Scientific papers–American Do not roll the videotape: effects of the health insurance portability and accountability act and the law on trauma videotaping practices Shannelle Campbell, M.D., M.P.H. a , Julie Ann Sosa, M.A., M.D. a , Reuven Rabinovici, M.D., F.A.C.S. a , Heidi Frankel, M.D., F.A.C.S. b, * a Department of Surgery, Yale University School of Medicine, New Haven, CT, USA b UT Southwestern Medical Center, Division of Burn, Trauma, Critical Care, 5323 Harry Hines Blvd. E 5-514, Dallas, TX 75390, USA Manuscript received April 12, 2005; revised manuscript July 29, 2005 Presented at the 18th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January 10 –15, 2005 Abstract Background: We hypothesized that trauma video practices would be affected as a result of Health Insurance Portability and Accountabilty Act (HIPAA) enactment. Methods: A survey was distributed electronically to coordinators and/or directors of level 1 trauma centers. Centers were queried on demographics, trauma video use, and reasons for changes, if any, in their video practice patterns. Descriptive statistics and chi-square analysis were employed. Results: Survey response rate was 75%. Prior to HIPAA, 58% of responding trauma centers used video compared to 18% now. On a Likert scale of 1–5, video analysis rated 3.80. For those using video currently, the most common purposes are education (91%) and quality assurance (83%). HIPAA has affected the way video is used at one third of these centers. Ten percent receive institutional review board approval for videotaping, 35% get patient consent, and more than half report capturing a poor patient outcome on tape. The most commonly cited reasons for stopping video use were HIPAA and legal concerns about patient privacy, consent, and discoverability (79%). Scarce resources were, in part, to blame at 70% of centers, while video technology was found to be ineffective at only 32%. Conclusions: A minority of level I trauma centers currently use video, although it is effective according to users. HIPAA and medicolegal concerns have affected its use at some centers and contributed to its abandonment at others. © 2006 Excerpta Medica Inc. All rights reserved. Keywords: HIPAA; Medicolegal; Video recording; Videotaping; Performance improvement; Level I trauma center Video analysis of trauma resuscitations can be a valuable educational and performance improvement tool. Video has been used to examine compliance with the use of universal precautions, general resuscitation algorithms, identification of the command physician, success of en- dotracheal intubation, and quality of patient-family-nurse interactions among others [1–10]. Invariably, these stud- ies, documenting 15 years of experience in analyzing trauma resuscitations, underscore the value of videotap- ing in teaching and quality assurance [11–14]. There have been growing concerns regarding the most effective use of video analysis in the trauma setting, particularly in “mature” centers with long-established care algorithms. In 1999, Ellis et al conducted a survey of videotaping practices in trauma centers of the 10 most densely populated states to address these issues [15]. The authors concluded that resource constraints more than medicolegal concerns impeded implementation and con- tinuation of a videotaping program. Still, approximately one third of trauma centers surveyed used video analysis. However, in the interim, hospitals have been mandated to address issues of patient confidentiality with the enforce- ment of the Health Insurance Portability and Account- abilty Act (HIPAA) of 1996 and with growing medico- * Corresponding author. Tel.: +1-214-648-5469; fax: +1-214-648-2213. E-mail address: heidi.frankel@utsouthwestern.edu The American Journal of Surgery 191 (2006) 183–190 0002-9610/06/$ – see front matter © 2006 Excerpta Medica Inc. All rights reserved. doi:10.1016/j.amjsurg.2005.07.033