Pediatric Informatics: Computer Applications in Child Health (Health ...

22 Privacy Issues 307
patient must be visible (or restricted) to all clinicians. Similar restrictions may be
created for Adolescent Medicine and Obstetrics/Gynecology issues:
A locum tenens physician is covering a clinic for a medical group. Review of a sick 14 year
old female’s EMR by the physician reveals an SSRI and an oral contraceptive on the medication
list. There is a record for a previous visit to the groups’ family practitioner who
prescribed the oral contraceptive. The SSRI was prescribed by the group’s psychiatrist, for
which there is no progress note or diagnosis available in the EMR.
22.4.5 Restricting Access to Diagnosis and Problem Lists
The personal, legal and economic impact of certain diagnoses (especially when
generated by templates) on liability, job qualifications, medical and life insurance
and security clearances 5–6 make control over active problem lists and diagnoses
essential from a privacy viewpoint. Psychiatric issues and other medical diagnoses
such as drug abuse, malingering, poor parenting, prenatal drug abuse on
newborn lab screening, gender identity issues, 7 HIV, and Munchausen’s Syndrome
(including by proxy) have potential consequences and must be verified with valid
medical findings and facts beyond a simple notation:
A mother completes an application to add life insurance for her 22 year old daughter to her
policy. An EMR report is automatically released to the insurance company as part of the
application process. The daughter is denied coverage based on a diagnosis of suicidal
thoughts 5 years prior, although no diagnosis of depression is currently on the problem list.
A 21 year old works for a company contracting to the federal government, which requires
all employees to pass security clearance. The employee fails the security clearance based
on a positive drug test discovered in the EMR for marijuana at age 17.
22.4.6 Documenting and Releasing Information
on Alleged Abuse
Documentation standards for interviews and examinations of minors for sexual
abuse and physical abuse must meet defined legal standards and be available to
legal and protective services. Documentation and evidence must be passed through
an auditable chain of custody and is confidential, unless there is a concern that a
child or teen is in imminent danger by a caretaker or parent:
A mother requests a clinic nurse to review the EMR of a developmentally delayed 4 year
old evaluated 2 weeks previously for bruises (with digital photos that are in the EMR). The
mother alleges that the father (who has joint custody of the child and who has the child for
the weekend) inflicted the bruises and requests the nurse to file a protective services report
to get the child back. Upon review of the record with the physician, the nurse finds the
physician remembers numerous contacts in the past, previously cleared by CPS (but documented
only in the archived paper chart) and evidence of a custody battle with a restraining
order against the mother.