Dr. Ness is moderating a policy forum discussion on "Confidentiality and HIPAA: What's a Researcher to Do?" today during the annual meeting of the American College of Epidemiology. Scientific sessions take place through Sept. 14 at the Boston Park Plaza Hotel.
"HIPAA has had substantial negative effects on our ability to recruit individuals to participate in research," says Dr. Ness, whose expertise is in women's health-related research, including preeclampsia, ovarian cancer, vaginal microbiology, pelvic inflammatory disease and pregnancy outcomes. "The way that HIPAA has hurt research, I believe, is a classic example of the law of unintended consequences."
The Privacy Rule, which became effective in April 2003, allows patients to have access to their medical records and find out when the records are disclosed, and it restricts what health professionals can do with the information. Those who violate the rule risk large fines, and possibly jail time.
In the past, identifying patients who might potentially benefit from a clinical trial of a new drug or treatment was simply a matter of reviewing medical records for suitable candidates and then contacting them to see whether they would be interested in participating. Under HIPAA regulations, however, patient contacts now must be initiated by their physicians - busy people whose understandable priority is the practice of primary or specialty patient care.
Epidemiologists such as Dr. Ness - and many other scientists and physicians who do clinical research involving human subjects - now must spend months compiling registries of patients who have given their doctors permission to share their medical records with researchers or devising other complicated alternatives.
Some researchers at the University of Pittsburgh do direct mail solicitation for study participants using voter-registration or drivers' license databases. This may work fine for large population studies that seek health trends, but is inefficient for physicians and scientists who want to target a particular group, such as recently diagnosed ovarian cancer patients who have not yet had radiation or chemotherapy treatments, to try an investigational drug.
"What is happening is that the public is losing access to research," said Dr. Ness. "If clinical research becomes too burdensome here, it will be much easier to do it overseas."
Other participants in the HIPAA policy forum are Robert Hardesty, M.D., professor of surgery at the University of Pittsburgh School of Medicine and director of Pitt's Institutional Review Board; Susan Ehringhaus, J.D., the American Association of Medical Colleges;Martha Linet, M.D., M.P.H., National Cancer Institute; and Russell Localio, J.D., University of Pennsylvania.
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