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A Clinician's Guide to Privacy and Communication in the ICU
Leslie Francis1, Micah A Vorwaller, Hanan Aboumatar
11Department of Philosophy, University of Utah, Salt Lake City, UT. 2S.J. Quinney College of Law, University of Utah, Salt Lake City, UT. 3Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Department of Medicine, School of Medicine, and Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 4Palo Alto Medical Foundation Research Institute, Palo Alto, CA. 5Department of Medicine, University of California, Los Angeles, Los Angeles, CA. 6Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 7Division of General Internal Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA. 8ARDS Foundation, Northbrook, IL. 9Berman Institute of Bioethics; Department of Medicine, School of Medicine; and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 10Nursing, University of California San Francisco Medical Center, San Francisco, CA. 11Center for Humanizing Critical Care, Intermountain Medical Center, Murray, UT. 12Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
Objective:
To review the legal issues concerning family members' access to information when patients are in the ICU.
Data Sources:
U.S. Code, U.S. Code of Federal Regulations, and state legislative codes.
Data Extraction:
Relevant legal statutes and regulations were identified and reviewed by the two attorney authors (L. F., M. A. V.).
Study Selection:
Not applicable.
Data Synthesis:
Review by all coauthors.
Conclusions:
The Health Insurance Portability and Accountability Act and related laws should not be viewed as barriers to clinicians sharing information with ICU patients and their loved ones. Generally, under Health Insurance Portability and Accountability Act, personal representatives have the same authority to receive information that patients would otherwise have. Persons involved in the patient's care also may be given information relevant to the episode of care unless the patient objects. ICUs should develop policies for handling the issues we identify about such information sharing, including policies for responding to telephone inquiries and methods for giving patients the opportunity to object to sharing information with individuals involved in their care. ICU clinicians also should be knowledgeable of their state's laws about how to identify patients' personal representatives and the authority of those representatives. Finally, ICU clinicians should be aware of any special restrictions their state places on medical information. In aggregate, these strategies should help ICU managers and clinicians facilitate robust communication with patients and their loved ones.
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