Privacy and confidentiality have long been recognized as essential elements of the relationship between patients, pharmacists, physicians and other health care professionals. The compilation of a complete, accurate medical record is essential to optimal patient care. To effectively provide quality patient care and evaluate the health status of enrolled populations, managed health care systems must assemble, integrate and provide timely access to complex patient information across a broad spectrum of providers, provider organizations, data sources and users. The increasing use of new information technologies offers many opportunities to improve patient care. However, increased use of these new technologies has also raised concerns about the need to preserve patient rights to privacy and limit access to protected medical and pharmacy information.¹

The responsible use of PHI enhances the effectiveness and quality of health care services delivered to groups of patients with similar needs. The individual patient’s right to the privacy of his or her patient-identifiable medical information often preempts access to such information for other than allowable reasons involving treatment, payment or operations. In order to maintain patient confidentiality and deliver quality, cost-effective care to patients with similar treatment needs, managed health care systems develop confidentiality policies and procedures that meet statutory requirements and strike a balance between the need to ensure an individual patient’s right to privacy and the need of practitioners, managed health care systems and payers to share information to demonstrate the quality of the care provided. Individuals must have assurance that those privileged to access their confidential medical record will abide by statute and tenets of ethical behavior to protect such information from inappropriate disclosure and that the responsible, judicious use of such information will enhance their medical care. Managed health care systems therefore implement programs that guarantee these requirements.

In addition, secure access to complete and reliable information, which by necessity includes PHI, is imperative to the continuing improvement of public health and health care delivery through health care related initiatives such as community health information networks, tele-medicine, outcomes research, disease management programs and the creation of population-based statistical data bases.