Electronic databases and privacy protection: issues for a free society

More efficiently managed programs of health insurance claims processing and remittance with reduced costs and paperwork burdens hold out the potential for increased benefits to subscribers and health insurers alike. The computer/telecommunications systems and databases by which these efficiencies may be realized also hold great promise for improved services in other arenas. Early and candid recognition of the equally great potential for danger and abuse in those systems and the technology can guide the development and implementation of appropriate and necessary safeguards to individual privacy and to a democratic society in concert with system design.

A medical diagnostic index for rehabilitation

This paper records the developments of a computerized database suitable for recording the history, signs and symptoms of handicapping conditions, monitoring recovery, and measuring the impact of different forms of treatment. The original model described was designed for stroke and the paper describes its integration into the routine use of a stroke and rehabilitation unit in a district general hospital.

A comparison of doctors' practice in notifying addicts to the Home Office and reporting them to the North Western Drug Misuse Database

Doctors have been required to notify named addict patients to the Chief Medical Officer at the Home Office since 1968, and since 1990 have been encouraged to report voluntarily all their drug misusing patients to anonymized NHS regional databases. The North Western Drug Misuse Database, set-up for research purposes in 1985, was the forerunner of these databases. Compliance by doctors from three North Western District Health Authorities with both data collection systems between 1986 and 1989 was assessed by matching the names of notified addicts with the attributors of individuals reported to the NWDMD as users of notifiable drugs. By 1989 72% of addicts notified were also reported to the NWDMD although doctors working in hospital general departments still tended only to notify them. There was no evidence that particular general practitioners consistently did not notify their addict patients while reporting them to the NWDMD. The findings suggest that it will take some time for doctors to become accustomed to reporting all their drug misusing patients to the regional databases as well as notifying to Home Office those who met the notification criteria.

A primer of drug safety surveillance: an industry perspective. Part II: Product labeling and product knowledge

OBJECTIVE

To place the fundamentals of clinical drug safety surveillance in a conceptual framework that will facilitate understanding and application of adverse drug event data to protect the health of the public and support a market for pharmaceutical manufacturers' products. Part II of this series discusses specific issues regarding product labeling, such as developing the labeling, changing the labeling, and the legal as well as commercial ramifications of the contents of the labeling. An adverse event report scenario is further analyzed and suggestions are offered for maintaining the product labeling as an accurate reflection of the drug safety surveillance data. This article also emphasizes the necessity of product knowledge in adverse event database management. Both scientific and proprietary knowledge are required. Acquiring product knowledge is a part of the day-to-day activities of drug safety surveillance. A knowledge of the history of the product may forestall adverse publicity, as shown in the illustration.

DATA SOURCES

This review uses primary sources from the federal laws (regulations), commentaries, and summaries. Very complex topics are briefly summarized in the text. Secondary sources, ranging from newspaper articles to judicial summaries, illustrate the interpretation of adverse drug events and opportunities for drug safety surveillance intervention.

STUDY SELECTION

The reference materials used were articles theoretically or practically applicable in the day-to-day practice of drug safety surveillance.

DATA SYNTHESIS

The role of clinical drug safety surveillance in product monitoring and drug development is described. The process of drug safety surveillance is defined by the Food and Drug Administration regulations, product labeling, product knowledge, and database management. Database management is subdivided into the functions of receipt, retention, retrieval, and review of adverse event reports. Emphasis is placed on the dynamic interaction of the components of the process. Suggestions are offered to facilitate communication of a review of adverse event data for various audiences.

CONCLUSIONS

Careful drug safety surveillance is beneficial to the health of the public and the commercial well-being of the manufacturer. Attention to the basic principles is essential and, as illustrated, may be sufficient to resolve some problems.

The National Practitioner Data Bank: an introduction

The National Practitioner Data Bank, mandated by law, has created a great deal of anxiety in the medical community. The author describes the origin, development, and operation of the bank. Army implementation procedures emphasize safeguards for practitioners and are also felt to be fully consistent with patient protection. Potential problems and areas for further research are described. Linking practitioner entry to standard of care or setting a dollar cut-off for entries are two possible solutions.

