Q & A: A Journey in Healthcare Administration

Alumni Spotlight — Journey from Clinician to Administrator: Advancing in Healthcare Administration

Neel Pathak, an MHA graduate, has eight years of progressive management experience in diverse settings, including major health systems, healthcare associations, accrediting organizations, and academic institutions. He is a skilled clinician, an experienced administrator, and a strong advocate of initiatives in process excellence. He also serves as a Baldrige Examiner for state and national levels. His unconventional career path, he says, was shaped by earning his MHA degree at The University of Scranton. Read on to learn how he’s impacted patient care on national and regional levels.

How did you decide on a career in the healthcare field?

I’ve had an interest in the healthcare field since high school. I’m originally from India and I spent a year and a half practicing as a clinician—a physical therapist. Though I loved being a clinician, I had an insider’s look at the management activities of the clinic. That sparked my interest to learn more about the business and delivery of healthcare. That interest motivated me to move to the United States to pursue a program in healthcare administration.

What made you choose The University of Scranton?

It was the combination of having all the right elements in one place. First, I wanted to attend a program that was strong academically and demanded an administrative residency or fellowship so I could gain more first-hand experience in the field. Second, I only looked at CAHME-accredited programs because I knew that meant the rigor, integrity, and quality of my education was ensured. I was able to have a phone interview with the program director, Dr. West, while I was still in India researching schools. He’s also a member of CAHME’s Board of Directors, so I knew I was talking to an extremely knowledgeable professor—and we really connected! I appreciated the personal and student-centric approach. It seemed like the perfect fit.

How did you find your residency/fellowship?

Scranton’s MHA program provided multiple resources early in the program that helped orient me with the residency/fellowship process. Current students in those phases spoke with us about their experiences. We were encouraged to join the American College of Healthcare Executives, which in turn offered seminars and education regarding fellowships. Faculty advisors were familiar with our goals and matched us with appropriate residency and fellowship opportunities. I knew these are very competitive and it was important to me to find the right option to better understand the healthcare delivery system in its entirety, from strategy to operations and front-line management.

Where did you complete your residency?

I was selected for the Aramark Healthcare Administrative Fellowship and placed at OhioHealth, a health system headquartered in Columbus, OH. This was a unique opportunity to get exposure to two different organizations. Aramark sponsored the healthcare fellowship and the selected fellows were paired with a client organization. Aramark’s philosophy “Everything’s Connected” gave us a unique vantage point in understanding the day-to-day operations of a hospital or healthcare system from not just a practice management standpoint, but also from a service and patient-experience standpoint.

They selected five fellows from across the nation, and I was paired with the senior vice president of support services at OhioHealth. While I was there, I worked on projects in eight different hospitals. They included strategy development and planning for a new neuroscience building, quality and process improvement initiatives, physician-practice management projects, and revenue-cycle management initiatives, among others.

Throughout my fieldwork, I was able to attend industry conferences like the American College of Healthcare Executives Leadership Congress, the American Hospital Association’s Leadership Summit, and the National Association of Health Services Executives Conference.

Because of the unique fellowship structure, Aramark was also able to leverage other healthcare clients in their network to offer us unique observation opportunities at leading healthcare organizations like the Children’s Hospital of Philadelphia, MD Anderson Cancer Institute, and Texas Children’s Hospital, among others.

How did you transition from an administrative fellow to a research/program specialist at the American Hospital Association?

I wanted to explore different settings in the healthcare industry and build upon my quality improvement experience. I got an opportunity with the American Hospital Association (AHA) in Chicago—they advocate for 5,000 hospitals and healthcare systems across the country.

I worked on The CUSP: STOP CAUTI project with Health Research and Educational Trust—the research arm of the AHA. The project specifically focused on reducing catheter-associated urinary tract infections across the country.

We had a national team of experts who provided leadership and guidance on content. In addition, we worked with state hospital associations to get their buy-in and assist them in their journey to reduce hospital-acquired infections. We collected, analyzed, and reported the data on a national level to identify trends and assisted individual hospitals through their state’s hospital associations by sharing best practices.

I’m proud to report that we saw a significant reduction in hospital-acquired infections throughout the project, saving millions of lives and millions of dollars.

After the AHA, you took an opportunity with CAHME. What was that experience like?

