Emergency Medical Evaluation of Dangerousness
eMed International Inc®
Suicidal and Homicidal Assessments
In developing this statement, eMed Colorado™ obtained input from the National Institutes of Mental Health (NIMH), Joint Commission on the Accreditation of Hospitals (JCAHO), and individuals with expertise in clinical research with persons at high risk of suicidality, bioethics, and lethal issues pertaining to liability risks. This statement is not intended to be exhaustive with regard to ethical, legal, or safety issues.
Suicide is a complex and complicated family of behaviors. The goal of suicide risk assessment is systematic evaluation of statistically relevant risk factors that informs treatment. The standard of care is not prediction with mathematical certainty, but rather reasonable foreseeability of dangerous behavior. Courts typically recognize that prediction of suicide is fraught with uncertainty. However, an acceptable standard of care requires initial and periodic evaluation of suicide potential for all outpatients in clinical practice. In contrast, hospitals and institutions appear to be held to a higher standard of care since they are assumed to have greater control over the patient environment.
Emergency room and primary care physicians, as well as other mental health practitioners are responsible for assessing suicide risk as a core competency. That is, an incomplete risk assessment, well documented, is inadequate. Similarly, a complete risk assessment, incompletely documented, is still incomplete. eMed Colorado™ assessments strive to identify evidenced-based factors from the best available external research, some of which are unobvious or unconventional. Nevertheless, the wide diversity of general and individual risk factors cannot be identified in a single assessment.
These instruments are measured by reliable and valid self-report and interview rated examinations possessing psychometric properties. The quality of eMed Colorado™ assessment data gathered needs to be monitored and evaluated in a timely manner by appropriately trained and supervised personnel. However, while empirically validated instruments can aid in the judgment of risk status, the decision to shift into risk management protocol, that is, criteria for emergency coverage, additional consultation, and hospitalization is best left to clinical judgment.
eMed Colorado™ assessments are not intended to diagnose, treat, prevent, or cure patients at risk for suicide. eMed Colorado™ assessments are not proposed as “stand-alone” measures or a substitute for integrated clinical assessment. Therefore, beyond screening, the next level of risk evaluation should include systematic recording of clinicians’ concerns and prompting of further consultation.
eMed Colorado™ assessments are in accordance with applicable professional emergency psychiatry mental health standards, Expert and Consensus Statements of the Suicide Prevention Resource Center, American Foundation for Suicide Prevention, NIMH, and JCAHO for their intended purposes. eMed Colorado™ is not responsible for any damages incurred in connection with a test, their use or misuse, scoring or other services connected to test administration.
The position of eMed Colorado™ on whether our test materials must be disclosed to patients in order to comply with the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) is summarized below. Please take a minute to read this statement carefully.
The wide spread dissemination of test materials (which may disclose test items and answers) would render test instruments invalid and therefore useless to the professional community and the general public. eMedColorado™ test instruments are trade secrets and protected by intellectual property laws including copyright and trade secret laws, and their usefulness and value would be greatly compromised if they were generally available to the public.
The U.S. Department of Health and Human Services (HHS), which is responsible for HIPAA, provided clarification related to this matter. This clarification is stated in an explicit exception in the HIPAA1 statute that exempts trade secrets from disclosure (see Social Security Act § 1172(e) (codified at 42 U.S.C. § 1320d-1(e)).
“Any requirement for disclosure of protected health information pursuant to the
Privacy Rule is subject to section 1172(e) of HIPAA ‘protection of trade secrets’.
As such, we confirm that it would not be a violation of the Privacy Rule for a
covered entity to refrain from providing access to an individual’s protected health
information, to the extent that doing so would result in a disclosure of trade secrets.”
ACUTE™/VISTA™/ACTA™ software and Rating Forms and Interpretive reports are exempt from disclosure as trade secrets. Test booklets, manuals, user guides, wall charts, scoring keys and templates are exempt from disclosure because they are not Personal Health Information (PHI) or individually identifiable health information. Nevertheless, some patients may be entitled to inspect and/or copy portions of PHI such as their bubble answer sheet (without question text). The HIPAA regulations allow a covered entity to provide an individual with summary information rather than underlying file documents but only if the patient agrees in advance to receive such a summary.
As the HHS has now confirmed, as long as test items (which may be included in record forms) are trade secrets, such information is not required to be disclosed under HIPAA. Thus, the position of eMed Colorado™, given the guidance from HHS, is that Customers may not disseminate copies of test record,test booklets, manuals, user guides, wall charts, scoring keys and templates, forms or protocols that disclose items to persons who request copies under HIPAA’sPrivacy Rule in that the test materials are copyrighted and constitute trade secrets.
eMed Colorado™ respects your privacy. The information that you provide will not be rented or sold. Information provided will be used for internal purposes, such as subscription and registration; analyzing preferences, and statistics; and informing you of new products and services. However, we may work with outside entities to: (1) manage our database; (2) assist with data collection; (3) provide data storage and analysis; (4) provide fraud protection (5) perform other services designed to maximize accurate dissemination of information. eMed Colorado™ requires that these outside entities agree to keep confidential all information and to use the information only to perform duties specified in our agreements with them.