Consider this question. Say the mother of a 22-year old student that you have treated requests to see her daughter’s medical records. The Bursar’s office confirms that the student is listed as a dependent for tax purposes. There seems to be no urgent reason for such a release and the student does not wish to give her mother access. How would you protect the privacy of her information?
Situations such as this one that require knowledge of privacy laws to resolve successfully are all too common in the average student health center, yet the acronyms HIPAA and FERPA tend to strike fear into the hearts of the staunchest of college health professionals. So much has been written anecdotally on the subject of how complicated and unspecific these laws are that some may be surprised to find that according to legal professionals, the intersections between the laws are generally clear-cut. This article aims to explain which laws apply to you and what you can do to avoid the headaches that ensue from a conflict between your principles as a care provider and the law.
Six golden rules of privacy law
* FERPA never applies to non-students
* FERPA only applies when the student’s medical records are released
* HIPAA doesn’t apply to records covered by FERPA or to student “treatment records”
* Even if you treat non-students, you’re not bound by HIPAA unless you perform electronic transactions.
* Student health and counseling centers that do perform electronic transactions for non-students only have to abide by HIPAA for those transactions.
* State laws are applicable whether or not other federal laws apply
This is how these rules break down.
RULE 1: FERPA never applies to non-students
RULE 2: FERPA only applies when the student’s medical records are released
The Family Educational Rights and Privacy Act (FERPA) is the older of the two federal privacy laws. Enacted in 1974, one aspect of its governance is the privacy of educational records. There is a popular myth circulating that student medical records fall under the FERPA’s umbrella term “educational records”. In fact, FERPA specifically excludes the treatment records of students in higher education from its definition of educational records (see USC 20, 1232g for a complete definition). It also excludes employees of an educational institution if they are not students. FERPA does come into play, but only if the records are released to someone outside the health center, whether that is the student, their parents, their professors, or another health provider outside the university, at which point they become “educational records” rather than treatment records.
It is important to note that it is not the request for the release that brings FERPA into effect. Many student health professionals believe that if a request to see the records is made that is in accordance with FERPA guidelines, they have to release them or be in violation of FERPA. Not so, says Kristine Dunne, BA, EdM, JD, an associate at the Washington, D.C. office of law firm Arent Fox, LLC.
“It's the release of the records that triggers FERPA,” she explains. “There are no rights extended under FERPA to those medical records until such time as they have been made available to someone other than the treating health professionals, at which point the FERPA protections of student records kick in.”
Applying this to the example at the beginning of the article, if state law doesn’t require you to release the student’s unreleased medical records to her mother, you are under no legal obligation to do so without a court order. Similarly, even if you think a professor may have a “legitimate educational interest” in requesting a student’s unreleased medical records, you still don’t have to release them.
FERPA is just one part of the puzzle, however. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is another relevant law that seeks to be the national privacy standard in health care. It was updated in 2003 to take into account the trend toward automation and electronic record-keeping. These privacy guidelines have been well publicized and generally uphold the kind of patient confidentiality that most health care providers are comfortable with and there has therefore been a widespread trend in health centers to apply these standards to student medical records, even if they are not legally required. It is important to realize, however, that while its principles of privacy and confidentiality are excellent, in most cases, compliance is not required by law.
RULE 3: HIPAA doesn’t apply to records covered by FERPA or to student medical records which are made, maintained, or used only in connection with the provision of treatment to the student, and are not available to anyone other than persons providing such treatment.
RULE 4: Even if you treat non-students, you’re not bound by HIPAA unless you transmit health care information in electronic form in connection with the submission of claims for payment.
HIPAA’s definition of protected health information (PHI) specifically excludes education records covered by FERPA and the treatment records of students in higher education as defined above. Dunne explains that the goal of this exclusion is simplification.
“If student medical records were subject to HIPAA, there would be two completely different schemes – up until the health center released the record, it would be governed by HIPAA, and when it had been released it would be governed by FERPA,” she says.
