Regulatory Compliance

When I was a child, the threat “just wait ‘til your father gets home” was enough to make me change my attitude. I wasn’t punished much as a child, and time with my father was far happier and positive than not, but that phrase still resonated. For many, the meaning of The Health Insurance Portability and Accountability Act (HIPAA), is in many ways, like that threat.
HIPAA often inspires doom, gloom, and fear. Because of that, it can lead to unintended expectations and behaviors regarding patient information, making effective care coordination a challenge. In reality, HIPAA gives us some guidance about the protection of information and is a very real threat — only if you ignore it. However, it’s not all doom and gloom.

First, let’s look at what you can do with patient medical data under HIPAA. You can:

• Connect
• Share
• Cooperate
• Consult
• Question
• Exchange
• Communicate
• Treat

That’s a significant list and it’s all about coordination.

Now let’s compare that to what you can’t do with this same information under HIPAA. You can’t:

• Ignore
• Distribute
• Expose
• Publish

It’s easy to see how this can be confusing. The security and privacy standards defined by HIPAA combined with the expanded responsibilities under the Omnibus Rule, have created layers of bureaucracy and whole industries have sprung up to “explain” the meaning of it.

So, let’s step back for a minute and look at what HIPAA is really supposed to be about, which to me, is stewardship. Stewardship is the responsible overseeing and protection of something considered worth caring for and preserving. On the official Federal site, it says that the HIPAA Privacy Rule “establishes national standards to protect individuals’ medical records and other personal health information.”

Stewardship implies a personal ownership and responsibility. The word “ethic” implies that very high personal and professional standards should be applied to the responsible management and protection of a patient’s information. It is really about taking care of the health information entrusted to you.

Perhaps the biggest shift in mindset for physicians in the last several years has been the emergence of patient health information as a valuable component of their practice and to treat it accordingly. Let me use an analogy and compare money to information. As a person, you don’t carelessly give away your money or leave it lying around. You don’t share your financial account logins with strangers and you certainly wouldn’t want your financial records being released, exposed or published. As part of our upbringing, from our initial allowance to our first job to your career today, we have been learning about money, its value, and the steps we should take to protect it. Being good stewards of money is a role we recognize and understand. Patient health information should be viewed in the same way.

Medical records are filled with personal data, otherwise known as protected health information (PHI). Once we make the connection that information or data has value and must be treated like money, the standards for HIPAA stop being cumbersome and start being understandable.

So, with good stewardship in mind, let’s go back to the “can I” or “can’t I” question and ask yourself the following:

• Can I connect with another person about a patient? Yes, just make sure that your method of connection is safe and that you have a valid reason for doing so.
• Can I share a patient’s record with another provider? Absolutely, provided you take steps to ensure the information is protected.
• Can I cooperate and consult on patients? Of course, but do so in a manner that maintains a patient’s privacy and the protection of the data.

There are a lot of myths around HIPAA, and while the “letter of the law” be confusing at times, “the spirit” and meaning is clear. HIPAA really does not need to be confusing. Be a good steward of the information in your practice of medicine, and you’ll be a long way down the path of complying with HIPAA regulations.

The goal of Population Health Management (PHM) communication is to improve the health outcomes of a group of patients with similar characteristics. One example of a population in this context are patients suffering from the same chronic condition. The care of patients in this group may be managed similarly, often involving the same treatments, tests, procedures and other forms of care.

The treatment of chronic conditions typically involves multiple parties, from a primary care physician to multiple specialists and of course the patient. This, in turn, requires frequent communications between the parties.

EHR systems were intended to facilitate these communications but have some shortcomings. And maintaining HIPAA compliance is a key challenge. This article looks at how organizations can use Direct Secure Messaging to overcome the technical and regulatory challenges of a Population Health Management communication scenario.

Chronic conditions are complex to manage. They typically involve multiple syndromes, symptoms, tests and treatments. They require multiple specialists to manage effectively, as well as a high degree of patient diligence.

Diabetes is a good example. It cannot be cured, only managed for the remainder of the patient’s life. As with most complex chronic conditions, managing diabetes involves regular visits with specialists to ensure that things don’t get worse. Managing a patient’s glucose level is always the short-term concern, but left unmanaged, diabetes can result in catastrophic outcomes such as the loss of a patient’s feet or eyes, or kidney or heart damage.

In addition to the patient’s primary care physician, medical professionals involved in the management of diabetes could include nurse educators, endocrinologists, ophthalmologists, cardiologists, dietitians, podiatrists, exercise physiologists, dentists and others. The coordination of care between so many providers – and with the patient – is essential.

Part of the promise of EHR systems was that they would facilitate the level of information exchange between healthcare providers that is necessary for coordinating the care of patients. To do that, the HL7 data standard emerged to ensure that the hundreds of EHR products in the market could “talk to” each other. Unfortunately, different EHR vendors interpret the HL7 standard differently, resulting in incompatible data formats. This, in turn, causes missing or inaccurate patient records.

In addition, some EHR vendors employ a proprietary data format that effectively blocks information exchange with EHRs from other vendors. And, some vendors charge providers to enable their systems to interoperate with others.

These constraints make it harder to manage patient care across providers, rendering the ultimate goal of PHM – better patient outcomes – harder to reach. The alternative for information exchange – provider-to-provider email, postal mail or faxes, can result in HIPAA violations (and are slow and unreliable).

Another challenge is that EHRs were designed to facilitate provider-to-provider care. But for PHM, the patient plays a pivotal role in achieving good outcomes. So, too, can family members or other caregivers, such as home health agencies, that might not have access to an EHR.

Electronic communication is by far the easiest, most efficient, most reliable, and most accountable means of communications between providers and patients. But standard email isn’t a viable option under HIPAA because the identity of the recipient – the reader of the email – cannot be validated. And, regular email is no more secure than sending a postcard with sensitive patient information written on it for all to see, which again presents HIPAA compliance issues. Moreover, regular email lacks a documentation and audit trail that all parties involved in the patient’s care can access.

The ideal solution is Direct Secure Messaging (“Direct”) from DataMotion. Direct is a secure email-like communications channel that enables providers to communicate with each other – as well as with patients and other caregivers – in a secure, HIPAA-compliant way. All messages are encrypted and require authentication to send and receive.

Importantly, Direct is an enhancement to EHRs, not a replacement. Providers can access Direct from within most popular EHRs.

On the provider side, Direct helps improve patient outcomes in a PHM environment by facilitating the exchange of patient medical records in a standardized manner. This includes formatted and unformatted data, as well as large files such as radiologic studies and diagnostic images. Direct enables better coordination of care. It also reduces errors and delays over conventional means of information exchange; for instance, delays when records are sent by courier, and mistakes due to the illegibility of handwritten notes.

On the patient side, Direct gets patients engaged in the management of their condition, which boosts outcomes. Patients can, for example, provide timely feedback on how well treatments are working, allowing providers to make adjustments accordingly without a delay for the patient to make an appointment with the provider. Patients can report new symptoms, complications or other issues to the provider immediately, thereby potentially avoiding life-threatening situations. And providers can ensure that patients refilled prescriptions when scheduled, or remind patients of upcoming office visits or tests to take.

Managing healthcare is increasingly a team effort. Frequent, accurate communication between the team members – including the patient – is paramount to achieving good outcomes. Direct offers an effective enhancement to EHRs that can help care providers deliver better patient outcomes while complying fully with HIPAA rules for privacy and security.

Based on the national encryption standard for securely exchanging clinical healthcare data via the Internet, DataMotion™ Direct enables secure messaging for healthcare providers, patients, business associates, and clinical systems. Using DataMotion™ Direct, PHI can be sent and received securely, in a manner that conforms to MU2 guidelines. It supports the transmission of a variety of sensitive data, including summary of care documents, large images, and personal messages. Best of all it integrates easily with existing EMR/EHR and other Health IT solutions to fully support in-network and out-of-network communications.

DataMotion is an accredited Health Information Service Provider (HISP), provisioning Direct services that are fully interoperable with other HISPs. Secure data delivery has been the core of DataMotion’s business since 1999, ensuring your ability to meet HIPAA compliance and Meaningful Use requirements.