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Readability Analysis of HIPAA Privacy Notices. Donna Silsbee, Ph.D., RHIA, CTR, CCS SUNY Institute of Technology. Research Partners. Janice Welker, Ph.D. Health Services Management Program Kimberly Jarrell, Ph.D. Marketing Program. Motivation for Research.

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Readability Analysis of HIPAA Privacy Notices

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Readability analysis of hipaa privacy notices

Readability Analysis of HIPAA Privacy Notices

Donna Silsbee, Ph.D., RHIA, CTR, CCS

SUNY Institute of Technology

Research partners

Research Partners

  • Janice Welker, Ph.D.

    • Health Services Management Program

  • Kimberly Jarrell, Ph.D.

    • Marketing Program

Motivation for research

Motivation for Research

  • Do Consumers Read and Understand Insurance Disclosures?

    • Brenda J. Cude, University of Georgia

    • 2006 Marketing and Public Policy Conference Proceedings

Objectives for today

Objectives for Today

  • At the end of the presentation, the participants will know:

    • Research questions

    • Some of the pertinent literature

    • Methodology used

    • Preliminary findings

    • Limitations of the research

    • Future Plans

Research questions

Research Questions

  • How many hospitals comply with the requirement to post the notice on their web sites?

  • What is the readability of the posted notices?

Literature review

Literature Review

  • National Council for Educational Statistics:

    • 43% read below GED prep level

    • White and McCloskey (2006)

Literature review1

Literature Review

  • Plain Language Principles and Thesaurus for Making HIPAA Privacy Notices More Readable

    • HRSA

    • 9th grade level – recommended

      • American general public

      • Older Americans would be lower


Literature review2

Literature Review

  • Matthews and Sewell (2002)

    • Some states require lower levels on consumer materials:

      • Minnesota: 7th

      • Alabama: 6th

      • Nebraska: 4th

Literature review3

Literature Review

  • Hochhauser (2003)

    • 31 notices

    • 2cd to 4th year college level

  • Walfish & Watkins (2005)

    • 40 academic medical center notices

    • 65% beyond 12th grade

Literature review4

Literature Review

  • Collins, Novotny and Light (2006)

    • 51 research authorizations

    • High school or above reading level

  • Paasche-Orlow, Jacob, and Powell (2005)

    • 115 Best Hospitals in America

    • Average grade level 12.3

Literature review5

Literature Review

  • AMIA/AHIMA Joint Position Statement on Health Information Confidentiality

    • Use of clear language

    • Journal of AHIMA (December 2006)

Literature review6

Literature Review

  • “What did the doctor say?:” Improving Health Literacy to Protect Patient Safety

    • Joint Commission (2007)

    • Use plain language

    • Address community served



  • Initial sample:

    • 4 randomly selected hospitals from

      • Each state

      • District of Columbia

    • 1 hospital volunteered by COP member

    • Total = 205 hospitals

Two readability tests used

Flesh Reading Ease Test:

Microsoft Office 2003

Two readability tests used:













Two readability tests used1

Two readability tests used:

  • Flesh-Kincaid Grade Level Formula

    • Corel Word Perfect X3

    • Grades 13-16 = college level

Preliminary findings

Preliminary Findings

Preliminary findings1

Preliminary Findings

Preliminary findings2

Preliminary Findings

Figure 3: Distribution of hospitals by type

Preliminary findings3

Preliminary Findings

Preliminary findings4

Preliminary Findings

Preliminary findings5

Preliminary Findings:

HRSA Recommendation

Limitations of research

Limitations of Research

  • Only used notices posted on the web

  • Only used English-language notices

  • Some disagreement about value of readability tests

Future plans

Future Plans

  • Increase the sample size

  • Use purposeful sampling to develop a sample that more closely matches the general population of hospitals

Reference list

Reference List

  • Collins, N., Novotny, N. and Light, A. (2006) A cross-section of readability of health information portability and accountability act authorizations required with health care research. Journal of Allied Health 35:4, p. 223-225.

  • Hochhauser, Mark. Why patients won't understand their HIPAA privacy notices. (retrieved January 17, 2007)

  • Matthews, Trudi and Sewell, Jenny. State Official's Guide to Health Literacy. The Council of State Governments, 2002. (retrieved January 18, 2007)

  • Paasche-Orlow, M., Jacob, D. and Powell, J. (2005) Notices of privacy practices: a survey of the health insurance and portability act of 1996 documents presented to patients as US hospitals. Medical Care 43:6 p. 558.

  • Walfish, Steven and Watkins, Keely. Readability level of health information portability and accountability act notice of privacy practices utilized by academic medical centers. Evaluation and the Health Professions, Vol 28, No. 4, 479-486.

  • White, S., and McCloskey, M. (forthcoming). Framework for the 2003 National Assessment of AdultLiteracy (NCES 2006-473). U.S. Department of Education. Washington, DC: National Center for Education Statistics.

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