How to Comply with HIPAA

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Healthcare providers have struggled with the need to protect patient privacy and share information.
Healthcare providers have struggled with the need to protect patient privacy and share information.
The Health Insurance Portability and Accountability Act (HIPAA) was created in 1996 to protect patients' health information. Since its inception, health care providers have struggled with the need to protect patient privacy, share information, and keep paper work under control. 

“When HIPAA came out, everyone was so afraid of penalties … but a lot of it was a reasonable recognition of patients' privacy that was already occurring in 99.9% of the cases,” said L. Lee Hamm, MD, Professor of Medicine and Executive Vice Dean at Tulane University School of Medicine in New Orleans.

“It added a lot of administrative burden and … it introduced a few things to make certain that people didn't inadvertently do something they shouldn't do.”

Electronic information

A part of HIPAA with which specialists in particular are concerned is sharing information among other health care providers. Entities covered under HIPAA are allowed to share private information with other health care professionals for the purposes of treatment, payment, and operations.

But Heinold said there are often delays during this process that can negatively impact quality of care and increase liability. This can occur when providers unnecessarily request patients' consent.

One of the most efficient ways to communicate among providers is via electronic communication. HIPAA was amended in 2009 to encompass the use of electronic health records with the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Fresenius staff is increasingly receiving communication about patients electronically through mediums such as text and instant messaging, Heinold said. While this can facilitate exchange of records, it also comes with inherent risks. Fresenius trains staff to provide the minimum necessary information when texting about patients.

Louis Liou, MD, Chief of Urology at Cambridge Health Alliance, said his organization's biggest HIPAA concerns relate to electronic information. To comply, Cambridge ensures that all physicians with smart phones have them password protected and that their e-mail is secure.

Cambridge physicians try to avoid texting patient information when possible, but if they must, they do not use any patient identifiers in the text messages.

“There are a lot of pitfalls that could potentially happen,” Dr. Liou said. “Thumb drives have given way to Cloud issues. I think potentially there can always be problems – no matter how failsafe you make the system, there is always human error.”

Dialysis settings

Another concern is the communal open-floor nature of some clinical settings, as is often the case in dialysis centers, which may make it difficult to protect patient privacy. Still, training staff and implementing privacy procedures can go a long way to meeting HIPAA requirements.

Rosemary Heinold, Director of Communications for Fresenius Medical Care North America, a dialysis services provider and manufacturer of peritoneal and hemodialysis machines and equipment, said their organization has a handful of practices that help them comply with HIPAA.

Although patients are examined on the dialysis floor, Fresenius clinics also offer private examination rooms. Patients are never required to be examined in an open setting and may request a private room for physician consultations.

Like most providers, Fresenius staff gives patients a notice of privacy rights, which individuals must sign. They also post a notice of their privacy practices at all treatment sites.

Fresenius providers also work by the “minimum necessary” rule. The staff only shares the least amount of information necessary with patients on the clinic floor, particularly when others are within earshot.

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