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PubMed2003

HIPAA privacy rule and public health. Guidance from CDC and the U.S. Department of Health and Human Services.

New national health information privacy standards have been issued by the U.S. Department of Health and Human Services (DHHS), pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The new regulations provide protection for the privacy of certain individually identifiable health data, referred to as protected health information (PHI). Balancing the protection of individual health information with the need to protect public health, the Privacy Rule expressly permits disclosures without individual authorization to public health authorities authorized by law to collect or receive the information for the purpose of preventing or controlling disease, injury or disability including but not limited to public health surveillance, investigation, and intervention. Public health practice often requires the acquisition, use, and exchange of PHI to perform public health activities (e.g., public health surveillance, program evaluation, terrorism preparedness, outbreak investigations, direct health services, and public health research). Such information enables public health authorities to implement mandated activities (e.g., identifying, monitoring, and responding to death, disease, and disability among populations) and accomplish public health objectives. Public health authorities have a long history of respecting the confidentiality of PHI, and the majority of states as well as the federal government have laws that govern the use of, and serve to protect, identifiable information collected by public health authorities. The purpose of this report is to help public health agencies and others understand and interpret their responsibilities under the Privacy Rule. Elsewhere, comprehensive DHHS guidance is located at the HIPAA website of the Office for Civil Rights (http://www. hhs.gov/ocr/hipaa/).

Confidentiality↗

PubMed2003

Recent developments in privacy legislation.

In this article, Ruth Carey takes a critical look at recent privacy-of-personal-information legislation drafted in three Canadian provinces--Ontario, Alberta, and British Columbia. The article begins with a historical overview of international legal instruments and other privacy guidelines, and the Canadian experience with privacy protection. It then critically analyzes the provincial initiatives in the context of the federal Personal Information Protection and and Electronic Documents Act and accepted privacy principles. The article goes on to highlight certain types of legislative provisions of particular interest to people with HIV/AIDS and those who advocate on their behalf. It concludes that the numerous legislative initiatives underway in Canada provide an opportunity to alter the public discourse around the virus, thereby improving the lives of people with HIV/AIDS.

Canada↗

PubMed2004

HealthConnect and privacy: a policy conundrum.

A shared electronic health record is intrinsically privacy-invasive because it creates a comprehensive record for information-sharing. The author explains the significance of information privacy and why it is that health information warrants special protection. She also provides an overview of the existing regulatory framework and an evaluation of suggested options and proposals for addressing privacy-related issues. Her analysis of suggested consent models suggests that they ultimately involve a trade-off between privacy and the broader benefits promised by HealthConnect and that obtaining the right balance is essential if HealthConnect is to achieve optimal health outcomes.

Australia↗

PubMed2004

Making sense of HIPAA Privacy: solutions for complex compliance dilemmas.

This Article examines and proposes solutions for the following compliance problems under the Health Information Portability and Accountability Act's Privacy Rule: (a) determining compliance requirements when multiple provisions of the Privacy Rule allow a use or disclosure of protected health information; (b) managing minimum necessary for disclosures to noncovered entities; (c) managing interaction between organized healthcare arrangements and noncovered providers; (d) processing joint health and life/disability insurance applications; (e) reconciling family coverage explanations of benefits and family member's confidential communication demands; and (f) explaining denial of protected health information access based on endangerment. In the course of the analysis, the Article presents a Privacy Rule Compliance Tool that summarizes the compliance requirements associated with each Privacy Rule provision that allows protected health information use or disclosure.

Computer Security↗

PubMed2001

Lochner redeemed: family privacy after Troxel and Carhart.

At least since its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Supreme Court has differentiated its review of abortion laws from its scrutiny of other intrusions on family privacy. Whereas abortion restrictions are reviewed under the middling "undue burden" standard, incursions on other family-related liberties, including marriage, kinship, and child rearing are said to be subject to the strict scrutiny ordinarily employed in the defense of fundamental rights. This Article contends that the Court's most recent decisions in this context give reason to reconsider both sides of that equation. Stenberg v. Carhart, striking down Nebraska's ban on "partial-birth" abortions, suggests that the Court's scrutiny in the abortion context will be more aggressive and rigid than most had supposed. At the same time, its decision in Troxel v. Granville, limiting states' authority to order grandparent visitation over the objects of a parent, suggest that there is more fluidity in the Court's review of other family liberties than is conventionally assumed. Together the cases signal a convergence in both sorts of family-privacy controversies toward a common standard of "reasonableness." That standard bears, for many, an uncomfortable association with the much-maligned "natural law-due process formula" of the Lochner era, but Professor Meyer argues that it is precisely the right approach in the context of family privacy. Although more rigid doctrinal formulae are sometimes preferred on the ground that they constrain judicial judgment, here they are undesirable precisely because they obscure the value judgments that are inevitably at the core of every family-privacy decision.