This was apparently considered unworkable by Congress, hence the blanket exception that HIPAA makes for any kind of student medical records. However, many student health and counseling centers also treat non-students, and this is where it starts to get a little bit trickier. To be considered a “covered entity” (i.e., bound by HIPAA), your health center must electronically transmit health information in connection with a “HIPAA transaction”. More detailed information on what constitutes a HIPAA transaction can be found in this primer released by The American Council on Education, but essentially it is any administrative or financial task carried out in the course of health care that transmits PHI. If you don’t perform electronic transactions, you don’t have to comply with HIPAA.
RULE 5: Student health and counseling centers that do perform electronic transactions for non-students only have to abide by HIPAA for those transactions.
Usually, every transaction of “covered entities” has to be bound by HIPAA standards, even if they are not all electronic transactions. However, because of the intersection with FERPA, these health centers are able to be bound by HIPAA just for the non-student transactions.
RULE 6: State laws are applicable whether or not other federal laws apply
With all the fuss about HIPAA and FERPA, don’t forget about your state’s laws concerning privacy. In some cases, state laws are the only ones that will apply to student medical records, but even where HIPAA or FERPA apply, state law is still relevant. Despite the fact that HIPAA is a federal law, it bows to state law in those cases where state law is more stringent. Arent Fox Associate Richard Liner, BA, JD, MPH, elaborates:
“HIPAA has an enormous pre-emption problem because it sets a floor and not a ceiling for health care privacy. Congress only established a minimum for protecting patient information. If a state’s laws or regulations are more stringent than HIPAA in their protection of patient health information, then covered entities must follow state requirements.”
This may conjure up ideas of conflicting laws, but Arent Fox counsels that generally, state laws are more specific and will very rarely conflict directly with HIPAA or FERPA. If more than one law is applicable, generally the more stringent requirements will apply. When in doubt, consult counsel before taking action.
Knowing the theory is one thing, but applying it can be a lot more complicated. FERPA requires the student to give written, dated permission before his or her student records information is released – even to other health care providers outside the university, which is a source of frustration for many. But the same information can be released, unauthorized, to school officials who have a “legitimate educational interest”. Similarly, FERPA allows unauthorized disclosure in an emergency, if it is “necessary to protect the health or safety of the student or other persons”. Dunne counsels to rely on common sense to interpret these terms, and to consult counsel early in the process. No law can specifically cover every eventuality; the burden of responsibility and interpretation must, through necessity, rest on the care provider.
This responsibility weighs all the more heavy because schools are concerned about penalties for breaching FERPA. If the Family Policy Compliance Office (FPCO) found a pattern of violations of FERPA with no obvious attempts to follow the guidelines, it could result in a removal of federal funding. However, it is important to know that individuals cannot be prosecuted for a FERPA breach and individual students cannot sue for damages for such a breach. Schools should carefully develop, implement and maintain compliance oversight with regard to these important privacy laws in order to prevent unlawful release of student records. Likewise, if your school treats non-students, files electronic claims and is bound by HIPAA for those transactions, you should make sure that HIPAA protections are implemented, even though a HIPAA violation may not – for now – result in a fine being imposed. Liner explains:
“In the vast majority of cases where there’s found to be a violation of HIPAA, there is what’s called an ‘administrative resolution’, which generally means the mistake wasn’t intentional and the organization voluntarily agrees to take appropriate remedial action.”
No civil fines for violations of HIPAA have been imposed so far, although Liner warns that is likely to soon change.
Although information on the triumvirate of privacy laws has always been available to those who know where to look for it, there is also a wealth of partial and incorrect information available on the Internet that has muddied the waters for those health professionals attempting to do a little research on the laws that apply to them. Dunne and Liner counsel that you should speak to a professional who knows the law in your state and the ins and outs of FERPA and HIPAA if you are worried about misinterpretation of the law. Even if you know the basics, state laws vary greatly and knowing the details of how the three laws intersect will allow you the greatest leeway to interpret them in a way that is consistent with your ethics.
“It is complicated,” sympathizes Liner. “Talk to the privacy officer within the university, if there is one. There are also a few government Web sites that are really good in terms of user-friendly guidance to help people navigate through the more basic pitfalls.” For instance, the Office of Civil Rights, the enforcement agency for the HIPAA privacy standards, offers tremendously helpful information and FAQs on its Web site.
