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In the world of healthcare, confidentiality is key. But with the advancement of technology, it’s much easier to share patient information among healthcare professionals. So, how do we ensure that people’s private health information is kept confidential and secure at the same time? Well, in the U.S., this concern has been addressed by a group of federal laws known as “HIPAA,” or the Health Insurance Portability and Accountability Act of 1996.
Everyone who works in healthcare-related fields should have a practical understanding of HIPAA regulations and how HIPAA affects them. HIPAA established three rules for safeguarding the privacy and security of patients’ medical information: the Privacy Rule, Security Rule, and Enforcement Rule. The Privacy Rule gives patients specific rights regarding their health information and regulates who else can have access to this information. The Security Rule established standards for safeguarding this information when it is transmitted or stored in electronic form. Finally, the Enforcement Rule set up procedures for investigating potential violations of HIPAA regulations and established penalties to help enforce compliance.
HIPAA was followed by two other acts related to the privacy and security of health information: the Genetic Information Nondiscrimination Act (GINA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). The latter updated the penalties for violating HIPAA requirements and extended the reach of HIPAA requirements. In 2013, a final “omnibus rule” officially integrated GINA and HITECH with HIPAA, creating the final health information regulations that are in force today.
So, what exactly is “protected health information” (PHI)? PHI is any data about a person’s health, healthcare, or payment for their healthcare that is created or collected by a healthcare provider, health plan, or “healthcare clearing house,” their business associates, and subcontractors, and identifies the person or could be used to identify the person that it relates to. This can include things such as physicians’ notes, healthcare billing information, blood test results, doctors’ telephone records, MRI scans, and appointment scheduling notes, and can be in any form, oral, recorded, written down on paper, stored on a computer, or on the internet. PHI that is stored or transmitted in electronic form is sometimes referred to as “EPHI,” but whatever term is used, the “P” stands for “protected”!
HIPAA groups the organizations and people that are responsible for protecting health information into three categories: covered entities, business associates, and subcontractors. Covered entities are healthcare providers that transmit health information in connection with certain types of administrative and financial transactions electronically, including doctors, clinics, psychologists, dentists, nursing homes, and pharmacies. Covered entities can also be health plans, such as health insurance companies, HMOs, or government programs that pay for healthcare, as well as military and veterans’ programs. A healthcare clearinghouse can also be a covered entity. Business associates are people or businesses that have access to PHI as a result of working with or providing services to a covered entity. Subcontractors are people or businesses who have access to PHI while they are working with or providing services to a business associate.
Patients have specific rights regarding their protected health information. Covered entities are required to provide patients with a “Notice of Privacy Practices” (NPP) that outlines the entity’s policies regarding the use and disclosure of a patient’s PHI. The NPP must be given to patients on the first day they are provided with a service or as soon as possible following an emergency. Under HIPAA, patients have the right to inspect, correct, and request that changes be made to their PHI. They may also request that their PHI be communicated to them by other means and at alternate locations to protect confidentiality. Patients can also restrict disclosure of their PHI to a health plan or the plan’s business associates if the person has already paid for the treatment themselves.
It is important to note that healthcare providers need access to PHI to provide quality care to a patient, which means patients cannot restrict the disclosure of their PHI for purposes of medical treatment. However, patients can restrict the disclosure of their PHI to a health plan or the plan’s business associates if they have already paid for the treatment themselves.
HIPAA also enforces the “minimum necessary” standard, which restricts how much patient PHI can be used or disclosed. This standard requires that any PHI that is not strictly necessary to “get the job done” will not be used by a covered entity or disclosed to a business associate or subcontractor.
There are several situations where minimum PHI may be used or disclosed without patient authorization, including day-to-day healthcare operations and when a health plan is making payment for services that a patient has received. The minimum necessary PHI may also be shared without patient permission or authorization when it’s in the interest of public health, to control or prevent disease, for health oversight activities, to monitor FDA-regulated products, to comply with a HIPAA investigation, and for certain law enforcement purposes.
When a covered entity wishes to use or disclose an individual’s PHI for marketing purposes, they must first obtain the individual’s signed authorization. However, marketing communication does not require a patient’s authorization when it is made in the form of a face-to-face communication or a gift of nominal value given to the patient by the covered entity.
HIPAA’s Security Rule deals with protecting the confidentiality and integrity of PHI when it is in electronic form (known as EPHI). The rule is intended to prevent EPHI from being accessed by unauthorized persons or otherwise tampered with. To accomplish this, the Security Rule requires the use of administrative, technical, and physical safeguards on the part of entities that have custody of this information.
Administrative safeguards are policies and procedures that limit access to EPHI and include systems that detect, correct, and prevent security breaches, incident policies that describe how to respond to a breach if one occurs, ongoing audits and evaluations to ensure compliance with HIPAA regulations, and contingency plans for protecting EPHI during emergencies and natural disasters.
Technical safeguards protect the data storage and transmission systems that handle EPHI from inside computer systems and networks. They include monitoring and anti-virus software, encryption and digital signatures, and alarms regarding suspicious activity. Physical safeguards work from the outside and restrict access to computers and other high-tech equipment that stores and transmits EPHI, as well as the rooms and buildings that house the equipment.
When impermissible access, acquisition, use, or disclosure of PHI occurs in spite of these measures, that violation is called a “breach.” If a breach is suspected, HIPAA presumes that one has actually occurred unless the covered entity involved can demonstrate that there is a low probability that PHI was actually compromised.
If it is determined that a breach has in fact occurred, the covered entity must inform patients of that fact. This “breach notification” must be accomplished within 60 days of the date of the breach. If the breach affects the PHI of 500 people or more, the news media must be informed of the breach as well. HIPAA also requires that the Department of Health and Human Services be notified of all breaches.
HIPAA is a federal law that establishes regulations for safeguarding the privacy and security of patients’ medical information. Covered entities, business associates, and subcontractors must comply with these regulations to avoid significant penalties. Patients have specific rights regarding their PHI, and covered entities must provide them with a “Notice of Privacy Practices (NPP) that outlines their policies regarding the use and disclosure of PHI. Additionally, patients have the right to access, inspect, and request corrections to their PHI. It’s essential to ensure that patient information is handled with care and in compliance with HIPAA regulations to protect patients’ privacy and prevent breaches.
It’s also worth noting that HIPAA compliance is not just the responsibility of healthcare providers and covered entities. Business associates, such as third-party billing companies, must also comply with HIPAA regulations when handling patient information. Additionally, subcontractors that are contracted by business associates are also required to comply with HIPAA regulations.
It’s crucial for all parties involved in the handling of patient information to understand and comply with HIPAA regulations to ensure the protection of patient privacy and avoid potential penalties for non-compliance.
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