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At least 19 recordsLinked to original sources
PubMed2006

Taiwan's perspective on electronic medical records' security and privacy protection: lessons learned from HIPAA.

The protection of patients' health information is a very important concern in the information age. The purpose of this study is to ascertain what constitutes an effective legal framework in protecting both the security and privacy of health information, especially electronic medical records. All sorts of bills regarding electronic medical data protection have been proposed around the world including Health Insurance Portability and Accountability Act (HIPAA) of the U.S. The trend of a centralized bill that focuses on managing computerized health information is the part that needs our further attention. Under the sponsor of Taiwan's Department of Health (DOH), our expert panel drafted the "Medical Information Security and Privacy Protection Guidelines", which identifies nine principles and entails 12 articles, in the hope that medical organizations will have an effective reference in how to manage their medical information in a confidential and secured fashion especially in electronic transactions.

Computer Security↗
PubMed2005

Diagnostic imaging costs: are they driving up the costs of hospital care?

PURPOSE: To retrospectively determine how changes in utilization of computed tomography (CT), magnetic resonance (MR) imaging, and other imaging technologies between 1996 and 2002 influenced costs of inpatient hospital care at one large academic medical center. MATERIALS AND METHODS: Institutional review board did not require its approval or patient informed consent for studies with use of billing data. Patient anonymity was protected by removal of potentially identifying information. Data on hospital costs for 17 139 patients admitted to Massachusetts General Hospital, Boston, Mass, between 1996 and 2002 were downloaded from hospital cost-accounting system; sample was restricted to inpatients with diagnoses in diagnosis-related groups 014-015 (Stroke and TIA [transient ischemic attack]), 164-167 (Appendectomy), 082 (Lung Cancer), 182-183 (Upper Gastrointestinal Conditions), 148-149 (Colon Cancer), and 243 (Back Problems). For each patient, data on demographics, all products and services used, and costs associated with each product or service were obtained. By using institutional codes, we calculated costs of CT, MR imaging, and total imaging relative to total hospital costs. Statistical analyses were performed with Student t test and multiple linear regression analysis. RESULTS: Between 1996 and 2002, number of inpatient CT and MR images obtained at the hospital more than doubled. In 2002, hospital costs were 155% those of 1996 levels; inpatient imaging costs were 151% those of 1996 levels. Total costs increased an average of 7.8% per year; imaging costs increased 8.3% per year. Although highly variable over the study period, as a percentage of total imaging costs, CT and MR imaging costs appeared to remain stable relative to costs of other imaging modalities. CONCLUSION: Despite substantial increases in utilization of inpatient CT, MR imaging, and other imaging technologies, diagnostic imaging costs increased at approximately same rate as did total costs for inpatients with several diagnoses. CT and MR imaging do not appear to be driving the cost increases seen between 1996 and 2002.

Costs and Cost Analysis↗
PubMed2001

[Personal identifiability in the Health Sector Database.].

INTRODUCTION: Personal identifiability is a fundamental question in the debate about the Bill and Act on the Health Sector Database (HSD). If the data are personally identifiable, Iceland's international committments dictate that a priori consent be obtained from patients for the use of their health records data. The HSD Act presumes that one way encryption renders the data non-personally identifiable and that therefore an a priori consent is not required. RESULTS: The history of the concept of personal identifiability during the debate on the HSD reveals changes made to the concept. In the first instance a reference was made to Recommendation R(97)5 of the Council of Europe Committee of Ministers which was changed by adopting a direct translation of the definition of personal data from the Directive 95/46/EC of the European Parliament and of the Council. These changes were made in response to the Data Protection Commission's opinion on the HSD Bill submitted to the Minister of Health that overturned the ideology previously used regarding indentifiability of persons. Information is identifiable if there exists a key and it makes no difference who holds the key. One way encryption was then adopted as a method that was supposed to mean that a key does not exist. Nevertheless, the database proponents now admit that a key exists. The making of keys for opening up the database is discussed. The database is a longitudinal collection and linkage of records on each individual and therefore the method of encryption must remain stable. Therefore, anyone with access to the method can easily make a lookup-table containing side by side the names and the personal numbers produced by the encryption. Although it may be hard to go from a personal number directly back to a name, given the table it always is possible to look up what personal number belongs to a certain person or what person stands behind a certain personal number. This is a key. If the method of encryption was lost or access to it was not available it would nevertheless be possible to make a key. The intention is to encrypt the genealogy of the entire nation using the same encryption method used for the HSD. The genealogy of the nation with names is also generally available. The patterns of family trees become unique when one family is connected to another through marriage and childbirth. A comparison of the encrypted genealogy containing personal numbers with the same genealogy containing names is therefore a method for making a key. Finally a key can be made from the context of general information. Even if the names were irreversibly removed there will be enough available bits of general information connected to a personal number to allow re-identification of the person in a large number of instances. This amounts to making a key. CONCLUSIONS: The information in the Health Sector Database is personal information. Therefore it is both right and reasonable to obtain an a priori consent of patients for the transfer of their health data to the database as Iceland's international obligations stipulate. Anything less is unreasonable.

