Health Insurance Portability And Accountability Act Rules Research Articles

HIPAA Compliance for Telehealth to Be Required Again on August 9

Back to table of contents Next article Government & LegalFull AccessHIPAA Compliance for Telehealth to Be Required Again on August 9Mark MoranMark MoranSearch for more papers by this authorPublished Online:31 May 2023AbstractHIPAA compliance is about more than just technology—it also means having physical or environmental and process security measures in place. A business associate agreement with a vendor may be necessary to ensure compliance with HIPAA.The federal Office of Civil Rights (OCR) in April extended the deadline for requiring telehealth compliance with the Health Insurance Portability and Accountability Act (HIPAA) by 90 days to August 9.At that time, health care professionals practicing telehealth must comply with HIPAA’s Security Rule and will no longer be able to use standard video technologies such as Zoom, Skype, or Facebook to meet with patients, as they had been allowed to do during the Public Health Emergency (PHE), which ended on May 11. Even before the new deadline, psychiatrists and other health care professionals need to pay attention to state rules about HIPAA compliance as well as the requirements of their institution, organization, or practice.“Best practices to ensure environmental privacy include clinicians connecting from a private space and letting patients know if there are others in the room with them,” said Shabana Khan, M.D. “This demonstrates to patients that their telehealth clinician values protecting their health information.”“OCR is providing this transition period to allow health care practitioners and practices to make necessary changes to ensure that their telehealth technologies are private and secure in a way that is adherent with HIPAA rules,” said Shabana Khan, M.D., chair of the APA Committee on Telepsychiatry. “Though OCR has provided this 90-day transition period through August 9, telehealth clinicians must also consider state rules and practice or organization requirements when deciding which technologies to use for telehealth services. We have this flexibility at the federal level, but an organization may require that their clinicians use approved HIPAA-adherent technologies.”HIPAA, which was signed in 1996 by President Bill Clinton, sets national standards for health information protections. The U.S. Department of Health and Human Services (HHS) established these standards to ensure protected health information (PHI) processed and utilized by “covered entities” is private and secure. OCR is responsible for implementing and enforcing this rule. HIPAA requirements cover a broad range of patient data and information, including making an appointment, conducting the appointment, and billing the patient’s insurance.HIPAA encompasses two major rules: the Privacy Rule and the Security Rule. The Privacy Rule protects all identifiable data of an individual patient; the Security Rule, a subset of the Privacy Rule, protects information that a covered entity creates, receives, maintains, or transmits in electronic form.So what does it mean to be HIPAA compliant when providing telehealth services? Importantly, it’s not just about technology. It also means having physical or environmental and process security measures in place to ensure that only those who are supposed to have access to patients’ information are able to get it.“Environmental privacy best practices include clinicians connecting from a private space and letting patients know if there are others in the room with them—for instance, a nurse or medical student who may be off screen,” Khan said. “Clinicians should also provide guidance to their patients on the importance of connecting to telehealth visits from a private space and avoiding public or semi-public settings. Clinicians can also ask patients if there is anyone in the room with them at the start of the visit. This demonstrates to patients that their telehealth clinician values protecting their health information.”Technology features that can help a HIPAA-covered entity meet compliance requirements include the following:Fully encrypted data transmission.Additional authentication and security through required passwords.Secure point-to-point connection.Private high-speed network.Administrative, physical, and technical safeguards for electronic protected health information.Audit controls.Breach notification.John Torous, M.D., chair of the APA Committee on Mental Health IT, said psychiatrists must use vendors of telehealth technology who can assure HIPAA compliance and have a signed business associate agreement (BAA).“Often you can use the same product (such as Zoom) without a BAA, but to make it HIPAA complaint, a psychiatrist needs to use the version of Zoom that requires the signature of a BAA,” he wrote in an email. “Regardless of the technology, being HIPAA complaint means the psychiatrist still has to offer reasonable physical safeguards (such as keeping computer passwords secure) and have process safeguards in place too (restricting access to patient files, creating plans for appropriate use of data).” ■ResourcesHHS Office for Civil Rights AnnouncementHIPAA & HIT: A PrimerSummary of the HIPAA Privacy RuleThe Security Rule ISSUES NewArchived

A comparative study on HIPAA technical safeguards assessment of android mHealth applications

