Chris Newgard, Ph.D., outlined his work with diabetes. (photo by Dana Johnson)
Ethics grand rounds explores privacy policies
Which will it be, a stumbling block or a stepping stone to privacy?
That was the question at the Fall Ethics Grand Rounds on Monday as ethicists, physicians and managers discussed new patient privacy guidelines imposed by the federal Health Insurance Portability and Accountability Act (HIPAA), which are coming down the health care pike toward Vanderbilt and other medical centers, ETA April 2003.
The privacy rules are just one subject heading listed under Title II of the HIPAA “Administrative Simplification” regulations.
“These regulations stand to significantly change the way in which information is processed in the institution,” said Stuart Finder, Ph.D., assistant professor of Medical Ethics and Philosophy and director of Center for Clinical and Research Ethics.
According to Jim Hollender, Vanderbilt’s HIPAA manager, surveys suggest they’re needed: one showed that an average of 150 people see a patient’s medical records during a hospital stay, another found that 43 percent of patients think their records should not be used for research. Privacy issues extend outside hospitals: 35 percent of Fortune 500 companies review medical records during the hiring process.
“There are two issues in the privacy debate,” said Dr. Ellen Wright Clayton, professor of Pediatrics and Law and a grand round panel member. “People want information kept private, and people are deeply worried that information will be used in ways that will harm them.”
But enough bureaucratic hurdles already exist between physicians and their patients, said Dr. Keith Wrenn, professor and vice chairman of Emergency Medicine and another panel member. “Do people really understand that this will create a whole new infrastructure (to oversee the privacy regulations) and that it’s going to cost a lot of money?” Wrenn said.
Access to records might also hinder retrospective research, Wrenn said. “That worries me.”
Other physicians in attendance also expressed concern that more regulation equals more distance between care providers and patients, and between consulting physicians, that could stymie care.
Mark Bliton, Ph.D., assistant professor of Medical Ethics and Philosophy and chief of the Clinical Ethics Consultation Service, said, “it’s the tendency of an institutional culture to draw back and ask, ‘Why? Why should we have to make an account (for obtaining information) if we’re trying to do good for someone?’” But, he said, the regulations promise to provide “transparency,” methods of recording who taps into patient information and why, rather than limiting access on the front end.
Enforcement of the HIPAA rules is still unclear, Hollender said. The Joint Commission for Health Care Accreditation has already begun to fold some of the rules into their inspection list, he said. Vanderbilt has taken a positive step forward by dedicating staff, such as himself, to implementing and overseeing the rules, rather than piecing them together part-time, he said.
The bottom line, Clayton said, is that the regulations exist. “You can come down on the side of privacy or regulating use, but new technology can make it breathtakingly easy to get information about someone.”