Author Topic: Rough Draft: A critique on the 2003 HIPAA Privacy Rules Amendment  (Read 423 times)

Lorenzo

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Dear members, am currently preparing to present another paper and would appreciate your input ; any qualitative feedback is appreciated. Salamat Daan.


Truly,
Lorenz
 ;D


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Lorenzo

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Re: Rough Draft: A critique on the 2003 HIPAA Privacy Rules Amendment
« Reply #1 on: October 23, 2012, 02:01:09 PM »
By: Dr. L. Lucino, M.D., Ph.D-candidate



ABSTRACT

The following paper includes the rough draft for the lobbying plan for an amendment to the 1996 HIPAA, which will include increased mental health privacy through the passing of an amendment that will allow patients to amend PHI with greater ease and thus protect patient information from being used in research, policy analysis without patient consent. The paper also addresses the many loop holes found in HIPAA and the necessity for Congress to make the changes so that there is greater certainty of patient confidentiality. The target patron is Congressman Daniel K. Davies, of the United States Congress, 7th District of Illinois.  


INTRODUCTION

   The United States health care industry has changed dramatically these past two centuries. One identifiable change has been the dramatic increase in the cost of drugs, the cost of medical procedures, the sophistication in medical data processes and the voluminous paper work related to medical documentation (Jonsen, Siegler, and Winslade, 2006). Prior to the age of HIPAA, particularly in the 1970’s and 1980’S, healthcare in the United States was rather liberated, the fields of surgery, pharmacology and clinical oncology were emerging and with such a phenomenon, the limitations and regulations in such fields were not as pronounced as it is now. The gross national product spent on health care was in the low single digits and there were no preferred provider organizations as we see now in the current era (Jonsen, Siegler and Winslade, 2006).  Specifically, there was no publicly available data indicating what is the preferred physician or surgeon and as a result, there were no regulations on disclosure of patient private information.


   With the advances in medical science and treatment options, the regularity of patient visits to physicians increased and as a result, the documentation procedures also increased. Many of these documents were sensitive personal information  that required to be safeguarded from being abused by patient employers, second parties. In the attempt to uphold and secure medical confidentiality, the United States Congress passed the 1996 Health Insurance Portability and Accountability Act, which is popularly known as HIPAA (Kassebaum-kennedy, 1996). HIPAA was enforced in order to protect patient confidentiality, which addresses some certain ethical issues. The ethical issue, then is determining what principles and circumstances justify exception to the rule. The ethical justifications for limiting confidentiality are based on principles of respect for autonomy, assuring that the privacy of a person is protected, and also on the principle of justice, assuring that others are not endangered because they are ignorant of a threat posed by another (Backlar, 1996).


   The Health Insurance Portability and Accountability Act of 1996 create a comprehensive system that defines the scope, value and limits of confidentiality. Under this law, health care providers, insurance providers are liable if they disclose information that is considered confidential without patient consent. In theory, this law is perfect, however, in application; there are significant issues that have manifested these past 16 years since ratification (Smith, 2011).


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Lorenzo

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Re: Rough Draft: A critique on the 2003 HIPAA Privacy Rules Amendment
« Reply #2 on: October 23, 2012, 02:04:19 PM »
ARGUMENT

   The regulations set in place according to the Health Insurance Portability and Accountability Act of 1996 is rather complex. According to HIPAA regulations, “covered entities”, which include health plans, health care providers that include hospitals and clinics, should make an effort to limit the use and disclosure of confidential patient information (Lorence, 2004). In a nutshell, the identifiable information that is obtained from these groups should not be disclosed without prior written authorization from the patient.

   Here is the exception to the rule, which has resulted in countless violations of HIPAA mandates these past 12 years since the law’s ratification: clinicians may use and share information  necessary for the treatment of patients; the institution can use the patient information to obtain or give reimbursement or payment for services rendered. Additionally, the institution can use or disclose information for a variety of policy and assessment activities that range from quality assurance, evaluation of outcomes. The exceptions to the rules are a reason why there are literally over 20,000 cited violations against confidentiality (Gostin, Hodge & Valdiserri, 2001).

   The complexity of the rules not only increases the red tape in medical documentation, resulting in physicians and clinical care providers to fill out forms that ensure confidentiality, which incidentally decreases patient interaction time. Another spectrum that must be addressed is the effects on research. Since the 2003 implementation of the privacy rules, which are added into HIPAA, there are studies (Lela, and Beachboard, 2007) that show HIPAAhas actually imposed more barriers to research in academic health centers, thereby slowing the pace of research, which lead to increasing costs and decreases the propensity of subjects taking part in important research studies. This affects future population-based research in that it prevents research institutions to collect patient contact information for fear o violating laws (Kolton, Costa and David, 2002).