Right after my time with AHA, an opportunity with the Commission on Accreditation of Healthcare Management Education (CAHME) came along. While I was still a student, I worked with Dr. West on a small project with them. When I saw CAHME had a position open for a director of business and development, I knew it would be a great learning opportunity. And it was! CAHME taught me more about business development and I was proud that they ensure the future generations of healthcare leaders are training appropriately.

During my time at CAHME, we made our business processes more efficient by leveraging the right technologies and moving to a cloud-based environment. By using tools like Box, Salesforce, Office 365, and Constant Contact, we improved our day-to-day processes and provided better value for our programs.

This experience of improving quality on a national scale taught me a lot about teamwork and further fueled my passion for quality and process improvement. I launched a signature program—the CAHME Awards—which recognizes organizations that are going above and beyond meeting accreditation standards and are doing exceptionally well. The awards program is very successful and is sponsored by leading healthcare organizations like Modern Healthcare, Ascension, Cerner, Canon, and Baylor Scott & White Health.

The University of Scranton just won the CAHME CANON Award. Is that part of this project you worked on?

Yes! The full name of the award is Canon Solutions America Award for Sustainability in Healthcare Management Education and Practice. As its name suggests, the award serves to incorporate the ideals of sustainability in future healthcare leaders. It recognizes the significant influence of education programs in creating sustainable, inclusive, and socially responsible healthcare organizations. I’m very glad that Scranton won that award!

What do you do in your current role in Ambulatory Services Administration at the Johns Hopkins Hospital?

We have a state‐of‐the‐art outpatient center with over 60 clinics, providing 20 ancillary services, and serving about 650,000 patient visits annually. I’m a project administrator in the Ambulatory Services department. My role is to serve as an internal change-management consultant by planning, directing, and implementing projects to improve quality, operations, efficiency, access, delivery, and experience of care for ambulatory patients. We use innovative technologies and business-intelligence tools with Epic and Tableau to make data-driven decisions.

After my time with CAHME, I wanted to explore the ambulatory and practice management setting further. This opportunity with Johns Hopkins, which has been ranked the number one hospital in the country for more than 20 straight years, has been a dream come true in experience and learning.

Are there any projects that stand out in your experiences in ambulatory services administration?

I serve as the Patient Experience Lead for Ambulatory Services. At Johns Hopkins, we have a really strong focus on providing the best possible care in the best possible place. It is challenging to provide that seamless experience in a complex academic medical center environment.

We created an executive council to set goals and provide leadership and mentorship for all aspects of patient experience. We also created a coordinating committee—the working arm that digs deep into the patient-experience data points: Current processes and challenges, workflows, and sharing of best practices to improve care delivery and experience. We look at our scores and compare them to national benchmarks to see what’s working and what we can do to deliver a better experience.

We discuss these results with our clinical care teams to find opportunities for improvement together. We have gained a lot of traction on this and our clinics are highly engaged in this journey. I’m very proud of that.

It sounds like a lot of data and analytics go into your role. Was that something you learned in Scranton’s MHA program? Or is it more on-the-job learning?

There was a lot of emphasis on data in the program, beyond just understanding the foundation of data and finances. We focused on evidence-based decision-making in the MHA program. That being said, I think there are always skills and nuances you have to learn on the job. I’m a graduate of the Leadership and Excellence in Analytics and Data Science (LEADS) program at Johns Hopkins, which focuses on teaching professionals how to use data in their decision-making.

Congratulations on your appointment to the Baldrige Board of Examiners! How did you become involved with the Board?

I was first introduced to the Baldrige criteria while at the AHA. I talked to a few members who completed the examiner training and studied the Baldrige approach and criteria. What I liked about their approach is that it’s not prescriptive and not built for a specific health system with exactly 200 beds. It’s for anyone looking to improve their performance: A hospital, nonprofit, city, or small business. The Baldrige criteria can adapt to these unique situations.

I was selected for the state examiner role after my training opportunity. A few years later, I applied for the national level and became the national examiner.

I review applications for the Baldrige award—a prestigious presidential award that demands a very rigorous process. Baldrige is administered by the National Institute of Standards and Technology from the U.S. Department of Commerce. The Baldrige criteria encourages applicants to think about their processes and the results from an organizational viewpoint. This, in turn, stimulates conversations about improvement strategies.

How long do you serve as examiner?

The Baldrige examiner term is for one year. You need to reapply again to serve on the Board and go through the training.

