Proposed federal legislation jeopardizes patient privacy

In the last year there has been a move to enact federal legislation concerning private health-care information. This move has been fueled by a growing trend toward the computerization and electronic transmission of health-care information. These advances in technology call for appropriate new protections of patients' privacy. Unfortunately, the proposed legislation has not received adequate attention in the medical community. Physicians and patients in general are not aware of the legislation and have not been engaged in shaping its contents. In its current form, the legislation would seriously undermine traditional protections of confidentiality that are ensured by physicians. The flaws of the proposed legislation are examined in this article.     

Protecting privacy to improve health care

No comprehensive federal law now protects the privacy of people's medical records. The Health Insurance Portability and Accountability Act of 1996 mandates that if Congress fails to enact such legislation by August 1999, the secretary of health and human services must promulgate regulations. This paper argues that health privacy legislation is necessary both to improve patient care and to enhance the reliability of the health information used for research and public health initiatives. Within this framework I review pending federal health privacy legislation and make recommendations for moving forward.     

Communication and records: Hippa issues when working in health care settings.

To refocus awareness on the original mandate of the Health Insurance Portability and Accountability Act (HIPPA) regulations, this article will review record keeping requirements and examine patient-doctor and interdisciplinary communication as a way to improve the health care consumer's trust in the privacy of their personal information while facilitating integrated and fluid health care delivery systems. The HIPPA rules especially important in medical settings are discussed with a special emphasis on issues confronting psychologists who practice outside of medical institutions and hospitals. The article also examines important implications for practice activities when psychologists attend patients who are hospitalized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two routes to privacy protection: a comparison of health information legislation in Canada and the United States

The privacy of health information is a subject of great sensitivity in both Canada and the United States. As a result of public demands for more effective protection of such information as medical records, Canada and, particularly, its provincial governments, have implemented extensive legislation. The United States, on the other hand, has largely confined its efforts to private sector initiatives that are more reflective of voluntary codes than legal statutes. Because new technologic developments facilitate data sharing in the medical field, especially in the face of a continual reduction of healthcare budgets, the concern for privacy protection in this domain has intensified. Correspondingly, there has been a gradual theoretical shift in protective health information policies on both sides of the border. As Canada pushes to extend its federal and provincial legislation to the private sector, the United States is on the brink of approving a national bill that would protect the privacy of personal medical records. It is becoming evident that efforts to secure the privacy of health information in both countries are converging.     

Psychologists in defense of the Federal Trade Commission.

The professional and economic challenges to psychologists posed by organized medicine have been stymied in the past by the Federal Trade Commission and by strict enforcement of the antitrust laws. Now that professionals' competition and consumer choice are being supported in the courts, the American Medical Association (AMA) is redoubling its efforts to retain a monopolistic hold on health care, hospital practice, and health insurance throughout the nation. Organized psychology, with the help of other professions and the Congress, has barely held the line against politically and economically stronger forces. The Association for the Advancement of Psychology and the American Psychological Association actively opposed the AMA's proposed legislation in 1981 and 1982 that would have allowed the AMA to circumvent valid law. The medical profession has actively worked to control all health care and deny psychologists hospital staff privileges, preventing group practice between physicians and psychologists, denying them health insurance reimbursement, and restricting psychological services to physician supervision. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alzheimer's disease: Current congressional response.

Addresses the public policy component of Alzheimer's disease (AD) by examining legislation (either proposed or passed by Congress) in the areas of research, aid and assistance to AD patients and their families, long-term care, and information dissemination. Barriers to the passage of Alzheimer's legislation in Congress are noted. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confidentiality: Ethical and legal aspects for Canadian psychologists.

Discusses the ethical and legal aspects of confidentiality for Canadian psychologists, with particular emphasis on clinical psychology. The concepts of confidentiality, privileged communication, and privacy are clarified. The law of privileged communication in Canada is presented. Ethical standards, provincial and federal legislation, and case law bearing on confidentiality in clinical practice are discussed. Issues of mandatory child abuse reporting, the duty to protect, informed consent, and 3rd-party and client access to records are explored. Suggestions are made to the psychologist regarding the management of confidentiality. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical dilemmas in AIDS research: Individual privacy and public health.

