Compelled Authorizations for Disclosure of Health Records: Magnitude and Implications

Each year individuals are required to execute millions of authorizations for the release of their health records as a condition of employment, applying for various types of insurance, and submitting claims for benefits. Generally, there are no restrictions on the scope of information released pursuant to these compelled authorizations, and the development of a nationwide system of interoperable electronic health records will increase the amount of health information released. After quantifying the extent of these disclosures, this article discusses why it is important to limit disclosures of health information for nonmedical purposes as well as how it may be possible to do so.     

Les autorisations d’équipements lourds d’imagerie médicale : un désordre organisé

Medical imaging is essential for all medical specialties and it is natural that the government wants to create a real healthcare provision policy in this area. Medical imaging and particularly the “heavy” equipment are subject to a regulatory and legal framework. This framework results in respect of administrative authorization mechanism. These authorizations are a major tool for development of medical imaging on French territory. This mechanism is an important instrument of economic regulation in controlling health costs. However, the access to this kind of equipment raises various issues in governance and administration but also in matter of economic regulation, distribution of healthcare supply in medical imaging in health territories and respect of public health issues. The authorization mechanism raises questionings, not only at national and regional level in terms of unequal access, but also at European and international level. Indeed, France is among the last countries in the ranking of CT (computed tomography) and MRI (magnetic resonance imaging) equipment rates in comparison with many OECD (Organization for Economic Cooperation and Development) countries. Now, these authorizations will integrate much more the concepts of accessibility and quality of patient care. The legal and regulatory framework of these authorizations will have to evolve and to adapt to new technologies and practices, which today should be a source of significant cost savings.     

“In Sickness and in Health”? Disclosures of Genetic Risks in Dating

Individuals who have, or are at risk for, various genetic disorders face many challenges concerning disclosures of genetic information in dating situations. We conducted a qualitative interview study of 64 individuals confronting Huntington’s disease, breast cancer, or Alpha-1 antitrypsin deficiency, examining what issues these individuals encountered, and how they viewed and addressed these—including issues of understandings, privacy, and disclosures of genetic information to various groups (e.g., family members). Incidental to the primary research questions addressed, participants also often described a series of dilemmas in dating situations that they and/or family members, friends, and fellow patients faced of whether to date, and if so, whether, what, how, why, and when to disclose their genetic risk or illness. At times, these individuals feared and experienced rejection, and hence delayed, avoided, or opposed disclosure, or disclosed indirectly or inadvertently. These data are reported in this paper and highlight the importance of patients, their loved ones, genetic counselors, and other health care providers being aware of these issues, and appreciating the complex factors involved, which can affect patients’ coping and social support. This paper, the first to explore several key aspects of disclosures of genetic information in dating, thus suggests needs for public and professional education, and future research in this area.     

Television Advertising Disclosures: An Empirical Assessment

Televised advertising disclosures are supposedly designed to supply consumers with important information for decision-making. From the perspective of models of information processing, however, these disclosures may well be improperly conceived and executed. Disclaimers presented in other media are also challenged, though television represents a special case because of consumers' inability to control the processing situation (e.g., to study the disclaimer at length if desired) and because of the extensive use of disclaimers in this medium. In this study, televised advertising disclosures are examined experimentally and found generally to be ineffective. Resultant suggestions for researchers and policy-makers are developed.     

Denial and minimization among sex offenders

A review of empirical studies of offenders—particularly sex offenders, and more particularly those who offend against children—demonstrates that denial of offenses and minimization of offending behavior are quite common at every stage of the criminal justice process. This is true during police interviews, during pretrial and presentencing mental health evaluations, among incarcerated offenders, among offenders seeking treatment, among offenders facing parole review, and among offenders already released into the community. This review highlights gaps in the research literature arising from inconsistencies in the definitions and measurement of denial and minimization, from the stage of adjudication or treatment at which measurements are made, and from the use of polygraphy to increase disclosures. Despite these limitations on the generalizability of empirical findings, it appears beyond dispute that many sex offenders maintain their innocence in the face of evidence to the contrary or even criminal conviction, and that many are able to recite additional crimes they have committed when they believe it is in their self-interest to do so.     

Ethical and legal risks associated with archival research

Mental health facilities and practitioners commonly permit resarchers to have direct access to patients' records for the purposes of archival research without the informed consent of patient-participants. Typically these researchers have access to all information in such records as long as they agree to maintain confidentiality and remove any identifying data from subsequent research reports. Changes in the American Psychological Association's Ethical Principles (American Psychological Association, 1992) raise ethical and legal issues that require consideration by practitioners, researchers, and facility Institutional Review Boards. This article addresses these issues and provides recommendations for changes in ethical standards as well as alternative avenues for conducting research using archival mental health records.     

