patient's record which are essential to fulfill the objective of the order 2) Limit disclosure to those persons whose need for information is the basis for the order: and 3) Include such other measures as are necessary to limit disclosure for the protection of the patient, the physician-patient relationship and the treatment services, for example, sealing from public scrutiny the record of any proceeding for which disclosure of a patient's record has been ordered.

Protections Afforded under the Genetic Information Nondiscrimination Act of 2008 (GINA)

1) Prohibits both individual and group health insurers from using an individual's genetic information in determining eligibility or setting premiums 2) Prohibits both individual and group health insurers from requiring or requesting an individual undergo a genetic test or collecting genetic information as part of enrollment plan 3) Prohibits employers or employment agencies from using a person's genetic information in decision making, including decisions involving hiring, firing, job assignments, or other terms and conditions of employment. 4) Prohibits employers or employment agencies ffrom requesting, requiring, or purchasing genetic information about individuals or their family members 5) Prohibits labor unions from excluding or expelling or otherwise adversely affecting the status of a union member because of genetic information with respect to the member

Components of a Valid Authorization Form

1) The specific name or general designation of the program or person permitted to make the disclosure 2) The name or title of the individual or the name of the organization to which disclosure is to be made 3) The name of the patient 4) The purpose of the disclosure 5) How much and what kind of information is to be disclosed 6) The signature of the patient and, when required for a patient who is a minor, the signature of a person authorized to give consent, or, when required for a patient who is incompetent or deceased, the signature of a person authorized to sign in lieu of the patient 7) The date on which the consent is signed 8) A statement that the consent is subject to revocation at any timne except to the extent that the program or person which is to make the disclosure has already acted in reliance on it. Acting in reliance includes the provision of treatment services in reliance on a valid consent to disclose information to a third party 9) The date, event, or condition upon which the consent will expire if not revoked before. This date, event, or condition must ensure that the consent will last no longer than reasonably necessary to serve the purpose for which it is given.

Mandatory Testing

A decision by the legislature or court that forces an individual to receive testing for some health reason, without granting the individual the right to refuse.

Preemption

A doctrine adopted by the U.S. Supreme Court that certain matters are of such a national, as opposed to local, character that federal laws preempt or take precedence over state laws. As such, a state law inconsistent with that of the federal law will be held invalid.

Human Genome Project

A joint effort of the US Department of Energy and the National Institutes of Health; its mission is to map and characterize each human gene, which is made available to the public on the projects GenBank Web site as the research material is made available.

Official Record

A record containing that information necessary to document the patient's care and treatment: history and mental status exam, consent forms, treatment plans, physicians orders, laboratory results, etc. This record is required to be maintained by law.

Personal Record

A record, seperate from the official medical record, maintained by the clinician in the mental health or develpomental disability context that gives the clinician's viewpoint of the patient and their communications.

Anonymous Testing

A system that assigns a unique identifier to the individual tested, thereby protecting his or her identity.

What are the similarities and differences of voluntary testing, mandatory testing, and annonymous testing?

All three types of testing detect HIV infection. Voluntary testing involves the consent of the individual to be tested. Mandatory testing involves the forcing of the individual to be tested, without the individual's right to refuse. Anonymous testing is a form of voluntary testing, allowing the individual to maintain anonymity by using a unique identifier in lieu of signature on the consent form and name of the vial containing the blood sample.

Court Order

Authorizes disclosure of patient-specific data or records that would otherwise be prohibited by statute or regulation.

Why should genetic information be protected from access by the general public?

Because of the potential for its misuse by employers, health insurers, and parents in child custody battles.

What would influence a substance abuse program's decision whether to make additional efforts beyond the governing regulations to safeguard the release of patient information?

Because of the sensitive nature of the information involved, the consequences of improper disclosure or disclosure without the notice prohibiting redisclosure come at a greater cost to the patient.

What restrictions apply to the disclosure of a patient's identity or test result?

Confidentiality statutes and ethical guidelines.

Treatment Program

Entities whose sole purpose is to provide alcohol or drug abuse diagnosis and treatment.

Patient Identification

Federal regulations restrict identification of a patient who is in a facility publicly identified as providing substance abuse treatment. Written consent of the patient or a court order is required for disclosure.

How does the Health Insurance Portability and Accountablity Act apply to genetic information?

HIPAA specifically prohibits genetic information, absent a diagnosis of a condition, from being considered a preexisting condition for health insurance purposes and prohibits health insurers from charging higher premiums because of the existence of genetic information.

Disclosure with Patient Authorization

Health information may be disclosed to third parties on written authorization of the patient. Certain components must be present for the written authorization form to be valid.

Disclosure without Patient Authorization

Health information may be disclosed to third parties without written patient authorization in limited circumstances, such as medical emergencies, scientific research activities, and audits.

Specialized Patient Records

Health records of patients undergoing treatment for certain illnesses, such as substance abuse or mental illness, or in nonacute care settings, such as a patient's home. These records are subject to different legal requirements from those in an acute care setting. They contain not only truly medical information, but also therapeutic mental and emotional information.

Genetic Information

Informatin about an individual or family obtained from a genetic test or an individual's DNA sample. Genetic information relates to a person's future, not past, health.

What is the definition of genetic information?

Information about an individual or family obtained from a genetic test or an individual's DNA sample.

Subpoena or Subpoena Duces Tecum`

Is a command to appear and/or present certain documents and othe things.

Psychotherapy Notes

Notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or group, joint, or family counseling session.

Patient Notice

Patients must be given a notice of federal confidentiality requirements upon admission to a substance abuse treatment program or soon thereafter.

Discovery Request

Seeks disclosure of patient-specific data or records that may be used in litigation.

Documentation of what types of situations may be present in a mental health or developmental disability context that may not be present in a general health record?

Situations may include changes in a patient's settings (from seclusion to use of restraints, privileges, passes, and discharge), significant legal events (commitment orders, interaction with police), the presence of suicide attempts, or restrictions on patient rights.

What are the types of specialized patient records covered in this chapter and their distinguishing characteristics?

Specialized patient records include treatment for substance abuse or mental illness or in non-acute-care settings, such as the patient's home. They are distinguished from general health records in that the nature of information presented in the record contains not only truly medical information but also therapeutic mental and emotional information. They also differ in that entries in the record are not only made by professionals who are licensed and certified but also by paraprofessionals, such as teachers. They also differ in that they are subject to stricter confidentiality requirements.

Voluntary Testing

Testing with patient consent. Voluntary testing for HIV encompasses three areas: consent for testing, delivery of pretest information, and disclosure of test results. Based on the ethical concepts of autonomy and the individuals self-determination.

Why should substance abuse treatment programs comply with the regulations governing release of patient information?

The programs are subject to enforcement mechanisms and criminal penalty in the event of a violation of regulations, a strong consideration for compliance.

Release of Information

The written consent form that permits the dissemination of confidential health information to third parties. The components of a valid release of information are determined by state law and federal and state regulation.