
In a world where data has quickly become a massive commodity, regulators are continually busy trying to stay on top of the data that arguably matters most–sensitive health information, which, as you can imagine, is a lot of health data.
A Brief History of HIPAA
The Health Insurance Portability and Accountability Act, better known as HIPAA, was passed into law in 1996 in an attempt to simultaneously increase the number of Americans with health insurance and improve the efficiency of healthcare delivery. This bill came into force as healthcare systems across the country were beginning to digitize their records and was the first national regulatory standard to govern health information.
In the postwar period, the responsibility for health insurance began to shift towards employers, with job-linked insurance rates rising steadily (alongside insurance rates as a whole), but what happens when you change jobs? Your health records could well be required for a new insurer…every time you change jobs. Although electronic health records were emerging, the set of rules governing their use and sharing–especially interstate was virtually nonexistent.
So, we needed health information to flow smoothly between all parties involved in a secure manner. If HIPAA succeeded, health insurance would become more convenient and easier to manage, while health information would only be available to those who really need to see it.
What HIPAA Protects
In short, ‘Personal Health Data’ or PHI, which includes medical charts and diagnoses, PHI also covers billing information, insurance claims, and communications between patients and healthcare providers. Importantly, PHI protects information stored in digital health records, emails, and even spoken exchanges in both physical and electronic formats.
HIPAA also defines 18 ‘identifiers’ that must be protected if they are linked to health information. These range from names, Social Security numbers, and medical record numbers to biometric data, geographical information smaller than a state, device attributes, vehicle information, and more.
The act comprehensively covers anything that could connect the aforementioned personal identifiers to health details—this guarantees thorough protection. Even partial identifiers such as a ZIP code or date of birth are covered by HIPAA’s protections as they could potentially reveal a patient’s identity when combined with other data. This broad scope highlights how healthcare providers, insurers, and business associates are accountable for safeguarding sensitive health data–in all its forms.
Who is Protected, Who is covered, and Who Needs to Be Compliant?
In short, the Health and Human Services Department stipulates that “the Privacy Rule and all Administrative Simplification provisions under HIPAA apply to health plans, healthcare clearinghouses, and healthcare providers who electronically transmit health information related to transactions for which the HHS Secretary has established standards.” These organizations are collectively referred to as “covered entities,” there is an online tool to check if your organization falls under the “covered entity” classification.
In essence, the above jargon means all data accessed by health plans, whether that is employer-based, government-assisted, i.e., medicare, or private. At the same time, providers who engage in HIPAA-defined “transactions,” involving the electronic exchange of information between two parties for healthcare-related financial or administrative tasks, are subject to HIPAA requirements. These providers include physicians, dentists, pharmacists, and nurses who have completed online accelerated BSN programs, hospitals, clinics, nursing homes, and other healthcare providers delivering or administering medical care.
Providers are big players, but they don’t always do all the work in-house. At times, what the HHS defines as ‘business associates’ is that they are employed to complete certain tasks that require access to patient information. This could be a third-party administrator managing claims processing, a CPA firm offering accounting services, an attorney providing legal counsel, or a consultant conducting utilization reviews—all involving access to protected health information.
HIPAA: Keeping Compliant
So, your company is a covered entity–how do you stay compliant in the age of big data, AI, and increasing regulation? According to the experts, there are a few key steps to take:
1. Assessing risk
Regular risk assessments make sure you are aware of just how safe PHI is. These could be annual or quarterly but should asses how your covered entity and business associates are storing, accessing, and transferring PHI. The HIPAA ‘security rules’ are key to good security and are outlined thoroughly by the HHS. The rules are divided into four key areas:
- Confidentiality, integrity, and availability: to safeguard all electronic protected health information (e-PHI).
- Protection against security threats: to identify and mitigate potential risks.
- Unauthorized access prevention: ensures digital PHI is protected from improper use or disclosure.
- Workforce compliance: train and manage staff to adhere to security measures.
The health IT website has a handy security risk assessment tool to check up on the digital side of these rules.
2. Strong Data Safeguards
Whether you have come across a potential weakness in data systems or simply want to beef up security, data safeguards are critical.
3. Training Your Workforce
The fourth security rule highlights just how important it is to keep staff on the same page with regular training on new systems, security updates, and training for new staff.
4. Incidence Response Plan
Planning for the worst is definitely worth it, as failing to keep up with data protection can have severe consequences; merely failing to analyze risks to PHI and leaving it vulnerable can carry fines of over $100,000.
Evolving Health Security
HIPAA is not a new piece of regulation, but as it should, HIPAA and how it applies to you will likely continue to evolve. Under the HIPAA Security Rule, 45 CFR 164.304, the safeguards have already been revised to incorporate artificial intelligence, which is becoming widely used in health.
The security rule makes it possible to use AI to identify and detect nuances and anomalies within patient data, enhancing the overall security and precision of health information systems. Advanced AI algorithms are able to recognize patterns in ways that may not be readily apparent using traditional approaches, therefore helping to surface potential security breaches and protecting patient health information integrity. This adaptation shows how the act can be strengthened and adapted to keep up with the time, protecting data while simultaneously using AI to improve security and patient care.
Cybersecurity is a constant concern, and HIPAA must address new cyber threats with updates to the HIPAA Security Rules. Healthcare is threatened by attacks such as ransomware, phishing, and data breaches that may cause interruptions to vital health systems, damage records containing PHI, and, in the worst-case scenario, leak PHI. To address these challenges, HIPAA works closely with the National Institute of Standards and Technology to update guidelines to address the threats that healthcare entities face when safeguarding digital PHI. This proactive approach between government agencies ensures the integrity and confidentiality of patient data in the ever-changing digital world.
The Future of Health Data Privacy
Health data is becoming more valuable than ever, insurance and providers aside, the research industry is developing exponentially with AI and big data at the center. AI algorithms have already been used in clinical trials to screen thousands of potential participants’ health records–a step that saves precious time. It could soon be used to determine doses, trial design, and more by analyzing patient data.
Healthcare delivery has evolved significantly over the past decade. AI is, but one change, and new delivery methods like telemedicine and virtual consultations are reshaping how care is delivered. These changes mean providers need to have access to critical health information instantly, even when they are thousands of miles from their patients.
With all these changes, HIPAA has a lot on its plate, but staying compliant does not have to be a headache; keeping up to date is in everyone’s best interest, and the agencies involved are there to streamline the process–not just scare you with fines.
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