Administrative simplification: adoption of standards for health care electronic funds transfers (EFTs) and remittance advice. Interim final rule with comment period

This interim final rule with comment period implements parts of section 1104 of the Affordable Care Act which requires the adoption of a standard for electronic funds transfers (EFT). It defines EFT and explains how the adopted standards support and facilitate health care EFT transmissions.

Informational privacy, public health, and state laws

Developments in information technology that make it possible to rapidly transmit health information also raise questions about the possible inappropriate use and protection of identifiable (or potentially identifiable) personal health information. Despite efforts to improve state laws, adoption of provisions has lagged. We found that half of states have no statutes addressing nondisclosure of personally identifiable health information generally held by public health agencies. Exceptional treatment of HIV, sexually transmitted infections, or tuberculosis-related information was common. Where other provisions were found, there was little consistency in the laws across states. The variation in state laws supports the need to build consensus on the appropriate use and disclosure of public health information among public health practitioners.

Are you ready for an OCR audit?

Proposed rules aimed at strengthening HIPAA privacy and security requirements have put CIOs and security officers at provider organizations on alert. Experts weigh in on how the changes will play out and what it means for provider organizations.

Stigmatized silence: the exclusion of HIV and AIDS sufferers from the "Obamacare" legal landscape

The continued presence and growing rates of individuals infected with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in the United States has come to reflect an epidemic of significant proportion. Unfortunately, federal legislation has been eerily silent regarding the establishment of protections against health status-based discrimination for asymptomatic HIV and AIDS sufferers. Congress has done little to change this reality, despite the institution of major healthcare system and insurance reform by the Obama Administration in 2010. This Note argues that "Obamacare" and the two laws that define it—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010—fail to address asymptomatic HIV and AIDS infection as a significant source of health status-based insurance discrimination. As a result, these individuals continue to be ignored, subject to the ambiguities of "disability"- based legislation, and relegated to the status of a legally invisible class.

A review of basic patient rights in psychiatric care

Although patient rights is a concept that all nurse managers need to be aware of, this concept often becomes confusing when applied to patients undergoing psychiatric treatment. It is important for the nurse manager to understand the basic rights that psychiatric patients are entitled to, to best be able to help staff nurses under his/her supervision to protect these rights. The nurse manager on a psychiatric unit often serves as a reference for staff nurses, and even for physicians, when questions regarding patient rights present themselves. The nurse manager should be certain to discuss these issues with the facility's legal and risk management team to be aware of particulars of the law of the state in which the facility is located, as state laws may differ somewhat in their treatment of psychiatric patients.

Invited commentary: Population-based human subjects research in the era of enhanced privacy regulation

Privacy seems to be of increasing public concern, as evidenced by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, a regulatory framework that appears to hinder access to data and thus to limit population-based research. A 2009 Institute of Medicine (IOM) report urged Congress, via the US Department of Health and Human Services (HHS), to develop a new approach to protecting privacy that would not employ the HIPAA Privacy Rule. In an accompanying article in the Journal, Nattinger et al. (Am J Epidemiol. 2010;172(6):637-644) employ one of the constructs recommended in the IOM report: use of a centralized honest broker. Unfortunately, Nattinger et al.'s approach would not be acceptable to all institutional review boards. The IOM report also urged the HHS to reduce variability in interpretations of the HIPAA Privacy Rule by privacy boards through revised and expanded guidance and harmonization. HHS Secretary Kathleen Sebalius has not acted upon any of the IOM report recommendations. The need to remove major barriers to human health research cannot be forgotten. At risk is America's progress in finding solutions to our most pressing health concerns.

Heightened attention to medical privacy: challenges for unbiased sample recruitment and a possible solution

Subject recruitment for epidemiologic studies is associated with major challenges due to privacy laws now common in many countries. Privacy policies regarding recruitment methods vary tremendously across institutions, partly because of a paucity of information about what methods are acceptable to potential subjects. The authors report the utility of an opt-out method without prior physician notification for recruiting community-dwelling US women aged 65 years or older with incident breast cancer in 2003. Participants (n = 3,083) and possibly eligible nonparticipants (n = 2,664) were compared using characteristics derived from billing claims. Participation for persons with traceable contact information was 70% initially (2005-2006) and remained over 90% for 3 follow-up surveys (2006-2008). Older subjects and those living in New York State were less likely to participate, but participation did not differ on the basis of socioeconomic status, race/ethnicity, underlying health, or type of cancer treatment. Few privacy concerns were raised by potential subjects, and no complaints were lodged. Using opt-out methods without prior physician notification, a population-based cohort of older breast cancer subjects was successfully recruited. This strategy may be applicable to population-based studies of other diseases and is relevant to privacy boards making decisions about recruitment strategies acceptable to the public.

Invited commentary: Evaluating epidemiologic research methods--the importance of response rate calculation

Epidemiologic research that uses administrative records (rather than registries or clinical surveys) to identify cases for study has been increasingly restricted because of concerns about privacy, making unbiased population-based research less practicable. In their article, Nattinger et al. (Am J Epidemiol. 2010;172(6):637-644) present a method for using administrative data to contact participants that has been well received. However, the methods employed for calculating and reporting response rates require further consideration, particularly the classification of untraceable cases as ineligible. Depending on whether response rates are used to evaluate the potential for bias to influence study results or to evaluate the acceptability of the method of contact, different fractions may be considered. To improve the future study of epidemiologic research methods, a consensus on the calculation and reporting of study response rates should be sought.