The Subpoena and Day in Court: Guidelines for Nurses

Psychiatric nurses or therapists may be subpoenaed to appear as direct or expert witnesses. The response must be carefully prepared, and nurses must be aware that testifying in court can be an anxiety-provoking experience. Testifying often involves being an advocate for a client. Clients who have a mental illness, are developmentally disabled, or have a history of abuse or recent violence deserve a conscientious response. The legal process is the avenue for providing safety or empowerment, for assuring that needs are met, and rights are obtained, and being part of that process is an important role. Being prepared for the role is essential.

Community Pharmacists’ Awareness of and Involvement with Medications Intended for Use in Primary and Secondary Schools

OBJECTIVE

To observe the degree to which community pharmacists are aware of and involved in issues related to the use of medications in primary and secondary schools and to identify the interventions they use to deal with these issues.

DESIGN

Cross-sectional survey.

SETTING

Illinois.

PARTICIPANTS

569 licensed pharmacists with community pharmacy experience.

INTERVENTIONS

A survey comprising questions about the experiences, attitudes, and behaviors of community pharmacists with regard to medication use in schools was mailed in June 2003.

MAIN OUTCOME MEASURES

Descriptive and bivariate statistical analysis of survey items.

RESULTS

Almost all respondents reported that they had dispensed medications for use in school; two thirds thought that taking medications at school creates the potential for special problems (e.g., missed dose, social stigma). Of nine interventions that could help minimize these problems, the respondents used a mean of 3.34 interventions. Providing additional labeled containers for use at school was the most common intervention reported. Respondents who thought that medication use in schools caused special problems provided significantly more interventions than those that did not share this concern.

CONCLUSION

Pharmacists are aware of and involved in the issues and potential problems created by medication use in schools. While they make use of interventions that are available to all community pharmacists, they could do more to help resolve issues. Additional effort to raise pharmacist awareness about medication use in schools is warranted.

Inherited medullary thyroid cancer and the duty to warn: revisiting Pate v. Threlkel in light of HIPAA

Familial medullary thyroid cancer (FMTC) is one of the few autosomal dominant cancers for which genetic testing provides a clear medical indication for prophylactic and/or curative therapy, and for which prophylactic thyroidectomy, followed by thyroid hormone replacement, presents a relatively low morbidity risk. Medullary thyroid cancer (MTC) is a particularly aggressive type of thyroid cancer, and screening by traditional biochemical markers yields a high proportion of advanced stage diagnoses in individuals from FMTC families. This is particularly hazardous since there are no curative systemic treatments for MTC. Genetic testing for germline mutations of the RET proto-oncogene provides a reliable method of identifying at-risk family members in those FMTC families in which a mutation has been identified in the proband. Prophylactic thyroidectomy in such at-risk family members has significantly reduced the proportion of advanced stage MTC diagnoses in MTC families. Since a clear medical benefit exists for genetic testing in family members, and a clear danger to family members exists in the absence of genetic counseling, establishing genetic diagnosis as standard of care has critical legal and ethical implications for medical providers caring for probands and family members. The "duty to warn," reinforced by the courts in the legal case of Pate v. Threlkel, may override recent confidentiality legislation, known as the HIPAA Privacy Rules, which came into effect April 12, 2003.

National Provider Identifier (NPI) planning and implementation fundamentals for providers and payers

Federal HIPAA legislation mandates that the National Provider Identifier (NPI) be fully implemented across all healthcare entities between May 2005 and May 2007, or 2008 for small payers. Starting May 2005, healthcare providers will be eligible to obtain an NPI and use these numbers to submit claims or conduct other transactions specified by HIPAA. By 2007, the NPI must be used in connection with the electronic transactions identified in HIPAA. Today, individual payers assign unique identification numbers to healthcare providers, and, in most cases, payers assign multiple identification numbers to healthcare providers and their "subparts." As a result, providers have multiple payer-specific identification numbers. The NPI is a unique, 10-digit federal healthcare provider identification number that will be used by all healthcare providers and payers and other healthcare entities involved in administrative and financial transactions associated with health service events and related activities. This article will use software and data experts' knowledge as well as the authors' NPI implementation readiness assessment work to review the impact to both payers and providers, including hospitals, clinics, and other service entities. The authors will suggest planning, budgeting, architecting, and data management solutions for payers and providers to achieve the optimal administrative simplification goals intended by the NPI, without compromising data integrity and interoperability objectives across the service spectrum of the healthcare enterprise.

Currents in contemporary ethics. Research privacy under HIPAA and the common rule

For nearly twenty-five years, federal regulation of privacy issues in research involving human subjects was the primary province of the federal rule for Protection of Human Subjects (Common Rule). As of April 14, 2003, the compliance date for the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA), however, the Common Rule and the Privacy Rule jointly regulate research privacy. Although, in theory, the Privacy Rule is intended to complement the Common Rule, there are several areas in which the rules diverge. In some instances the inconsistencies result in gaps in privacy protection; in other instances the inconsistencies result in added burdens on researchers without additional privacy protections. In all instances, the lack of harmonization of these rules has created confusion, frustration, and misunderstanding by researchers, research subjects, and institutional review boards (IRBs). In this article, I review the major provisions of the Privacy Rule for research, explain the areas in which the Privacy Rule and Common Rule differ, and conclude that the two rules should be revised to promote consistency and maximize privacy protections while minimizing the burdens on research.

