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Study urges hospitals to reduce paper documents to protect patient privacy

The doorway used by paramedics to bring in patients to the emergency department at St. Michael's Hospital located at the corner of Shuter and Victoria Sts. in downtownToronto, is photographed on Oct 20 2016. .
The doorway used by paramedics to bring in patients to the emergency department at St. Michael's Hospital located at the corner of Shuter and Victoria Sts. in downtownToronto, is photographed on Oct 20 2016. . (Fred Lum/The Globe and Mail)

TORONTO – Hospitals should step up their efforts to protect patient privacy by trying to generate less paper and ensure confidential files are shredded rather than recycled, a new study suggested Tuesday.

The research, undertaken by staff at Toronto’s St. Michael’s Hospital and published in the medical journal JAMA, found that thousands of documents containing sensitive and potentially identifying patient information make it out of hospitals in recycling bins where they become potential privacy liabilities.

Dr. Nancy Baxter, study author and St. Michael’s chief of general surgery, said the vast majority of patient information appeared to be properly disposed of.

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The electronic age, however, has paradoxically created a stronger impetus for hospitals to tighten their document disposal practices.

“Before, if you got a test, … you treated that piece of paper as precious,” Baxter said in a telephone interview. “But now that we have it on our computers electronically, if you print out a chart for ease of review or to facilitate work flow, we’re just throwing it out. So we’ve actually generated a lot more pieces of paper to throw out. So actually with the electronic records I think many people would have thought that this problem had gone away when in fact it likely is worse.”

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Baxter and a team of St. Michael’s researchers spent a month collecting more than half a tonne of paper from recycling bins at five Toronto-area hospitals and combing through the documents they recovered.

They gathered papers from recycling bins three times a week from the hospitals’ in-patient wards, out-patient clinics, emergency departments, doctors’ offices and intensive care units. Baxter said the names of the participating hospitals could not be disclosed.

Researchers collected 591.6 kilograms of paper and found 2,687 documents containing personal information, a number Baxter characterized as relatively low.

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But she said some of those documents contained very sensitive material, such as clinic notes, detailed health records or financial information. The bulk of the sensitive documents came from physicians’ offices, while financial matters were most likely to surface, the study found.

Personal details were collected from all five hospital sites included in the study.

This did not surprise Baxter, who said her interest in this issue was peaked while working in the United States years ago.

After observing a member of the custodial staff wheeling a recycling cart brimming with patient files out to recycling, she said she physically barred his path and called hospital staff to make sure the documents were redirected to shredding for more secure disposal.

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“It got me thinking that it probably has happened before or something similar to it, and I probably wasn’t going to be there next time it happened,” Baxter said, noting the issue is not unique to Ontario. Hospitals in the province, in fact, must comply with legislation meant to safeguard patient privacy.

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Baxter said all collection sites involved in the study have policies and protocols around document protection, but said the research results highlight areas in which those could be improved.

While generating less paper would make a great start, she said health-care facilities could consider other measures to limit the potential for human error.

Hospitals, for instance, could dictate that all documents being purged from doctor’s offices should go directly to shredding rather than recycling in order to minimize the possibility of sending patient records through the wrong disposal channel.

She also suggested hospitals could train custodial staff to recognize personally identifying documents so they can send such files for shredding if they spot them.

Baxter does not know of any instances in which recycled personal documents were actively misused and said patients need not worry about widespread carelessness with their information.

Nonetheless, she said the matter is still a valid privacy concern.

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“Obviously, we need to take this very seriously, and I think this is an important step towards thinking about our processes.”