Protecting personal health records is becoming increasingly important as more people use Mobile Health applications (mHealth apps) to improve their health outcomes. These mHealth apps enable consumers to monitor their health-related problems, store, manage, and share health records, medical conditions, treatment, and medication. With the increase of mHealth apps accessibility and usability, it is crucial to create, receive, maintain or transmit protected health information (PHI) on behalf of a covered entity or another business associate. The Health Insurance Portability and Accountability Act (HIPAA) provides guidelines to the app developers so that the apps must be compliant with required and addressable Technical Safeguards. However, most mobile app developers, including mHealth apps are not aware of HIPAA security and privacy regulations. Therefore, a research opportunity has emerged to develop an analytical framework to assist the developer to maintain a secure and HIPAA-compliant source code and raise awareness among consumers about the privacy and security of sensitive and personal health information. We proposed an Android source code analysis framework that evaluates twelve HIPAA Technical Safeguards to check whether a mHealth application is HIPAA compliant or not. The implemented meta-analysis and data-flow analysis algorithms efficiently identify the risk and safety features of mHealth apps that violate HIPAA regulations. Furthermore, we addressed API level checking for secure data communication mandated by recent CMS guidelines between third-party mobile health apps and EHR systems. Experimentally, a web-based tool has been developed for evaluating the efficacy of analysis techniques and algorithms. We have investigated 200 top popular Medical and Health & Fitness category Android apps collected from Google Play Store. We identified from the comparative analysis of the HIPAA rules assessment results that authorization to access sensitive resources, data encryption–decryption, and data transmission security is the most vulnerable features of the investigated apps. We provided recommendations to app developers about the most common mistake made at the time of app development and how to avoid these mistakes to implement secure and HIPAA-compliant apps. The proposed framework enables us to develop an IDE plugin for mHealth app developers and a web-based interface for mHealth app consumers.

Current Topics in Health Care Law

Current Topics in Health Care Law

What's Important: Weathering the COVID-19 Crisis: Time for Leadership, Vigilance, and Unity.

What's Important: Weathering the COVID-19 Crisis: Time for Leadership, Vigilance, and Unity.

Review of HIPAA, Part 2: Limitations, Rights, Violations, and Role for the Imaging Technologist.

This article is the second part of a continuing education series reviewing the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The term HIPAA should be familiar to those who work in the medical profession, but this article includes details on its rules, patients' rights, violations, breaches, and penalties. To help administer these safeguards, HIPAA requires that every organization designate a HIPAA privacy and security officer. HIPAA violations can have serious repercussions when rules are not followed; these violations can be either negligent or willful. If breaches of unsecured protected health information occur, HIPAA requires covered entities to notify affected individuals, the Secretary of Health and Human Services, and in some cases the media. Violations in which the covered entity did not know of the violation are now punishable under the first tier of penalties. Unintended violations carry a minimum penalty of $100 per violation and a maximum of $50,000 per violation. All patients have a right to privacy and a right to confidential use of their medical records. The role of medical professionals includes understanding how and when to apply these HIPAA rules verbally and electronically.

Health Insurance Portability and Accountability Act Noncompliance in Patient Photograph Management in Plastic Surgery.

Today, plastic surgeons have largely transitioned to digital photography. This shift has introduced new risks to daily workflows, notably data theft and Health Insurance Portability and Accountability Act (HIPAA) violations. We performed a national survey of digital photograph management patterns among members of the American Society of Plastic Surgery and trainees in Accreditation Council for Graduate Medical Education-accredited plastic surgery programs. Our findings showed that attendings preferred the use of stand-alone digital cameras (91.4%), whereas trainees preferred the use of smartphones (96.1%) for capturing patient photographs. The rate of noncompliance was nearly identical; 82.8% of attendings were HIPAA noncompliant when using stand-alone digital cameras compared with 90.2% of trainees using smartphones. Both groups also breached HIPAA rules when using other photographic management modalities. This is the first study to quantify the prevalence of noncompliance with regard to an entire digital photograph management workflow. These findings were consistent with previous studies that reported that younger physicians tend to embrace newer technologies, whereas older attendings are more reluctant. The findings also suggest that HIPAA noncompliance in digital photograph security and management is a significant problem within the plastic surgery community.

Sequence Diagram Aided Privacy Policy Specification

A fundamental problem in the specification of regulatory privacy policies such as the Health Insurance Portability and Accountability Act (HIPAA) in a computer system is to state the policies precisely, consistent with their high-level intuition. In this paper, we propose UML sequence diagrams as a practical means to graphically express privacy policies. A graphical representation allows decision-makers such as application domain experts and security architects to easily verify and confirm the expected behavior. Once intuitively confirmed, our work in this article introduces an algorithmic approach to formalizing the semantics of sequence diagrams in terms of linear temporal logic (LTL) templates. In all the templates, different semantic aspects are expressed as separate, yet simple LTL formulas that can be composed to define the complex semantics of sequence diagrams. The formalization enables us to leverage the analytical powers of automated decision procedures for LTL formulas to determine if a collection of sequence diagrams is consistent, independent, etc. and also to verify if a system design conforms to the privacy policies. We evaluate our approach by modeling and analyzing a substantial subset of HIPAA rules using sequence diagrams.

The Legal Implications of HIPAA Privacy and Public Health Reporting for Correctional Facilities.

