Mental health practitioners and HIPAA.

The privacy and security of patients' medical records continue to challenge mental health practitioners in an ever-increasing electronic environment. Although practitioners were to be in compliance of the 1996 Health Insurance Portability and Accountability Act (HIPAA) by April 20, 2006, many practitioners still struggle to understand the nuances of the regulations. This article will cover the areas of HIPAA that relate specifically to the mental health practitioner who treats both adults and children. The article begins with important definitions such as “covered entity,” “individually identified health information,” and “electronic transactions.” Establishing that many mental health practitioners likely meet the definition of covered entities, the article details The Privacy Rule and The Security Rule. Included are issues concerning consents, authorizations, and objections along with enforcement of HIPAA. Also changes in enforcement to HIPAA by the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of the American Recovery and Reinvestment Act of 2009 are discussed. Examples of violations and resulting enforcement will help practitioners better understand the regulations and how best to comply with these regulations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Health information systems and the role of state government

State government entities have created a range of innovative electronic information systems to support their diverse and evolving roles in the health care system. Primary goals of these initiatives include improvement of traditional public health programs, meaningful oversight of providers, simplification of administrative procedures, and support of state purchasing decisions. We establish a taxonomy of state efforts, describing primary capabilities to (1) provide meaningful data to state decisionmakers; (2) disseminate information to purchasers and consumers; (3) coordinate and improve government services; (4) establish mechanisms for electronic transactions; and (5) support telemedicine services. Reductions in the costs of technology and use of the Internet have dramatically increased state capabilities in recent years. Both the successes and failures of existing programs offer important lessons for states that are initiating new electronic communication initiatives.     

Health insurance reform legislation

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), enacted on August 21, 1996 (Public Law 104-19), provides for improved access and renewability with respect to employment-related group health plans, to health insurance coverage sold in connection with group plans, and to the individual market (by amending the Public Health Service Act). The Act's provisions include improvements in portability and continuity of health insurance coverage; combatting waste, fraud, and abuse in health insurance and health care delivery; promoting the use of medical savings accounts; improving access to long-term care services and insurance coverage; administrative simplification; and addressing duplication and coordination of Medicare benefits.     

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)     

Computers, privacy, and the national data center: The responsibility of social scientists.

Discusses the assets and liabilities of establishing a national data center with the aim of facilitating statistical analysis for administrative planning and social research. It is noted that the research process raises the question of conflict between the individual's right to privacy and society's right of discovery. It is suggested that the general standards for collection and use of individual data must be established. The major advantages of a national data center in regard to research are (1) the availability of more data, (2) less expense, (3) data from more and better samples respondents, (4) less redundant data collection, (5) more comparable variables, (6) variables covering more areas, and (7) easier verification of analysis. Suggestions regarding the input, processing, and output of data are made. (32 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The practical implications of a critique of traditional science

Patti Lather writes of the convincing critique of traditional science that has amassed in the past 2 decades. The displacement of the assumptions of traditional science makes space for some interesting and exciting developments in the human sciences. However this theoretical rearrangement is not matched in practical spheres. While Lather is referring to education research I would include nursing when she writes, '...positivism retains its hegemony over practice'. There is ample evidence of the effects of this domination in nursing. Nurses work closely with the medical profession, which is still predominantly influenced by 'scientific' research, and health administrators who are in organizations which are bureaucratic and preoccupied with rationally. Medical practitioners control research ethics committees and funding bodies, which have relatively few nursing representatives and continue to judge proposals for qualitative projects by applying standard 'scientific' criteria. The administrators control budgetary matters and impose standards in the organizations. The dominance of traditional science needs to be challenged if nurses wish to make a place for different ways of knowing in their practice.     

The BC health information standards council

The establishment of a British Columbia (BC) Health Information Standards Council is one of the strategies that is helping to develop and implement BCs vision for health information management. This vision is of effectively and efficiently managed information that enables informed decision making to achieve the results desired in our health system. The Council focuses on the identification of standards and guidelines that will enable, facilitate and promote effective health information sharing. This focus has resulted in approved and mandated informatics standards for use across the health system in the areas of data, applications, technology, security, confidentiality and privacy.     

Psychologist as a mental health center director.

The psychologist functioning as executive director (ED) of a new community mental health center must be a leader-strategist, business manager, motivator-staff developer, and organizational representative. The position requires creativity and problem solving. Frustrations of the position involve slow bureaucratic decision making, lack of control over circumstances, ill-defined expectations for services, and insecurity surrounding the ED position. Psychological training contributing to management performance includes interpersonal skills, family dynamics as a model to analyze organizations, group dynamics, applied behavioral analysis to reinforce an employee's behavior, and evaluation research for decision making. Career opportunities are in mental health centers, private psychiatric hospitals, wellness programs, and training and development departments. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

JCAH standards for accreditation of community mental health service programs: Implications for the practice of psychology.

