The Ethics of Sharing: How Do Social Workers Decide What to Record in Shared Health Records?

ABSTRACT

Social workers form part of many healthcare teams. This role can involve in-depth conversations with clients and home visits. These encounters can reveal sensitive information, not all of which may be accessible to other members of the healthcare team. Most modern healthcare systems employ shared care records, which are populated by, and accessible to, multiple members of the healthcare team. Shared care records are valued for their capacity to enhance inter-professional communication and improve patient care. But this very capacity may increase an underlying tension between privacy and efficient, effective care. Ethical tensions can arise for health social workers between comprehensive documentation and protecting client privacy by limiting access to privileged information obtained in the context of a social work encounter. This qualitative empirical ethics study investigated health social workers' experiences of tensions between client privacy and maintaining complete records, and how they thought the tension should be resolved. Participant testimony informed a pragmatist approach to identify principles governing recording of sensitive information in shared care records. Three principles were identified: necessity, accuracy, and neutrality. Participants' reports of moral concerns about recording indicate that ethical tensions can occur. The identified principles offer a starting point for managing such tensions.

KEYWORDS:

• Health social work
• records
• record-keeping
• privacy
• confidentiality
• empirical ethics
• sensitive information
• qualitative research

Acknowledgements

We gratefully acknowledge the support of the Office of the Privacy Commissioner’s Privacy Good Research Fund. Our thanks to the social workers who took the time to participate in this research and shared their wisdom with us, and to the social work teams who facilitated contact with participants.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Isobel Cairns holds a first- class Honours Degree in Philosophy and a Graduate Diploma of Science in Psychology from Victoria University of Wellington. She completed her Master of Public Health at the University of Auckland in 2016, with a thesis focusing on the ethical judgements made by health social workers when recording sensitive information in shared records. Her research interests include public health and applied ethics, the philosophy of mental health, and ethical issues relating to computers and information technology.

Katharine Wallis is an Auckland general practitioner and a senior lecturer in the Department of General Practice and Primary Health Care at the University of Auckland. Katharine developed an interest in health information privacy while studying for the degree of Master of Bioethics and Health Law at the University of Otago in Dunedin. Katharine's other research interests include patient safety in primary care, safer prescribing for older people, and medical professional regulation. Katharine is currently a member of the Health Practitioners Disciplinary Tribunal, the Medicines Adverse Reactions Committee, the NZMA ethics committee, and the Maternal Mortality Working Group.

Monique Jonas is a Senior Lecturer in ethics at the Faculty of Medical and Health Sciences at the University of Auckland. She is the Director of the Bachelor of Health Sciences, and has a Doctorate in Medical Ethics from Kings College London. Her research focuses on topics in bioethics, and questions relating to the role of the state in the family, and decision-making for children. She has been a member of New Zealand's National Health Committee, and the National Ethics Advisory Committee.

Notes

1 A number of terms are used to refer to the person to whom the record relates. For simplicity’s sake we use a single term, client, in keeping with the practice of our participants.

Additional information

Funding

This work was supported by the New Zealand Office of the Privacy Commissioner’s Privacy Good Research Fund, 2015.