Can You Keep a Secret?Nurses play a key role in ensuring the security of patient data. As a young woman, I can clearly remember the sequence of events following the birth of my third child. I had been ill throughout the pregnancy, and following my return home after Chris' birth, I hemorrhaged several times--and suffered a recurrence of the severe abdominal pain Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. I had experienced during the pregnancy. As it turned out, I had lodged gallstones Gallstones Definition A gallstone is a solid crystal deposit that forms in the gallbladder, which is a pear-shaped organ that stores bile salts until they are needed to help digest fatty foods. and an icterus index icterus index n. A calculation indicating the level of bilirubin in serum or plasma, in which the intensity of the color of a specimen is compared with that of a standard solution using a colorimeter. that was off the scales. Thus I was hospitalized for several days prior to gall bladder gall bladder, small pear-shaped sac that stores and concentrates bile. It is connected to the liver (which produces the bile) by the hepatic duct. When food containing fat reaches the small intestine, the hormone cholecystokinin is produced by cells in the intestinal surgery, complete with a drain in the common duct. At discharge, I was asked many questions among which were: 1) How many children do you have at home? (Answer: three under the age of 4); 2) Do you have help at home? (Answer: no); 3) Do you have any family members who can help you? (Answer: no); 4) Can you afford to hire someone to help you? (Answer: no); 5) What is your household income? (I told them.) And so on--all of which went into my permanent record that was transferred to my OB/GYN, to my family physician and to all of their staff. Brat the upshot of all of this form-filling and questioning was nothing whatsoever, other than an unjustified and unproductive intrusion into personal facts about my family. What's the Point? Other than asking questions, no one did anything: no referrals, no help, and, in fact, no follow-up whatsoever. It was just more information gathered, filed and kept for folks to look into if, for any reason, they were interested. Some of my classmates Classmates can refer to either:
Today such intrusions and such liberal "sharing," no longer will be tolerated. The Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. According to the Centers for Medicare and Medicaid Services (CMS) website, Title I of HIPAA protects health insurance coverage for workers and their families when (HIPAA (Health Insurance Portability & Accountability Act of 1996, Public Law 104-191) Also known as the "Kennedy-Kassebaum Act," this U.S. law protects employees' health insurance coverage when they change or lose their jobs (Title I) and provides standards for patient health, ) mandates the implementation of strong policies and procedures Policies and Procedures are a set of documents that describe an organization's policies for operation and the procedures necessary to fulfill the policies. They are often initiated because of some external requirement, such as environmental compliance or other governmental to insure the confidentiality of patient health data. While few would argue the importance of HIPAA's mandates, these mandates do pose a dilemma: How can organizations implement procedures that protect patient privacy but don't obstruct patient care--especially in view of the coordination of efforts and the sharing of information that is so integral to good patient care and seamless post-discharge care? Nurses' Key Role As originators, managers and users of patient data, nurses can--and should--play a key role in resolving this dilemma. For example, nurses know exactly what data is needed--and the operative word here is needed--to ensure safe nursing care delivery. So why shouldn't nursing--rather than the CIO--suggest and implement procedures that allow staff to see information only on patients currently assigned to their duty station? In addition, nursing should evaluate the systems it uses to make sure they include: * Encryption software Encryption software is software whose main task is encryption and decryption of data, usually in the form of files on hard drives and removable media, email messages, or in the form of packets sent over computer networks. for any health data transmitted over the Internet. * Authentication to validate the identities of senders and receivers of information. * Authorization (e.g., unique user IDs and passwords) to ensure the right access to the right data by the right people. * Audit trails to track who accessed what information. HIPAA compliance will be a reality soon enough. When it is, keeping data secure may not be nursing's primary job, but it will definitely be everyone's problem. By helping solve this problem, nursing can further confirm its contribution to both healthcare and the healthcare IT bottom line. Leah Curtin, RN, ScD (h), FAAN FAAN abbr. Fellow of the American Academy of Nursing , is editor-in-chief of CurtinCalls, an irreverent, fact-filled scan of nursing and healthcare, Cincinnati, OH. Roy L. Simpson, RN, FNAP FNAP Fédération Nationale des Praticiens des Hôpitaux Généraux , FAAN, is vice president of Cerner Corp., Kansas City, MO. |
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