Insurance Accounting Research Articles

Health Care Software Engineering: A Review of Selected Literature

The use of software applications in the health care industry is increasing dramatically. Competitive pressures and government regulations are driving this effort to improve the efficiency of administrative software. Clinical Information Systems and decision support software packages are being developed in order to assist health care providers achieve better patient outcomes to therapy. Software engineering for health care systems is an emerging field for software developers and IT managers. This paper reviews literature that describes trends, issues, and novel applications that influence the theory and practice of software engineering in the health care industry. Topics covered include Object Oriented Design and UML in the development of health care information systems and the influence of the Health Insurance Portability and Accountability Act on security development.

Speech privacy for healthcare

The Healthcare Insurance Portability and Accountability Act, also known as HIPAA, requires healthcare providers to implement reasonable safeguards to protect the privacy of healthcare information. This includes privacy for oral communications. Architects and facility managers are aware of this mandate, and are calling for these capabilities to be designed into current projects. HIPAA contains no objective, measurable criteria for speech privacy, leaving the design team to select specific criteria for their project. Criteria options will be discussed including Privacy Index and other descriptors that have been developed and correlated with subjective evaluation of privacy. This paper describes several recent projects, which began with evaluations of existing facilities and led to establishment of criteria and design solutions. These studies included various aspects of the healthcare facility such as offices, exam rooms and conference rooms as well as open plan reception, waiting and registration areas. Field conditions, measurement techniques, measurement results, criteria selection and design solutions will be presented.

Readability Level of Health Insurance Portability and Accountability Act Notices of Privacy Practices Used by Nursing Homes

Readability Level of Health Insurance Portability and Accountability Act Notices of Privacy Practices Used by Nursing Homes

Variability in institutional review for an observational multicenter health services study with waiver of consent

Study objectives: We provide a descriptive analysis of the variability in institutional review for an observational, multicenter, health services study. Methods: From 2001 to 2004, we conducted a prospective study to validate a previously derived clinical decision rule to identify seriously injured children evaluated by 1 of 20 paramedic squads at the scene of a motor vehicle crash in Los Angeles County. All potential receiving hospitals (27) for the 20 squads were sent an identical research protocol requesting a retrospective chart review for children transported to their facility by 1 of the participating squads. The research protocol included strict confidentiality protections, was noninterventional, did not alter the standard of care for enrolled children, and met requirements for waiver of informed consent and Health Insurance Portability and Accountability Act regulations. We used descriptive statistics (proportion, median, and interquartile range [IQR]) and the Pearson correlation coefficient to describe the percentage of hospitals ultimately approving the research protocol and the variation in total number of days fromemic status and presence of an institutional review board (IRB). Results: Overall, 6 (22%) of 27 hospitals refused to participate in the study. Hospitals approving the study included 3 (100%) of 3 academic IRBs, 7 (100%) of 7 part academic IRBs, 8 (73%) of 11 community hospitals with an IRB, and 3 (50%) of 6 community hospitals without an IRB. Of hospitals approving the study, the median time from submitting an application to study approval was 118 days (IQR 34 to 254, range 12 to 960 days), with a positive correlation between hospital type or presence of an IRB and increasing time to approval ( P =.0231). No institutional review resulted in a change in the basic study protocol, although 1 hospital required paramedic consent. Eight (5%) of 173 children with emergency medical services data were excluded solely because of the refusal of institutional approval, and if hospitals requiring more than 12 months to review the request were dropped from the study, 22 (13%) of 173 children would have been excluded (all from community hospitals). Conclusion: There is significant variability in institutional review and hospital participation for an observational study that qualifies for waiver of consent, particularly among community hospitals. This variability resulted in large inefficiencies and delays in research and threatens the generalizability and validity of study results while adding no additional human subjects protections.

Elderly patients presenting to the emergency department: Do physicians identify unsafe drivers?

Study objectives: The 1995 US Department of Transportation Nationwide Personal Transportation Survey reports that the crash involvement rate per 1 million miles traveled triples from age 65 up to age 85. The fatality rate per 1 million vehicle miles increases by 500% for the same populations. The Pennsylvania Vehicle Code requires physicians to report patients with a “condition that could impair their ability to drive” to the Pennsylvania Department of Transportation (PENNDOT). Thirteen diagnoses of disorder or disability are listed on the Department of Transportation Initial Reporting Form. We conduct a survey of elderly patients presenting to the emergency department (ED) to determine driving status, ED diagnosis compared with PENNDOT's reportable diagnoses, and driving recommendations by discharge physician. Methods: A 1-month convenience sample of patients aged 65 years or older was asked to participate in a study of their driving practices. The survey was conducted in a community teaching hospital ED with an annual census of 60,000. Verbal informed consent was obtained. Participants were asked whether they had a valid driver's license. Drivers were asked about their driving habits, whether their ability to drive had ever been questioned, and whether they felt safe to drive. Each driver's ED diagnosis, medication list, and potential reportable diagnoses were recorded. Physician driving recommendation at discharge was noted. One author (RSB) reviewed all medical records to determine potential reportable diagnoses. Institutional review board/Health Insurance Portability and Accountability Act–approval was obtained. Descriptive statistics were used. Results: Of 112 patients asked to participate, 31 (28%) were excluded because of the following: 24 declined consent; 4 younger than 65 years; 2 incomplete data; 1 surveyed twice on the same visit. Of the remaining 81 patients, 24 (30%) did not have a valid license or had voluntarily stopped driving. Thirty-nine (48%) patients were judged not to have a reportable diagnosis. Of the 18 patients judged to have a reportable medical condition, only 3 were instructed not to drive at discharge. There was no documentation on any record that a PENNDOT form was completed. Family had previously discussed driving ability with 9 patients. All 9 reported continued driving at the ED visit. Two other patients had voluntarily stopped driving after being told by their family physician to stop. Conclusion: Elderly patients often present to the ED with conditions that could impair their ability to drive. A sample of patients in our ED demonstrates a lack of discharge instructions about driving and underreporting of potentially hazardous conditions to PENNDOT. Of the 11 patients told by family or physician to stop driving, only the 2 patients instructed by the family physician discontinued driving. Emergency physicians should be educated about reporting requirements in their locale. Elderly ED patients should have a driving history obtained. Patients with conditions that could impair their ability to drive should be given driving-specific discharge instructions. Reporting to the appropriate agency should be completed if required by the practitioner's state.

Organizing Safety: Conditions for Successful Information Assurance Programs

Organizations must continuously seek safety. When considering computerized health information systems, "safety" includes protecting the integrity, confidentiality, and availability of information assets such as patient information, key components of the technical information system, and critical personnel. "High Reliability Theory" (HRT) argues that organizations with strong leadership support, continuous training, redundant safety mechanisms, and "cultures of high reliability" can deploy and safely manage complex, risky technologies such as nuclear weapons systems or computerized health information systems. In preparation for the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the Office of the Assistant Secretary of Defense (Health Affairs), the Offices of the Surgeons General of the United States Army, Navy and Air Force, and the Telemedicine and Advanced Technology Research Center (TATRC), US Army Medical Research and Materiel Command sponsored organizational, doctrinal, and technical projects that individually and collectively promote conditions for a "culture of information assurance." These efforts include sponsoring the "P3 Working Group" (P3WG), an interdisciplinary, tri-service taskforce that reviewed all relevant Department of Defense (DoD), Miliary Health System (MHS), Army, Navy and Air Force policies for compliance with the HIPAA medical privacy and data security regulations; supporting development, training, and deployment of OCTAVE(sm), a self-directed information security risk assessment process; and sponsoring development of the Risk Information Management Resource (RIMR), a Web-enabled enterprise portal about health information assurance.

Commercial Tissue Repositories: HIPAA Raises Sponsors' Fears

beyond their original research use. Rather than being destroyed or discarded, these specimens can be stored in repositories for future applications (for example, cell lines, genotyping, and other biotechnologies). These repositories are especially attractive to commercial sponsors, because with little additional capital, a repository can increase the potential return on research and development dollars already spent. Not surprisingly, then, commercial sponsors have amassed huge repositories over the years. Any cloud on the legal right to use these specimens could be catastrophic for the commercial sponsors and could chill important, future discoveries. The threat of just such a situation has emerged. The patient privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)' have rekindled legal questions which were raised well over a decade ago, but which still remain unresolved. Generally, commercial repositories have been built quietly, without the specific knowledge of research participants. HIPAA has fundamentally changed the visibility of these commercial repositories. Now, when a health care provider proposes to conduct research on a patient, all research uses and disclosures, including the retention of specimens2 in a repository, must be described on a HIPAA-compliant written authorization form. The patient must sign this form before research activities can begin. Sponsors seem to be uncomfortable directing attention to an area of legal uncertainty. When specimens result in commercially important discoveries, who owns the profits derived from them? The patient? The researcher? The commercial sponsor? Important legal concepts, including property rights, informed consent, and the general fiduciary duty owed by a physician to a patient are implicated. In 199o, the Supreme Court of California addressed these questions in the case of Moore v. Regents of the University of California.3 Mr. Moore suffered from hairy-cell leukemia, and for therapeutic reasons, his physicians recommended that his spleen be removed. Mr. Moore alleged that after surgery, his blood, blood serum, skin, bone marrow aspirate, sperm, and material from his spleen were used to develop a valuable cell line.4 Mr. Moore further alleged that his physicians did not disclose these research activities to him or obtain his