Guest alliance: uses of state-level hospital discharge databases

The applications of state-level hospital discharge data are increasing. SDOs, however, face several substantial challenges if they are truly to be perceived as a legitimate tool for managing the healthcare system. These challenges include obtaining a commitment at the state and national levels, and in the public and private sectors, to the following principles: promotion of the long-term stability of SDOs; expansion of state databases beyond hospitals into ambulatory and long term care settings; and provision of necessary financial, technical, and educational assistance so that SDOs can meet their legislative mandates. Stakeholders should be educated about the value of state-level data. SDOs should expand their dissemination efforts as a way of reinforcing the importance of placing data in the public domain. NAHDO is working with SDOs and other data collectors and users to improve uniformity, standardization, access, and use of health data.

Avoiding traps and pitfalls in National Practitioner Data Bank compliance

Quirks in the National Practitioner Data Bank regulations and operations may catch medical staffs and hospitals unawares, creating potential traps and pitfalls that could result in exposure to lawsuits and federal sanctions. In this article, the author outlines several areas of possible difficulty and offers tips to help medical staffs avoid problems in these areas.

Malpractice and the National Practitioner Data Bank: what OR nurses need to know

The National Practitioner Data Bank will record any payments made for any reason related to a malpractice suit in a central data bank available to a number of designated parties. Hospitals will be required to request this information to screen applicants and at least every 2 years for appointment renewals. The data bank may also be consulted by hospitals and state licensing boards as they deem necessary and by professional societies when reviewing membership applications. It is in the best interests of all malpractice defendants to insist on adequate representation of their personal, professional, and financial interests, which may necessitate insurance carriers providing each defendant with individual counsel.

Civil money penalties for failure to report on medical malpractice payments and for breaching the confidentiality of information--HHS. Final rule

This final rule establishes civil money penalties (CMPs) pursuant to title IV of Public Law 99-660, the Health Care Quality Improvement Act of 1986 (HCQIA), as amended by section 402(a) of Public Law 100-177. Section 421(c) of HCQIA establishes a CMP against any entity that fails to report information that is required to be reported on medical malpractice payments. Section 427(b) of HCQIA establishes a CMP against any person that breaches the confidentiality of information which is reported or furnished pursuant to HCQIA and which the Secretary has established the National Practitioner Data Bank to collect and disseminate.

"Black marks on your soul"--the National Practitioner Data Bank

In 1986, Congress mandated establishment of a National Practitioner Data Bank. The goal was to improve the quality of medical care by creating an environment to weed out impaired or incompetent physicians. The authors discuss the effects of the Bank since it became operational on September 1, 1990.

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners--PHS. Final regulations

This final rule amends the existing regulations governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank), codified at 45 CFR part 60, authorizing the reporting and release of information concerning: (1) Payments made for the benefit of physicians, dentists, and other health care practitioners as a result of medical malpractice actions or claims; and (2) certain adverse actions taken regarding the licenses and clinical privileges of physicians and dentists. This final rule revises section 60.12 to change the process for collecting user fees from eligible individuals and entities requesting disclosure of information from the Data Bank.

Risk management or political micromanagement?

A major healthcare issue of the 1990s is whether providers will create effective risk management programs to cope with government reform mandates or whether an increasingly costly and complex regulatory structure will force them to make changes. Compliance with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards on patient care will become increasingly important to healthcare risk management in the 1990s. The JCAHO standards create a benchmark from which government entities set their present standards and assemble agendas for the future. Another healthcare risk management factor is compliance with the National Practitioner Data Bank. The data bank is intended to protect healthcare consumers from providers who have demonstrated a tendency to commit malpractice. However, the data bank could cause problems for healthcare providers: Inaccurate or misleading data could unfairly haunt them. Healthcare risk managers should be familiar with the prohibitions on patient dumping found in the Consolidated Omnibus Budget Reconciliation Act of 1985. The amendments of the Omnibus Budget Reconciliation Act of 1989 (OBRA '89) do not create strict liability, nor do they impose traditional tort standards that could guide courts in cases that will inevitably result from new rules, creating a "litigation time bomb." And OBRA '90 significantly revises the law. Other risk management issues include the manner in which facilities handle and dispose of medical waste and the manner in which they resolve disputes.