Monitoring of access to confidential patient imaging information hasn't kept up with changes in technology, according to the results of a survey by the European Society of Radiology (ESR) published in the current issue of Insights into Imaging. In addition, Europe lacks a unified approach to define clear guidelines on patient confidentiality and invasion of privacy, as well as updated patient consent policies.
Healthcare is becoming more patient-centered -- patients are given more direct access to their images and health records -- but what the patient is told, how test procedures and results are communicated to them, and how much access patients and others have to reports and images vary considerably across Europe.
"The safeguarding and protection of medical information about the patient and their right to confidentiality is also more difficult to maintain in an electronic age of PACS," wrote the ESR, noting that the systems "store large volumes of data, but are also accessible to a large number of people who have no medical responsibility for the patient" (Insights Imaging, April 2013, Vol. 4:2, pp. 153-156).
The Audit and Standards subcommittee of the ESR sent a questionnaire to 41 presidents of national societies to evaluate practices in Europe and determine similarities and differences; 80% responded.
Some of the survey results:
- 45.5% of patients routinely receive reports and can access them electronically.
- 45.5% of radiologists routinely discuss the imaging findings (particularly ultrasound) directly with the patient.
- 45.5% said radiologists rarely receive training on communication, such as giving bad news to the patient; it depends on the individual's initiative.
- 75.8% said there is a national policy or guidance on disclosing patient information to anyone not directly involved in their care.
- 63.6% said there are national society or other guidelines on who should or has the right to view an individual patient's films or images and reports.
- 45.5% said there is monitoring of who has looked at individual patient reports and images.
- Only 28.1% responded that written consent is given for all procedures involving ionizing radiation.
- Only 21.9% responded that patients are given written information about radiation risks for all investigations involving radiaton.
Patient communication
With respect to direct discussion of imaging findings between patients and radiologists, free text comments by survey respondents indicated there may be variation between private and state-provided care, the ESR said.
"Other factors cited were the time available and variation depending on the modality, for example more discussion was likely to take place about ultrasound examinations [than] MRI," the organization wrote. "One respondent also indicated that radiologists did not discuss the findings because the referring doctors preferred to discuss the examination results with the patients (with which the radiologist respondent indicated that they did not agree)."
It seems likely as radiology moves further toward openness and providing reports to patients, greater direct communication between radiologists and patients may follow, the ESR said.
This may make the radiologist's role clearer to patients, but direct discussions or even electronic communication between radiologists and patients may be very time-consuming, potentially reducing radiologists' reporting productivity, the society noted.
"As patients become better-informed, they may require more explanation and information about the risks and benefits of the procedures they undergo in radiology departments," the ESR concluded, adding that "with more openness and direct patient access to their records, radiologists may have an increasing need to communicate directly with patients, which is not usually part of their training, and may be difficult to achieve in an era of teleradiology."
Confidentiality
With electronic medical records, "password protection can be misused, and large numbers of people may have access to an imaging archive, which may be a temptation to view others' imaging information just for personal interest," according to the ESR.
However, proving wrongful access to patient information is difficult, because more than half of the national societies responded that there is no monitoring of who has accessed individual patients' images or reports. One respondent cited a case from the European Court, I vs. Finland. The applicant "I" stated her private medical records were accessed by other people and as a result she possibly lost her job as a nurse. The access was not recorded because this was in 1992 and there were no records of this at the time.
The court decided the hospital was controlled by the state so Finland was responsible for the actions at the hospital. The court also stated personal information relating to a patient undoubtedly belongs to his or her private life.
"The European Court of Human Rights found that a person's right to respect of their private life (under the ECHR) may be breached where the state fails to take appropriate steps to secure data, so that it cannot be accessed improperly," the ESR wrote. "Confidentiality of imaging records may be an area where policy has not kept up with technological advances."
When patient records were films and paper reports, access by any individual was usually obvious. With electronic storage, anyone with access to a password can browse a whole archive.
"It is apparent from the survey that monitoring of this browsing is not usually routine, and there is at least the potential for misuse," the society stated.
It is also clear Europe lacks a unified approach to define guidelines for patient confidentiality and guidance on what constitutes invasion of patient privacy, the ESR concluded.
