Characterizing the neighborhood risk environment in multisite clinic-based cohort studies: a practical geocoding and data linkages protocol for protected health information v1

Methods. This protocol demonstrates how to: (1) securely geocode patients’ residential addresses in a clinic setting and match geocoded addresses to census tracts using Geographic Information System software (Esri, Redlands, CA); (2) ascertain contextual variables of the risk environment from the American Community Survey and ArcGIS Business Analyst (Esri, Redlands, CA); (3) use geoidentifiers to link neighborhood risk data to census tracts containing geocoded addresses; and (4) assign randomly generated identifiers to census tracts and strip census tracts of their geoidentifiers to maintain patient confidentiality. Results. Completion of this protocol generates three neighborhood risk indices (i.e., a Neighborhood Disadvantage Index, a Murder Rate Index, and a Assault Rate Index) for patients’ coded census tract locations. Intended Usage. This protocol can be used by research personnel and clinic staff who do not have prior GIS experience to easily create objective indices of the neighborhood risk environment while upholding patient confidentiality. Future studies can adapt this protocol to fit their specific patient populations and analytic objectives.

Characterizing the neighborhood risk environment in multisite clinic-based cohort studies: a practical geocoding and data linkages protocol for protected health information v1

Methods. This protocol demonstrates how to: (1) securely geocode patients’ residential addresses in a clinic setting and match geocoded addresses to census tracts using Geographic Information System software (Esri, Redlands, CA); (2) ascertain contextual variables of the risk environment from the American Community Survey and ArcGIS Business Analyst (Esri, Redlands, CA); (3) use geoidentifiers to link neighborhood risk data to census tracts containing geocoded addresses; and (4) assign randomly generated identifiers to census tracts and strip census tracts of their geoidentifiers to maintain patient confidentiality. Results. Completion of this protocol generates three neighborhood risk indices (i.e., Neighborhood Disadvantage Index, Murder Rate Index, and Assault Rate Index) for patients’ coded census tract locations. Intended Usage. This protocol can be used by research personnel without prior GIS experience to easily create objective indices of the neighborhood risk environment while upholding patient confidentiality. Future studies can adapt this protocol to fit their specific patient populations and analytic objectives.

Compromising Confidentiality: Where to Strike the Balance?

"Patient confidentiality is a central tenet of medical practice, fundamental to ensuring the maintenance of trust in medical professionals. Yet are there any circumstances where a duty of care to others overrides patient confidentiality and allows disclosure of medical information without consent from the index patient? We present the case of a patient with CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) a progressive, neurodegenerative condition that is inherited in an autosomal dominant manner. Admitted to ICU with a severe Traumatic Brain Injury (TBI), the patient ultimately had withdrawal of life sustaining therapy following discussion with family. The patient never regained capacity following admission and had never disclosed the diagnosis of CADASIL to his daughters. The question of whether to disclose the diagnosis to adult children and alert them to their potential risk of inheriting CADASIL (the knowledge of which could fundamentally affect their life choices) raises tensions around confidentiality and any duty of care to the patient’s daughters. Previously, for inheritable risks, the prevailing discourse gave prominence to patient confidentiality. However, a recent UK court case and professional guidance is challenging this notion. ICU clinicians faced the choice of disclosing the CADASIL diagnosis to the adult children, breaking patient confidentiality or remaining silent so allowing potential harm to befall them and even future generations. We examine the ethical issues this raises and suggest how clinicians, if faced with a similar situation in future, might proceed. "

Doing Harm

Under the guise of “protecting the unborn,” anti-abortion and related measures such as feticide laws are being used as the basis for arresting pregnant women and new mothers. It is often the case that the initial disclosure of information that led to the involvement of criminal law, child welfare, or other state authorities has been made by healthcare professionals, including doctors, nurses, and hospital social workers. Pregnant patients—like other patients—should expect that their medical health is a private matter and that healthcare provider–patient confidentiality will be respected. Such disclosures have legal, social, and public health consequences and frequently lead to interventions that are punitive and counterproductive, not protective. This chapter describes the ethical obligations of healthcare professionals, including their duty to advocate for the protection of confidential information and to work to change unjust practices, policies, and laws.

WhatsApp Tele-Medicine – usage patterns and physicians views on the platform

Background Telemedicine has become an integral part of health care delivery in recent years. One of the leading applications for this use is WhatsApp — a free smartphone application that allows instant messaging with pictures and videos. This study analyzed the emerging role of WhatsApp on reducing the need for referrals to medical specialists and to compare the views of physicians regarding WhatsApp consultations. Methods A cross-sectional study based on an anonymous web-survey was conducted among PCPs and medical specialists working in the Israel Defense Forces Medical-Corps during September and October, 2019. Results Of 201 participants, 153 were PCPs and 48 were medical specialists. 86.9 % of PCPs and 86.5 % of specialists used WhatsApp every day in professional settings. Added workload, potential breaching of patient confidentiality and lack of full documentation of consultations were the main concerns among physicians using the application. 60.7 % of PCPs and 95.7 % of specialists stated that these consultations have reduced the need for in-person appointments at least once a week. Conclusions In times of COVID-19 that require social distancing, WhatsApp provides a simple, readily available platform for consultations between healthcare providers, even to the extent of rendering some in-person appointments unnecessary. Healthcare organizations should address the matters troubling healthcare providers, mainly patient confidentiality and lack of documentation in patients’ medical records, while providing adequate compensation for those providing the service during and after work hours.

Orthodontic Referrals: Electronic versus Paper

The Cwm Taf Community Dental Service (CDS) has previously used a paper system to refer patients to the orthodontic specialists within the Cwm Taf CDS. However, at the beginning of June 2019, an electronic referral system was introduced. Although electronic referrals have had a minimal effect on the overall waiting time for a patient, there has been an improvement in the efficiency of transfer of orthodontic referrals within the CDS. Electronic referral systems have reduced the number of inappropriate referrals, improved patient confidentiality and maintained an accurate record that is accessible from any of the Cwm Taf CDS clinics. CPD/Clinical Relevance: The article highlights the benefits of an electronic referral system with respect to reducing both inappropriate referrals and waiting times.