Research on the acquired immune deficiency syndrome (AIDS) presents a stark example of the dilemmas involved in balancing individual rights and social welfare in conducting psychosocial research. These dilemmas are pronounced in research on public health. Unfortunately, significant legal threats to confidentiality are matched inadequately by legal means of protecting privacy. Researchers are advised to request certificates of confidentiality from the Public Health Service. A privilege statute is needed to protect the privacy of participants in research on AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists as legislators: Results of the 1998 elections.

The November 1998 elections saw a significant increase in the number of psychologists elected to the U.S. Congress and to state legislatures. These psychologists bring health care expertise to their positions as legislators, which enhances their contributions to public policy. They are playing key roles in sponsoring health care reforms such as patient protection legislation and mental health parity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A legislative view of Medicare and DRGs.

Discusses the prospective payment system of medical costs according to diagnosis-related groups (DRGs) rather than actual cost of treatment introduced by the federal government in response to rising costs. The impact and expansion of DRGs and alternatives for Congress are discussed. It is suggested that Congress and the administration need the encouragement of health care specialists to determine the kinds of changes needed to maintain quality medical care for the elderly. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists, Congress, and public policy.

As professional psychologists become increasingly involved in shaping health care policy in our nation, it is imperative that they understand the various forces that influence congressional members to enact legislation. This article examines two major issues: (a) Congress's cautious and restrained approach to health care policy and (b) preemption and the relationship between Congress and the states. Understanding these issues will enable psychologists to become more effective representatives of both the professional and societal interests of professional psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Steps to improve the quality of life for people who are dying.

Congress has largely ignored the public health crisis of pain and symptom management in the United States. However, the state of Oregon has taken several steps to improve quality of life for people who are dying. The author has also worked to improve the care provided to the terminally ill by introducing the Conquering Pain Act, by asking the General Accounting Office to explore why people do not receive their full hospice benefit, and by examining ways to respond to the mental health issues associated with dying. The author believes that quality end-of-life care is both a right and a responsibility and that it deserves immediate attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response of the law to developments in genetics

In this article, first of all the potential role of the law with regard to complex developments like those in genetics is examined; a distinction is made between substantive law (for example prohibitions) and procedural law (for example licensing systems), and between statutory and voluntary regulation. In Europe, in particular the parliament of the European Union has called for legislation. Although several European countries have prepared legislation relating to particular aspects (for instance embryo research, genetic screening, use of genetic tests in employment and insurance), in general the response would seem cautious. When legislation is envisaged the outcome of the lawmaking process is not always predictable because of moral pluralism and political pressures. Legislating in this field is hard also for other reasons, such as the pace of development and the difficulty to assess the social consequences of developments. Other problems are the similarity or difference between genetic information and conventional medical information, and the fact that the developments in genetics lay bare more general deficiencies in the social system. With regard to many developments, the response of the law in the immediate future should be to monitor rather than to ban; where possible, self-regulation should be preferred over statutory regulation, and general laws over genetic specific laws. An international level, common principles should be adopted to serve as a framework for national legislation. Nevertheless, in some areas legislation may already be needed: in particular where genetic technologies or their results are being applied outside the regular health care setting, for instance in the form of population screening or testing for insurance purposes.     

Acquiring CMS funding for an APA-accredited postdoctoral psychology fellowship program.

In 2001 Congress reinterpreted existing legislation allowing hospital based, postdoctoral psychology training programs that were accredited by the American Psychological Association (APA) to file for and receive allied health reimbursement through the Center for Medicare/Medicaid Services (CMS). This became effective on March 13, 2001 (Health Care Financing Administration, 2001). Historically physician and other allied health training programs have received government funding, while psychology training has been nonfunded. This new legislation symbolized a shift in federal health policy and recognized psychology as a valuable discipline within the health care system. This article discusses several postdoctoral programs' successful approach in obtaining CMS funding and encourages other eligible programs to pursue it as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarifying confidentiality with the ethical practice model.

