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 In an audit of recycling bins at five hospitals in Toronto,
researchers found more than 2,500 paper documents with personally
identifiable patient information, according to a report in JAMA.
“Patients divulge private information to their doctors and
hospitals, often that they wouldn’t want widely known, and we need
to maintain that information in a confidential way,” said senior
study author Dr. Nancy Baxter of St. Michael’s Hospital in Toronto.
In Ontario, as in the United States, legislation requires personal
health information to be protected. As more patient data is kept in
electronic health records, however, paper records may be discarded
more frequently and create risk for privacy breaches, Baxter’s team
writes.
In the U.S., the federal Health Insurance Portability and
Accountability Act of 1996 spells out privacy rules for patient
information.
“We didn’t have as much paper around 20 years ago as we do now
because we’d receive a test that would be the only copy, so we’d put
it in the chart,” Baxter said in a telephone interview. “Now we
print for convenience, and although most of these thousands of
documents go into shredding bins, some go astray.”
The researchers conducted a recycling audit at five teaching
hospitals in Toronto between November 2014 and May 2016. Each
hospital had personal health information policies, as well as
recycling bins and secure shredding bins for disposal of sensitive
material. At each site, the researchers collected recycling three
times a week during a four-week period from inpatient wards,
outpatient clinics, emergency departments, physician offices and
intensive care units.
The study team looked for any papers with personally identifiable
information, including single sheets or stapled documents, and then
they classified the sensitivity of the contents: low for
identifiable information only, medium for information about a
diagnosis and high for a description of the patient’s medical
condition.
The research team found 2,687 documents and rated 807 as low, 843 as
medium and 1,042 as high sensitivity. Personal information was found
at all the hospitals and in all locations, although more than half
(1,449 items) were found in doctor’s offices. The most commonly
found personally identifiable documents included clinical notes,
summaries and medical reports.
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“Although some sites in hospitals can get chaotic, those areas
aren’t the ones with problems,” Baxter said. “Instead, we found the
most in physicians’ offices, which should get as close to 100
percent appropriate shredding as possible. We really need to work on
this.”
Baxter and others created a podcast called “The Differential” to
highlight issues in healthcare delivery, and launched the series
March 20 with an episode detailing what they found in this study
(https://bit.ly/2DMNRX8).
Baxter said she has talked to the privacy commissioner of Ontario
about what to do moving forward, including the importance of
maintaining patient trust about confidentiality.
“My concern is that additional rules and regulations won’t get to
the heart of the problem. We could focus on shredding, but we should
really focus on reducing paper waste,” she said.
“For patients, privacy comes first, so what security measures do we
have in place to prevent a breach and then how can we talk to
patients about them?” said Mohamed Abdelhamid of California State
University Long Beach, who wasn’t involved in the study.
“Although private information on paper is of concern, that’s limited
to the people who can physically get to those papers,” Abdelhamid
told Reuters Health by phone. “Once you go electronic, you’re
subject to hackers from elsewhere, and we need to be aware of how we
protect that information.”
Ultimately, patients should understand that sharing information is
not a binary “yes-or-no” decision and often varies by situation,
Abdelhamid said. Sharing records when seeking a second opinion for a
diagnosis, for instance, could cause bias for the second doctor who
sees the first doctor’s notes. On the other hand, sharing documents
that outline medical history or track medications that may interact
could help doctors create the best medical plan.
“Increase your awareness of both the positive and negative sides of
sharing data electronically,” he said. “Consider your own privacy
barometer and calculate what’s beneficial for you in your specific
case.”
SOURCE: https://bit.ly/2GavAbD JAMA, online March 20, 2018.
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