Security Concerns About Copying Clinical Letters to Patients

Abstract

In the last 12 years there has been a move to provide NHS patients with more information about their treatment. This began in 2000 with The NHS Plan, which declared that 'letters between clinicians about an individual patient's care will be copied to the patient as of right'. Although the implementation of this plan was to be achieved by April 2004, more than eight years down the line compliance with this regulation is still poor.

Improving best practice for patients receiving hospital discharge letters: a realist review

“…There is a substantial risk of breaching patient confidentiality when distributing correspondence by post. A well-designed security arrangement is therefore required to ensure the safety of confidential information 48…”

“…Across a range of specialties and settings, the reported patient preference for receiving copies of their discharge letter is generally high (79%–97%) 7 8 14 34 35 40 43 44 48–51. However, not all patients may find letters helpful32 42 or necessary,7 32–34 39 42 52 and some may not want to be reminded of their diagnosis,34 which could decrease satisfaction, and generate queries if these patients were sent letters without a choice [CMOC40].…”

“…There are concerns and legal implications surrounding potential confidentiality breaches associated with patients receiving letters, particularly when they are sent out in the post 35 40 48 50 53 86 91. One recent paper48, which looked at confidentiality, continued to stress risks around postal communication and the importance of secure information transfer:…”

“…Some documents2 35 48 53 55 suggested ways to reduce potential risk of confidentiality breach through communication platforms and the processes involved in sending letters, for example, verifying patient contact details before sending letter35 58 [CMOC3, CMOC27, CMOC28].…”

“…A common practitioner concern of the intervention across specialties was letter comprehensibility and patient understanding11 16 33 35 36 45 47 50 86 88 97 98 [CMOC6]. Other concerns included cost of additional materials/staff time17 32 33 48 50 86 88 [CMOC23, CMOC32], patient anxiety16 17 35 36 47 50 88 95 [CMOC6, CMOC19], increased patient queries17 33 [CMOC29], potential confidentiality breaches47 [CMOC6, CMOC27] and that letters would need to be oversimplified 16 17 47 88 98 99. An attitudinal issue found in two oncology documents45 88 published 17 years’ apart was the view that letters are tools to be used between doctors only [CMOC6].…”