Are patient relationships the driver for information governance?

The confidential relationship between patients and their practitioners is the foundation of clinical practice and is predicated on trust. Both parties develop expectations about how information shared in the therapeutic setting will be used and protected. However, as contemporary clinical practice is rapidly evolving through the use of digital technologies, our understanding and assumptions around those expectations are being tested while their importance in protecting a trusting relationship is becoming paramount. We illustrate this in this editorial by exploring how the technology-driven evolution in practice increases the risks of information disclosure outside the confidential relationship by accident while directly enabling it with the support of legislation by design. In the direct care setting, doctors and nurses are finding the use of smartphones and the apps that run on them particularly useful for providing care to their patients. They are also realising that this emerging practice poses risks to patient privacy and raises their concerns about the accidental disclosure of confidential information if it is not carefully governed.1 But the extent to which any concerns around accidental disclosure are affecting patients’ trust in the confidential relationship is not clear. This issue becomes more pressing as we consider other digital (or eHealth) interventions, including electronic health record and advisory systems, which are also an important part of evolving practice and face their own governance challenges. Such interventions are targeted at practitioners as well as patients and the public to help them engage with managing their own care. They also enable the sharing of more information outside the doctor–patient relationship with researchers, commissioners, managers and policy makers,2 often for uses that may not have been envisaged by patient or practitioner when it was first shared and recorded in confidence. But as information is more routinely shared electronically outside the confidential relationship, sometimes even without patient consent by design, another factor is emerging that is compounding the uncertainty around the effects of evolving practice on the confidential therapeutic relationship. It is becoming clearer that information governance legislation and strategy have been developed without regard for the expectations that form within that relationship. There is frequently a mismatch between confidentiality as a driver for protecting the relationship between patients and their practitioners, and the focus of information law and governance on the protection of information itself. This can be illustrated with use of examples where the relationship of trust is being overlooked by the current governance approach to evolving practice and new uses of healthcare information. We are unaware of the extent to which these issues are undermining trust in the confidential relationship and encouraging patients to withhold information from their practitioner, or indeed the practitioner from recording everything that they are told. We therefore propose a greater focus on understanding the relationship of trust and the expectations formed therein as a means to address these concerns