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"Privacy," says the President, "is a permanent public issue." So permanent, in fact, that the federal Privacy Protection Study Commission made 34 recommendations covering employee recordkeeping, all of which deserve personnel's attention. Our author also focuses on General Electric's all-out privacy compliance program, which may well prove a good model for other corporations to follow.
The Office for Civil Rights of the Department of Health and Human Services maintains a system of records entitled "Complaint Files and Log. HHS/OS/OCR." The Department intends to exempt this system from certain provisions of the Privacy Act, 5 U.S.C. 552a. The proposed exemption is authorized by subsection (k)(2) of the Privacy Act, which applies to investigative materials compiled for law enforcement purposes. The Office for Civil Rights (OCR) is authorized to gather information for civil and administrative law enforcement purposes pursuant to several statutes requiring nondiscrimination in programs or activities receiving Federal financial assistance. In order to maintain the integrity of the OCR investigative process and to access to complete and accurate information, the Department proposes to exempt this system, under subsection (k)(2), from the notification, access, correction and amendment provisions of the Privacy Act. The Department is requesting public comments on the proposed exemption.
The Assistant Secretary for Personnel Administration, through the Office of Personnel systems Integrity of the Department of Health and Human Services, by separate Federal Register notice is proposing alteration in the system of records entitled. "Management Information System Efficiency Report (MISER), HHS/OS/ASPER/OPSI", 09-90-0095. The Department intends to exempt portions of this system from certain provisions of the Privacy Act, 5 U.S.C. 552a. The proposed exemption is authorized by subsection (k)(2) of the Privacy ect, which applies to investigative materials compiled for law enforcement purposes. The Offices of Personnel Systems Integrity (OPSI) is authorised to gather information for personnel, legal and regulatory enforcement purposes under Title 5 U.S.C., Chapter 12. In order to maintain the integrity of the OPSI process of merit system and prohibited personnel practice complaints investigations, and to ensure that the Office of Personnel Systems Integrity will be able to obtain access to complete and accurate information, the Department proposes to exempt from the notification, access, correction, and amendment provisions of the Privacy Act those portions of Management Information System Efficiency Report (MISER) which contain personal information that would identify either a confidential source or an individual other than the complainant or subject of an investigation.
The Office for Civil Rights of the Department of Health and Human Services maintains a system of records entitled "Complaint Files and Log. HHS/OC/OCR." The Department is exempting this system from certain provisions of the Privacy Act, 5 U.S.C. 552a. The exemption is authorized by subsection (k)(2) of the Privacy Act, which applies to investigative materials compiled for law enforcement purposes. The Office for Civil Rights (OCR) is authorized to gather information for civil and administrative law enforcement purposes pursuant to several statutes requiring nondiscrimination in programs or activities receiving Federal financial assistance. In order to maintain the integrity of the OCR investigative process and to assure that OCR will be able to obtain access to complete and accurate information, the Department is exempting this system, under subsection (k)(2), from the notification, access, correction and amendment provisions of the Privacy Act.
Concerns about the protection of personally identifiable information are not unique to the health care industry; however, consumers view their medical records as more "private" than other information, such as financial data, because involuntary disclosure can affect jobs or health insurance status. This paper briefly touches upon new sweeping federal privacy standards mandated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The article outlines who and what is covered under the new rules, considers how practitioners can approach compliance with common sense, addresses concerns related to risk management, discusses consumer health privacy issues, and notes the difficulty of evaluating these rules and regulations. The article also looks at some unique privacy issues facing telemedicine and telehealth practitioners.
With the exception of small health plans, covered entities have less than four months to come into compliance with the final HIPAA privacy rule. Instead of obtaining written consent, providers must make a good-faith effort to obtain a patient's signed acknowledgment of receipt of the provider's notice of privacy practices. A covered entity may use patient information to market its own healthcare services without violating the privacy rule. A research institution may continue to use protected health information obtained with a valid authorization to maintain the integrity of a study even if authorization is revoked.