共享信息资源 促进卫生研究

近20年来,由于住处技术的迅速发展,住处的采集、处理和传播也随之发生了革命性的变化,住处技术的应用是提高卫生研究能力的有效措施之一,必须把计算机和网络功能等住处技术在卫生研究领域中的广泛应用提高到战略高度来认识,在卫生研究创新中住处是必备的条件,信息筛选和加工本身就是研究工作,需要发展、促进。卫生研究的成果,不仅要公开发表,而且要向决策者提供,互联网上拥有大量的医药卫生信息,要充分发挥它的巨大潜力。行政管理部门应充分重视作为信息源的网络建设和互联网的利用,信息开放和共享能力的提高是加强卫生研究能力、促进卫生研究发展的重要条件。     

Collaborative Communication Between Psychologists and Primary Care Providers

Psychologists frequently collaborate in the care of patients managed in primary care. Communication with a patient’s primary care team is important to ensure coordination and continuity of care. The communication is far from seamless. Although The Health Information Privacy and Portability Act (HIPPA) is designed to promote sharing of clinical information while protecting patient confidentiality, unique problems arise when mental health records are included. Mental health records are subject to different regulations to protect the patient’s confidentiality. Thus, what is communicated and how it will be accomplished are challenges. Further, psychologists and primary care providers often view documentation differently, resulting in different styles of documenting that may also impede coordinated care. Increasingly, health care systems are moving toward electronic medical records, creating greater opportunities for an integrated record. Improved communication through the record can keep other providers abreast of the mental health care being provided as well as suggestions they can use to reinforce the mental health care treatment plan.     

Psychopharmacology and the Power of Narrative

This report offers recommendations to physicians who provide information or services through online sites. The recommendations maintain that physicians responsible for health-related information should ensure that it is accurate, timely, reliable, and scientifically sound. Also, advice to online users with whom physicians do not have preexisting relationships or the use of decision-support programs that generate personalized information directly transmitted to users should be consistent with general and specialty-specific standards. In particular, these standards should address truthfulness, protection of privacy, informed consent, and disclosures including limitations inherent in the technology. Finally, physicians who establish or are involved in health-related online sites must minimize conflicts of interest and commercial biases and, if patient specific information is transmitted, they must provide high-level security protections, as well as privacy and confidentiality safeguards.     

Use of health-related online sites

This report offers recommendations to physicians who provide information or services through online sites. The recommendations maintain that physicians responsible for health-related information should ensure that it is accurate, timely, reliable, and scientifically sound. Also, advice to the online users with whom physicians do not have pre-existing relationships or the use of decision-support programs that generate personalized information directly transmitted to users should be consistent with general and specialty-specific standards. In particular, these standards address truthfulness, protection of privacy, informed consent, and disclosures including limitations inherent in the technology. Finally, physicians who establish or are involved in health-related online sites must minimize conflicts of interest and commercial biases and, if patient specific information is transmitted, they must provide high-level security protections, as well as privacy and confidentiality safeguards.     

Development of a Streamlined Work Flow for Handling Patients’ Genetic Testing Insurance Authorizations

Obtaining genetic testing insurance authorizations for patients is a complex, time-involved process often requiring genetic counselor (GC) and physician involvement. In an effort to mitigate this complexity and meet the increasing number of genetic testing insurance authorization requests, GCs formed a novel partnership with an industrial engineer (IE) and a patient services associate (PSA) to develop a streamlined work flow. Eight genetics clinics and five specialty clinics at the University of Michigan were surveyed to obtain benchmarking data. Tasks needed for genetic testing insurance authorization were outlined and time-saving work flow changes were introduced including 1) creation of an Excel password-protected shared database between GCs and PSAs, used for initiating insurance authorization requests, tracking and follow-up 2) instituting the PSAs sending GCs a pre-clinic email noting each patients’ genetic testing insurance coverage 3) inclusion of test medical necessity documentation in the clinic visit summary note instead of writing a separate insurance letter and 4) PSAs development of a manual with insurance providers and genetic testing laboratories information. These work flow changes made it more efficient to request and track genetic testing insurance authorizations for patients, enhanced GCs and PSAs communication, and reduced tasks done by clinicians.     

Safeguarding Student Records

Schools, and particularly Guidance Departments, are inundated with requests for information about both past and present students. The inquiries originate from a surprisingly wide variety of sources. Reflecting the increasing tendency in personnel work to accumulate more and more knowledge about the individual, colleges and industry particularly attempt to requisition as much information as possible about the student or potential employee. Student personnel records can be neither released wholesale nor totally locked away. Based on typological analysis of the student's cumulative record, suggested guidelines incorporating both ethical and legal considerations can be established. The recommendations contained herein should assist the custodian of the records in establishing certain necessary conditions pertaining to the release of information.     

Patient consent for release of sensitive information from their medical records: an exploratory study

The disclosure of sensitive information concerning mental health, drug and alcohol use, and communicable diseases requires express patient consent under federal and state laws. This paper presents the results of a retrospective medical record abstraction of hospital consent-to-treatment and release-of-information forms, examining whether the forms are present in the records, and, if so, whether they are signed by patients. The results suggest that patients who have sensitive information in their medical records or pay out of pocket for their care are less likely to consent to disclosure of their records. We discuss the implications of these results and recommend further research to understand patients' perceptions of medical confidentiality and the processes used for securing consent to hospital treatment.     