The Joint Commission on Accreditation of Hospitals (JCAH) has recently developed standards for the accreditation of community mental health centers (CMHCs). A review of these standards and the Balanced Service System reveals little that could be considered restrictive of the practice of psychology in CMHC settings. Unlike JCAH accreditation of hospitals and psychiatric facilities, the CMHC standards do not endorse the view that patient care be the ultimate responsibility of the physician. Although the standards were developed with no formal involvement from organizations representing psychologists, they do reflect contemporary psychological thought in the area of effective delivery of mental health services. Given the heavy consumer orientation and accountability focus emphasized in the standards, the present article maintains that JCAH accreditation could be an appropriate criterion for CMHC eligibility for national health insurance reimbursement. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional equivalence of native light-sensitive channels in the Drosophila trp301 mutant and TRPL cation channels expressed in a stably transfected Drosophila cell line

As we have pointed out in this article, a health care study should have a well-defined intent that is matched to the study type, population of interest, and outcome. Care must be taken to collect samples in a meaningful way, so that results can be generalized to larger populations. Outcomes must be selected carefully to ensure that they will be sensitive to the types of care being considered, and only a few main outcomes should be selected so as to preserve the level of statistical significance of the research results. Sample sizes should be sufficient to detect an effect of reasonable size, after accounting for attrition in longitudinal studies and rates of occurrence with dichotomous outcomes. If the study purpose is to compare multiple institutions or health care providers, statistical adjustments for case mix will generally be required. Outcome research is an expanding area of development for rheumatology care and for medical care in general. It offers the promise of the use of administrative data bases to answer questions that are important both to arthritis researchers and to consumers of rheumatology care. As with all areas of clinical research, we must maintain appropriate levels of statistical rigor to protect the integrity of the results. Inadequate attention to the design and analysis of data can compromise research results before a study even gets started, and health care research studies have as many potential statistical pitfalls as other types of clinical research.     

Internal bremsstrahlung: Exact relativistic independent-particle-approximation calculations

Recently, natural and social scientists have pointed out that the need to make scientific results apply to both sexes is not met by simply adding women as research subjects. They suggest that the social and biological specificity of both sexes must be recognized and adjustments made to the ways questions are asked, hypotheses are generated, research subjects are chosen, and data are analysed. It is important to examine the definitions, concepts and methods used in research in occupational health to see whether they obstruct recognition of women's occupational health problems or interfere with gender-neutral standard setting. Unravelling the effects of sex on occupational health is complicated by the fact that women and men do not, by and large, work at the same jobs. Definitions of "work" must in some cases be adjusted to take account of women's occupations, just as definitions involving "health" must include women's biological specificity. Appropriate changes must be made to generate sex-inclusive definitions of exposures to occupational hazards and of health effects. Methods for evaluating exposures typical of women's work must be developed. Women and their work must be appropriately included when standards for occupational exposures are set. If these adjustments are not made, women's occupational health problems will be seriously underestimated and understanding of health problems of both sexes will be hindered. Sociological analysis should also be done to reveal the mechanisms by which biased concepts and procedures develop and are reinforced.     

The strategic agenda for community health care organizations

This article proposes a vision, strategies, and structure for the organizations that will replace community hospitals. The vision must embrace health rather than health care, and cost reduction as an explicit, measured goal. Strategies must include immediate cost savings, but also longer-term revision of organizations, wage structures, prevention, and medical attitudes. Structures must assure local stakeholders their voice in health issues.     

Ensuring health care quality: JCAHO's perspective. Joint Commission on Accreditation of Healthcare Organizations

In recent years, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has expanded its traditional role as a leading evaluator of health care organizations to incorporate new attitudes and strategies in the areas of quality and performance improvement. This paper outlines plans for modifying the current accreditation process, and includes a proposition that accredited organizations actively participate in a quality measurement system and become involved in the process of selecting appropriate measures. The paper presents current and proposed methods for measuring performance standards, compares major accreditation systems, and explores the public's expectations for health care quality and the JCAHO's role in quality improvement and cost containment.     

Outcome after trans-tibial amputation for vascular disease. A follow-up after eight years

Steps to encourage clinicians to adopt the best practices for communicating bad news to patients are outlined. First, official, credible guidelines endorsed by key organizations or professional bodies, giving a clear message about the components and importance of the best practices, must be produced. Second, the guidelines should be disseminated; publication in journals or mailing to clinicians is unlikely to be sufficient. Third, clinicians should be provided with feedback on whether their performance meets established standards. This requires acceptable systems to collect valid and reliable performance data. Fourth, clinicians need contingencies for providing best practice care. Fifth, barriers to improvement should be explored and strategies to address them, including interactional skills training, implemented. Continuous quality assurance, commitment, and evaluations will help clinicians use the best practices for breaking bad news to patients.     