“Consult with your legal counsel to ensure you’re interpreting and applying the law correctly,” adds Dunne. “And be clear to those who use student health center services, especially students, about the laws that apply.”
Tuesday, September 23, 2008
Acne Vulgaris
What is Acne Vulgaris? This is a medical term used to describe most cases of acne. It really isn't as bad as it sounds! Vulgaris doesn't mean that the acne is vulgar, only that it means that it is common.
Be aware that there are many factors that contribute to acne. First, research indicates a propensity for acne may well be inherited. Parents who had acne in their teenage and young adult years may have children who are likewise prone to having acne in their teen and young adult years.
Next, clogged skin pores are certainly a major contributing factor for acne out-breaks. When pores become clogged with an excess production of sebum and mix with dead skin cells or makeup that isn't sufficiently cleaned from the skin, problems start to develop. When skin pores are clogged, bacteria are produced and pus starts to form causing a pimple, a white head or a black head.
The most commonly accepted causes for acne are hormonal imbalances. Hormones in boys and girls may become unbalanced during puberty, during menstrual cycles, when starting or stopping birth control pills, during times of extreme stress, and at other times as well.
All of the above situations can cause the body to over produce a male hormone which causes the sebaceous glands to produce sebum. The sebum combines with dead skin cells to block pores and acne develops. So, basically, it still comes back to blocked pores.
Other causes for acne include a lack of vitamins, minerals and trace elements that the body needs to maintain a healthy skin. Vitamins A, E and B6 are especially important in maintaining healthy skin as are zinc, essential fatty acids (EFA), Chromium and Selenium.
Most diets of teenagers and young adults do not contain these vitamins, minerals, and trace elements in sufficient quantity to maintain healthy skin and to help prevent the onset of Acne.
Acne: The 8 Stages:
Full blown, Stage 8 acne doesn't usually develop overnight. Acne is progressive condition. Acne is one of the diseases that are so common that it is sometimes just disregarded as a serious problem...like the common cold. It has been estimated that 95 of people will have at least a mild case of acne at some point in their lives.
Acne, much like the common cold, is usually treated by the sufferer with over-the-counter medications that alleviate the symptoms of the disease in the belief that it will simply go away all by itself....eventually. And, it usually does but not always.
Most people throughout their life will have the occasional pimple, zit, white head or black head.
Although these pesky little outbreaks do seem to appear at the most inopportune times, they really aren't a serious problem that requires medical attention. A little over-the-counter acne facial wash to help prevent another outbreak will usually take care of the problem. It isn't a big deal. This kind of acne is referred to as Stage 0 and really nothing to be concerned about unless the acne progresses to subsequent stages.
Acne stages are graded from 0 through 8. Zero is the least severe and 8 is the most serious of the stages. The stages are as follows:
Stage 1: There will be white heads and black heads with some mild inflammation. The outbreaks will start to occur more frequently. Using products that contain Benzyl Peroxide are in order.
Stage 2: There will be some papules in addition to the white heads and black heads. Papules are skin lesions that are solid and raised but usually small. This is still considered to be a very mild case of acne. Treatment can be continued using over-the-counter products that contain Salicylic Acid.
Stage 3: Stage 3 is the same as stage 2 but with more frequent occurrences.
Stage 4-5: Pustules begin to appear. Now, it's time to schedule an appointment at a dermatologist.
Stage 6-7: Nodules and cysts are forming. Scarring is going to start happening at this stage. Your dermatologist will begin to take more drastic action.
Stage 8: Breakouts are almost continuous and include nodules and cysts. There are modern technologies that will help and your dermatologist will advise you.
Acne Skin Care:
As we know, our hair follicles secrete sebum. Sebum makes its way up the hair follicles to the skin pores where it lubricates and protects the skin. Sometimes there are oil glands which get overworked, get enlarge, and produce too much sebum. The sebum can get trapped in the hair follicle.
When this happens the pores get clogged and black heads or white heads form and the bacteria start to multiply at an alarmingly fast rate.
