What are the best ways to maintain patient privacy in quality improvement and patient safety?

1 Understand the regulations

The first step is to familiarize yourself with the relevant laws and regulations that govern patient privacy in your jurisdiction. For example, in the United States, the Health Insurance Portability and Accountability Act (HIPAA) sets the standards for protecting the privacy and security of patients' health information. HIPAA applies to covered entities, such as health care providers, health plans, and health care clearinghouses, and their business associates, such as contractors and vendors. HIPAA requires that covered entities and business associates obtain patient consent or authorization before using or disclosing their protected health information (PHI) for purposes other than treatment, payment, or health care operations, unless an exception applies. HIPAA also gives patients the right to access, amend, and request an accounting of their PHI.

2 Use de-identified data

One of the exceptions to the HIPAA consent or authorization requirement is the use or disclosure of de-identified data. De-identified data is data that has been stripped of any information that could identify an individual, such as name, address, date of birth, social security number, medical record number, etc. De-identified data can be used for quality improvement and patient safety purposes without violating HIPAA, as long as the data is not re-identified or linked to other sources of identifiable data. To de-identify data, you can either follow the HIPAA Privacy Rule's standards for statistical or expert methods, or use the HIPAA Privacy Rule's safe harbor method, which involves removing 18 specific identifiers from the data.

3 Implement safeguards

Another best practice is to implement appropriate safeguards to protect the privacy and security of the data you use for quality improvement and patient safety. This includes physical, technical, and administrative measures to prevent unauthorized access, use, disclosure, modification, or destruction of the data. For example, you should store the data in a secure location, limit access to authorized personnel, encrypt the data in transit and at rest, use strong passwords and authentication methods, monitor and audit the data activities, train and educate the staff on privacy and security policies and procedures, and report and respond to any breaches or incidents.

4 Collaborate with stakeholders

Finally, you should collaborate with the physicians and other health care professionals who are involved in or affected by your quality improvement and patient safety initiatives. You should communicate with them about the goals, methods, benefits, and risks of your initiatives, and seek their input and feedback. You should also respect their professional judgment and autonomy, and avoid imposing unnecessary burdens or constraints on their clinical practice. By working with them as partners, you can foster a culture of trust, transparency, and accountability, and enhance the quality and safety of patient care.

5 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?