Maddox P J
Health Systems Management Program, College of Nursing and Health Science, George Mason University, Fairfax, VA, USA.
Nurs Econ. 1998 Jul-Aug;16(4):212-4.
The administrative simplification provisions of HIPAA will establish the first national standards for the electronic transmission of health care transactions with which all federal programs (DOD, Medicare, and Medicaid) and all private health plans must comply. Individuals and organizations should prepare themselves, their systems, and their processes to meet these new administrative and financial data standards and requirements. The benefits of standardized electronic transactions on achieving a single paper-free claims submission to be used by all providers and payers is of obvious benefit. Not so obvious are consequences associated with limiting the access and use of existing data repositories on a variety of clinical, administrative, and research functions. It is critically important in this age of increased accountability for fiscal restraint and improving the outcomes of entire patient populations that clinicians, managers, organizations, and researchers to use data for a variety of clinical, quality improvement/evaluation, and research purposes. Administrative simplification and protecting individual privacy should not be achieved by overly bureaucratic and restrictive responses that impede epidemiologic and health services research, quality improvement activities, and optimization strategies for improving the health of populations. While the health system understands the need for some increased regulation to ensure the privacy of individual patient privacy in the "wired" world solutions must be found and overly restrictive consequences associated with prohibiting access to data must be resolved. More than ever, the entire system requires data to inform every level and type of decision made. Legislation and bureaucratic processes that do not understand and support responsible data-driven decision-making will serve to roll-back, not advance health system improvement. As we prepare ourselves for HIPAA compliance and the expectations of the benefits it will achieve, we must wait to see what impact it will have on clinical, administrative, and research functions concerned with improvement.
《健康保险流通与责任法案》（HIPAA）中的行政简化条款将确立医疗保健交易电子传输的首个国家标准，所有联邦项目（国防部、医疗保险和医疗补助）以及所有私人健康计划都必须遵守这些标准。个人和组织应让自身、其系统及流程做好准备，以满足这些新的行政和财务数据标准及要求。标准化电子交易对于实现所有医疗服务提供者和支付方都能使用的单一无纸化索赔提交具有明显益处。然而，限制对各种临床、行政和研究功能的现有数据库的访问和使用所带来的后果却不那么明显。在这个财政紧缩问责制增强且要改善全体患者治疗效果的时代，临床医生、管理人员、组织和研究人员利用数据用于各种临床、质量改进/评估及研究目的至关重要。行政简化和保护个人隐私不应通过过度官僚化和限制性的措施来实现，这些措施会阻碍流行病学和卫生服务研究、质量改进活动以及改善人群健康的优化策略。虽然卫生系统明白在“网络世界”需要加强一些监管以确保患者个人隐私，但必须找到解决方案，并解决因禁止访问数据而产生的过度限制后果。整个系统比以往任何时候都更需要数据来为各级各类决策提供依据。不理解和支持基于数据的负责任决策的立法和官僚程序将起到阻碍作用，而非推动卫生系统的改进。在我们为遵守HIPAA及其预期效益做准备时，我们必须等待观察它将对与改进相关的临床、行政和研究功能产生何种影响。
