title: Potential impact of the HIPAA privacy rule on data collection in a registry of patients with acute coronary syndrome.
abstract: BACKGROUND
  Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule has the potential to affect data collection in outcomes research.
  
  
  METHODS
  To examine the extent to which data collection may be affected by the HIPAA Privacy Rule, we used a quasi-experimental pretest-posttest study design to assess participation rates with informed consent in 2 cohorts of patients eligible for the University of Michigan Acute Coronary Syndrome registry. The pre-HIPAA period included telephone interviews conducted at 6 months that sought verbal informed consent from patients. In the post-HIPAA period, informed consent forms were mailed to ask for permission to call to conduct a telephone interview. The primary outcome measure was the percentage of patients who provided consent. Incremental costs associated with the post-HIPAA period were also assessed.
  
  
  RESULTS
  The pre-HIPAA period included 1221 consecutive patients with acute coronary syndrome, and the post-HIPAA period included 967 patients. Consent for follow-up declined from 96.4% in the pre-HIPAA period to 34.0% in the post-HIPAA period (P<.01). In general, patients who returned written consent forms during the post-HIPAA period were older, were more likely to be married, and had lower mortality rates at 6 months. Incremental costs for complying with the HIPAA Privacy Rule were $8704.50 for the first year and $4558.50 annually thereafter.
  
  
  CONCLUSIONS
  The HIPAA Privacy Rule significantly decreases the number of patients available for outcomes research and introduces selection bias in data collection for patient registries.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, and the Cardiovascular Center of the University of Michigan Health System, and Health Services Research and Development Center of Excellence, Ann Arbor, USA.
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.forename: Eva
authors.initials: E
authors.lastname: Kline-Rogers
authors.forename: Sandeep M
authors.initials: SM
authors.lastname: Jani
authors.forename: Edward B
authors.initials: EB
authors.lastname: Goldman
authors.forename: Jianming
authors.initials: J
authors.lastname: Fang
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
mesh_terms: D000208:Acute Disease; D000368:Aged; D003219:Confidentiality; D032962:Consent Forms; D003324:Coronary Artery Disease / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis; D003625:Data Collection; D005500:Follow-Up Studies; D020408:Health Insurance Portability and Accountability Act / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D008875:Middle Aged; D018907:Privacy / Q000331:legislation & jurisprudence*; D012042:Registries / Q000592:standards*; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology