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Module 7: Confidentiality in Tuberculosis Control
Reading Material

Measures to Protect Patient Confidentiality

Protecting Patient Confidentiality

Health care workers can provide measures to protect confidentiality anywhere, whether in an office, clinic, institution, or in the field.

Any situation. In any situation there are important measures that all health care workers can take to protect patient confidentiality:

  • Confirm the patient's identity at the first encounter
  • Never discuss the patient's case with anyone without the patient's permission (including family and friends during off-duty hours)
  • Never leave hard copies of forms or records where unauthorized persons may access them
  • Use only secure routes to send patient information (for example, official mail) and always mark this information confidential
  • When using an interpreter, ensure that the interpreter understands the importance of patient confidentiality

When in an office, clinic, or institution. Great care should be taken to protect patient confidentiality in health care settings and in the field.

  • Conduct patient interviews in private rooms or areas (Figure 7.3)
  • Never discuss cases or use patients' names in a public area
  • If a staff member or health care worker requests patient information, establish his or her authority to do so before disclosing anything

Confidentiality can be further protected in the ongoing management of data collected on the TB patient.

  • Keep records that contain patient names and other identifying information in closed, locked files (Figure 7.4)
  • Restrict access to electronic databases to designated staff
  • Carefully protect computer passwords or keys; never give them to unauthorized persons
  • Carefully safeguard computer screens
  • Keep computers in a locked or restricted area; physically or electronically lock the hard disk
  • Keep printouts of electronic information in a restricted or locked area; printouts that are no longer needed should be destroyed

Figure 7.3  This is a picture of a health care worker demonstrating conducting a patient interview in private behind a closed door.

Figure 7.4  This is a picture of a health care worker locking a cabinet that contains patient files.

Health care workers have a responsibility to protect patient records from unauthorized access. Information that should be kept in closed, locked files except when being processed by authorized staff include

  • All medical records
  • Report of Verified Case of TB (RVCT) forms
  • Communicable disease report cards
  • Other records that contain patient names and other identifying information

Offices should be locked during nonbusiness hours. No papers should be exposed when workers are away from the work area, even for brief periods. Access to all RVCT forms, communicable disease report cards, and the files containing them should be restricted to designated TB program staff who are directly involved with surveillance or case work and who have a need to know.

Electronic surveillance databases should be restricted to designated TB surveillance staff who are directly involved with surveillance and other case work, and who have a need to know. Access to such databases should be protected by a combination of user IDs and passwords; user IDs should be issued only to staff who require access to the database to perform their official duties. Passwords should be changed on a regular basis and should not be easy to deduce (for example, employee's names, birthdates, or other personal information should not be used as passwords).

All computers and work stations accessing surveillance databases should be kept in a locked or restricted area. If this is not feasible, the hard disk must be physically or electronically locked when the computer is not in use. All hard copy output (for example, file listings or reports) generated by surveillance databases must be kept in a restricted or locked area. All hard copy output that is no longer needed must be destroyed.

When in the field. In the course of locating a patient for DOT or conducting a contact investigation in the field, TB workers may need to ask for patients by name or inquire about a patient's work location and habits. This should be done as discreetly as possible. Before giving out patient information to anyone, health care workers should ask themselves, "Does this person need to know?" Health care workers do need to identify themselves as having a legitimate reason to seek a particular individual, but there is no need to disclose the nature of the problem or any specific details of the case in question. When a disclosure occurs during the course of a field investigation, it is a good idea to document what information was given out and to whom it was given, in case there are any follow-up questions from the patient or the person who was informed of the patient's health problem.

In the patient's home, health care workers should allow the patient to determine who is present during an interview. Family members or friends should be present and participate in the discussion only if the patient specifically requests this. In the field there are important measures that can be taken to protect patient confidentiality:

  • Be discreet when making patient visits
  • Conduct patient interviews in private; never discuss the case in a public place
  • Don't leave sensitive or confidential information in messages for the patient on a door; but if a message must be left on the door, it should be left in a sealed envelope, marked confidential, and addressed to a specific person
  • Don't leave sensitive or confidential information on an answering machine that other people can access
  • Don't leave sensitive or confidential information with a neighbor or friend, and be careful not to disclose the patient's condition when gathering information on his or her whereabouts

Table 7.2 summarizes the important measures all health care workers can take to protect patient confidentiality.
 

Table 7.2
Measures to Protect Patient Confidentiality

Any situation
  • Confirm the patient's identity at the first encounter
  • Never discuss the patient's case with anyone without the patient's permission (including family and friends during off-duty hours)
  • Never leave hard copies of forms or records where unauthorized persons may access them
  • Use only secure routes to send patient information (for example, official mail) and always mark this information confidential
  • When using an interpreter, ensure that the interpreter understands the importance of patient confidentiality
When in an office, clinic, or institution
  • Conduct patient interviews in private rooms or areas
  • Never discuss cases or use patients' names in a public area
  • If a staff member or health care worker requests patient information, establish his or her authority to do so before disclosing anything
  • Keep records that contain patient names and other identifying information in closed, locked files
  • Restrict access to electronic databases to designated staff
  • Carefully protect computer passwords or keys; never give them to unauthorized persons
  • Carefully safeguard computer screens
  • Keep computers in a locked or restricted area; physically or electronically lock the hard disk
  • Keep printouts of electronic information in a restricted or locked area; printouts that are no longer needed should be destroyed
When in the field
  • Be discreet when making patient visits
  • Conduct patient interviews in private; never discuss the case in a public place
  • Don't leave sensitive or confidential information in messages for the patient on a door; but if a message must be left on the door, it should be left in a sealed envelope, marked confidential, and addressed to a specific person
  • Don't leave sensitive or confidential information on an answering machine that other people can access
  • Don't leave sensitive or confidential information with a neighbor or friend, and be careful not to disclose the patient's condition when gathering information on his or her whereabouts

 
Study Questions 7.18

7.18 List the ways in which a patient's confidentiality can be protected in

  • Any situation
  • An office, clinic, or institution
  • The field

Answers 


 
Case Study 7.4
Rolando is a health care worker at a busy TB clinic. It is the end of a very busy Friday afternoon. He is trying to wrap things up and go home after his extremely stressful week. He is going through the patient-related papers and forms he has been working on that day. He is on his way to put the papers and forms in the file cabinet when he is interrupted by a phone call from his babysitter. His babysitter explains that she has to leave early that day. Thinking it is an emergency, Rolando hastily hands over the files to his co-worker Sam in the clinic area. He asks Sam to put the files on his desk. Before getting a reply from Sam, he leaves. Sam was not very happy because he was just leaving himself. He ends up leaving the files on the table in the clinic, an area where other TB patients may see the files.
  • What measures should Rolando have taken to protect patient confidentiality?

Answers 


 
Case Study 7.5
Another outreach worker, Janice, has been trying to contact her patient Jerry for several days. She has visited his home several times, and tried to call him on the telephone. One time when she visits Jerry's house she sees Jerry's neighbor. The neighbor tells Janice that Jerry just left. Janice introduces herself to Jerry's neighbor and explains that she is from the TB clinic in the health department and is looking for Jerry. She tells the neighbor that the reason she is looking for Jerry is that he has TB and has missed taking treatment for over 1 week. She also tells the neighbor that if she sees Jerry to please tell him that she has stopped by to see him. Finally, she leaves a message for Jerry on the door of his apartment. She does not have any envelopes for her letter, but decides Jerry must really get her message and so she tapes it to his front door.
  • Did Janice do anything that possibly threatens Jerry's confidentiality? What measures should she have taken to protect patient confidentiality?

Answers 


 
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