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There has been a proliferation in the use of digital health records. Although electronic records have many benefits, concerns have been raised about associated risks and barriers. This article focuses on risks associated with development, utilization, and maintenance of provider-owned electronic medical records and institution-owned electronic health records. Strategies to reduce risks and overcome barriers are also offered. Attention to these issues can minimize risks and improve healthcare services delivered to consumers.

Physicians, risk managers, and quality assurance personnel may incorrectly assume that all communications that take place in hospital committee discussions or investigations are privileged and thus protected from discovery. This article addresses that inaccurate assumption and sets forth some simple steps to help protect these communications, including the protections afforded by the agency privilege.

Context: The abuse of stimulant drugs is increasing in the western United States. Although numerous case reports and animal studies suggest a link with stroke, epidemiologic studies have yielded conflicting results., Objective: To test the hypothesis that young adults who abuse amphetamines or cocaine are at a higher risk of stroke., Design, Setting, and Participants: Using a cross-sectional design and from a quality indicators' database of 3 148 165 discharges from Texas hospitals, we estimated the secular trends from January 1, 2000, to December 31, 2003, in the abuse of various drugs and of strokes. We developed separate logistic regression models of risk factors for hemorrhagic (n = 937) and ischemic (n = 998) stroke discharges of persons aged 18 to 44 years in 2003, and for mortality risk in patients with stroke. Main Outcome Measure Incidence of stroke using definitions from the Agency for Healthcare Research and Quality's stroke mortality Inpatient Quality Indicator., Results: From 2000 to 2003, the rate of increase was greatest for abuse of amphetamines, followed by cannabis and cocaine. The rate of strokes also increased, particularly among amphetamine abusers. In 812 247 discharges in 2003, amphetamine abuse was associated with hemorrhagic stroke (adjusted odds ratio [OR], 4.95; 95% confidence interval [CI], 3.24-7.55), but not with ischemic stroke; cocaine abuse was associated with hemorrhagic (OR, 2.33; 95% CI, 1.74-3.11) and ischemic (OR, 2.03; 95% CI, 1.48-2.79) stroke. Amphetamine, but not cocaine, abuse was associated with a higher risk of death after hemorrhagic stroke (OR, 2.63; 95% CI, 1.07-6.50)., Conclusion: Increases in stimulant drug abuse may increase the rate of hospital admissions for strokes and stroke-related mortality.

In February 2004, privacy concerns captured the public's attention when the United States government, the defendant in a lawsuit challenging the constitutionality of the Partial-Birth Abortion Ban Act of 2003, sought to subpoena the medical records of patients receiving intact dilation and extraction (also known as "partial birth") abortions in six different hospitals and six Planned Parenthood centers across the country. Three different federal court cases explored the enforceability of the subpoenas. This Note explores the rationales used by the three courts in examining the privacy interests involved. It then suggests some possible solutions for systematically protecting medical information: a legal solution; a technological solution; and a combination of both. The legal solution involves creating a federal physician-patient privilege, similar to that enforced in many states and parallel to the federal psychotherapist-patient privilege. The technological solution requires the complicity of multiple jurisdictions to verify the necessity of revealing medical information. Taken together, these solutions can assist the government in protecting its citizens by imposing more checks on itself.

Background: Federal regulation requires hospitals to present patients with a Notice of Privacy Practices (NPP) that contains all stipulated content items, is readable by patients, and posted on institutional web sites., Objective: The objective of this study was to determine whether the NPP texts contain the required content, if readability is influenced by local literacy rates, and if readability or the presentation of NPP texts in other languages is influenced by local rates of English proficiency., Research Design: The authors conducted a cross-sectional study of the web sites of 115 hospitals selected from the US News and World Report list: Best Hospitals in America., Measures: English NPP texts were evaluated for 18 content items and readability using the Flesch-Kincaid scale, which assigns the minimal grade level required to read a text (range, 0-16)., Results: NPP texts were available for all hospitals (115 of 115). A Spanish-language NPP was available for 25% (29 of 115). All content items were evident in 76% (87 of 115) of hospitals' NPP texts. The average grade-level readability of NPP text was 12.3 (95% confidence interval, 12.0-12.7). Readability was not associated with the rate of local literacy (P = 0.07). Hospitals with a lower local rate of English proficiency had NPP texts that were more difficult to read (P = 0.03) and did not present NPP texts in other languages more frequently (P = 0.15)., Conclusions: Although NPP texts typically cover the stipulated content, they are written beyond the reading capacity of the majority of American adults. Explicit federal guidance is needed to help privacy lawyers draft NPP texts that are both comprehensive and comprehensible. The goals of the Health Insurance Portability and Accountability Act of 1996 Privacy Rule cannot be met with NPP texts patients cannot decipher.