BACKGROUND: A survey of 142 South Australian general practices was conducted on the eve of the new Privacy Act amendments coming into force. OBJECTIVE: The survey had two aims: to establish the extent to which medical records systems were already compliant, and to identify those areas in which change would be required in order to achieve compliance with the requirements of the new legislation. DISCUSSION: The sample was biased in favour of larger group practices. Among the practices surveyed, the areas of best compliance were in providing security, allowing patients access to records and obtaining consent for disclosure of information. There was poor compliance with the requirement to provide patients with information about medical records, or to have a practice policy on privacy. Anonymous care was rarely offered to patients. General practices will need to develop policies and procedures to address these requirements of the new law. Some general practices met the standard required by the amended Privacy Act before it came into force. For those who were not compliant, relatively simple measures will overcome the most common deficiencies.
HIPAA mandates the development of privacy and security standards, including the designation of a privacy officer responsible for the development and implementation of the policies and procedures. However, the rule does not give guidance as to the specific qualifications, job description, or details concerning policy and procedure development and implementation. The qualities and skills of informatics nurse specialists (INS), plus their commitment to patient advocacy and a professional code of ethics to ensure the privacy of confidential personal information, make the INS ideally suited to manage the processes necessary to achieve HIPAA compliance.
Regional healthcare initiatives seek to improve the quality of healthcare by collecting, analyzing, and disseminating information about chronic diseases such as diabetes. The data required to support such initiatives comes from several organizations such as insurers, physicians, hospitals, pharmacies and labs each of which gather and maintain data for the purpose of healthcare delivery. In this paper, we focus on mediator-based architectures and the privacy problems that arise in the healthcare context owing to the linkage of information about patients, physicians, and diseases enabled by the mediator. In particular, we examine privacy issues for the two separate steps of the actual data release. First, raw data is released to the (not necessarily trustworthy) mediator and second, the mediator creates and releases the health report. For both steps, we present a technical solution that permits the final report to be useful to the user while respecting the data owners' privacy.
In 1996, HIPAA or the Health Insurance Portability and Accountability Act (HIPAA) was enacted into law. This law has had a significant impact on the health care industry including the need for numerous changes in the way we communicate with our patients, their families, and with each other. This law provides rights to patients and safeguards for employees. It affects everyone in a health care setting. Since the days in which the Nightingale Pledge was written, nursing has stressed the importance of confidentiality regarding all patient matters. The current Code of Ethics for Nurses ANA, 2001) is clear in intent and meaning as it relates to the nurse's role in promoting and advocating for patient's rights related to privacy and confidentiality. For nurses, HIPAA is an endorsement of our previously articulated responsibility to our patients. The purpose of this article is to remind nurses of the importance of keeping patient information private. This reminder will come first as HIPAA is reviewed and the implications of this Act for nurses is discussed. The reminder will also come as challenges to maintaining privacy and strategies for promoting privacy are presented.
A structured survey of patients in three illness groups (acquired immune deficiency syndrome, multiple sclerosis and mental disorders) was undertaken to describe patients' perspectives on privacy, consent and the use of their health information for medical research. The survey was distributed by mail to subjects in the AIDS and MS groups and was completed in a clinic waiting room by people in the mental disorders group. Of the 478 patients approached for participation, 235 returned completed surveys (response rate 49.2 percent). Most subjects were concerned about privacy and they valued opportunities to provide consent for the use of their personal health information for research. Contextual factors, such as identification, type of illness and who was conducting the research, were important to individuals' preferences in granting consent. When health information was used specifically for research, the majority of subjects wanted to be asked for their consent unless anonymity was assured. Privacy and control over personal health information were important to patients in these groups. Patients prefer to be asked for research access to their health information.
