Utilizing Medical Information for good results without violating an employees right to privacy

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Utilizing Medical Information for good results
without violating an employees right to privacy

• Dr. Ciaran OShea, MD, FCBOM
• Atlantic Offshore Medical Services
• November 15th, 2005

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• Need for confidentiality between patient and
  physician
• Principles governing practice of Occupational
  Medicine
• When can medical information be released?
• Current practices regarding release of medical
  information

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Hippocratic Oath (460-377 BC)

• What so ever things I see or hear concerning
  the life of a man, in any attendance of the sick
  or even a part there from which ought not to be
  noised about, I will keep silent there on,
  counting such things to be inviolably sacred.

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Principles governing practice of Occupational
Medicine

• All medical information is confidential between
  patient and health care professional
• Medical information should be restricted so far
  as possible to health care professionals
• Medical information should only be distributed on
  a need to know basis
• The patient has a right of access to all medical
  information regarding his or her health or
  fitness

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Continued

• Disclosure of any part of the patient medical
  record to any third party requires the patients
  informed written consent
• Disclosure of medical information between health
  care professionals where there is consent or
  justification is generally ethically acceptable
• The physician has an explicit duty to furnish any
  report requested by a patient within a reasonable
  period of time

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When can medical information be released?

• Written informed consent from the patient
• When required by law for example infectious
  disease, court order, subpoena, WHSCC
  legislation, etc.
• Where there is risk to the health and safety of
  the patient or the public, or risk of damage to
  the environment, project, property, etc.

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Current practices regarding release of medical
information

• Fitness statements - pre-employment, return to
  work assessments, etc.
• Global health statistical information - trends,
  occurrences, etc.
• Occupational illness or injuries - part of body,
  mechanism of injury etc.
• Non-occupational heath information, via health
  monitoring programs to develop health and
  wellness strategies.

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In summary

• Respect the patients right to confidentiality
• Encourage release of non sensitive medical
  information on a need to know basis
• Encourage employees to participate in non
  occupational illness/injury data collection

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• The Use of Pre-employment Screening and Testing

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• Medical/health assessment for fitness to work
• Biological screening to manage health effect
  associated with work place hazard exposure
• Fitness testing for fitness to work evaluation
• Practical on the job testing
• Drug and alcohol testing

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Medical/health assessment for fitness to work

• Canadian Human Rights/Medical Guidelines
• Individual fitness for safe work performance
• Individual fitness to work in the work
  environment
• Regulated medical standards, for example
  aviation, divers, etc.

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Biological screening to manage health risks
associated with workplace health hazard exposure

• Monitoring of health effects of workplace hazard
  exposures for example, audiograms, pulmonary
  function, blood analyses, etc.
• Pre placement baseline data collection
• Ongoing monitoring of exposed personnel (health
  surveillance)

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Fitness testing for fitness to work evaluation

• Disciplines of occupational therapy, ergonomics,
  physiotherapy, etc.
• Acceptable and reliable testing tools/protocols
• Accurate job task requirements data (BFOR)
• Establish capabilities of existing workforce for
  validation of BFOR

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Practical on the job testing

• Color vision deficiency
• Obesity
• Permanently impaired, e.g., amputee, hearing
  impaired, etc.

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Drug and alcohol screening

• Policy development and implementation
• Specimen collection and chain of custody
• Medical review officer/designated employer
  representative
• Generally post incident, random for safety
  sensitive positions and with cause

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Summary

• Program must be consistent, and supported by
  research and literature
• Program must be in keeping with Canadian Human
  Rights Legislation
• Program should have clear policies, protocols
  and reporting formats that respect the principles
  of medical confidentiality
• Program should be supported by senior management
  as well as employee and labor representatives
  before implementation