Institutional members access full text with Ovid®

Share this article on:

A Clinician’s Guide to Privacy and Communication in the ICU

Francis, Leslie JD, PhD; Vorwaller, Micah A. JD; Aboumatar, Hanan MD, MPH; Frosch, Dominick L. PhD; Halamka, John MD; Rozenblum, Ronen PhD, MPH; Rubin, Eileen JD; Lee, Barbara Sarnoff MSW; Sugarman, Jeremy MD, MPH, MA; Turner, Kathleen RN; Brown, Samuel M. MD, MS, FCCMfor the Privacy, Access, and Engagement Task Force of the Libretto Consortium of the Gordon and Betty Moore Foundation

doi: 10.1097/CCM.0000000000002190
Concise Definitive Review

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.

Supplemental Digital Content is available in the text.

1Department 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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Francis’ institution received funding from the Gordon and Betty Moore Foundation. Dr. Vorwaller received support for this article research from the Privacy, Access, and Engagement Task Force of the Gordon and Betty Moore Foundation. Dr. Aboumatar’s institution received funding (Dr. Aboumatar has received research awards from Patient-Centered Outcomes Research Institute for research work that is unrelated to this article and she has received research awards from Agency for Healthcare Research and Quality, and the Moore Foundation for research work that is unrelated to this article). Dr. Rozenblum received support for this article research from the Gordon and Betty Moore Foundation and disclosed work for hire. His institution received funding from the Gordon and Betty Moore Foundation. Dr. Rubin’s institution received funding from the Gordon and Betty Moore Foundation. Ms. Lee received funding from US-China Health Summit. Her institution received funding from the Gordon and Betty Moore Foundation. Dr. Sugarman disclosed other support (he serves on the Merck KGaA Bioethics Advisory Panel and Stem Cell Research Oversight Committee; the Quintiles Ethics Advisory Panel; and has been a consultant for Novartis. None of these activities are related to the work described in this article). His institution received funding from the Gordon and Betty Moore Foundation. Dr. Turner received funding from Gordon and Betty Moore Foundation. Dr. Brown received support for this article research from the Gordon and Betty Moore Foundation. Dr. Halamka has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: samuel.brown@imail.org

Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.