On 1.23.2013, Devin McGraw, Brian Ahier, and David Harlow sat down and chatted about HIPAA.Â These are big industry leaders, and it was great to hear their thoughts on the matters involved. Â Here’s the link to the video of the Session.
Here are links to their media.
Brian Ahierâ€™s blog – http://www.ahier.blogspot.com/
David Harlow – http://healthblawg.typepad.com/
Deven McGrawâ€™s profile on CDT – https://www.cdt.org/personnel/deven-mcgraw
Below are our notes from the discussion â€“ theyâ€™re not specifically tied to the individual speaker.
EMRSoap write-up of the HIPAA Hangout by Industry Leaders
- Most of the final rule was the same.Â Except for the Marketing provision – that was quite a bit different than the proposed rule.
- Weâ€™re still not done. Even though this is the â€˜Omnibus ruleâ€™, thereâ€™s still 2 new rules that need to come out.
- Bus related puns abound.
- What do providers need to watch out for?Â One thing: Primary liability of BAâ€™s and subcontractors.Â You really canâ€™t sub out responsibility entirely.
- Thereâ€™s a community of small providers and Business Assocaites who arenâ€™t aware of the reality of HIPAA and havenâ€™t completed Risk Assessments (and more).Â Theyâ€™re just not familiar enough with their obligations and the HIPAA environment.Â Theyâ€™ll have till September 23rd to comply with this rule.
- Date by which new BAA and NPP need to be entered into is a year after that September 23rd.Â The agency will be issuing further guidelines throughout this timeline.
- The government is committed to more audits and fines.Â The fines they collect will fund the audit process.Â Weâ€™re going to have audits of Business Associates and their subcontractors, not just Covered Entities.
- Enforcement is moving to Penalty base, and away from voluntary compliance.
- But not entirely, says Devin.Â Rule was pretty clear â€“ informal resolution and voluntary compliance would still play a factor in enforcement.Â HHS will have discretion.
- HHS has been going after the smaller groups as well, even without the Omnibus rule.
- Environment of â€˜Hands offâ€™ has led to people being careless.Â Behavior has been beyond whatâ€™s acceptable for building up trust in EMRs.
- Why should patients be excited?Â People most bugged by marketing â€“ thatâ€™ll be limited by HIPAA Omnibus rule.Â Also, breach notification provision much more clear means that institution are going to pay a lot more attention to encryption.
- Discussion on the â€˜conduitâ€™ exemption â€“ very narrow exemption.Â Really only works for courier-like firms (ISP and postal services, for example). Â Only making sense in cases of random or intermittent access to ePHI.Â As opposed to entities that store data â€“ would be a BA, even if the intention is to not to look at it.
- Failing to sign a BAA doesnâ€™t exempt you from BA status.
- Researchers are now permitted to give people conditional treatment if they agree to research.
- Now allowed to have authorizes for future research as long as the description is rich enough to give patient a general idea of the types of research thatâ€™ll be enacted.Â No need for individual study approval.Â Requirement is somewhere in between â€˜all researchâ€™ and â€˜one studyâ€™.
- Patients can request records in forms that makes sense for them.Â If you canâ€™t technically do it in the form (5.5 in floppy, for example?) then the provider will have to reach an agreement with the patient.
- Is it possible to segment your record, and keep some info off of your Health record?Â Yes.Â Itâ€™ll probably be hard for a fair amount of providers.Â If a patients says â€˜donâ€™t send this to my payerâ€™, you canâ€™t do it.
- Patient right to get data trumps security requirement.Â If the patient is notified of risks of transmitting ePHI over email, then the ePHI can be transmitted to the patient.Â Requirement of alerting patients is fairly low.Â Bi-lateral communication is a different realm, however.
- Changes to enforcement rule â€“ bottom line is thereâ€™s a max of 1.5 million per violation.Â Likelihood of greater fines in the future?Â Maybe.Â Largest fine to date was against a bankrupt company.
- Thereâ€™s more breaches reportedâ€¦not necessarily more breaches in total.Â Now, with our digital health system, we know whoâ€™s seen what.Â Weâ€™ll see more breaches in total, but thatâ€™s not necessarily a bad thing.
- BAâ€™s right to use data is explicitly limited.Â BAâ€™s are directly liability, but theyâ€™re still subordinate to Covered Entities.
- Breach Notification â€“ weâ€™ve moved away from the â€˜harm standardâ€™ â€“ moved away from the subjective value of the underlying data.Â Weâ€™ve moved to an examination of â€˜what happened in this instance?â€™Â Presumption being if we donâ€™t know what happened, then there wasÂ a breach.Â Notion of â€˜if itâ€™s info about your big toe then itâ€™s not harmfulâ€™ is gone, as is underlying subjective value judgment of data.Â Faxing info to Doctor X instead of Doctor Y, maybe less of a big deal.Â As long as that mistake is handled appropriately, itâ€™s not that big of a deal.Â If thereâ€™s greater than a low probability that the ePHI was breached, then there needs to be a notification.Â Thereâ€™s a 4 pronged set of standards that need to be examined in that investigation to determine if there was a breach.Â Â But if you know that there was a breach, you donâ€™t need to do an investigation.
- Everybody: gotta revise your Notice of Privacy Practices.Â Remember that you have until September.
Return to EMRSOap’s Omnibus Guide