Abortion, Legal↗

PubMed1999

The U.S. health data privacy debate. Will there be comprehension before closure?

After 25 years of debate about privacy of automated personal health data, the U.S. Congress has set a deadline of August 1999 for enacting health information privacy legislation. The urgency to establish national policy in the United States re-emerges with implementation of a 1996 law mandating a unique identifier for each participant in the U.S. medical care system and the use of a uniform electronic data set for all health information transmitted in financial and administrative transactions. The impact of electronic data storage and transmittal on privacy, health outcomes, and medical care is unclear. A three-step analytic scheme can clarify the issues in the policy debate and for future assessment. The first step is intended to elicit, for the first time, a precise, accurate, and reproducible description of personal health data transactions and chains of transactions, independent of the policy preferences of any interested party. The second step allows the reader to analyze these transactions according to who benefits first and foremost from each. This scrutiny clarifies the reasons why parties to the debate tend to disagree. The third step characterizes how Congress is likely to perceive the policy process and consider its options before enacting any particular set of compromises. Understanding the policy deliberations and potential effects of evolving information technologies and new national privacy rules should aid assessment of results.

Computer Security↗

PubMed2004

Enhancing privacy and data protection in electronic medical environments.

Raising awareness and providing guidance to on-line data protection is by all means a crucial issue worldwide. Equally important is the issue of applying privacy-related legislation in a coherent and coordinated way. Both these topics become even more critical when referring to medical environments and thus to the protection of patients' privacy and medical data. Electronic medical transactions require the transmission of personal and medical information over insecure communication channels like the Internet. It is therefore a rather straightforward task to construct "patient profiles " that capture the electronic medical behavior of a patient, or even reveal sensitive information in regard with her/his medical history. Clearly, the consequence from maintaining such profiles is the violation of the patient's privacy. This paper studies medical environments that can support electronic medical transactions or/and the provision of medical information through the Web. Specifically it focuses on the countermeasures that the various actor categories can employ for protecting the privacy of personal and medical data transmitted during electronic medical transactions.

Computer Communication Networks↗

PubMed2001

[Autonomy, privacy and the implementation of the principle of "informed consent" with regard to nursing intervention from the view point of the aged].

The aim of this study was to describe patient autonomy, privacy and the implementation of the principle of informed consent in the care of elderly patients in facilities experienced by themselves. This study is part of the BIOMED 2 project "Patients' autonomy and privacy in nursing interventions" supported by the European Commission. Interview data (n = 95) were collected among elderly people in German facilities for geriatrics and in nursing homes. The results showed there was a lack of opportunity by the elderly people to make self-determined decisions. The principle of "informed consent" was hardly realised. The participants felt their privacy was not respected in multi-bedded rooms and in situations of dressing and eliminating. One can proceed on the assumption that the lack of information, the need of help and the fixed organizing structures of the facilities are the reasons why elderly people play a rather passive role as patients. It might be possible to improve the autonomy of elderly people if the nurses as an advocate supported them to make self-determined decisions. The implementation of the principle of informed consent with regard to nursing interventions would promote both autonomy and respect of privacy. Furthermore, one can assume that the autonomy and quality of life of elderly people could be promoted if the organizing structures of the facilities were more flexible.

Aged↗

PubMed2006

Information privacy in organizations: empowering creative and extrarole performance.

