OUTCOME 1: Understand the need for secure handling of information in health and social care settings
1.1.Identify the legislation that relates to the recording, storage and sharing of information in health and social care
A medical record in paper or electronic format provides a written account of a patient's medical history, containing information about diagnosis, treatment, chronological progress notes and discharge recommendations. A whole raft of legislation, standards and guidance on what has become known as 'Information Governance' has been produced in the last few years to cover issues of access, confidentiality and disclosure. The Health and Social Care Act 2008 established the National Information Governance Board for Health and Social Care (NIGB) as the body with statutory duty to oversee information governance. One of its functions is to allow the common law duty of confidentiality to be set aside in specific circumstances.
Legislation
The following are the main pieces of legislation covering the creation, storage and sharing of health information * Common law duty of confidence - confidential patient information may only be disclosed: * with a patient's consent, or * where it is required or permitted by law (statutory instrument or Court Order), or * where the public good achieved by disclosure outweighs the individual's right to confidentiality * Computer Misuse Act 1990 - identifies a range of offences relating to unauthorised access to, or unauthorised modification of, computer records. This act may apply where an unauthorised third party accesses information being transferred. Enforcement is difficult, prosecutions uncommon but may be relevant where systems are used other than by authorised staff for approved purposes. * Access to Health Records Act 1990 - provides qualified right of access of a deceased individual where the person seeking access