what records are affected?

The health care industry each day creates millions of pages of records, an abundance of which are available for public inspection either through the federal government, state agencies or hospitals and medical clinics themselves.

But the openness of such records depends on a variety of factors, including state and federal law, the willingness of health officials and tradition. While laws require many such records to be open to the public, hospitals and medical officials, in many situations, have released records as part of longstanding policy or tradition or through negotiations with the news media and watchdog groups.

Either way, the advent of the federal medical privacy rules in compliance with the Health Insurance Portability and Accountability Act of 1996 threatens to close many of these records to the public and press.

Here is a listing of significant medical and hospital records used by reporters in covering the health industry:

Hospital Directory Information

Generally, directory information includes only the basic information about current or recent patients treated by a hospital. Such information typically includes the name and hometown of patients, their admittance and discharge times and general status.

Press advocates fear this vital source of information for daily and investigative reporting could dry up because such records include personally identifiable information. Although the rules allow for an exception for limited disclosure in the case of directory information, press advocates say hospital officials are likely to withhold more information than necessary to avoid any risk of penalties.

Hospital Billing Data

Billing data offers a unique picture into the workings of a hospital. Such information can detail the number of procedures that hospitals perform, including open-heart surgeries, angioplasties and hip replacements. Such data might also show death rates at the hospital, detailing mortality figures during operations and other procedures.

In some states, state hospital associations collect the information. Every hospital is also required to report to the federal government its billing data for Medicare, information that is open to public inspection.

Typically, such information does not include identifying personal information from patients and should not fall under the auspices of HIPAA. But overzealous hospital and state officials could lump such records among those that truly include personal information.

Ambulance Records

An ambulance log can yield an abundance of information about first response medical efforts. Such records include information about the time, place and causes of an incident as well as who responded and how quickly. Not all states and localities allow for the release of such records, particularly those that consider such information medical records. In many cases, a routine release of these records came after negotiations between journalists and public officials.

Since the advent of the HIPAA rules, ambulance records have become one of the first casualties in the effort to protect medical privacy.

Discharge and Transfer Records

A few states make hospital discharge and transfer reports available for public inspection, particularly when a state agency requires their compilation. Information in such reports can vary, but, generally, such records do not include identifying information of individual patients. But as with similar records, hospitals and medical associations might refuse to disclose this information because of the new medical privacy rules.

Birth Records

Few states actually require the release of birth reports from hospitals. But hospitals in many states have long offered birth records to newspapers so they may be published in community pages. Typically, many hospitals secure the permission of the new parents before submitting such information. So while such records include individually identifiable health information, the new rules might not curtail the practice.

Death, Autopsy and Coroner Records

State laws vary widely on the availability of such records. Even before the advent of medical privacy rules, the death of NASCAR racer Dale Earnhardt in 2001 and the subsequent request for his autopsy records and photos spurred lawmakers in many states to close such records. The news rules promise to continue the trend.

Organ transplant records

The federal government in 1991 began requiring hospitals to report quality data on organ transplants, data that includes survival rates, waiting times for organs and the number of people who die waiting for matches. The United Network for Organ Sharing of Richmond, Va., and the University Renal Research and Education Association at the University of Michigan manage and analyze such data.

Such information is currently available to the public, and it is unclear whether the new medical privacy rules would force nondisclosure.

Medical error reports and disciplinary reports

About 15 states require hospitals to report medical errors, and only a handful open these records to reporters. Once the medical privacy rules are fully in place, there is a chance that none of the states would release the records in the future since officials might fear they offer clues to the identity of patients.

As for disciplinary reports for doctors and nurses, public access to such records varies from state to state. Disclosure of such rules might be hampered with the new medical privacy rules.

Patient records

Patient records have always been confidential and closed to public inspection. Such a tradition would not change with the new rules. Reporters, however, often persuade individual patients to allow access to such records when important stories need to be told.

Budgets, ownership documents and other filings

Depending on state laws and the ownership status of the hospital, the operation's budget papers, ownership records and tax filings might be available for public inspection. If publicly owned, most of these records should be open. If not, some records could be available through state agencies such as a Department of Social Services or through federal avenues, such as the Securities and Exchange Commission and the Internal Revenue Service. The Department of Veteran Affairs would have information on Veteran Administration hospitals across the nation.

It is unlikely that a hospital's budget, tax filings and ownership papers would include personal medical information of patients.

Nursing Homes

Federal and state laws require nursing homes to submit to routine inspections and to report complaints and accidents to state and federal agencies. In most cases, such reports are open to public inspection. A variety of databases allow easy access to the reports and complaints, including the Online Survey, Certification, and Reporting ("OSCAR") system, which contains the results of nursing-home inspections nationwide.

Most of these reports do not include personally identifiable information, and, thus, would not be affected by HIPAA directly. But state and federal officials, fearful of the strict penalties in the rules, might refuse to disclose the records.

Lawsuits and bankruptcy filings

Claims against doctors and hospitals for malpractice, broken contracts and the like can offer considerable information and records, even those that have always been confidential. Bankruptcy filings, too, can yield a trove of information about hospitals, doctors and medical personnel.

The HIPAA rules do not apply to the courts or to lawyers.

Other records

Accident reports, incident reports and arrest reports regularly offer detailed information about medical and emergency situations. Although not medical records, reporters have already faced situations where law enforcement officials redact information for medical privacy reasons.

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