Health Information Privacy Code 1994
The code regulates how health agencies (such as doctors, nurses, pharmacists, health insurers, Primary Health Organisations and District Health Boards) collect, hold, use and disclose health information about identifiable individuals.
Key concepts in the code
The two key concepts in the code are:
- Purpose: Agencies must know why they are collecting health information and collect only the information they need. Once health information has been collected from a patient for a particular purpose, it can be used or disclosed for that purpose without additional consent.
- Openness: Agencies need to let patients know how their information is going to be used and disclosed so the patients can make decisions about whether to provide it.
'Ownership' of health information is a red herring
It's common for people to wonder who owns their health information. However, ownership isn't necessarily the best way to think about health information.
It is more accurate to say that:
- People have rights over health information about themselves. Rule 6 gives individuals the right to access information about themselves and rule 7 gives them the right to seek correction of that information if they think it is inaccurate or misleading.
- Health agencies have obligations over the health information they hold. These obligations are set out in the 12 rules of the code, and are briefly summarised below and in the other fact sheets in this series.
Patient expectations about health information
The code recognises that people expect their health information:
- to be kept confidential, because it was probably collected in a situation of confidence and trust
- to be treated as sensitive, because it may include details about body, lifestyle, emotions and behaviour
- may have ongoing use if a piece of medical information becomes clinically relevant even a long time after it was initially collected
- will be used for the purposes for which it was originally collected and they will be told about those purposes.
The code's twelve health information privacy rules
The code applies rules to agencies in the health sector. When it comes to health information, the 12 rules of the code substitute for the 12 principles of the Privacy Act.
From the point of view of a health agency, the rules in the code can be summarised:
1. Only collect health information if you really need it.
2. Get it straight from the people concerned where possible.
3. Tell them what you're going to do with it.
4. Be considerate when you're getting it.
5. Take care of it once you've got it.
6. People can see their health information if they want to.
7. They can correct it if it's wrong.
8. Make sure health information is correct before you use it.
9. Get rid of it when you're done with it.
10. Use it for the purpose you got it.
11. Only disclose it if you have a good reason.
12. Only assign unique identifiers where permitted.
The first eleven rules form a kind of life-cycle' for health information.
Agencies must first decide what information they need, and where and how they are going to get it. They then need to ensure they hold the information with appropriate protections and that they comply with any access or correction requests they receive. Finally, use and disclosure need to be done with care and kept in line with the purposes for which the information was collected.
There are also a number of exceptions to the general rules listed above. For instance:
- Doctors can collect information about a patient's family member's health when preparing a family or genetic history (which could otherwise breach rule 2 since it's not being collected from the family member directly).
- Hospitals can disclose basic information to enquirers about a hospital patient's presence, condition and progress (as long as the patient hasn't directly vetoed that disclosure).
- Doctors can disclose information about a patient to caregivers or close relatives in line with recognised professional practice (again, as long as the patient hasn't vetoed that disclosure).
- Health agencies can disclose information where necessary to deal with a serious threat to anyone's health or safety.
The other fact sheets in this series have more detailed information on the rules.
How the rules are enforced
The first stop for a complaint will always be the agency itself. Under the code, agencies have to have privacy officers and complaint handling procedures.
These rules are all enforceable by complaining to the Privacy Commissioner's office, and then, if necessary, to the Human Rights Review Tribunal. There can be financial consequences for agencies that breach the rules, so compliance is important.
Where to get additional assistance
There are four other health information privacy factsheets that give a broad overview of how the code works in practice.
For more detailed information, a copy of the Health Information Privacy Code (with explanatory commentary) is available for free download from the Privacy Commissioner's website at www.privacy.org.nz, as is On the Record: a Practical Guide to Health Information Privacy.