You’ve had many high-level positions. Do you think your clinical background helped you get to where you are today?

Yes, it certainly helped! My clinical background coupled with administrative experiences helps me better understand operational issues. It leads to a better vantage point in decision-making. When I was treating patients, I made one-on-one decisions regarding their care. Now the decisions I make affect patients on a larger scale. I have to be mindful of that fact and ensure each decision I make is ultimately patient-centric.

What advice would you give someone looking to move up in the healthcare field, even without that clinical background?

First, you can still succeed in this field without having a clinical background. What you must have top of mind at all times is a focus on quality patient care. With that, you can achieve your goals.

My second piece of advice to anyone looking to advance in healthcare is don’t limit yourself. Take advantage of how broad and diverse the healthcare field is to understand the levels of patient care in multiple settings. There are hospitals, outpatient settings, nursing homes, insurance companies, retail clinics—the opportunities are endless, so branch out.

You’re now involved with current students as a mentor. How did that come about?

I remember when mentors helped shape and guide my decisions as a student. I want to ensure our current students have that same opportunity, and so I serve as an external/alumni mentor for many students in the Scranton MHA program.

We also created The University of Scranton MHA Alumni Society. I serve as one of the board officers and make sure we give back to the Scranton MHA program in as many ways as we can. We meet on a monthly basis and talk through how to improve relationships with current students and re-engage past alumni to better the program.


Learn more about the MHA program here.

 

Do you think you know the Top Health Informatics Career Paths?

Professionals in “health informatics,” a rapidly growing field that involves collecting and analyzing health care data, are blazing a new path in an area where computers and care providers work together.

While informatics in medicine is increasing the usefulness of patient data, a federal mandate for “meaningful use” of digitized patient records plus financial incentives for creating and maintaining electronic health records are putting pressure on even the smallest clinics to use computers to improve care. As a result, job opportunities in the health informatics field are increasing.

Careers in health informatics vary depending on the size of the employer and what types of health data they manage. Most jobs involve gathering data and analyzing them, designing workflows, measuring impact, educating and training end users, managing a system or acting as a liaison between users and coders.

If you have a background in health or information technology, a Master of Science in Health Informatics degree, such as the one offered online at The University of Scranton, can be your introduction to a field where you can help others without having to learn to code.

Here are some of the opportunities graduates might have when they enter the workforce.

Clinical informaticist

This career can be applied to a range of responsibilities. In smaller settings, such as a doctor’s office or a small medical practice, a clinical informaticist might be responsible for organizing and managing patient data; making the information available to health care providers, staff, and patients; educating the end users in the current systems; optimizing information technology (IT) use; and receiving feedback and requests from users. In a large organization such as a network of hospitals, those duties might be split up among multiple informaticists.

Pharmacy or nutrition informaticist

On a smaller scale, informatics is useful when using patient and prescription data to make medication safer and more efficient. Pharmacy informaticists use data to monitor dosing and adverse reactions and ensure more accurate and detailed prescriptions from physicians to improve patients’ results.

Similarly, nutrition informaticists use patient data to make more informed decisions about food planning, whether the goal is to reduce allergic reactions, or improve a treatment plan.

Informatics analyst

The informaticist’s job can involve a lot of face-to-face education and problem solving; the analyst’s job is focused on working with data. A health informatics analyst studies data and develops models of events and concepts that can provide answers to clinical questions. Some analysts also collect data or support the collection and systems used to manage the data. What is analyzed — from study design to insurance claims, patient readmission, and education outcomes — depends on the employer.

Nurse informaticist

The intersection between informatics and nursing is particularly rich in job opportunities. Nurse informaticists are liaisons between nurses and developers. They study workflows to help developers build tools that nurses can use. They relay concerns and limitations to find solutions that work for both the programmers and the users. They design systems and build functions that allow nurses to make the best use of data.

Informatics specialist

Informatics specialists often work with an organization’s leadership on directives, quality initiatives, and governance to ensure IT systems that collect, manage, and secure data are working for the group. If a hospital chief executive officer wants to reduce patient readmissions and post-surgical infections, the informatics specialist is responsible for defining progress toward those goals and for identifying and testing solutions with data. The solutions may not necessarily involve developing an application or improving a computer system, but usually, the outcomes are measured and monitored with data.

