In a particular urban hospital in the 500 plus-bed range, it was a long-standing practice that each morning, the admissions of the preceding 24 hours were reviewed by at least two people. The director of the chaplain's service screened admissions for the names of employees and various others who might have been admitted. The hospital public relations director similarly screened admissions, alert to the possible admission of prominent local citizens, hospital board members, donors, volunteers, and members of the hospital auxiliary.

Not far away, in a rural area served by a small, community hospital, it was the practice of the local newspaper, an eight- or ten-page weekly, to publish the names of those persons admitted to and discharged from the hospital during the preceding seven days.

The practices described in the foregoing statements were no doubt embarked upon in good conscience; people become ill or injured, and others who care about them want to be able to visit or to do whatever they are able for someone experiencing a personal difficulty. However, these practices have been adjudged illegal, representing violations of today's laws governing patient privacy and confidentiality.

Beginning in April 2003, health care providers and their patients have had to deal with more paperwork in the name of privacy. Mid-April 2003 saw the implementation of the first wave of new medical privacy regulations established by the Health Insurance Portability and Accountability Act (HIPAA). Passed in 1996, but addressing far more than its title suggests, HIPAA may well be the most far-reaching federal health care legislation since the creation of Medicare in 1965. HIPAA initially addressed, as its title suggests, the portability of health insurance coverage by workers who change employers. But it also included significant privacy and confidentiality regulations to be implemented during 2003 and improved security that must be in place by 2005 on computer systems that handle patient information.

Under the new privacy regulations, patients will have to sign forms authorizing the release of any information regarding their medical care, even for actions as seemingly elementary as giving one's hospital room number to family members or providing insurance claim information to one's spouse. For example, a wife is now not permitted to call about her husband's condition unless he has provided written permission. Patients must now be asked if they wish to be included in a hospital database of patient names, conditions, room numbers, and religious affiliations. If someone declines inclusion in the database, not even the patient's relatives can be told room number and condition, and religious affiliations can be released only to clergy.¹

The present phase of HIPAA implementation holds significant implications for staff training. It is also affecting certain operating procedures, and is being felt on levels as elementary as office layout and the positioning of computers and the locations of patient schedules and files. Computer screens that show patient data must now be positioned such that they are effectively shielded from the public. And there can no longer be casual conversations on care issues between patients and caregivers in public areas, say at the reception desk or checkout window. All such conversations must now take place in private.

Providers must now track patient information disclosures that are not related to medical treatment or insurance claims, such as providing information to a birth registry, recording what was provided and when it was sent. HIPAA calls for all such disclosures to be documented for the past six years.

Greater concerns for privacy and confidentiality mean changes in the ways some managers operate their departments and will certainly bring about changes in how managers orient, train, and guide their staffs. But as some who have managed for a few years can say, to a considerable extent day-to-day management is about coping with change. Thus, we will incorporate HIPAA's 2003 requirements, meet the next phase of implementation in 2005, and assure ourselves that after HIPAA, something else will follow.

This issue of The Health Care Manager (HCM 22:3) offers the following articles for the readers' consideration:

* "Hospital-Affiliated Pediatric Urgent Care Clinics: A Necessary Extension for Emergency Departments?" reports on a study conducted to determine whether a children's hospital urgent care clinic helped increase the hospital's market share in addition to relieving some pressure from the emergency department.

* "Reclassifying Infusion Therapy Space at the University of Arizona: A Case Study" addresses reclassification of infusion therapy space at the University of Arizona Medical Center to a physician-based treatment setting. It is a companion article to "Relocating Rheumatology Patients to a New Infusion Center at Duke: A Case Study," which appeared in HCM 22:2 (April-June 2003).

* "Strategies to Decrease Medication Errors" recognizes that medication errors are becoming a hazard of increasing significance as the nursing shortage intensifies and suggests strategies for decreasing such errors and increasing patient safety.

* "Telemedicine: An Emerging Health Care Technology" addresses some of the advances in technology that have made telemedicine possible and provides an overview of the history, current applications, and future challenges for telemedicine as an important part of twenty-first century health care.

* The Case in Health Care Management, "Your Word against the Boss's," asks readers to consider how to proceed when caught in a strong disagreement with one's own manager within the context of a group meeting.

* "Personality Conflicts and Objectivity in Appraising Performance" explores the relationship between personality conflicts and performance appraisal and stresses the need for managers to maintain objectivity in making appraisals in the face of such conflicts.

* "Wireless Communication in Health Care: Who Will Win the Right to Send Data Boldly Where No Data Has Gone Before?" identifies the principal technologies in the field of wireless communication and suggests how these may be used by health care professionals both within and outside the health care facility.

* "Hospital Restructuring Stressors: Support and Nursing Staff Perceptions of Unit Functioning" reports on a study undertaken to examine the changes taking place during organizational restructuring that serve as sources of stress for nursing staff and suggests how some of the stresses might be minimized.

* "Marital Status and Health Care Expenditures Among the Elderly in a Managed Care Organization" reports on a study undertaken to determine the influence of marital status on health care expenditures among the elderly served by a managed care organization.

* "A Case Study of Organizational Decline: Lessons for Health Care Organizations" reports on the phenomenon of organizational decline as experienced within one organization and suggests why some organizations may be at risk of decline and further suggests how an organization might reverse an apparent trend toward decline.

* "Patient-Physician E-Mail: Passion or Fashion?" examines the nature, prevalence, risks, and potential benefits of patient-physician electronic mail as a prelude to critically evaluating the apparent requirements of e-mail as a truly transformational technology that has an important place in the patient-physician relationship.

* "Consumers Devise Drug Cost-Cutting Measures: Medical and Legal Issues to Consider" recognizes that prescription drugs represent the fastest growing component of health care cost and outlines strategies that are available to consumers for attempting to bring these runaway costs at least partially under control.

* "A Department Manager's Guide to Wage and Hour Laws and the Control of Overtime" reviews those portions of the Fair Labor Standards Act of which the department manager should be knowledgeable and suggests how to exercise control in the one area of wage and hour law of most importance to the individual manager: the use of and payment for overtime.