Local Public Health Cost Study in Georgia

Development of a uniform cost study methodology for local health department services in Georgia began with a desire to negotiate cost-based reimbursement from Medicaid. Managed care and the Health Insurance Portability and Accountability Act requirements for common coding standards added impetus to Georgia's efforts to document the cost of local public health. With a determination that the result was achievable, the Division of Public Health contracted with a medical practice management firm. What followed included a major team effort with active working groups of county, district, and state representatives. A template was developed by the consultants to compile the cost report and automated applications were installed. Statewide training engaged the local public health workforce and led to a successful pilot project. This article describes the interactive process that led ultimately to the ability of every county in the state to produce a valid cost report. The cost of direct services provided for individuals by county health departments can now be calculated with a cost per relative value unit. The cost report also includes the cost of environmental health, dental health, population-based services and all other local public health services. A brief description of the methodology is presented.

The Importance of Implementing a Code of Ethics for Home Health Agencies

It is Monday morning, and you have three messages waiting on your voicemail. One complains of a nurse who has made off-color remarks to a patient. The second involves an incident of potential abuse. The last involves a home health aide who was seen out on a date with one of his patients. Which incident should you investigate first? A code of ethics may not be able to make these problems disappear, but it would be extremely helpful in providing standards of conduct and guidelines to follow to address each of these and other situations. It is essential in the workplace, and especially in the home care field, to implement a strong code of ethics that supports an overall commitment to an agency’s mission and provides clear guidelines regarding expected conduct. This code of ethics should cover everything from patient care to the disciplinary consequences for failing to comply with the agency policy for accessing pornographic material on the computer. A code of ethics can function to protect and support an agency in a number of ways. Not only can a code of ethics serve as part of a successful corporate compliance program, addressing issues such as fraud and abuse, but it can also be used to emphasize confidentiality, including compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The overall nature of home care results in limited onsite supervision, unlike other health care settings (e.g., hospital, nursing home, etc.). All the more reason for an agency to have a strong code of ethics employees are expected to uphold. At the core of a strong code of ethics policy is the overall mission of an agency. Common themes include providing high-quality care, acting in good faith with honesty and integrity, and striving to meet the needs of all patients. In addition to overall goals and themes, it is equally important to set clear expectations for how employees are to act. Areas to cover in a code of ethics include the following:

ISO-17799 – Standard for Information Security: A Welcome Boon for Security Management and Audit

Imagine — no, fantasize — as an IT audit security or audit professional that your organization has taken on a dedicated commitment toward information security, its risk assessment, design, implementation, and testing. This commitment is felt by all levels — from the board of directors to senior management, all the way down to the computer console operator. Try to visualize the impact on your job duties and status, and the compliance with major regulatory directives, such as the: Sarbanes–Oxley Act (for publicly financed companies) Health Insurance Portability and Accountability Act (HIPAA) (for organizations dealing with health issues) Gramm–Leach–Bliley Act (for financial institutions)

How Will HIPAA Affect Your Consumer Health Information Services?

The Health Insurance Portability and Accountability Act (HIPAA) is forcing medical centers in the United States to scrutinize how individually identifiable patient information is kept and transferred. The jury is still out on whether medical-center-based consumer health information services are considered “covered entities” under HIPAA. However, the ethical codes of the American Library Association, the Medical Library Association, and many other professional organizations specify patron confidentiality as an important value of the library profession. Consumer health library staff should use the recent emphasis on privacy as a cue to determine where, and under what circumstances, patrons' personal and topical information is less secure than it should be.

Individualized Assessment Moderatesthe Impact of HIPAA Privacy Rules

In this comment, I express appreciation of Erard's (this issue) review, and urge psychologists to continue to protect test security. I disagree with Erard's belief that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is salient for nonhealth forensic issues. I then review some ways in which individualized assessment practices can moderate the negative impact of the HIPPA privacy rules. Assessors can use tests as a ground for joint exploration of the client's experience, behavior, and their contexts. Clients may later ask for a review of test data and collaborative life findings, but they rarely are interested in acquiring test records. Attorneys, after discovering that assessment conclusions are based largely on events/contexts provided by the client and others, are less interested in acquiring test records that the psychologist used as tools rather than as evidence for conclusions.

APA 2002 Ethics, Amphibology, and the Releaseof Psychological Test Records: A Counterperspective to Erard

APA ethics have sought to uphold the practice of psychology and protect its invaluable contribution to psychological assessment, namely the development and validation of tests and other psychometric measures. Faced with formidable challenges from the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations, the 2002 revision of the American Psychological Association (APA) ethical standards abandoned its protective stance. It makes previously protected material (i.e., answers, notes about testing, other forms of raw data, scoring, and test items included on protocols with answers) almost completely accessible to clients and others. Without any professional protections, the worldwide dissemination of these materials via the Internet is virtually assured. In this article, I examine the confused language of Ethical Standard 9.04 (a) with its permissive language and concatenated use of the or conjunction. I evaluate the release of test materials in light of nonmaleficence as both an aspirational principle and an enforceable standard (3.04). Relying on official statements from APA and other prestigious organizations, I document the substantial harm to clients, the community, and the profession of psychology in eroding test security.