Quality indicators using hospital discharge data: state and national applications

BACKGROUND: Demand for information about the quality of health care has escalated. Yet many organizations lack well-specified quality measures, statistical expertise, or the requisite data to produce such information. The Healthcare Cost and Utilization Project Quality Indicators (HCUP QIs) represent one approach to measuring health care quality using readily available data on hospital inpatients. METHODS: The HCUP QIs, developed in 1994, address clinical performance rather than other dimensions of quality such as satisfaction or efficiency. The 33 indicators produce rates that represent measures of outcomes (mortality and complications), utilization, and access. In lieu of complex multivariate techniques, two methods were used: (1) restrictions in defining patient subgroups to isolate homogeneous at-risk populations and (2) standardization when populations are diverse. Stratified analyses are recommended when patient or hospital factors are believed to influence the outcome. A simple method for making statistical comparisons to national rates was developed. The HCUP QI software, available in both mainframe and microcomputer applications, have enabled organizations to use their own data to produce comparative statistics and examine trends over time. Results summarized at the individual hospital or aggregate level are being used to stimulate continuous quality improvement initiatives. CONCLUSIONS: The HCUP QIs offer a low-cost alternative for organizations that have access to administrative data. Current users include hospital associations, state health departments, statewide data organizations, and individual hospitals. Although the HCUP QIs are intended to serve as indicators, not definitive measures, of quality, they were designed to highlight quality concerns and to target areas for more intensive study.     

Public health surveillance for hereditary hemochromatosis

The recent realization that hemochromatosis is a common condition has created opportunities to develop unified public health surveillance for this disorder and its complications and to design programs to prevent unnecessary illness and death resulting from this disorder. Public health surveillance for hemochromatosis can be used to measure the magnitude of the problem (for example, to establish the number of persons with evidence of early iron overload); identify research needs; reveal the natural history of the disease; detect changes in health care practices, such as use of screening tests; and evaluate interventions, such as phlebotomy. Existing surveillance has been limited to periodic measurement of morbidity and mortality done by using hospital discharge records, health examination surveys, vital statistics, and data from small research registries. The improvement of surveillance will entail the ongoing collection of information from population-based surveys, such as the Behavioral Risk Factor Surveillance System; the collection of data on provider practices (for example, through the National Ambulatory Medical Care Survey); and the establishment of population-based registries. Creating population-based registries requires consensus on case definitions; strategies to encourage case ascertainment and reporting; policies and procedures for protecting privacy and ensuring confidentiality; and partnerships among providers, researchers, and public health officials. Longitudinal data from population-based registries will provide insight into determinants of disease expression, such as pattern or degree of iron overload. This information is critical for developing evidence-based recommendations for population screening, monitoring changes in medical practices, and assessing the effect of preventive measures.     

Key issues in managed competition

All managed competition proposals for health system reform must confront several key issues. The premiums paid to health care purchasing cooperatives will need to be subsidized for those who cannot pay full fare; the amount and sources of the subsidies are controversial political issues. The payments passed on by purchasing cooperatives to health plans must be risk adjusted to account for differences in the health care needs of their enrolled populations. This is essential to create a level playing field for competition and to eliminate incentives for plans to use risk assessment for attracting enrollees. The data and methods needed for risk adjustment, however, are not adequate at present. The Clinton Administration's plan to limit expenditure increases raises a host of thorny issues. Maintaining quality of care will require health plan quality report cards to be supplemented by external quality assurance systems. Assuring quality will be particularly problematic for traditional indemnity plans. The structure and governance of the system, administration simplification, and other issues need to be addressed. The size and voluntariness of the purchasing cooperatives greatly influence all of these considerations. Physicians should inform their political representatives on how these issues should be resolved as compromise bills are drafted by the United States Congress this year.     

Patients' rights in laboratory examinations: do they realize?

This article discusses the rights of patients who are attending hospital for the most common laboratory examinations and who may also be taking part in research studies. A distinction is made between five kinds of rights to: protection of privacy, physical integrity, mental integrity, information and self-determination. The data were collected (n = 204) by means of a structured questionnaire specifically developed for this study in the clinical chemistry, haematological, physiological and neurophysiological laboratories of one randomly selected university hospital in Finland. The analysis of the data was statistical. On the whole, patients' rights were realized reasonably well. This was most particularly the case with protection of privacy, as well as with the rights of physical and mental integrity. The rights to information and self-determination were less well realized. There are various steps that health care professionals and organizations can take to make sure that patients can enjoy their full rights, by counselling the patient, by giving opportunities to plan the examinations in advance, and by arranging a sufficient number of small examination rooms.     

Accreditation in managed behavioral health care: an interview with Mary Cesare-Murphy and Claire Sharda. Interview by Gary J. Mihalik

Accreditation of managed behavioral health care organizations is being driven by the demands of multiple stakeholders in the health care industry. Accreditation is expensive-both in terms of the direct and indirect costs of preparation and survey but also in terms of the consequences of failure. Though accreditation is a new expectation for the managed behavioral health care field, it is unlikely that the major organizations in the industry will have the years to achieve accreditation that the nonbehavioral managed care field enjoyed. This article explores, in an interview format, the managed behavioral health care accreditation programs of the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance.