Information security and privacy in the healthcare sector is an issue of growing importance. The adoption of digital patient records, increased regulation, provider consolidation and the increasing need for information exchange between patients, providers and payers, all point towards the need for better information security. We critically survey the literature on information security and privacy in healthcare, published in information systems journals as well as many other related disciplines including health informatics, public health, law, medicine, the trade press and industry reports. In this paper, we provide a holistic view of the recent research and suggest new areas of interest to the information systems community.

http://www.mathcs.emory.edu/~lxiong/cs573_s12/share/slides/501.pdf

Information security and privacy in healthcare: current state of research

Background:There have been no population-based studies to evaluate the rate of pediatric anterior cruciate ligament (ACL) reconstruction.Purpose:The primary aim of the current study was to determine the yearly rate of ACL reconstruction over the past 20 years in New York State. Secondary aims were to determine the age distribution for ACL reconstruction and determine whether patient demographic and socioeconomic factors were associated with ACL reconstruction.Study Design:Descriptive epidemiology study.Methods:The Statewide Planning and Research Cooperative System (SPARCS) database contains a census of all hospital admissions and ambulatory surgery in New York State. This database was used to identify pediatric ACL reconstructions between 1990 and 2009; ICD-9-CM (International Classification of Diseases, 9 Revision, Clinical Modification) and CPT-4 (Current Procedural Terminology, 4th Revision) codes were used to identify reconstructions. Patient sex, age, race, family income, education, and insurance sta...

20 Years of Pediatric Anterior Cruciate Ligament Reconstruction in New York State

Despite a substantial literature documenting persistent disparities in health and health care utilization by race/ethnicity (Smedley, Stith, and Nelson 2008; AHRQ 2010), our understanding of the cause of these disparities is incomplete. Although health insurance coverage, individual socioeconomic position, provider bias, and discrimination have all been demonstrated to impede access to care, there is increasing interest in elucidating the role of place in shaping observed health care inequities (Zaslavsky and Ayanian 2009). Recent evidence suggests that health care resources often reflect the geographic distribution of race/ethnicity. As a prominent organizing feature of American society, we focus on racial/ethnic residential segregation, to elucidate a framework for investigating the role of place in disparities in health care.

Racial/ethnic residential segregation refers to the degree to which two or more groups live separately from one another in a geographic area (Massey and Denton 2003). Levels of racial/ethnic segregation (hereafter segregation) in the United States are higher than economic segregation (Massey, Rothwell, and Domina 2010). The segregation of blacks is distinctive and remains higher in comparison with other racial/ethnic groups. Competing explanations of the cause and persistence of segregation such as personal preference, socioeconomic status (SES), and prejudice have been theoretically articulated and empirically tested and suggest that personal preferences have not substantially contributed to endemic levels of segregation (Charles 2002). Although overt discriminatory policies and institutional practices promoting segregation are now illegal, segregation continues to have lasting implications for both individual and community well-being (Massey and Denton 1988). Considered a spatial manifestation of institutionalized discrimination, segregation policies protected whites from residential contact with blacks and fostered racial inequality (Massey and Denton 1988). Segregation continues to perpetuate racial disparities in educational and employment opportunities, concentrate poverty, and shape social and physical features of neighborhoods (Williams and Collins 2011). These mechanisms also have serious consequences for individual and community health (Acevedo-Garcia et al. 2003; Kramer and Hogue 2005). The excess burden of poorer health resulting from segregation may be further exacerbated by disparities in health care. Similar pathways affecting health status may also present barriers to accessing and utilizing health care resources in segregated neighborhoods. The purpose of this paper is to synthesize findings from the health services research literature and present a framework that extends a seminal model of segregation and health disparities (Williams and Collins 2011) to address segregation as a fundamental cause of racial disparities in health care. We identify gaps in the understanding of segregation and health care disparities, discuss methodological and conceptual challenges, and outline needed research to advance the understanding of how segregation contributes to the inequitable provision of health care.

https://scholar.harvard.edu/files/davidrwilliams/files/2012-elucidating_the_role-williams.pdf

Elucidating the Role of Place in Health Care Disparities: The Example of Racial/Ethnic Residential Segregation

Throughout the world, sensitive personal information is now protected by regulatory requirements that have translated into significant new compliance oversight responsibilities for IT managers who ...