This article examines the relationship of employee perceptions of information privacy in their work organizations and important psychological and behavioral outcomes. A model is presented in which information privacy predicts psychological empowerment, which in turn predicts discretionary behaviors on the job, including creative performance and organizational citizenship behavior (OCB). Results from 2 studies (Study 1: single organization, N=310; Study 2: multiple organizations, N=303) confirm that information privacy entails judgments of information gathering control, information handling control, and legitimacy. Moreover, a model linking information privacy to empowerment and empowerment to creative performance and OCBs was supported. Findings are discussed in light of organizational attempts to control employees through the gathering and handling of their personal information.

Confidentiality↗

PubMed2002

[Privacy within psychiatric wards].

OBJECTIVE: Privacy within psychiatric wards should be evaluated from the patient's point of view. METHODS: Different aspects of privacy were assessed by a self-rating scale given to all patients of a psychiatric hospital at a qualifying date. RESULTS: The adjusted response rate was 74.5 %. By means of a factor analysis, four factors were extracted: Intimacy, sexual restriction, discretion, and care. A lack of discretion when entering the patient's room were reported by more than 80 % of patients, disturbances of intimacy by nearly 25 %. Disturbances by patients or staff when taking a shower were especially found bothersome. 15 % of patients reported about being touched by patients or staff against their will. CONCLUSIONS: Disturbances of privacy play an important role in psychiatric wards. The therapeutic team should be aware of these findings and should pay attention to preserve patient's privacy during inpatient care.

Germany↗

PubMed1998

Developing genetic privacy legislation: the South Carolina experience.

The availability of presymptomatic and predisposition genetic testing has spawned the need for legislation prohibiting health insurance discrimination on the basis of genetic information. The federal effort, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, falls short by protecting only those who access insurance through group plans. A committee of University of South Carolina professionals convened in 1996 to develop legislation in support of genetic privacy for the state of South Carolina. The legislation prevents health insurance companies from denying coverage or setting insurance rates on the basis of genetic information. It also protects the privacy of genetic information and prohibits performance of genetic tests without specific informed consent. In preparing the bill, genetic privacy laws from other states were reviewed, and a modified version of the Virginia law adopted. The South Carolina Committee for the Protection of Genetic Privacy version went a step further by including enforcement language and excluding Virginia's sunset clause. The definition of genetic information encompassed genetic test results, and importantly, includes family history of genetic disease. Our experience in navigating through the state legislature and working through opposition from the health insurance lobby is detailed herein.

Confidentiality↗

PubMed1998

Two routes to privacy protection: a comparison of health information legislation in Canada and the United States.

The privacy of health information is a subject of great sensitivity in both Canada and the United States. As a result of public demands for more effective protection of such information as medical records, Canada and, particularly, its provincial governments, have implemented extensive legislation. The United States, on the other hand, has largely confined its efforts to private sector initiatives that are more reflective of voluntary codes than legal statutes. Because new technologic developments facilitate data sharing in the medical field, especially in the face of a continual reduction of healthcare budgets, the concern for privacy protection in this domain has intensified. Correspondingly, there has been a gradual theoretical shift in protective health information policies on both sides of the border. As Canada pushes to extend its federal and provincial legislation to the private sector, the United States is on the brink of approving a national bill that would protect the privacy of personal medical records. It is becoming evident that efforts to secure the privacy of health information in both countries are converging.

Canada↗

PubMed2006

A practitioner's response to the new health privacy regulations.

The established professional practice requiring informed consent for the disclosure of personal health information with its implied right to privacy suffered a serious setback with the first federal privacy initiative of the Bush administration. The new Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L. 104-191) privacy regulations supplant the patient's veto regarding disclosure with the requirement that the patient simply receive a written notice of the provider's policy on disclosure of personal health information. As the privacy paradigm shifts to balance the business interests of the health care industry with those of individual patients, this policy presents new challenges for protecting the confidential relationship between the practitioner and the patient. This article reviews the significant modifications in the new HIPAA regulations, briefly critiques these changes, and suggests strategies for practitioners to manage these changes.

Adult↗

PubMedDate not supplied

HIPAA Privacy 101: essentials for case management practice.