To share or not to share: The place of personal disclosure in scholarly writing

The norms of scholarly discourse have traditionally excluded personal disclosures in conceptual articles, as if the subjective nature of such revelations would be inconsistent with the scientific/objective stature of these works. Based on the author's experience with a recent publication, based on recent studies of researcher projection and bias in case studies, and using a framework of organizational communication, it is suggested here that there is indeed a contribution such disclosures can make. It is not recommended that sharing on a personal level become a new norm, but rather that the choice to share be considered as viable in a scholarly context. Five specific benefits of such sharing are listed, including unearthing and revealing bias, demystifying the process of discovery, and avoiding the trap of defensive reasoning.     

Between the sheets: Investigating young adults' communication during sexual activity

The present study investigated young adults' self‐reported communication during sexual activity and its link to sexual and relational outcomes. The associations between two forms of communication during sexual activity (i.e., positive relational disclosures and erotic talk) and orgasm and relationship satisfaction were explored. Additionally, the study tested whether orgasm mediated the association between communication during sexual activity and relationship satisfaction. Three‐hundred and nineteen young adults (237 women, 82 men) ranging in age from 18–32 years (M = 19) completed a survey within 2 hours of a recent sexual episode addressing their communication during sexual activity. Results revealed that positive relational disclosures, but not erotic talk, predicted the likelihood of orgasm, controlling for participants' biological sex. More specifically, individuals who disclosed more positive feelings during sexual activity were more likely to orgasm. Additionally, the more individuals disclosed positive thoughts and feelings for their partners during sexual activity or the more they engaged in mutualistic erotic talk that included intimacy and bonding, the higher their reported relationship satisfaction after sexual activity. The implications of these findings for research on sexual satisfaction, relational health, and the post sex disclosures model are discussed.     

Perceptions of self-disclosure as a function of gender-linked variables

One hundred and sixty raters with either an androgynous, masculine, or feminine sex role orientation judged the intimacy and commonness of masculine and feminine self-disclosures attributed to either men or women speakers. Feminine disclosures were rated as significantly more intimate and more common than masculine disclosures. Masculine disclosures made by women were rated as significantly less common than either feminine disclosures by women, or masculine or feminine disclosures by men. Although rater sex role orientation had no significant effects, physical gender did. Female raters judged all disclosures as more intimate than male raters. Implications for future research are discussed.We express our appreciation to Camille DeBell, to the late JoAnn Mantovani, and to Christine Robitschek for their assistance in this research.     

Applying motivational interviewing principles in a modified interpersonal group for comorbid addiction

The application of motivational interviewing (MI) principles in modified interpersonal group therapy (MIGT) addresses two gaps in the literature. First, it explicitly extends MIGT to non-abstinent, addicted patients who are in the precontemplative and contemplative stages of change in contrast to most MIGT models where abstinence is usually required. Second, it provides a novel, process-oriented group intervention for MI, in contrast to current applications of group-based MI which are more structured in their format. The main modification in technique was to prioritize the horizontal exploration of substance use disclosures with a focus on the here-and-now experience of disclosure and the interpersonal impact on the group, in order to: (1) encourage members to openly discuss their ambivalence and shifting motivational states, (2) harness the evocative impact of substance use disclosures between members to elicit change talk (self-motivational statements), and (3) selectively reinforce change talk when it emerges from these exchanges. The authors illustrate these concepts with a case report of an open-ended MIGT group with comorbid mental illness and addiction.     

Value revelations: disclosure is in the eye of the beholder

In interpersonal interactions ranging from job interviews to romantic dates, it is common for people to tell each other about what they care about and value. Six experiments explored the general hypothesis that people view their disclosures about what they value as more revealing of themselves than do others. This effect is demonstrated across a variety of contexts, ranging from the brief and anonymous to the more in-depth and social. A source of it is explored in actors' feeling that their most important values are especially important to them. Studies suggest that this feeling involves actors' sense of the intensity with which they hold their values, as opposed to their beliefs about the uniqueness of those values. Studies also show that actors' tendency to view value disclosures as more revealing than do observers is somewhat specific to value disclosures--that is, actors do not view their relatively off-the-cuff responses (Study 4) or their disclosures of their nonvalues (Study 6) as more revealing. Implications of this research for self-other differences and for interpersonal intimacy are discussed. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Disclosure of anxiety in everyday life: Effects of social anxiety

The current study examined the likelihood of disclosing one’s anxiety to others during anxiety-provoking conversations, as reported by individuals high or low in social anxiety. It investigated to whom these disclosures are made, and the content and intended purposes of these disclosures. Undergraduate students and community members low (n = 79) or high (n = 81) in social anxiety completed the Anxiety Disclosure in Everyday Life questionnaire, as well as several other measures as part of another study. Analyses indicated that individuals high in social anxiety were significantly less likely to disclose their anxiety as compared to individuals low in social anxiety. The likelihood of disclosing one’s anxiety varied significantly depending on to whom one was speaking, with intimate partners being disclosed to the most. The content of the disclosures typically involved stating that one is feeling shy or nervous without offering an explanation, or attributing it to one’s personality traits (e.g., shyness), with the intended purpose often being to elicit assistance or reassurance from their conversation partner or to manage the impressions of others.