A new amendment to its state constitution has opened up Florida's peer review meeting notes to the public, with chilling effects on the entire peer review process.

Background: The objective was to investigate how data on race and ethnicity are collected by hospitals reporting to the New Hampshire State Cancer Registry (NHSCR)., Method: NHSCR surveyed hospitals asking how information on race and ethnicity were collected. A review of relevant legal mandates and national guidelines was undertaken., Results: Many hospitals lack policies on collection, computer systems fail to support national guidelines, and staff rely on visual inspection., Conclusions: Hospital staffs are not now culturally equipped to collect race and ethnicity in a meaningful way. The numerator in cancer incidence rates is most likely not accurate and for some smaller populations very biased. A new framework is needed that takes into account the needs of the democracy.

What should healthcare facility security directors and administrators do when patients or employees are the victims of identity theft? Taking the right steps to safeguard personal data won't insulate your facility from ever having to deal with this growing crime but, says the author, it will reduce the opportunity and desire for a criminal to steal the data.

This proposed rule would implement part of the paternity establishment provisions contained in section 331 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) and amended by section 5539 of Pub. L. 105-33, which impose new statutory requirements for a State's voluntary paternity acknowledgement process and require the Secretary to promulgate regulations governing voluntary paternity establishment services and identifying the types of entities other than hospitals and birth record agencies that may be allowed to offer voluntary paternity establishment services. States will be required to adopt laws and procedures that are in accordance with the statutory and regulatory provisions. These proposed regulations will address these procedures and related provisions.

Radiology administrators nationwide were surveyed to determine current drug administration practices in their imaging departments. The survey also obtained information about the educational backgrounds of radiologic technologists administering pharmaceuticals and the documentation procedures used by imaging departments. Survey results showed that 86% of responding institutions allow radiologic technologists to administer pharmaceuticals. However, the amount and type of education technologists received regarding drug administration was limited. In addition, the type of legal documentation regarding the administration of contrast media varied considerably among the responding institutions.

Ottawa lawyer Karen Capen examines the case of five Ontario physicians who faced charges of professional misconduct after a patient they cared for died in 1988. The investigation, which focused on the concept of "most responsible physician," serves as a cautionary tale for all doctors who share the care of a patient with colleagues.

The purpose of this report is to develop a rational approach to the design of anaesthesia record forms. The history of anaesthesia record forms was reviewed. A logical approach to the design of an anaesthesia record was developed. The theoretical ideal anaesthetic record was contemplated and criteria were developed for the selection of items to be included in or excluded from the record. Principles were outlined which lead to logical organization of information on the form, improved ergonomics of data entry, and ready access to entered information. A desktop publishing system was used to execute quickly numerous form artwork revision cycles and iteratively converge on a complete design. This approach has resulted in the development and production of a new anaesthesia record for our institution. The record was well accepted by our colleagues. The rationale that has been developed is presented in the hope that it will be useful to others in the process of designing anaesthesia records for their institutions.

You are the chief executive officer of Friendly Neighbor Medical Center, an acute care hospital. On your desk is a letter from your counterpart at The Behemoth Clinic, a large local medical group that not only is very active in managed care contracting in your service area, but also has an important relationship with your hospital. Behemoth has requested extensive access to Friendly Neighbor's peer review files and patient records in order to investigate the care provided by one of Behemoth's physicians. You happen to be aware that the physician has been the subject lately of peer review scrutiny at your hospital, and you would like to cooperate with Behemoth. Can you do so without jeopardizing the legal confidentiality protections available to your hospital's peer review records, not to mention the peer review process generally?