THE HOMELESS AND THEIR PRIVACY RIGHTS

                                                                                      

INTRODUCTION

Health records are among the most sensitive data that are acquired, used, and disclosed by government and the private sector. Health information reveals a great deal of personal facts about individuals which may lead to stigma and discrimination when possessed and misused by government officials, employers,

insurers, and by friends and family. The increasing potential for disclosure of this information within a rapidly-developing national health information infrastructure, facilitated by massive computerization of records and other technological developments, presents significant risks to individual privacy.

Despite the highly-sensitive nature of individually-identifiable health information, protecting the privacy and security of these records has been historically de-emphasized when compared with statutory protections allotted to other types of personal information (e.g., banking and investment records, consumer

spending information, tax information, and video rental records). There are many reasons for the de-emphasis of health information privacy, including economic and political theories. However, modern legal developments are likely to improve privacy and security protection. As we develop a national health information infrastructure, the importance of privacy and security become crucial.

Health information privacy, of course, is a two-edge sword. While it is important in respecting the autonomy and dignity of individuals, excessive amounts of privacy can impede many of the goals of the health care system. Health information creates unprecedented opportunities to benefit individuals and communities.

Health care professionals can use computerized data to improve clinical care for patients; health service researchers can better assess the quality of services; government and health service managers can gain administrative efficiencies; health insurers, including Medicare and Medicaid, can prevent fraud and abuse; and public health authorities can improve surveillance and epidemiologic investigations within the community.

In each of these areas (and many others), overly-restrictive health information privacy and security protections may thwart legitimate and important uses of identifiable health data that benefit society. Though privacy is certainly necessary, legal protection should strike a reasonable balance between individual rights and the collective goods of health information.

Privacy, Confidentiality, and Security within a National Health Information Infrastructure

"No one engaged in any part of health care delivery or planning today can fail to sense the immense changes on the horizon, even if the silhouettes of those changes, let alone the details, are in dispute."

With this observation, the Institute of Medicine was referring to the development of a national health information infrastructure, defined as the "basic, underlying framework of electronic information collection, storage, use, and transmission that supports all of the essential functions of the health care system. "These functions include clinical and prevention services, quality assurance, financial reimbursement, monitoring of fraud and abuse, research, and public health services. Before discussing the national health information infrastructure, it is important to distinguish among the legal and ethical meanings of privacy, confidentiality, and security; these concepts are commonly misconstrued.

Health information privacy refers to an individual's claim to control the circumstances in which personally identifiable health information is collected, used, and disclosed. Maintaining the privacy of health information does not necessarily mean keeping the information secret. Rather, protecting the privacy of health information involves enabling the person to whom the information relates to control its acquisition, use, and disclosure. To respect one’s autonomous interests, patients should have the right to exercise some control over the acquisition, use, and disclosure of personal health information. However, respecting individual privacy becomes less important, or not important at all, where the information is non-identifiable. Non-identifiable information is defined as information that cannot be associated with any identifiable characteristics of the individual. Since the acquisition, use, and disclosure of truly anonymous data does not implicate individual interests, such data are entitled to virtually no privacy protections.

While privacy relates broadly to the acquisition and use of health information, confidentiality denotes individual privacy interests that arise out of a specific relationship with the person about whom the information is gathered. Privacy arising from these relationships – primarily between e.g. on-site resident program manager, the administrative clerk, on-site staff, the local physician and patient –is protected by traditional legal and ethical duties to maintain the confidentiality of the information. For example, the law has traditionally recognized a duty of physicians to not disclose medical information about their patients without the patient’s consent, absent some limited justification. Thus, confidentiality may be viewed simply as a narrower subset of health information privacy.

The security of health information is distinct from individual interests in privacy and confidentiality. Security refers to technological, organizational, or administrative processes designed to protect data systems from unwarranted access, disclosures, modification, or destruction. Maintaining the security of health information is not synonymous with preserving its privacy. Absolute privacy of health information can never be assured even with maximum security protections because no security system can safeguard against access by those who are authorized to use the data system. Thus, authorized users can invade patient privacy even in the most secure data systems. The purpose of security is to ensure that data systems are accessed only by those persons having authorization.

How are Human Rights Protected  at The House of Grace Homeless Shelter?

We are all equally responsible for the protection of human rights – not just for ourselves, but for others as well. This is not to say that as individuals we are solely responsible. Clearly, this responsibility is shared among our governments, and the courts.

In fact, all of these bodies play an important role in providing both direct protection and a means by which this protection may be pursued. However, the most successful form of protection is through widespread appreciation of, and respect for, human rights. It is this that forms the basis of our own self-respect as well as respect for the dignity of others.

There are two fundamentally interrelated answers to the question: how are human rights protected in at the House of Grace Homeless Shelter? The first answer considers the law and how the legal system as a whole protects human rights. The second answer considers the protection offered by other individual institutions and their processes e.g. hospitals.

Protection Through Institutions and Processes

Our lives are touched everyday by a great variety of public institutions and processes, and consequently, they affect almost everything we do. Through the operation of law and the implementation of governmental policies, human rights comprise an important part of public life. However, it is worth noting that human/civil rights are not so much protected by the law in any meaningful sense, but rather, by the institutions that create, up-hold and implement the law. The house of Grace acknowledges this sensitive condition and will work toward protection the right of our guest/clients and those of our partners i.e. hospitals, local police/fire departments, and red-cross etc.

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