Dentro de: "Thought Leaders : connected health": p. 16-25
ISBN: 0-9546445-0-6
Autor:

Dr. Anthony Nowlan
Executive Director of the National Health Service Information Authority (NHSIA), England

Resumen:

Confidentiality is one of the most confusing and contentious issues that arise in the course of applying information technologies in healthcare. At heart the issue appears straightforward. Individuals ? patients ? impart highly personal information to their carers and advisors and expect that confidence to be respected. The trust this establishes is a foundation of healthcare. Legal, professional and ethical principles exist in most jurisdictions to protect that
trust. However while the issue may be simple at heart, the realisation in
modern healthcare practice is far from straightforward. All too often a seemingly modest proposal to improve some aspect of the delivery of health care, such as the better management of scheduling, can become tangled in a web of issues under the heading of ?confidentiality?. There are many arguments and counter-arguments amidst a daunting collection of issues that range from the practicalities of a Public Key Infrastructure through to the relationship between teenage children and their parents over contraception.

In this essay I wish to provide a set of principles or perhaps just insights to help those who are wrestling with such issues. My central argument is that the key to progress is the realignment of information management and issues of confidentiality with the basic principles of health care practice. We must stop seeing the management of information as separate from and unlike other health care activities. In addition there is no single technical action that can ?fix the problem?. Progress requires coordinated technical, clinical, policy, and societal actions and I will list challenges to a variety of
constituencies.

This essay draws on my recent close experience of working on confidentiality
and privacy issues in the National Health Service (NHS) in England. This work
involved extensive research and consultation on new proposals with patients, carers, the public, health professionals and other interested parties. I shall also draw on my time in clinical practice and health informatics research and development both in academia and industry. This essay is not, however, an
account of the specific policies being followed in England. I seek to identify
common principles that may apply across healthcare systems.
Nowlan, Anthony