Informatics manager

The informatics manager is responsible for making sure systems are working when they are needed. They facilitate access to data, check that collected data are accurate and ensure all the information is in compliance with federal and state guidelines. A clinical informatics manager might oversee these tasks for an entire hospital or medical practice.

Informatics director

If you already have IT or hospital administration experience, being a director of informatics for a healthcare organization is the most lucrative job on the list. Responsibilities include promoting informatics systems within an organization, making those systems work for the organization, gauging feedback and staying up to date with the best tools available for your organization’s goals.


Learn more about a degree in Health Informatics from The University of Scranton.

What is “The Scranton Domino Effect”? Alumni Unite for a Common Mission.

Marie Yezzo ’01 calls it “the Scranton domino effect.”

As the vice president for professional support services at WMC-Health, a health care network in the Hudson Valley in New York that serves more than 3.5 million patients, she started hosting graduate students in Scranton’s Master of Health Administration program for their residency training five years ago. And she witnessed one Scranton graduate after another impress the hospital staff and go on to earn a full-time job in departments across the health system.

A few have moved on to other hospitals, but five of those Royals remain: Jack Burtis ’15, G’18, Brittany Drake-Koo G’11, Sahar Malek ’10, G’12, Robert Patella G’17 and Connor Shanahan ’15, G’16, all working alongside Yezzo and Elissa Chessari ’02, who is the vice president of operations for Westchester Medical Center, the network’s flagship hospital. These are just seven of the Scranton alumni at WMCHealth using their Jesuit education to make an impact in health care.

The Mission

For Chessari, the mission of WMCHealth resonates with her values and harks back to her years at Scranton.

“Our mission statement at Westchester Medical Center is to provide the highest quality of care, regardless of ability to pay, and that is what initially drew me (here),” she said. “I suspect that this mission is what attracts and retains so many other Scranton alums.”

Yezzo credits the strong network among Scranton health care administration alumni for bringing each of these graduates to WMCHealth. A biology major with a minor in business while she was an undergraduate at Scranton, Yezzo sees similarities in how both she and her colleagues from Scranton’s MHA program approach their day-to-day work.

“We didn’t all go to school (at Scranton) at the same time or even cross paths until we started working at Westchester Medical Center. I’m not sure if it was coincidence or divine intervention,” she said.

“We use our Scranton educations to treat others, both co-workers and patients, as we would want to be treated. Seeing our impact is the best part. Some of us have been with the organization for more than 10 years. We have been part of major construction projects, programmatic development and various initiatives from design to completion.”

Essential Indirect Care

Although, as administrators, the alumni are not providing direct patient care, each is impacting the lives of patients.

“While most on my team are not involved in direct patient care, we support the bedside care providers,” Chessari said. “We work hard to find enhancements to operational efficiency and improvements in processes and business initiatives, which translates into better patient care and better outcomes.”

Patella works as a financial analyst at Bon Secours Charity Health System, a group of three hospitals that are part of WMCHealth.

“I am helping the organization to reduce labor expenses, manage valuable resources and improve departmental performance,” said Patella, a 2017 MHA graduate. “At Scranton, I learned a lot about time management, personal brand management and managing conflict within a team, which I use in my day-to-day work.”

Burtis helps make decisions that lead to better patient outcomes in his role as a revenue integrity analyst. He earned his MHA from Scranton in 2018, after completing his undergraduate degree in 2015.

“I work alongside our revenue cycle team to improve processes and develop tools to help ensure accurate billing for services provided by our network’s physician group,” he said. “I love the challenge and the novelty of my work. No two days are the same in health care. There are always new challenges that really require you to think and problem-solve on your own.”

Similarly, Shanahan relishes the fast-paced environment in his job as the manager of the outpatient department clinics and AIDS care center.

“Health care is a growing industry, and the connections I made at Scranton allowed me to not only understand the potential opportunity in the field, but also allowed me to capitalize on starting a career in such a fast-paced industry at a great place like Westchester Medical Center,” he said. “Working with the many groups and departments within Westchester Medical Center on a daily basis can be challenging, because everyone has different desires and needs. But remembering that we are all working toward the same goal — providing the best possible patient experience — helps us work together to get the job done.”

The WMCHealth network also employs numerous Scranton graduates from the nursing programs, in addition to these health administration alumni. And their colleagues say the Scranton graduates stand out in their contributions to the health system.