The Health Insurance Portability and Accountability Act (HIPAA) has significant impact on the delivery of healthcare in the United States. The Administrative Simplification (AS) requirements of HIPAA are aimed at reducing administrative costs and burdens in the healthcare industry. The core components of HIPAA's AS requirements address healthcare transactions, code sets, security, unique identifiers, and privacy of health information. HIPAA's privacy standard limits the nonconsensual use and release of private health information, gives patients new rights to access their medical records and to know who else has accessed them, restricts most disclosure of health information to the minimum needed for the intended purpose, establishes new criminal and civil sanctions for improper use or disclosure, and establishes new requirements for access to records by researchers and others. This article focuses on HIPAA's privacy requirements as related to case management of workers compensation populations, the treatment of protected health information, and how case managers can ensure they provide appropriate services while navigating the requirements of HIPAA's privacy standard.

Case Management↗

PubMed2005

Technical guidelines for enhancing privacy and data protection in modern electronic medical environments.

Raising awareness and providing guidance to on-line data protection is undoubtedly a crucial issue worldwide. Equally important is the issue of applying privacy-related legislation in a coherent and coordinated way. Both these topics gain extra attention when referring to medical environments and, thus, to the protection of patients' privacy and medical data. Electronic medical transactions require the transmission of personal and medical information over insecure communication channels like the Internet. It is, therefore, a rather straightforward task to capture the electronic medical behavior of a patient, thus constructing "patient profiles," or reveal sensitive information related to a patient's medical history. The consequence is clearly a potential violation of the patient's privacy. We performed a risk analysis study for a Greek shared care environment for the treatment of patients suffering from beta-thalassemia, an empirically embedded scenario that is representative of many other electronic medical environments; we capitalized on its results to provide an assessment of the associated risks, focusing on the description of countermeasures, in the form of technical guidelines that can be employed in such medical environments for protecting the privacy of personal and medical information.

Computer Communication Networks↗

PubMed1973

Protection of privacy and confidentiality.

A multistate, cooperative program seeking to develop better methods for the effective and efficient gathering. storing, analyzing, and utilizing of mental patient records has made a comprehensive effort to protect the confidentiality and privacy of these psychiatric patient records. Administrative, technical, and legal safeguards have been implemented. The discussion of legal safeguards involves two areas: the protection of the system itself, located at Rockland State Hospital; and the specific legal environment of confidentiality and privacy of mental health records and information in the group of cooperating jurisdictions. On the whole, adequate legal and administrative protection can be afforded the confidentiality and privacy of an electronic data system in the mental health field, and access to the records can be restricted for the welfare of the patients. At the same time, access to aggregate data in the system can be allowed, under proper standards, for important research and planning purposes. The methods adopted by MSIS to preserve confidentiality and privacy by limiting access to such records could well prove an important model for the development of protective methods in other electronic data programs-not only those in psychiatry, but those in other fields where the data collected are sensitive and confidential.

Ethics, Medical↗

PubMed1988

Supervision and privacy in psychotherapy training.

Supervision is an essential element of training in psychotherapy, and the issue of privacy in relation to the supervisory process is an important one. The authors examine the attitude toward privacy implicit in each of the two major models of supervision, the so-called didactic and countertransference models. They consider the ways in which supervision, particularly the countertransference model, and the use of audiovisual devices intrude on the privacy of the therapist and the therapy. Finally, they consider how the institutional and professional structures within which supervision takes place deal with the issue of privacy.

Attitude of Health Personnel↗

PubMed2001

Human rights and patients' privacy in UK hospitals.

The European Convention on Human Rights has been incorporated into UK domestic law. It gives many rights to patients within the National Health Service (NHS). This article explores the concept of patients' right to privacy. It stresses that privacy is a basic human right, and that its respect by health professionals is vital for a patient's physical, mental, emotional and spiritual well-being. I argue that health professionals can violate patients' privacy in a variety of ways. For example: the right to enjoy their property; the right to protect their medical and personal information as confidential; the right to expect treatment with dignity during intimate care; and the right to control their personal space and territory. Some preliminary evidence indicates that many health care practitioners, including nurses, are presently unaware of the articles of the Convention and the implications of the Human Rights Act 1998. In order to prevent litigation for breaches of patients' privacy, it is advocated that universities and other educational institutions, the Government and NHS trusts should help to produce a clear educational strategy and protocols so that students and practitioners are well informed in this field. Although 41 European countries are presently the signatories of the European Convention on Human Rights, including the UK, it is important to stress that the principles discussed in this article are applicable world-wide.

Ethics, Nursing↗