In 2003, the HIPAA Privacy Rules was passed to increase further restrictions, however, by in doing so actually impacted the manner in which health care plans handle the privacy of plan participants’ medical records. In the original HIPAA law of 1996, the law prohibited sharing of medical information without written or authorized consent from the patient, with certain exceptions, namely, the care providers’ ability to share patient information with other health care professionals especially if it was necessary for treatment of the patient in the event the patient had a medical disorder (West, 1996). A scenario that necessitated this would be a patient who was suffering from a myocardial infarction, it would be pertinent for the family practioner to share patient health information, particularly the patient’s vitals, patient’s blood type, the medical drugs the patient is taking, as well as any allergies to medication. These are critical information that is necessary for proper treatment of the patient’s myocardial infarction as the cardiologist would require these files to make a proper prognosis and establish a treatment plan.


However, with the passing of the 2003 HIPAA Privacy Rules, there have been significant restrictions. The proposed changes would permit direct cae providers to use and internally disclose protected health information for their own treatment, payment or health care operations without prior consent. Prior to the passing of the 2003 HIPAA Privacy Rules, the physicians had limited access and could share limited patient information internally, and it was the patient who made decisions. Recent law now places the medical care provider as being equal to the patient or having the same power as the patient by allowing it to make decisions that should be made by the patient. One particular aspect that should be addressed is that prior the 2003 HIPAA Privacy Rule, research companies and academic groups were able to contact patients and ask them if they would be interested in taking part of clinical research. However, with the 2003 HIPAA Privacy Rules, medical care providers were denying research groups the right to contact patients and by doing so, affecting research process (APA Privacy Concerns, 2005).


There have been some complaints related to the access of personal protected health information. Incidentally it should be noted that this is one of the most common type of HIPAA privacy rule complaint filed by patients. These complaints towards HIPAA include the host cost that some entities charge, restrictions for patient access to their information (Pandiani, Banks, and Schacht, 1998).  One rather unique complaint that many patients make is that the privacy rules contain complex provisions that affects the patient’s right to access their PHI, which result in limitations for patients to make amendments to their PHI (West, 1996).


The paper written by Backlar (1996) addresses issues how medical information has been debated in the fields of medicine and justice as being sacrosanct. The author also points out that many governing institutions have promulgated laws and policies to protect patient privacy. Despite the current benefits of confidentiality via HIPAA, the current literature concedes that the demand of absolute confidentiality remains unrealistic, in particular, as what the author cites is the prevalence of online information and high speed communication. This article reiterates the importance of the necessity of an amendment to be made for HIPAA in which patients have the right to make amendments to their PHI with fewer restrictions (Gostin, Hodge, and Valdiserri, 2001).


   There are privacy experts, policy analysts and researchers as well as legislators how warn that without strong safeguards, the medical data network encouraged by HIPAA could be used to deny benefits to people with certain physical or mental ailments; in addition, it could be used to allow erroneous information to be freely spread throughout the system (Kassebaum-Kennedy health bill, 1996).


The role of a manager working in the mental health field is dependent on the structures that are set in place, the ethical code of conduct that is prescribed to be followed. Health managers must abide by the HIPAA laws, but at the same time, the same laws that are designed to protect patients, these same laws are producing a rebound effect (Dlugacz, Restifo & Greenwood, 2004). This rebound effect includes the increase in red tape, the spawning of medical informatics corporations that provide analysis. The end effect of these laws include a reduction in research, increase in prices, restrictions on patients’ ability to amend certain health information, and a longer duration time.


Landros (2004) illustrate how additional HIPAA Laws have actually affected the quality of medical care especially in regards to minors and the role of parents for children below 18 years of age. The complex patchwork of federal and state laws that allow adolescents to seek confidential family-planning and mental-health services without their parents’ consent. The electronic medical records system is not fool proof and because these patients are still minors, they cannot be placed onto their own security agreements nor can they make amendments on their online records. Patients that are still considered minors, under the law, are unable to make decisions against their own health information, but according to the 2003 HIPAA Privacy Laws, many decisions about whether to notify parents about protected health care information is done by the health care providers (Landro, 2005). This is an example of an ethical dilemma that has been seen throughout the country regarding the HIPAA Privacy Laws.


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Lorenzo

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Re: Rough Draft: A critique on the 2003 HIPAA Privacy Rules Amendment
« Reply #3 on: October 23, 2012, 02:05:07 PM »
ACTION


There should be an extension to HIPAA’s realm of interest to those that have mental health privacy concerns. There are instances in which medical care providers can minimize coverage for those with mental health disorders, and instances in which mental health records can be disclosed to employers. It is truly important to note that mental health records are very sensitive as any disclosure can affect a patient’s work status as well as his confidence in his health care provider. In order to protect patient information, the United States Congress needs to make an amendment to the 1996 HIPAA Law in which it will reduce restrictions to patient amendments to PHI. By doing this, by enabling this provision, patients can be secure that their PHI are under their control, that their mental health information is protected and cannot be easily shared with outside sources.


The United States Senate and Congress need to repeal the 2003 HIPAA Privacy Rules because this law truly does breach patient confidentiality and patient rights by placing a great amount of power and free sway for health care providers to dictate what kinds of health information is shared. In addition, this law actually is capable of allowing and empowering health care providers, be they physicians groups, nursing homes, mental health agencies and hospital systems, to make decisions on behalf of the patient regarding research options – by denying research organizations the right to contact patients. These imposed barriers to research in academic institutions such as medical universities, is slowing the pace of research, leading to the increase of costs of health care, and decreasing the likelihood of academic institutions getting access to a pool of patients for a population-based research that will be robust and scientifically credible.


There should also be an amendment to the HIPAA Law that allows patients who are below 18 years of age to make certain changes to their health information and to have the right to deny their parents access to private health care information, especially family planning records. Health care providers should not be given the right to make decisions for minors without prior consent of the minor patient. It is in my belief that confidentiality must be protected. The duty of medical confidentiality is an ancient one, this is illustrated in a verse from the Hippocratic Oath, “What I may see or hear in or outside the course of treatment which on no account must be spread abroad, I will keep to myself, holding such things shameful to speak about,” (Jonsen, Siegler, Winslade, 2006).


I believe that the 1996 HIPAA Law is, ideally, prudent in today’s society where the breadth and scale of medical processes, patient information and financial documentation warrant an effective system that ensures patient information is protected. That is why I don’t believe that overall HIPAA is a bad thing, I just believe that the 2003 Privacy Rules that was added 10 years ago does affect patient confidentiality in a negative way in that health care providers have the power to share information even without prior patient authorization or consent. Health care providers can share patient information to outside sources without prior consent and can even deny research entities the right to contact the patient of whether or not the patient is interested in partaking in population based studies. HIPAA Laws need to also make an amendment that allows minors to make amendments on their PHI files to bar their parents from knowing any family planning procedures undertaken as this is a violation of patient rights.


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Lorenzo

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Re: Rough Draft: A critique on the 2003 HIPAA Privacy Rules Amendment
« Reply #4 on: October 23, 2012, 02:05:41 PM »
CONCLUSION

   Privacy for mental health records abides by the HIPAA Privacy Rule, which states the following, “there shall be protected health information, including individually identifiable health or mental health information held or transmitted by a covered entity in any format, including electronic, paper, or oral statements,” (HIPAA, 2012). The major point of the Privacy Rule is to make sure there is a definition and limit the circumstances under which an individual information can be disclosed. However, it is evident that the 2003 HIPAA Privacy Rules are complex and produce a plethora of restrictions and barriers for patient privacy, putting greater emphasis on health care providers to make decisions for the patient.


The basis for health care providers to share information with each other rests on the fact that no confidential information may be publicized (Malone, 2008), however, there are instances that there are violations. As a result , an ethical dilemma manifests in the credibility and reliability of the 2003 HIPAA Privacy Rule. In addendum, there truly needs to be a stipulation in the HIPAA Law that allows minor patients to be able to access their health information and be able to make amendments to their health information such as any family planning operations, per se abortions, and limit access to their information from their parents.


   As the United States moves forward into the 21st century, with the advances of medicine and the liberalization of communication through the world wide web, which enables an individual to access medical information, scientific qualitative and quantitative data by a mere whim. Why should access to and amending one’s medical information be an exception? HIPAA , overall, is a great policy, however politicians need to address these complex issues in such a way that will reduce paper load and reduce restrictions for patients and researchers and in doing so will raise the quality of medical care.


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