“There is a learning curve for anyone who joins a network of the size and complexity of the WMCHealth,” said Anthony Costello, the senior vice president of professional and support services and the supervisor of many of the Scranton MHA alumni. “We’ve often found degree holders from The University of Scranton well prepared to handle the ever-evolving dynamics of a regional health care provider.”

The Network

As Yezzo pointed out, these Scranton alumni are ready to tackle the challenges in the health care field not only because of their rigorous Jesuit education in health administration but also because of the strength and support of the Scranton network. The Health Administration Alumni Council is a major part of that network.

Active since 2014, the Health Administration Alumni Council has built a thriving mentorship program between alumni and current students while celebrating the professional achievements of its alumni, both informally and with the annual Daniel J. West Award for early career success.

Alumni engage in a LinkedIn group and meet annually at the American College of Healthcare Executives (ACHE) Congress on Health Care Leadership in Chicago. The council is also involved in planning the Annual Healthcare Symposium on campus in Scranton.

Jonathan Forte ’07, G’09, the vice president of the Health Administration Alumni Council, emphasized how much the alumni council wants to support current students. “Every job that I’ve ever received is a result of some connection that I’ve made as a result of networking or mentorship, and all of that started for me as a student at The University of Scranton — relying on the professional network of my professors and guest speakers and people who felt it important enough to come in and speak and spend their time with current students,” said Forte, who will start a new job in September as senior vice president and chief operating officer of the Choptank Community Health System on the Eastern Shore of Maryland.

Forte said it’s important to share the knowledge these practitioners gain from being in the real world with students, both in Scranton’s undergraduate and graduate programs.

“We want students to have a sense of what being a hospital administrator looks like in today’s health care environment and of applying our Ignatian values learned on campus in health care management,” he said. “This is our opportunity to pay it forward and give back.”


Learn more about the MHA program.

This story was originally published in The Scranton Journal.

Why Our MHA Program Stands Out

Administrative Residency

As part of the MHA curriculum, students have the opportunity to complete a 1,000-hour fieldwork experience in a senior management position. Normally involves exposure to all major operating functions and contacts with department heads, administrative staff, and medical staff. Includes exposure to governing-board functions, governmental forces, and community influences. The resident is assigned projects of increasing complexity and importance and is expected to have an assigned preceptor. A major project is required. The residency is usually completed during two semesters. Prerequisite, 36 core credits completed.

Learn more here.

 

MHA Alumni Council

Mission:

The mission of the Council is to encourage professional development, engage alumni to remain connected to the University, and recommend improvements to advance the University of Scranton’s Health Administration Programs.

Vision:

To advance the Health Administration Program by following St. Ignatius’ spiritual vision and tradition of excellence, while developing an alumni community dedicated to the freedom of inquiry and personal development fundamental to growth in wisdom and integrity of all healthcare professionals.

Learn more here.

Student ACHE Chapter

Mission

Scranton’s ACHE Student Chapter is an independent organization serving the graduate student’s within The University of Scranton’s Health Administration Master’s program.  Our mission is to meet the student’s needs for professional development, leadership growth, and educational advancement; to promote involvement with ACHE, and to sustain and improve the continued excellence of the graduate program.

Vision

To be the premier source for outstanding health administrators and committed to professional development, continuing education, and improving the healthcare industry.

Learn more here.

Study Abroad Opportunities

Since 1995, the Department and MHA Program have developed international partnerships in Central and Eastern Europe and Asia. International faculty give guest lectures in classes, and students are encouraged to expand their global awareness and life experiences with other cultures. Specific coursework in the curriculum offers additional opportunities for students to study and engage in international activities. The MHA program provides graduate students with the option of taking a 3 credit elective course, HAD 517: Global Health Management, a 10-day study abroad experience. Currently, students have the option to travel to Eastern Europe or Brazil. The trip to Eastern Europe runs twice annually in late May and in early October. The study abroad to Brazil runs once in January during intersession.

Learn more here.


Visit the MHA Webpage here!

What’s the Deal with HIPAA?

Data breaches in health care organizations placing patient information at risk are increasingly common and have an estimated cost of over $2.2 million per occurrence.1In an effort to combat digital information from slipping through the cracks, the federal government crafted the Health Insurance Portability and Accountability Act of 1996 (HIPAA)2  to protect patient privacy through enforcement of how health care organizations use, store and disclose information.