Once you understand this process, you can see the reasoning behind the advice about caring for skin that has black heads, white heads and pustules on it.
The first piece of advice about caring for acne infected skin is to never pick at the pimples. Don't try to pop them and drain them. This will not cure them no matter what anybody tells you. Popping them will only serve to make them worse...not better.
However, there are things that you can do that really will help.
The first thing you can do is to wash your face with a mild soap or a sulfur based soap. Wash your face with just your finger tips. Don't ever use a wash cloth as it holds germs and bacteria. Rinse your face with clean water several times to ensure you remove all traces of soap, and then pat it dry with a clean towel. Do not rub your face with the towel and never use the same towel twice without it being clean.
Take a good multi-vitamin and multi-mineral supplement every day and drink at least 8 full glasses of water (not soda) every day. The vitamins and minerals will supply nutrients that are absent from most diets and the water will help to hydrate the skin as well as to flush toxins out of your system.
If you use over-the-counter acne medications, be certain that you follow the directions carefully and that you use a good sunscreen when you are outdoors as some acne medications make the skin more prone to sunburn.
Adult Acne:
Acne is not just a problem for teenagers and young adults. Once a person survives the teenage years, you would think that they don't have to deal with the embarrassment of acne any longer, right? Well....not exactly.
The sad truth is that about 25 of women will have acne at some time in their 20s, 30s or even 40s. Although there has never been a real cause established, it is believed that most adult acne is caused by the same thing that causes teenage acne...hormonal changes.
A doctor will sometimes prescribe hormonal treatments that will clear a case of adult acne right up. As with teenage acne, adult acne is not caused by diet. Stress has often been cited as one possible cause of adult acne but that assertion has never been verified.
Treating adult acne is a bit more difficult than treating teenage acne. Adults have the concern of drying out their skin that teenagers don't normally have to deal with. Adults don't want pimples; but, they don't want wrinkles, either. A dermatologist should be consulted if the acne is long lasting or is severe.
There are many treatments that are available to adults who suffer from acne. Most of the effective treatments are only available by prescription. Adults should not use over-the-counter acne medications that are intended for the treatment of teenage acne. These products tend to dry the skin and adults need to be concerned about wrinkling as well as acne.
A case of adult acne is not a happy occurrence to say because those ugly bumps always seem to occur at the most inopportune times and while a teenager may be embarrassed by acne, an adult is even more devastated.
Fortunately, there are treatments and a dermatologist has a lot of weapons in his arsenal to fight adult acne.
Acne Scar Removal Options:
Life hardly seems fair sometimes! First, a teenager or a young adult must suffer through acne, treat it, and have to live with it...sometimes for years. Then the acne is gone; but, the scars are there as a painful reminder of the mental and emotional agony the acne sufferer had to endure.
You're right, life doesn't seem fair; but, acne is one of those sad facts of life that some if not most of us have to deal with. The good news is there is help; unfortunately, it isn't free or cheap!
There are two basic procedures that are used to remove ugly pits and scars left over from a bad case of teenage or young adult acne. Laser resurfacing is the least expensive of the two available acne scar removal procedures. Dermabrasion is the second procedure.
Laser resurfacing can be done in the dermatologist office instead of a hospital so that provides a much greater financial savings. A laser is used to remove the top layer of skin and also to tighten the middle layer of skin.
The dermatologist will use a local anesthetic to help reduce the procedure pain. It usually takes several days for the skin to heal after a laser resurfacing procedure is completed. Very often, multiple resurfacing treatments must be done to achieve the desired results.
The second procedure used to remove acne scarring is called dermabrasion. In this procedure, a rotating wire brush is used to remove the top layer of skin. The body continually produces new skin and the new layer will be smoother than the layer that was removed. It usually takes between 10 days and 3 weeks for the skin to heal after a dermabrasion treatment. Once again, multiple treatments may be required to eliminate the scarring.
Acne may seem to be a devastating condition but with proper skin routine, vitamins, and over the counter products, most cases will not be severe. Remember, proper cleansing goes a long way towards minimizing outbreaks, so don't be afraid to cleanse your face 5 - 6 times a day of more if needed.
