Should Immigration Status Information Be Included in a Patient's Health Record?

doi:10.1001/amajethics.2019.8

Cited by 32 publications

(9 citation statements)

References 12 publications

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“…This approach was used when HIV infection and AIDS first emerged; during this period, clinicians were hesitant to record the HIV status of patients because of the potential for stigma and discrimination. In the past, practitioners were also reluctant to share patients’ DNA pedigrees and other genetic information that could be used by insurance companies or employers to target asymptomatic patients based on their genetic susceptibilities …”

Section: Discussionmentioning

confidence: 99%

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

et al. 2020

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IMPORTANCE Increases in the enforcement of immigration policies, deportations, and rhetoric critical of immigration during and after the 2016 US presidential election have been associated with a decrease in health-seeking behaviors and an increase in adverse health outcomes among immigrants. Efforts to address the health care needs of immigrants after the 2016 presidential election have centered on individual-level patient-practitioner strategies or federal-and state-level policy changes. However, these approaches have not captured the role of health care systems and the range of health care facilities encompassed within them.OBJECTIVE To characterize policies and actions implemented by health care facilities to address immigration status-related stressors. DESIGN, SETTING, AND PARTICIPANTSThis exploratory qualitative study involved semistructured interviews in a purposive sample of health care facilities across 5 states (California, Texas, New York, Florida, and Illinois) with the largest populations of individuals with undocumented immigration status. Data from media sources and informational interviews with local immigration advocacy leaders were used to identify health care facilities that had implemented welcoming policies and strategies. Stakeholders, including administrators, frontline clinicians involved in policy implementation, and senior executive leaders, were interviewed. Interviews were conducted between May 1 and August 9, 2018, and were recorded, transcribed, and coded using constant comparative analysis. Data analysis was performed from MAIN OUTCOMES AND MEASURES Stakeholder perspectives on the range, scope and content of policies and actions implemented to address immigration-related stressors at health care facilities.RESULTS A total of 38 in-depth interviews were conducted spanning 25 health care facilities in 5 states; these facilities included 13 federally qualified health centers, 7 academic or private hospitals, and 5 public institutions. Interviewees described policies and actions that mitigated one or more of the following perceived risks: (1) risk of exposure to immigration enforcement personnel at or near facilities, (2) risk of immigration status-related information disclosure, (3) risk associated with patient-level stressors, (4) risk associated with practitioner-level stressors, and (5) coordination of risk mitigation. Most personnel at health care facilities emphasized that their policies and actions fit within a larger mission and history of addressing the social needs of diverse patients and mitigating risks for patients. CONCLUSIONS AND RELEVANCEHealth care facilities can implement both active and reactive measures to address perceived immigration-associated risks among patients and practitioners.Population health and immigration policies are at the forefront of current policy debates. An (continued) Abstract (continued) understanding of the ways in which health care facilities can serve to mitigate perceived risks among their patients and employees can be one step toward ...

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Section: Discussionmentioning

confidence: 99%

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

et al. 2020

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“…Fourth, EDs must have a systematic process for whether or not to screen for patient status. Asking patients about their status can induce fear, and in general, the literature does not recommend documenting status in order to protect the identity of patients [22,27]. However, in practice, physicians or, more commonly, social workers often do ask.…”

Section: Discussionmentioning

confidence: 99%

Provider and administrator-level perspectives on strategies to reduce fear and improve patient trust in the emergency department in times of heightened immigration enforcement

et al. 2021

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Study objectives Heightened immigration enforcement may induce fear in undocumented patients when coming to the Emergency Department (ED) for care. Limited literature examining health system policies to reduce immigrant fear exists. In this multi-site qualitative study, we sought to assess provider and system-level policies on caring for undocumented patients in three California EDs. Methods We recruited 41 ED providers and administrators from three California EDs (in San Francisco, Oakland, and Sylmar) with large immigrant populations. Participants were recruited using a trusted gatekeeper and snowball sampling. We conducted semi-structured interviews and analyzed the transcripts using constructivist grounded theory. Results We interviewed 10 physicians, 11 nurses, 9 social workers, and 11 administrators, and identified 7 themes. Providers described existing policies and recent policy changes that facilitate access to care for undocumented patients. Providers reported that current training and communication around policies is limited, there are variations between who asks about and documents status, and there remains uncertainty around policy details, laws, and jurisdiction of staff. Providers also stated they are taking an active role in building safety and trust and see their role as supporting undocumented patients. Conclusions This study introduces ED-level health system perspectives and recommendations for caring for undocumented patients. There is a need for active, multi-disciplinary ED policy training, clear policy details including the extent of providers’ roles, protocols on the screening and documentation of status, and continual reassessment of our health systems to reduce fear and build safety and trust with our undocumented communities.

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“…In addition, sharing sensitive patient information outside of the scope of the provider and patient runs the risk of stigmatization and discrimination in vulnerable populations and law enforcement involvement, such as in cases of immigration status. Physicians in cases such as these must balance the professional and ethical responsibilities of justice to provide quality care to all people regardless of their background [7].…”

Section: Legal Considerations For Patient Data In the United Statesmentioning

confidence: 99%

Ethical Issues in Patient Data Ownership

Chiruvella

Guddati

2021

Interact J Med Res

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Patient data have conventionally been thought to be well protected by the privacy laws outlined in the United States. The increasing interest of for-profit companies in acquiring the databases of large health care systems poses new challenges to the protection of patients’ privacy. It also raises ethical concerns of sharing patient data with entities that may exploit it for commercial interests and even target vulnerable populations. Recognizing that every breach in the confidentiality of large databases exposes millions of patients to the potential of being exploited is important in framing new rules for governing the sharing of patient data. Similarly, the ethical aspects of data voluntarily and altruistically provided by patients for research, which may be exploited for commercial interests due to patient data sharing between health care entities and third-party companies, need to be addressed. The rise of technologies such as artificial intelligence and the availability of personal data gleaned by data vendor companies place American patients at risk of being exploited both intentionally and inadvertently because of the sharing of their data by their health care provider institutions and third-party entities.

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Should Immigration Status Information Be Included in a Patient's Health Record?

Cited by 32 publications

References 12 publications

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

Provider and administrator-level perspectives on strategies to reduce fear and improve patient trust in the emergency department in times of heightened immigration enforcement

Ethical Issues in Patient Data Ownership

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