Expanding the ethical analysis of biobanks

Biobanks are repositories of human biological materials collected for biomedical research. There are over 300 million stored specimens in the United States, and the number grows by 20 million per year. In the post-genome world of high throughput gene sequencing and computational biology, biobanks hold the promise of facilitating large-scale research studies. New organizational and operational models of research repositories also raise complex issues of big science, big business, and big ethical concerns.

From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine--Part I: conceptual, moral, and legal foundations

Respect for patient privacy and confidentiality is an ancient and a contemporary professional responsibility of physicians. Carrying out this responsibility may be more challenging and more important in the emergency department than in many other clinical settings. Part I of this 2-part article outlines the basic concepts of privacy and confidentiality, reviews the moral and legal foundations and limits of these concepts, and highlights the new federal privacy regulations implemented under the Health Insurance Portability and Accountability Act of 1996. Part II of the article examines specific privacy and confidentiality issues commonly encountered in the ED.

Final regulations for health coverage portability for group health plans and group health insurance issuers under HIPAA Titles I & IV. Final regulation

This document contains final regulations governing portability requirements for group health plans and issuers of health insurance coverage offered in connection with a group health plan. The rules contained in this document implement changes made to the Internal Revenue Code, the Employee Retirement Income Security Act, and the Public Health Service Act enacted as part of the Health Insurance Portability and Accountability Act of 1996.

Should dentistry be part of the National Health Information Infrastructure?

BACKGROUND

The National Health Information Infrastructure, or NHII, proposes to improve the effectiveness, efficiency and overall quality of health in the United States by establishing a national, electronic information network for health care. To date, dentistry's integration into this network has not been discussed widely.

METHODS

The author reviews the NHII and its goals and structure through published reports and background literature. The author evaluates the advantages and disadvantages of the NHII regarding their implications for the dental care system.

RESULTS

The NHII proposes to implement computer-based patient records, or CPRs, for most Americans by 2014, connect personal health information with other clinical and public health information, and enable different types of care providers to access CPRs. Advantages of the NHII include transparency of health information across health care providers, potentially increased involvement of patients in their care, better clinical decision making through connecting patient-specific information with the best clinical evidence, increased efficiency, enhanced bioterrorism defense and potential cost savings. Challenges in the implementation of the NHII in dentistry include limited use of CPRs, required investments in information technology, limited availability and adoption of standards, and perceived threats to privacy and confidentiality.

CONCLUSIONS

The implementation of the NHII is making rapid strides. Dentistry should become an active participant in the NHII and work to ensure that the needs of dental patients and the profession are met. Practice Implications. The NHII has far-reaching implications on dental practice by making it easier to access relevant patient information and by helping to improve clinical decision making.

The HIPAA Security Rule: implications for biomedical devices

The HIPAA Security Rule, with which hospitals must become compliant by April 2005, is broad in scope. Some aspect of this rule will affect virtually every function and department within a healthcare organization. The functions and departments that deal with biomedical technologies face special challenges due to the great diversity of technologies, the variety of data maintained and transmitted, and the risks associated with compromises to data security--combined with the presence of older technology and the absence of integrated expertise. It is essential that hospitals recognize this challenge and initiate steps now to implement appropriate information security management.

HIPAA???Clinical and Ethical Considerations for Nurses

Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) to protect patients' basic rights to privacy and their control over the disclosure of their personal health information. Advances in and the more widespread use of communication technology were increasing the public's concerns over the ease with which their health information could be transmitted, how protected that information was during such transmissions, and their lack of approval for the use of that information by known and unknown third parties. This article, the first of two papers focusing on HIPAA, discusses HIPAA from the clinical perspective and focuses primarily on the HIPAA Privacy Rule. Under what circumstances can a covered entity disclose protected health information? What are the ethical issues inherent in HIPAA? What does HIPAA require of covered entities? What are the implications of HIPAA for professional nurses? The goal of HIPAA is to ensure the protection of confidential health information through having appropriate security systems to guard against unintentional disclosure of that information.

The HIPAA privacy rule and bioterrorism planning, prevention, and response

Effective bioterrorism planning, prevention, and response require information sharing between various entities, ranging from public health authorities and health-care workers to national security and law enforcement officials. While the source of much information exchanged may be nonidentifiable, many entities legitimately need access to personally identifiable health information (or "protected health information" [PHI]) in planning for and responding to a bioterrorism event. The HIPAA Privacy Rule allows for essential exchanges of health data during a public health emergency while protecting against unnecessary disclosures of PHI. In the event of a bioterrorist attack, the Privacy Rule allows covered entities to disclose PHI without individual authorization in the following instances: (1) for treatment by health-care providers, (2) to avert a serious threat to health or safety, (3) to public health authorities for public health purposes, (4) to protect national security, (5) to law enforcement under certain conditions, and (6) for judicial or administrative proceedings. Despite these favorable disclosure provisions, some privacy challenges remain. The flow of PHI may be slowed by misunderstandings of the Privacy Rule's accounting requirement. In addition, in a bioterrorism scenario, nontraditional entities may find themselves acting as health-care providers, triggering Privacy Rule provisions. Finally, the potential for de facto disclosures of individuals' disease or exposure status increases where conspicuous treatment methods, isolation, or quarantine are implemented without additional measures to protect privacy. Understanding the Privacy Rule's impact on bioterrorism planning and response ensures that various entities can conduct their activities with needed information while still protecting individual privacy.