Fight acne by being smart. Take as many preventative steps as possible to avoid situations that create the opportunity for acne to develop. If acne does afflict you, consult a qualified medical professional before deciding on a course of action.
Be aware that there are many factors that contribute to acne. First, research indicates a propensity for acne may well be inherited. Parents who had acne in their teenage and young adult years may have children who are likewise prone to having acne in their teen and young adult years.
Next, clogged skin pores are certainly a major contributing factor for acne out-breaks. When pores become clogged with an excess production of sebum and mix with dead skin cells or makeup that isn't sufficiently cleaned from the skin, problems start to develop. When skin pores are clogged, bacteria are produced and pus starts to form causing a pimple, a white head or a black head.
The most commonly accepted causes for acne are hormonal imbalances. Hormones in boys and girls may become unbalanced during puberty, during menstrual cycles, when starting or stopping birth control pills, during times of extreme stress, and at other times as well.
All of the above situations can cause the body to over produce a male hormone which causes the sebaceous glands to produce sebum. The sebum combines with dead skin cells to block pores and acne develops. So, basically, it still comes back to blocked pores.
Other causes for acne include a lack of vitamins, minerals and trace elements that the body needs to maintain a healthy skin. Vitamins A, E and B6 are especially important in maintaining healthy skin as are zinc, essential fatty acids (EFA), Chromium and Selenium.
Most diets of teenagers and young adults do not contain these vitamins, minerals, and trace elements in sufficient quantity to maintain healthy skin and to help prevent the onset of Acne.
Acne: The 8 Stages:
Full blown, Stage 8 acne doesn't usually develop overnight. Acne is progressive condition. Acne is one of the diseases that are so common that it is sometimes just disregarded as a serious problem...like the common cold. It has been estimated that 95 of people will have at least a mild case of acne at some point in their lives.
Acne, much like the common cold, is usually treated by the sufferer with over-the-counter medications that alleviate the symptoms of the disease in the belief that it will simply go away all by itself....eventually. And, it usually does but not always.
Most people throughout their life will have the occasional pimple, zit, white head or black head.
Although these pesky little outbreaks do seem to appear at the most inopportune times, they really aren't a serious problem that requires medical attention. A little over-the-counter acne facial wash to help prevent another outbreak will usually take care of the problem. It isn't a big deal. This kind of acne is referred to as Stage 0 and really nothing to be concerned about unless the acne progresses to subsequent stages.
Acne stages are graded from 0 through 8. Zero is the least severe and 8 is the most serious of the stages. The stages are as follows:
Stage 1: There will be white heads and black heads with some mild inflammation. The outbreaks will start to occur more frequently. Using products that contain Benzyl Peroxide are in order.
Stage 2: There will be some papules in addition to the white heads and black heads. Papules are skin lesions that are solid and raised but usually small. This is still considered to be a very mild case of acne. Treatment can be continued using over-the-counter products that contain Salicylic Acid.
Stage 3: Stage 3 is the same as stage 2 but with more frequent occurrences.
Stage 4-5: Pustules begin to appear. Now, it's time to schedule an appointment at a dermatologist.
Stage 6-7: Nodules and cysts are forming. Scarring is going to start happening at this stage. Your dermatologist will begin to take more drastic action.
Stage 8: Breakouts are almost continuous and include nodules and cysts. There are modern technologies that will help and your dermatologist will advise you.
Acne Skin Care:
As we know, our hair follicles secrete sebum. Sebum makes its way up the hair follicles to the skin pores where it lubricates and protects the skin. Sometimes there are oil glands which get overworked, get enlarge, and produce too much sebum. The sebum can get trapped in the hair follicle.
When this happens the pores get clogged and black heads or white heads form and the bacteria start to multiply at an alarmingly fast rate.
Once you understand this process, you can see the reasoning behind the advice about caring for skin that has black heads, white heads and pustules on it.
The first piece of advice about caring for acne infected skin is to never pick at the pimples. Don't try to pop them and drain them. This will not cure them no matter what anybody tells you. Popping them will only serve to make them worse...not better.