/pdf/the-influence-of-the-informal-social-learning-environment-on-3nlezqkyzf.pdf

The influence of the informal social learning environment on information privacy policy compliance efficacy and intention

Background:Despite an increase in the prevalence of medial ulnar collateral ligament (UCL) reconstruction of the elbow in professional baseball and popularity within the media, there are no population-based studies examining the incidence of UCL reconstruction.Purpose:To examine the epidemiological trends of UCL reconstruction on a statewide level over a 10-year period. The primary endpoint was the yearly rate of UCL reconstruction over time; secondary endpoints included patient demographics, institution volumes, and concomitant procedures on the ulnar nerve.Study Design:Descriptive epidemiology study.Methods:The New York Statewide Planning and Research Cooperative System (SPARCS) database contains records for each ambulatory discharge in New York State. This database was used to identify all UCL reconstructions in New York State from 2002 to 2011 using the outpatient CPT-4 (Current Procedural Terminology, 4th Revision) code. Assessed were patient age, sex, ethnicity, insurance status, and associated proc...

Epidemiology of Medial Ulnar Collateral Ligament Reconstruction: A 10-Year Study in New York State.

The Science of Team Science

Although many perspectives on the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on health services research have been wide spread, little empirical evidence has been reported about HIPAA-related barriers during the implementation of research projects. Using three cases of health services research projects, this study examined practical barriers created by HIPAA regulation. During the stage of implementation of the three projects, we experienced some HIPAA-related concerns, previously raised in the field of health services research. We found that technically complicated consent forms and privacy protection forms as well as socially-sensitive clinical conditions make patients less willing to participate in research projects; concerns about safety of patient medical information makes health organizations more hesitant to let researchers have access to the patient's information, especially through electronic transfer; more restrictive IRB processes and challenging patient recruiting processes make health services researchers reluctant to go through the process; and as a result, they may compromise with the scientific soundness of the project. Overall, HIPAA complicates the research process and requires more resources and longer time to conduct research.

Barriers of HIPAA Regulation to Implementation of Health Services Research

Introduction Hospitals with high-technology services may have better outcomes. However, access to high-technology hospitals might not be uniform across racial/ethnic groups. This study examined if racial/ethnic minorities, compared to whites, are less likely to utilize hospitals that have the availability of technology services and infrastructure items such as computed tomography, positron emission tomography, magnetic resonance imaging, diagnostics radiation facility, and a level 1 trauma unit. Methods Data were obtained from the 2003 Healthcare Cost & Utilization Project’s Nationwide Inpatient Sample and the 2003 American Hospital Association’s annual survey data. The sample consisted of 3 381324 patients admitted to and discharged from 368 hospitals in 18 states in the United States. Results Logistic regression results suggest that Hispanic patients are less likely than whites to utilize high-technology hospitals when controlling for other factors (odds ratio[OR], 0.47; 95% confidence interval [CI], 0.28-0.79). Conclusions Our study adds empirical evidence that significant gaps persist in access to care between minorities and whites. Particularly, access to high-technology hospitals for Hispanics appears to be a major problem.

Racial/Ethnic Disparities in the Utilization of High-Technology Hospitals

We examined the level of hospice knowledge of caregivers of minority elderly hospice patients and determined how it influences the hospice enrollment decision and the decision on the use of hospice services after enrollment. Based on qualitative analysis of medical records and interviews with caregivers of minority elderly hospice patients who received personal care from paid caregivers (eg, other than family caregivers), we found that hospice knowledge increased access to hospice among minority patients who otherwise would not opt for hospice or enroll too late for comprehensive hospice care services. Furthermore, the highest level of knowledge-acquired through caregivers' health care occupations-appears to influence hospice care after hospice enrollment. Caregivers with that level of knowledge made requests for changes in site of care and/or additional services that may enhance the quality of hospice care that their loved ones receive.

/pdf/does-caregiver-knowledge-matter-for-hospice-enrollment-and-25jz9r1oa2.pdf

Does caregiver knowledge matter for hospice enrollment and beyond? Pilot study of minority hospice patients.

Background: The length of hospice stay, as an indicator of timing of hospice referral, is an important outcome to examine in end-of-life care because it is relevant to the quality and cost...

/pdf/ethnic-variation-in-timing-of-hospice-referral-does-having-hzkg9mnpf9.pdf

Linda F. Samson

Papers

The Science of Team Science

Barriers of HIPAA Regulation to Implementation of Health Services Research

Racial/Ethnic Disparities in the Utilization of High-Technology Hospitals

Does caregiver knowledge matter for hospice enrollment and beyond? Pilot study of minority hospice patients.

Ethnic Variation in Timing of Hospice Referral: Does Having No Informal Caregiver Matter?