Administrative Ethics-HIPAA - Essay Example

? Administrative Ethics-HIPAA      Introduction The 1996 Health Insurance Portability and Accountability Act (HIPAA) is an enactment by Congress primarily meant to protect workers from losing their health cover whenever they lose or change jobs. The main objectives of this act include simplification of administrative processes within the healthcare sector and reformation of the health insurance sector. The specifics of these objectives are highlighted under Title II and I respectively. Section one embodies the protection of health covers for workers and their families. This part is meant to ensure easy transfer of health insurance covers from an old employer to a new employer or at least guarantee the continuation of cover in the event of job loss. On the other hand, section II details administrative specifics under Administrative Simplification (AS) (Banks, 2006). The AS section dictates requirements in establishing nationwide standards, which define the manner in which healthcare transactions are conducted electronically. It also defines the specific identifiers for employers, insurance plans and healthcare providers. This section helps simplify administrative challenges emerging from requirements of portability. The AS section also addresses issues of privacy and security of patients’ information and records. Since its ambitious implementation, HIPAA has expanded its influence on to major health issues such as security, confidentiality, privacy and simplification (Banks, 2006). In a nutshell, HIPAA promises an effective and efficient mode of disseminating and sharing electronic information in the healthcare sector. The compliance deadline was 2003 and a slight extension for harmonization of some minor plans. Since 2003, the plan has gained widespread adherence by various players including health insurers, employer sponsored healthcare plans, healthcare service providers and clearing houses in the sector. In spite of its positive outlook and gains made, HIPAA still raises numerous challenges with regard to its implementation. This paper reviews one of the significant challenges in HIPAA’s implementation by highlighting a newspaper article covering the issue of disclosure. The article under highlight appeared in the New York Times on 3rd July, 2007. The piece of work by Jane Gross is titled “Keeping Patients’ Details Private, Even From Kin.” Disclosure Issues in HIPAA’s Implementation HIPAA dictates the rules of disclosure and non-disclosure for Protected Health Information (PHI). However, Gross (2007), indicates that a number of studies have shown that a number of healthcare providers are applying HIPAA inappropriately. These providers and practitioners under them apply the regulations overzealously by being excessively and unnecessarily prohibitive. These acts have left caretakers, family members, law enforcement officers and public health officers unable to access information that is essential for their operations and life. Gross’ article presents this challenge by citing various real-life situations in which family members have been barred from staying with their kin or assessing their treatment chart information while undergoing treatment. Gross cites Mr. Nussbaum’s case in which he was barred from staying with his father or checking his treatment chart as an example of misinterpretation of the act (Gross, 2007). A similar case involving Ms. Banks saw her drive from Oklahoma to Tampa to get information about her mother because this could not be disclosed over the . On arrival, she had to spend another 24 hours before she could get the disclosure from the doctor involved, simply because the nurse feared going against HIPAA (Gross, 2007). These examples show the frustrations that family and other parties such as researchers have when seeking patient information. The bigger challenge is that while there are “good faith nondisclosures,” there are also numerous cases of “bad faith nondisclosures” that unnecessarily bar access to information. For example, some practitioners may refuse to disclose information citing this as an act of compliance with HIPAA. But, in actual sense their non-disclosure may be an excuse for not taking their time to collect information that may be required by public health or law enforcement officers. This intentional non-disclosure coupled by a defensive approach ridden by fear makes information acquisition very difficult for different parties. The effect of this challenge has negatively impacted researchers that rely on chart information to conduct retrospective studies. The University of Michigan demonstrated through the findings of its study that the proportion of follow up surveys on heart attack patients had declined from 96% to 34% since HIPAA was implemented (Armstrong et al., 2005). According to Gross (2007), the overall effect is that information necessary for research, policy and decision-making for various parties is getting virtually inaccessible. In turn, this compromises decision-making, research studies and policy formulation (Armstrong et al., 2005). Current Facts Relating to HIPAA Disclosure Issues Gross (2007), states that the state of non-disclosure and facts about how often information is unnecessarily withheld is not well known. However, Gross’ interview with Susan McAndrew (a director in the Department of Health and Human Services) revealed that there were even cases where patients were denied access to their own medical information. According to Susan, out of 22778 complaints launched since 2003only a small percentage consisting of patient complaints had been investigated (Gross, 2007). The diagram below is an extract from the New York Times, which shows the status of disclosure-related cases in the year Gross’ work was authored. Image One (Gross, 2007). The total number of complaints above indicates that complaints related to non-disclosure are rampant and this indicates that there is a big problem with regard HIPAA’s implementation in current times. The above statistics coupled by the decline in studies that rely on patient records are sure statistical indicators of the significant impact that both ‘good faith non-disclosures’ and ‘bad faith disclosures’ may be having on the overall health sector. Managerial Responsibility and Ethical Issues on Disclosure Gross (2007), states that expert opinion blames providers and their management for failing to understand HIPAA laws. In addition, to this the management of most health providers has failed to educate and train employees on how to judiciously apply HIPAA laws on disclosure. The gap in training is cited as one of the significant failures that have given staff members discretionary capacity to interpret the laws in a manner that suites their situation. This often leads to unethical behavior, which is either a result of lack of knowledge or an outright act of intentional non-compliance. Although no significant fines have been levied, the fear of fines and incarceration is also cited as another contributor to the problem. Notably, the management has also failed in this regard because it has not stepped in to dissipate the unfounded fear by clearly elaborating the boundaries of the law (Armstrong et al., 2005). The misunderstanding of HIPAA is, therefore, a problem propagated by the management by simply failing to come up with proactive measures to ensure the act’s regulations are implemented appropriately. Part of the blame on this issue also lies with the language used in the law. The law states that “Health care providers may share information with others unless the patient objects.” However, the law does not explicitly require the providers to do so. As such, disclosures occur voluntarily. This leaves providers with great discretionary capacity on how to act. This is partly why staff members respond defensively and at times unreasonably. The hyper-technical nature of the law is also a challenge for nurses that do not have legal expertise in interpreting laws (Gross, 2007). This challenge is compounded by the fact that the law tells the staff to disclose, but it does not explicitly state that they have to disclose. The technical nature of legal issues and knowledge gap not bridged by management, therefore, creates a loophole for ethical breaches such as those experienced in bad non-disclosures (Choi et al., 2009). Proposed Solutions In spite of the identified hitches in the implementation of HIPAA, there is significant improvement in privacy and confidentiality. As such, the law seems well drafted and beneficial, but its failure may be a result of poor implementation. Gross’ work identifies various remedial measures that could ensure proper implementation of HIPAA and a realization of its full benefits. The gap in knowledge and understanding is cited as the biggest probable cause of the problem. As such, sufficient guidance and education are cited as the most appropriate measures towards improving implementation of HIPAA. Vermont’s Senator Patrick Leahy and others have initiated a plan to introduce legislation that would create a department in charge of enforcing and interpreting HIPAA’s stipulations on privacy within the Department of Health and Human Services (Gross, 2007). This measure would help ease the state of confusion in implementation of non-disclosure measures. The provision that allows HIPAA to defer some situations to state laws is also partly a solution to the problem. This is essential in instances such as child abuse investigations. The possibility allows legal deviation from HIPAA that opens opportunities for disclosure that cannot attract legal suits. As such, it is recommendable to have comprehensive state laws that can be used in ambiguous situations to permit reasonable exposure where necessary (Gross, 2007: Choi et al., 2009). The department in charge has also revised the website (www.hhs.gov/ocr/hipaa) detailing the specifics on HIPAA as a way to enhance clarity on HIPAA laws. In conclusion, HIPAA is an essential element the protection of privacy and confidentiality of patients’ information. The law also helps employees in maintaining their health insurance covers in case of job loss. In spite of the benefits conceptualized during its enactment the law has been found to pose great challenges in information acquisition. This has been a result of lack of legal understanding and management engagement in implementation and enforcement. This has led to frustration and reduced the use of medical data for research and policy making. In order to solve this problem the implementation of an educational program on implementation has been suggested as the best approach to ensuring proper implementation of HIPAA. References Armstrong, D. Kline-Rogers, E. Nallamothu, B. Fang, J. Jani, S. Mukherjee, D. Goldman, E. & Eagle, K. (2005). Potential impact of the HIPAA privacy rule on data collection in a registry of patients with acute coronary syndrome. Archives of Internal Medicine, 165 (10), 1125–1134 Banks, L. D. (2006). The Health Insurance Portability and Accountability Act: Does It Live Up to the Promise? Journal of Medical Systems, 30(1), 45-50. Choi, Y. B. Krause, J. S. Capitan, K. E. & Steeper, M. M. (2006). Challenges associated with privacy in health care industry: Implementation of HIPAA and the security rules. Journal of Medical Systems, 30 (1), 57-64. Gross, J. (2007, July 3). Keeping Patients’ Details Private, Even From Kin. The New York Times. Retrieved from http://www.nytimes.com/2007/07/03/health/policy/03hipaa.html?pagewanted=all&_r=0 Read More