Inmates in cramped living quarters, a situation common to correctional facilities, are especially vulnerable to disease. Cramped living conditions, coupled with above-average rates of HIV, tuberculosis, and other communicable diseases, increase inmates' risk of problematic health outcomes. Thus, high-quality health care and sustained efforts to prevent disease are especially important to improve inmate health within correctional facilities. Compliance with federal privacy restrictions pursuant to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and state disease reporting requirements will foster inmate health and assist efforts to prevent the spread of disease. This article examines the interplay between HIPAA rules and state reporting laws to preserve health information privacy and to control the spread of disease.

Protecting Patients In Health Information Exchange: A Defense Of The HIPAA Privacy Rule

Regional health information organizations (RHIOs) rapidly integrate and deliver patient information to clinicians from multiple independent care organizations. By providing such information, they can reduce health care costs and improve safety. Special concerns about privacy arise as these regional systems connect nationally. We should add special barriers beyond the protections of the Health Insurance Portability and Accountability Act (HIPAA) to protect against surprises at the national level. At the local level, we should remain within the HIPAA rules because the application of additional barriers to RHIO access would interfere with efficient and safe care.

HIPAA: Impact on Clinical Practice

HIPAA: Impact on Clinical Practice

Family Caregiver Research and the HIPAA Factor

Research in family caregiving recently has become more challenging because of the strict protection of privacy mandated in the Health Insurance Portability and Accountability Act (HIPAA) of 1996. We ask when should Institutional Review Boards (IRBs) follow HIPAA rules to the letter and when might they use the waiver option? What is the appropriate balance between the goals of protecting the privacy of patients' personal health information and facilitating family-caregiver research that may benefit them and others? More particularly, should patients be gatekeepers for caregiver participation in minimal-risk research? We describe one approach that successfully met HIPAA criteria and also allowed high-quality research. In developing protocols and applying for IRB approval, researchers must be as familiar with HIPAA regulations as they are with IRB standards. Finally, we recommend changes in the review process that may facilitate research efforts with family caregivers while protecting important privacy interests.

Dead or Alive: HIPAA’s Impact on Nursing Historical Research

Access patient information is integral nursing historical research; the essential work of nurses cannot be separated from patient care. Yet the 1996 Rule of the Health Insurance Portability and Accountability Act (HIPAA), places new barriers between nurse historians and archival resources. HIPAA's principle of patient confidentiality places often onerous new restrictions on access patient records, whether from 200 years ago or from yesterday, whether patients are dead or alive. HIPAA also appreciably increases the workload and the responsibilities of medical archivists, underscored by their awareness that infractions may result in significant penalties for researchers and institutions alike. The broad and complex HIPAA privacy rule has undoubtedly led some medical archives closing all or part of their collections in order adhere the letter of the law and avoid the stress and expense of compliance. Collecting institutions may refuse accept materials with identifying patient information. At worst, institutions might simply destroy documents with identifying patient information rather than preserve them for their intrinsic value and deal with the implications of access under HIPAA. This inexpensive and expedient response HIPAA compliance would be a significant loss any medical history collection. Already nurses' notes are often destroyed before patients' records are filed or microfilmed. Thus the HIPAA Rule has the potential seriously affect the ability of nursing historians conduct research involving patient care. Given the uncertainties of how strictly HIPAA will be enforced, many health care providers are opting for the most stringent (and often most impractical) interpretation of the regulations. This chapter briefly describes HIPAA's potential impact on bio-medical research and then more fully discusses HIPAA's effect on historical research. It then explains how medical archives are working within these regulations allow researcher access. Areas of special concern and confusion are also addressed. It must be emphasized that legal opinion related archival research varies over interpretation of ambiguities found in the HIPAA Rule. Naturally, archivists have sought legal counsel from their specific institutions guide the implementation of the law in their archives. Therefore some of the HIPAA privacy interpretations cited here may not be followed in quite the same way at all archives. HIPAA and Biomedical Research HIPAA was designed optimize health care for U.S. workers by making it easier obtain and retain health insurance coverage. One part of HIPAA mandated federal guidelines protect personal health information, known as Protected Health Information (PHI), from being inappropriately revealed insurance companies or employers. In compliance with HIPAA, the Secretary of the Department of Health and Human Services (DHHS) announced its proposed privacy regulations in 1999.1 Following public comment, these regulations, termed the Privacy Rule, were first issued in 2000 and a modified version, following further extensive public comment, was released in 2002. The purpose of the privacy rule was to protect the privacy of health information that identifies individuals who are living or deceased.2 Most institutions were required comply with the new regulations by April 14, 2003. The effect of the HIPAA privacy rule on research has raised a tremendous outcry from biomedical researchers. The de-identification of patient records, particularly in paper records, presents a formidable task. Researchers are particularly concerned that the complexities of HIPAA compliance and penalties for disclosure or other errors, may force medical institutions deny researchers access patient data.3 The Association of American Medical Colleges cautioned that the privacy rule will hamper research associated with clinical trials, the study and treatment of disease, epidemiology, and genetics. …

HIPAA transition: challenges of a multisite medical records validation study of maternally linked birth records.