Replies to comments (see record 2008-14338-012) on the author's original article Protecting confidentiality rights: The need for an ethical practice model (see record 2007-19520-001). The important issues raised by Pipes, Blevens, and Kluck illustrate the complications that can arise in discussing confidentiality and making decisions about it: First, they noted that the term client consent is used by psychologists to mean two quite different things about confidentiality: (a) acknowledgement of its limits and (b) consent to disclose specific information. Second, Pipes et al made several comments about laws, one of which referred to Behnke's (2004) "doors" model. Third, Pipes et al elicited my personal thoughts about the current APA Ethics Code (APA, 2002). Finally, Pipes et al expect the ethical practice model to be used in psychology training programs. The current author hopes it will provide the next generation of psychologists with a clear ethical framework for considering confidentiality issues. Meanwhile, as in this exchange, it can facilitate conversation among colleagues not only about ethical and legal questions but also about cultural issues, personal values, and professional standards that affect our approach to confidentiality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criteria for the evaluation of quality improvement programs and the use of quality improvement data.

This document provides a set of criteria to be used by psychologists in evaluating quality improvement programs (QIPs) that have been promulgated by health care organizations, government agencies, professional associations, or other entities. These criteria also address the privacy and confidentiality issues evoked by the intended use of patient data gathered by such QIPs. Although developed for psychologists, these criteria may be useful across health service areas and professions. Psychologists support continuous quality improvement and professional development to ensure that their patients receive the best possible care. Careful evaluation of quality improvement strategies helps ensure improved quality of care while avoiding unintended negative consequences to the patient and/or the therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confidentiality of industrial psychological tests.

Traces the 8-yr history of the first legal challenge involving a union's right to obtain confidential test data used by company psychologists. Union rights are felt by many to be more important than an individual's right to confidentiality when dealing with a company's psychologist. New right-to-privacy legislation may be helpful in assuring protection to the psychologist and to the individual union member. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The medical expense deduction provision: Public policy in a vacuum?

Traces the legislative history, underlying assumptions, and subsequent modifications of the medical expense deduction provision of the Internal Revenue Code. Special attention is given to the efforts of the Congress and the various administrations to provide coverage of extraordinary expenses and to define medical expenses as contrasted with personal expenses. The author suggests that as currently implemented, the provision does not fulfill the congressional intent. As psychologists become more active in health care, they should make a concerted effort to have Congress reevaluate the underlying assumptions of the provision. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surat''94: was it melioidosis?--interesting observations from the first case of imported melioidosis in India

With regard to HIV/AIDS, this editorial claims that attitude problems, communication difficulties, issues of confidentiality in connection with the prevention of disease spread, absence of uniformity in the management of patients, and lack of counseling skills all contribute to dilemmas in AIDS care. First, the author claims that, since attitude affects the way we communicate and reflects on every area of life, health care givers should change their negative attitudes in order to serve each patient with love and compassion. Next, the issue of confidentiality is addressed. The author writes that tracing of contacts is difficult when an HIV-infected individual is given his/her full right to confidentiality. Next, it is suggested that the management of HIV/AIDS patients should be made uniform by putting one person in charge in the hospital setting. Finally, the author concludes that all health workers ought to have basic counseling skills, as this is one of the most important aspects of care.     

Incapacity principles in mental health laws in Europe.

Many North American jurisdictions permit involuntary psychiatric treatment to proceed only when a person lacks the capacity (or competence) to consent or when an emergency exists, even following lawful civil commitment. This may prevent the rapid commencement of treatment, but it shows considerable respect for personal autonomy, and it brings mental health law more into line with other branches of health care law. The authors examine how these issues are handled within European human rights law and within the civil codes and involuntary hospitalization laws of selected European nations. This material reveals that many different approaches are taken to the inclusion of incapacity principles within European civil commitment regimes. Reliance on incapacity criteria may lead to greater professional involvement by psychologists in involuntary treatment decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)