For health and human services students committed to comprehensive quality in patient care, health and safety, it’s important to understand the purpose of HIPAA laws and how they affect the operations of organizations. Qualified professionals, who have a clear understanding of the HIPPA privacy laws, are vital to improving HIPAA workflows and mitigating risks of data breaches.

The Basics of HIPAA

Patients have often encountered HIPAA whether they realize it or not; when they go to their health care provider’s office prior to an appointment and fill out their health history, they’ll be asked to read and sign several pages of forms. These forms may include HIPAA paperwork that outlines how their information may be shared within the organization.

HIPAA regulations include the Privacy Rule3 and the Security Rule.4 The Privacy Rule establishes protections  that set parameters on how providers use patient information and who they share it with. This rule also enables patients to request health record copies or make corrections to them in case of errors. The Security Rule outlines actual procedures on how to safeguard patient information. Procedures may include details on how or where information can be housed as well technological specifications for software protection.

Health care providers such as physicians, registered nurses, emergency medical technicians, and patient care coordinators must abide by HIPAA regulations2 to ensure quality patient care and privacy. Health plans and third party organizations that process patient health information are also bound to compliance.

HIPAA’s Influence on the Health Care Industry

HIPAA regulations create a unique ripple effect in health care and public health. These federal rules are in place to harmonize privacy with access to quality care; the regulations protect patient privacy, but sharing information between providers from different organizations requires increased coordination with patients and facilities to ensure consent. For clinicians, students, scientists and other professionals involved in health care, research is vital as a cornerstone to improving patient care outcomes and the effective use of technology.

HIPAA’s impact on research can present obstacles to participant recruitment, diversity in study participants, access to data and the completion of studies. These challenges may directly increase the amount of funding needed for research.5

In many cases, HIPAA can work to directly benefit the workplace by boosting the responsibility and transparency of health information management. Digital paper trails can determine who views patient records, tracks changes, or updates information.

HIPAA also enhances integrity of a health care facility’s business practices by enforcing data access restrictions, which limits liability. Strong password enforcement is another key feature of HIPAA’s security measures, which can cut back on sensitive data access from inside and outside of a health care organization.

Regulations require the implementation of data backup strategies and malware protection parameters. Cyber breaches cost the industry up to $6.2 billion in losses, 1 so protection augmented by HIPAA can reduce a facility’s overall cost of operation, and prevent loss or tampering of patient records.

HIPAA’s physical security requirements, which include details regarding camera surveillance, securely locked doors, identification badges and power loss contingency help organizations implement the extra layers of protection they need to ward off data breaches.

The Role of HIPAA for Health Informatics Jobs

While the HIPPA privacy rules protect sensitive information regarding patient health and care, rules do permit certain authorities to disclose protected information without authorization to protect the health of individuals and populations.6 Examples of situations where disclosing information may be critical include child abuse or neglect, persons at risk of contracting or spreading disease and medical surveillance related to workplace injuries.

Cultivate Solutions for the Health of Your Community with an Online MSHI Degree

The University of Scranton’s Master of Science in Health Informatics (MSHI) program offers a curriculum developed to teach students the skills to protect the health of individuals and communities through prevention and health education. The online MSHI program offers a flexible class schedule to accommodate working professionals who demonstrate leadership skills and to wish to advance their education and career.

Learn more about Health Informatics at The University of Scranton.


1 Ponemon Institute. (2016). The sixth annual benchmark study on privacy & security of health care data. Retrieved from http://www.cahiim.org/hi/aparprocess.html
2 U. S. Department of Health & Human Services. (n. d.). Health information privacy. Retrieved from http://www.hhs.gov/hipaa/index.html
3 U. S. Department of Health & Human Services. (n.d.). The HIPAA Privacy Rule. Retrieved from http://www.hhs.gov/hipaa/for-professionals/privacy/index.html
4 U. S. Department of Health & Human Services. (n.d.). The Security Rule. Retrieved from http://www.hhs.gov/hipaa/for-professionals/security/index.html
5 U.S. Dept. of Health & Human Services National Institutes of Health. (2007). Clinical Research and the HIPAA Privacy Rule. Retrieved from https://privacyruleandresearch.nih.gov/clin_research.asp
6 U. S. Department of Health and Human Services. (n. d.). Public health. Retrieved from http://www.hhs.gov/hipaa/for-professionals/special-topics/public-health/index.html