Numerous researchers have expressed concern over the impacts on medical records availability of the newly effective Medical Information Privacy rule, as authorized by the Health Insurance Portability and Accountability Act (HIPAA). The increased costs associated with compliance with the rule, and the increased potential for financial liability, raises the possibility that hospitals may be less likely to participate in such research, resulting in a decrease of the validity of multisite studies designed to represent an entire population. Our multisite medical record validation study, designed to assess the accuracy of maternally linked birth records, provides an overview of a number of HIPAA implementation challenges. We found that the new HIPAA rule presents new challenges for those who rely on the release of medical record information for epidemiologic research. At the very minimum, increased compliance costs associated with human subjects protection and increased administrative burden for researchers would seem to be inevitable as medical institutions address the requirements of the new HIPAA rule by instituting more complex and thus more cumbersome procedures. Researchers should anticipate increased costs and plan accordingly when budgeting for human subjects review processes.

Guidelines for Adolescent Health Research*1, *2A position paper of the Society for Adolescent Medicine

Guidelines for Adolescent Health Research*1, *2A position paper of the Society for Adolescent Medicine

Security and Privacy After September 11: The Health Care Example

This article examines the interaction between data which was a highly salient political issue before the events of September 11, and cyber-security and homeland security, which became much more salient after those events. The article illustrates the shift in salience by examining the USA-PATRIOT Act, which was passed quickly in the fall of 2001 despite containing a number of surveillance provisions that had been explicitly rejected by Congress in 2000. To understand the interaction between and security, the article examines the medical rule issued in 2000 under the Health Insurance Portability and Accountability Act (HIPAA). (In the interests of full disclosure, the authors were the lead White House officials in coordinating the rule.) The analysis here shows that the HIPAA rule stands up well to the concerns of the post-September 11 era. Concerns about public safety are met by existing provisions that permit disclosures to protect national security, to react to emergency circumstances, and to respond to law enforcement inquiries. The article explores in particular detail the proposed Model State Emergency Health Powers Act, drafted in the wake of the 2001 anthrax attacks. Professors Lawrence Gostin and James Hodge have argued that this Act is justified by a new model of information sharing for medical information. Our article concludes that public health concerns are appropriately addressed by the current HIPAA rule, and that a model of information sharing sends precisely the wrong signal about how the health system will handle issues of data and security. More generally, the article analyzes situations of vs. privacy, where the two values are antagonistic, and situations of and privacy, where the two values work together. Security in some instances means greater surveillance, information gathering, and information sharing. For instance, law enforcement can monitor the online movements of hackers or hospitals can more quickly report cases of anthrax infection. These situations of vs. privacy are defined as instances where security is promoted by getting information to the proper decisionmakers. As these information flows increase, decreases. By contrast, security measures often promote privacy. Good security is one of the standard fair information practices, because otherwise any hacker can get into a sensitive database. Good security, moreover, creates audit trails about which authorized users have accessed particular systems or data. Such auditing mechanisms promote the fair information practice of accountability, by deterring wrongdoing and making enforcement more effective. Finally, the authors explain how the most cost-effective and thorough implementation of occurs at the time of a computer system overhaul. This approach is fundamental to HIPAA, which provided that and security protections should be built at the same time as the shift to electronic health records. The new emphasis on security after September 11, in short, is a major strategic opportunity to improve data handling practices in general, for both security and privacy.

The Impact of Electronic Claims Submission on Cash Flow in a Private Practice

The Impact of Electronic Claims Submission on Cash Flow in a Private Practice

The Health Insurance Portability and Accountability Act: Is It Really All That Bad?

The Health Insurance Portability and Accountability Act (HIPAA) was developed in 1996 and became part of the Social Security Act. The primary purpose of the HIPAA rules is to protect health care coverage for individuals who lose or change their jobs. However, HIPAA also includes Title II, better known as the Administrative Simplification Act. Title II requires the health care industry to become more efficient by encouraging the use of electronic media for transmission of certain patient administrative data. To make the public feel more secure with electronic transmission of data, the government developed privacy and security rules to complement the transaction rules. HIPAA rules on electronic transactions, code sets, and privacy have been finalized; dates of finalization vary depending on the individual rules. While details of the rules may be modified, their essence and breadth will live indefinitely. It took Congress numerous attempts over a decade to get these regulations in place. Congress is not going to back down now. The country is still waiting on the final HIPAA rules related to national identifiers and security.