English Abstract↗
PubMed1995

Balance billing under Medicare: protecting beneficiaries and preserving physician participation.

Medicare's experience with balance billing provides valuable lessons for policy making for national or state health care reform. Medicare developed several policies to encourage physicians to become participating providers who accept Medicare-allowed charges as payment in full. Only nonparticipating physicians are permitted to bill for additional amounts beyond that paid by Medicare, and there are limits on the amount of balance billing per claim. As shown by the analysis of claims presented in this article, Medicare has successfully provided financial protection to beneficiaries. In 1986, more than 60 percent of expenditures for physician services were on assigned claims for which there could be no balance billing; by 1990, 80 percent of expenditures were on assigned claims. Balance billing decreased by about 30 percent during the same period. Although these policies have been successful in reducing total expenditures for balance billing, they may not provide financial protection to the most economically vulnerable beneficiaries. Using survey and claims data, we found that the poor have lower balance billing expenditures for services provided by primary care physicians, but that there is no relationship between poverty status and balance billing expenditures for services of nonprimary care physicians. In addition, most low-income beneficiaries are liable for balance bills. Under health care reform, adoption of Medicare's incentive-based approach with mandatory assignment for the poor would allow for some choice based on price and would provide financial protection for all consumers.

Aged↗
PubMed1997

[Confidentiality of data in medical-scientific research with humans].

The bill on Medical-Scientific Studies of Humans states that researchers should protect the privacy of test subjects to the extent possible. The right to privacy is also laid down in the Data Protection Act and the Medical Contract Act. Data gathered in the context of medical-scientific studies of humans should relate to the problem to be investigated, as set forth in the protocol. They must have been obtained legitimately-with the test subject's permission- and must as a matter of principle not be used for any other purpose than the study as a part of which they have been obtained. The data should be protected adequately, e.g. by encoding, and may be placed at other people's disposal only after permission from the test subject. Once research data have been processed in such a way that they can no longer reveal the test subject's identity, the latter's right to inspect them is cancelled. Furthermore, the test subject cannot assert his power of destruction regarding any parts of his file relating to the study. He must be so informed before-hand. Study results should be published in such a way that they cannot reveal individual identities. Every study protocol should include an 'information section' on the confidentiality of the data. It might be considered to draw up a code of behaviour regarding protection of privacy in medical-scientific studies of humans.

Clinical Protocols↗
PubMed1985

The Laboratory Information System (LIS): I-Application to the clinical chemistry laboratory.

The Laboratory Information System (LIS) was designed as a "turn-key" system. The main functions are operated interactively on a mini-computer which gives the laboratory complete control over daily processing. Collection of results from automated analyzers is accomplished via a micro-computer/micro-processor network. Links are provided with a central main frame computer for immediate patient identification and historical data processing. LIS is designed to manage all the operations involved in laboratory activities. The system has 14 major functions: registration of test requests, production of specimen collection sheets and identification labels, confirmation of specimen collection, production of aliquot labels, workload inquiry, production of worksheets, manual entry of test results, automated entry of test results, results inquiry, preliminary report, final report, daily activities reports, statistical reports, billing. System security is provided along three directions: data entry validation, system access control, and memory protection. The main advantages of LIS are: reduced clerical work, better evaluation of workload, faster communication, improvement of information given to the clinician: adapted reference values, interpretation, comments, improved retrieval operations, faster billing.

Autoanalysis↗
PubMed1985

Who are the underinsured?

Inadequate insurance, whether private or public, can impose ruinous private hardship and unexpected public burdens. "Who are the underinsured?" is both a definitional and an empirical question. Data from the National Medical Care Expenditure Survey, applied under various concepts of risk and expense, reveal that over a quarter of the nonelderly population is inadequately protected against the possibility of large medical bills. The private burdens of the underinsured are widely distributed across the population.

Actuarial Analysis↗
PubMedDate not supplied

Data field standards and the Health Insurance Portability and Accountability Act.

The Administrative Simplification Title of the Health Insurance Portability and Accountability Act of 1996 addresses the creation and adoption of nationwide standards for the electronic exchange and confidentiality protection of all individually identified data used in health care administration. The U.S. Department of Health and Human Services (DHHS) is implementing standards under this law. In addition to new standards, the law mandates that the Congress pass a health information privacy bill by August 1999 or that the DHHS adopt privacy protections for health information by February 2000. Published in 2001 by John Wiley & Sons, Ltd.

Computer Communication Networks↗