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Sports Medicine Braces for HIPAA Impact

Sweeping federal legislation designed to ease the electronic flow of medical information while protecting patient privacy has ignited a high degree of fear and uncertainty across the sports medicine community.

The proposed version of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was published in August, and the law goes into effect for most health groups on April 14, 2003. Though the bulk of the law applies to electronic transmissions, the privacy laws contained in the act also apply to oral and written communications.

In light of the new law, sports medicine shares the same broad concerns as other medical interests about new layers of bureaucracy and potential obstacles to treatment. However, perhaps the biggest concerns for sports medicine revolve around new directives that cover oral and written communications; primary care sports medicine involves frequent consultations with others such as orthopedic surgeons, athletic trainers, physical therapists, and coaches. Because routinely issued player injury reports are a part of professional sports culture, medical privacy concerns extend to another layer of communication—the media.

The questions raised in e-mail discussion groups and news reports include:

  • Will teams and physicians be allowed to release reports about injured players?
  • Will team physicians be prohibited from consulting with specialists and athletic trainers about player injuries?
  • Are medical communications between the healthcare professionals and the school or team illegal?

James Garrick, MD, director of the Center for Sports Medicine at St Francis Memorial Hospital in San Francisco and orthopedic consultant for the San Francisco Giants, says a particularly thorny issue will be sharing medical information between schools and teams when athletes move from high school to college or are traded at the professional level. He worries that physicians would be held responsible, even if they're not directly sharing the information in those instances. "I'm hopeful that some of this will be clarified as the regulations are more thoroughly spelled out, but right now, it seems a little frightening," he says.

Who's Covered?

Keith Webster, MA, ATC, who chairs the governmental affairs committee of the National Athletic Trainers' Association, was part of an athletic trainers' group that met with US Department of Health and Human Services (HHS) representatives in December to seek guidance about some of the sports medicine issues. "They were very open and candid. They tried to work through several scenarios with us," Webster says.

Though it seems as though there are several "gray areas" about how the law applies to sports medicine, Webster says the first clarification step is to determine if one's group or institution is a covered, hybrid, or noncovered entity in the eyes of the law. Because sports medicine care often has clinical and academic components, Webster suggests that those who are unsure of their status consult a useful HHS tool on the Web ( Webster, who is also head administrative athletic trainer at the University of Kentucky in Lexington, says that the HHS officials indicated that physicians, as covered entities, are free to share patient private health information—even with noncovered entities—for patient treatment purposes.

Communication between the medical team and coaches also appears to be on safe legal ground, Webster says, because athletic departments and student health services are already covered by another federal data privacy law, the Family Educational Rights and Privacy Act. "In these instances, proper authorizations are always very important," he says.

A 'Hybrid Entity' Experience

Many sports medicine professionals work in "hybrid entity" institutions. Stanford University is a typical hybrid entity, with sports medicine crossing academic, athletic, clinic, and hospital lines. Donald Chu, PhD, PT, ATC, CSCS, director of athletic training and rehabilitation at Stanford, has been involved in the institution's HIPAA planning. He says the biggest change to date has been the involvement of a computer consultant to ensure secure wireless transmissions through computers and personal digital assistants throughout the sports medicine system.

Chu and his colleagues are also researching how to incorporate privacy policies, releases, and disclosures into the preparticipation exam system, which Stanford students complete online before receiving their physical exams.

One sticking point that Stanford encountered was how to classify athletic trainers. In California, athletic trainers—despite their schooling or certification—are not licensed by the state and as such are not considered healthcare professionals in the eyes of the law. "This would have turned the system topsy turvy," Chu says. However, he says Stanford has opted to include athletic trainers as covered entities. "This will be an individual decision for all major universities and colleges in California to make," Chu says.

Broad Laws Bring Typical Woes

Matthew Mitten, JD, associate dean of student affairs and director of the National Sports Medicine Law Institute at Marquette University in Milwaukee, says the broad laws often create uncertainty because lawmakers didn't have sports injuries in mind when they drafted the legislation. Broad laws can have unpredictable outcomes that influence sports medicine, such as in the case of Casey Martin, who won the right to use a golf cart in professional tournaments based on the Americans With Disabilities Act.

He notes that now is an appropriate time for healthcare professionals to approach the HHS to voice their sports medicine concerns, which the HHS will likely take into consideration before issuing the final official regulations.

Lisa Schnirring

Field Notes

DVDs Pump Up Home Workouts

Those who have watched movies on digital video discs (DVDs) are already familiar with the interactive options and bonus tracks that the new technology allows. Now, exercise video producers are harnessing DVD technology to bring these new options to exercisers.

Since 1997, several titles have entered the market. A search for exercise DVDs on yielded 212 titles. One example is The Interactive Yoga Series (Body Wisdom Media, Bethesda, Maryland). Users can customize workouts using the DVD menus. For example, a DVD in the series titled Yoga for Athletes offers 15 sports to chose from, and each sport has 12 specific workout options.

How Active Are Our Readers?

We recently tallied an unscientific poll of our readers' exercise activities, and here are the results, listed by activity and number of participants:

Bicycling: 100,044
Walking: 61,036
Swimming: 54,445
Tennis: 51,214
Running/jogging: 49,847
Golf: 47,442
Skiing (cross-country): 45,733
Skiing (downhill): 45,602
Weight training: 43,078
Racquetball: 38,884
Aerobics: 29,984
Other activities: 24,417