Nursing leaders promoting the development and use of computerized databases such as the Nursing Minimum Data Set (NMDS) have not adequately addressed the complex ethical issues involved with computerized information systems. The purpose of this article is to describe the privacy issues involved with the NMDS. Moral considerations and principles guiding resolution of ethical issues concerning violations of patient privacy are discussed. A paradigm case is used to demonstrate the significance of privacy violations in computerized databases. Two security systems currently being considered in other disciplines are included for their relevance to the development of the NMDS. The broader implications concerning the impact of technology on preservation of human dignity and the quality of life are addressed.
Thirty paired female rhesus monkeys were tested in a control situation when companions had no privacy, and in an experimental situation when they were offered the option to move behind a panel and be alone. Paired partners spent significantly more time in close proximity (same half of the cage) when the privacy panel was provided (means with panel = 76.0%/h vs. means no panel = 60.8%/h; p less than 0.005). At the same time, they were more engaged in affiliative interactions (means with panel = 37.4%/h vs. means no panel = 26.5%/h; p less than 0.025) while the incidence of agonistic interactions tended to decrease (means with panel = 0.3/h vs. means no panel = 2.2/h; p less than 0.1). It was concluded that rhesus monkeys have a need for companionship. They prefer to stay in close proximity with a compatible partner even though this may reduce their available cage space. It was further concluded that companions have no need for prolonged periods of visual seclusion, but occasional privacy is beneficial for their relationship.
The principle of patient privacy has evolved from the Hippocratic Oath to current medical ethics guidelines and to legal protections for doctor-patient communications. Privilege statutes now abound in the United States with considerable difference from state jurisdiction to state jurisdiction. Recently several bills have been introduced to establish a federal standard for patient privacy. These bills are critically examined--particularly in regard to the conflict between the need to keep doctor-patient interactions private and the demand by law enforcement agencies for information. The federal bills lean towards the latter at the expense of the protection of confidentiality and therefore should not be adopted. The narrowness of the scope of the proposed laws is reflected in a comparison with a proposed model privacy act.
A European directive on privacy may make illegal much life-saving research on cancer in Britain, and the "fundamental principle" (no use of named records without permission of the individuals) could limit statistical work in Canadian cancer registries. Although the intent is to protect individuals from improper administrative use, this hardly applies to statistical aggregates that cannot identify anybody. Abstract position statements have done little to clarify the reasoning. To counter this, the present paper points to actual statistical uses of Canada's mortality database for individual follow-up on an unprecedented scale under conditions of strict confidentiality. The statistics serve to connect earlier causes with later harm. However, confusion still surrounds the question of whether privacy can be fundamentally violated by statistics drawn from personal records. Without wider understanding, real harm to health will compete poorly with imagined harm to privacy.
Privacy and security issues increase in complexity as we move from the conventional patient record to the computer based patient record (CPR) supporting patient care and to cross-institutional networked CPRs. The privacy and security issues surrounding the CPR are outlined. Measures for privacy and security protection are summarized. It is suggested that we lack a key component of an information sharing culture. We need means for semantic indexing in the form of a metadata base at the level of the instantiation of a data base rather than at the level of its schemas.
The relation between privacy and confidentiality is critically discussed. The need to be able to process data for epidemiology and management is presented. Too often the protection of privacy is considered to be a synonym of denying access to the patient's data. The function of the Canadian National Institute for Health Information is mentioned as as example of a wider trend to have a national focal point in the development of national databanks and for administering health information networks. Protection of privacy is considered to be the most important threat to the effectiveness of such networks.
Computing plays an important role in genetics (and vice versa). Theoretically, computing provides a conceptual model for the function and malfunction of our genetic machinery. Practically, contemporary computers and robots equipped with advanced algorithms make the revelation of the complete human genome imminent--computers are about to reveal our genetic souls for the first time. Ethically, computers help protect privacy by restricting access in sophisticated ways to genetic information. But the inexorable fact that computers will increasingly collect, analyze, and disseminate abundant amounts of genetic information made available through the genetic revolution, not to mention that inexpensive computing devices will make genetic information gathering easier, underscores the need for strong and immediate privacy legislation.