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Todd FrechOcius Medical Informatics6650 Rivers Ave, Suite 137North Charleston, SC 29406
843-576-1426
http://www.ocius.biz
Health Insurance Portability and
Accountability ActGeneral Overview for Software Vendors
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Background
• Originally proposed in 1996 as part of a comprehensive set of reforms targeting health insurance
• Administrative Simplification section created in response to the commercialization of health information and the potential for abuse with the increased use of electronic systems
• Prior to HIPAA, there were no federal regulations to govern the use of personal health information (PHI)
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Some Significant Abuses
• Marketing• Employment Screening• Inappropriate release of private
information
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Legislative Authority
• Department of Health and Human Services– Defines requirements– Educates and inspects (Office of Civil
Rights)– Fines for minor offences
• Department of Justice– Criminal prosecution
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What is HIPAA?
• Four Components– Transaction Standards– Privacy Regulations– Security Regulations– National Provider ID
• Regulation of individually identifiable health information
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What is HIPAA?
• Covers electronic systems– Billing– EMR– Scheduling
• Impacts– Health plans– Health care providers– Health care clearing houses
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HIPAA’s Goals
• Reduce administrative burdens• Protect the privacy of individually
identifiable health information• Ensure the security, integrity and
availability of health information
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Transaction Standards
• Creates standard transaction sets for communicating health information via electronic interfaces
• Creates a standard definition of data elements
• Impacts billing, enrollment, disenrollment and authorization transactions
• Final rule published in August 2000• Requires implementation within 24
months
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Privacy Standards
• Requires a covered entity to make a reasonable effort to obtain a patient’s permission to use their PHI for Treatment, Payment and Healthcare Operations (TPO)
• Requires a covered entity to obtain a patient’s permission for any non-TPO use of health information
• Defines the approved uses of health information• Defines the process for gaining approval• Gives patients the right to dispute information in
their health records• Defines the process for patient disputes
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Security Standards
• Regulate integrity, confidentiality, unauthorized access, and availability
• Five components:– Administrative procedures – Physical safeguards– Technical security services– Technical security for networks– Electronic signature
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Impact on Software Vendors
• Transaction Standards– Implementation by 10/2004– Standard data elements and transaction
formats
• Privacy Standards– Implementation by 4/2003– Minimal impact on software vendors
• Security Standards– No implementation date (12 months from final
rule date)– Largest impact on software vendors
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Operational Issues
• Legal requirements– Business Associate Agreements
• Changes to policies and procedures– System Access– Training
• Software enhancements– Audit– Security
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Client Issues
• Interpretation and implementation of three standards in a short period of time
• Developing appropriate polices and procedures
• Training, training, training
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Regulatory Issues
• Enforcement– Office of Civil Rights– Department of Justice
• Fines and Penalties– Monetary fines for inappropriate
disclosure of PHI– Potential jail time for willful
misuse of PHI
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Risk and Opportunities
• Timeline for implementation of security requirements
• Client focus during the implementation process
• Development of new policies and procedures
• Additional or upgraded network infrastructure
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Got Questions?