HIPAA: the Big Picture for Home Care and Hospice

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) are a new regulatory challenge faced by home care and hospice agencies. Compliance with these regulations will have a significant impact on daily operations and requires the implementation of new systems and processes. This article provides an overview of the three major components of administrative simplification: the transactions rule, the privacy rule, and the security rule. The emphasis of this overview is on the major purposes and requirements of these federal regulations and their implications for home care and hospice programs.

The End of the World As We Know It (and I Feel Fine): Comment on Erard

We review Erard's (this issue) article. We laud him for the measured tone and carefully reasoned position that is taken. Although his main point that The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the new American Psychological Association (APA) Ethics Code (2002) need not be seen as disasters for the practice of assessment, we pose several problems with his analysis. In particular, we argue that although his point that test security is not airtight at present is well taken, nonetheless, it is important to set the bar as high as possible to limit breaches in security. Although Erard is correct that more complex instruments may withstand attempts to manipulate the results, many smaller or more focused instruments may be irrevocably damaged. Furthermore, the release of raw test data can have a deleterious effect in the clinical arena, especially in instances in which it could be subject to misinterpretation and misuse. Finally, we criticize the APA for subjugating the interests of the profession to political expediency.

Release of Test Data Under the 2002 Ethics Codeand the HIPAA Privacy Rule: A Raw Deal or Just a Half-Baked Idea?

Until quite recently, many psychologists believed themselves ethically bound to fall on their swords before releasing raw test data to anyone but another qualified professional. Under the American Psychological Association Ethics Code (2002), consistent with the Health Insurance Portability and Accountability Act of 1996 Privacy Rule of 2002 (U.S. Department of Health and Human Services, 2002), test materials may still be protected, but documents containing participants' responses are ordinarily subject to disclosure. Although many may lament the cost to test security, the virtues of secrecy regarding testing are often exaggerated and its vices underestimated. Several measures, including appropriate informed consent, sensitive and detailed test feedback, offers of suitable alternatives to raw test data, copyright notices, and the use of protective orders and supervised inspection in forensic matters can still be used to maintain a reasonable degree of test security.

Impact of Insurance Accounting on Business Reality and Financial Stability

This paper deals with the development of International Financial Reporting Standards on the insurance industry particularly the impact of “fair value” accounting as encompassed in “International Accounting Standard 39: Financial Instruments; recognition and measurement” and in the current insurance project of the International Accounting Standards Board. It outlines the background and developments in this area together with a summary of the present position. There is no present consensus on an appropriate basis for insurance accounting and from 2005 the industry will almost certainly have to deal with a mixed model for accounting which would have assets accounted for at fair value whilst liabilities are primarily accounted for as at present. The standard setters' current goal would be to have a full fair value reporting system in place by 2007. The paper covers the issues in respect of capital and products that this position gives rise to. Despite the uncertainty surrounding the development of a new standard, it is apparent that the insurance industry will have to deal with very significant changes in its financial reporting and these changes have potentially major consequences for the nature of the business. Insurance companies need to continue to pay attention to the on-going accounting debate over reporting standards and ensure that an industry voice is heard in the determination of a standard which reflects the present business reality and economic position and is also truly useful to the users of financial statements.

Challenging Themes in American Health Information Privacy and the Public’s Health: Historical and Modern Assessments

Protecting the privacy of individually-identifiable health data is a dominant health policy objective in the new millennium. Technological, economic, and health-related reasons substantiate the development of a national electronic health information infrastructure. Through this emerging infrastructure, billions of pieces of health data of varying sensitivities are exchanged annually to provide health care services and service transactions, conduct health research, and promote the public’s health. These multi-purpose, rapid exchanges of electronic health data, far removed from the typical disclosure of health information through the doctor/patient relationship of yesteryear, contribute to heightened individual concerns about identifiable health data. Responding to American fears and perceptions of actual and potential privacy abuses, policymakers have recently developed new, modern privacy protections through legislative and regulatory laws, as well as ethical and industry codes.Modern health information privacy protections are reflected in federal regulations developed by the federal Department of Health and Human Services (DHHS) pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The Impact of Insurance Accounting on Business Reality and Financial Stability

The Impact of Insurance Accounting on Business Reality and Financial Stability

The Impact of Insurance Accounting on Business Reality and Financial Stability

The insurance industry has become more important for systemic financial stability. As a result, the supervision and disclosure of financial risks of insurance companies need to be strengthened. The insurance industry's increasing systemic importance also suggests that there is a need to search for some middle ground in the discussion of fair value accounting to mitigate potentially destabilizing financial volatility.