However, there are things that you can do that really will help.
The first thing you can do is to wash your face with a mild soap or a sulfur based soap. Wash your face with just your finger tips. Don't ever use a wash cloth as it holds germs and bacteria. Rinse your face with clean water several times to ensure you remove all traces of soap, and then pat it dry with a clean towel. Do not rub your face with the towel and never use the same towel twice without it being clean.
Take a good multi-vitamin and multi-mineral supplement every day and drink at least 8 full glasses of water (not soda) every day. The vitamins and minerals will supply nutrients that are absent from most diets and the water will help to hydrate the skin as well as to flush toxins out of your system.
If you use over-the-counter acne medications, be certain that you follow the directions carefully and that you use a good sunscreen when you are outdoors as some acne medications make the skin more prone to sunburn.
Adult Acne:
Acne is not just a problem for teenagers and young adults. Once a person survives the teenage years, you would think that they don't have to deal with the embarrassment of acne any longer, right? Well....not exactly.
The sad truth is that about 25 of women will have acne at some time in their 20s, 30s or even 40s. Although there has never been a real cause established, it is believed that most adult acne is caused by the same thing that causes teenage acne...hormonal changes.
A doctor will sometimes prescribe hormonal treatments that will clear a case of adult acne right up. As with teenage acne, adult acne is not caused by diet. Stress has often been cited as one possible cause of adult acne but that assertion has never been verified.
Treating adult acne is a bit more difficult than treating teenage acne. Adults have the concern of drying out their skin that teenagers don't normally have to deal with. Adults don't want pimples; but, they don't want wrinkles, either. A dermatologist should be consulted if the acne is long lasting or is severe.
There are many treatments that are available to adults who suffer from acne. Most of the effective treatments are only available by prescription. Adults should not use over-the-counter acne medications that are intended for the treatment of teenage acne. These products tend to dry the skin and adults need to be concerned about wrinkling as well as acne.
A case of adult acne is not a happy occurrence to say because those ugly bumps always seem to occur at the most inopportune times and while a teenager may be embarrassed by acne, an adult is even more devastated.
Fortunately, there are treatments and a dermatologist has a lot of weapons in his arsenal to fight adult acne.
Acne Scar Removal Options:
Life hardly seems fair sometimes! First, a teenager or a young adult must suffer through acne, treat it, and have to live with it...sometimes for years. Then the acne is gone; but, the scars are there as a painful reminder of the mental and emotional agony the acne sufferer had to endure.
You're right, life doesn't seem fair; but, acne is one of those sad facts of life that some if not most of us have to deal with. The good news is there is help; unfortunately, it isn't free or cheap!
There are two basic procedures that are used to remove ugly pits and scars left over from a bad case of teenage or young adult acne. Laser resurfacing is the least expensive of the two available acne scar removal procedures. Dermabrasion is the second procedure.
Laser resurfacing can be done in the dermatologist office instead of a hospital so that provides a much greater financial savings. A laser is used to remove the top layer of skin and also to tighten the middle layer of skin.
The dermatologist will use a local anesthetic to help reduce the procedure pain. It usually takes several days for the skin to heal after a laser resurfacing procedure is completed. Very often, multiple resurfacing treatments must be done to achieve the desired results.
The second procedure used to remove acne scarring is called dermabrasion. In this procedure, a rotating wire brush is used to remove the top layer of skin. The body continually produces new skin and the new layer will be smoother than the layer that was removed. It usually takes between 10 days and 3 weeks for the skin to heal after a dermabrasion treatment. Once again, multiple treatments may be required to eliminate the scarring.
Acne may seem to be a devastating condition but with proper skin routine, vitamins, and over the counter products, most cases will not be severe. Remember, proper cleansing goes a long way towards minimizing outbreaks, so don't be afraid to cleanse your face 5 - 6 times a day of more if needed.
Fight acne by being smart. Take as many preventative steps as possible to avoid situations that create the opportunity for acne to develop. If acne does afflict you, consult a qualified medical professional before deciding on a course of action.
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