Table of Contents
Introduction
The Health Insurance Portability and Accountability Act of 1996, better known as HIPAA, was introduced by Congress. It was initiated with the intention to protect patient data and information, observing the need to ensure transparency through the health insurance system. In the then scenario, a rise in the number of data breaches were observed that in turn affected the security and interests of medical insurers as well as the providers. This Act was, therefore, passed to secure the medical information recorded by either of these parties to increase transparency in the process (Techtarget Network, 2017). At the rudiment, it allows certain benefits to the patients, as well as, to the health insurance service providers. For instance, it facilitates the transfer of the insurance policies bought by American workers, when they change their jobs, which is also applied to the families. Maintaining a strong lift portfolio, the measure is also believed to restrict frauds and abuses in the health insurance system. It not only helps in maintaining the industry health care standards by keeping the information of the insurers and the providers updated, but also contributes to the confidential handling of the data through electronic billing and other technology equipped processes (DHCS, 2017).
From a general perspective, the HIPAA rules are segregated into two dimensions, which are the privacy rules and security rules, which are aimed at satisfying the data protection needs of the health care insurance sector. It is the legal statute that these rules follow, which makes the implementation process rigid and liable. Moreover, it considers the effective inclusion of technology measures along with the applicability of corresponding norms, which assists in increasing current practices of the health care industry. Nonetheless, these measures have often been argued to be vague and limited in ensuring the safety of the patients with respect to every dimension of health care insurance (Chaikind, 2004). Through this study, a comprehensive elaboration of the HIPAA rules will be provided, emphasizing its direct impression and contribution to patient safety measures in the industry.
An overview of HIPAA rules
According to Annas (2003), policies recommended as per the HIPAA Regulations are strongly influenced by the privacy concerns observed during the 1970s in the health care sector. Its extensive emphasis to protect data and information is found to be associated with the medical and health care processes. However it helps with a step forward with regards to national security aspects through information security measures. Mercuri (2004) further states the way HIPAA rules interconnect to the dimensions of information technology, computing security along with the structure of the nation, making it quite a complex phenomenon. It also imbibes various conceptual, moral, and legal considerations demanding extra attention from the practitioners within the health care industry (Moskop, Marco, Larkin, Geiderman & Derse, 2005).
The notions and considerations upheld thorough the HIPAA rules bear a strong resemblance to the idea of Hippocratic Oath, being practiced by health care providers since antiquity. Its fundamental concern was to maintain confidentiality with the information about patients in the hands of the physicians and therefore, contribute to patients’ safety (Moskop et al., 2005). In the present context, patients’ safety has gained significant attention, with key emphasis to protect their medical records, which has further motivated the implementation of HIPAA. Technology also had a major role to play in this regard, imposing significant concerns related to its continuous development and inclusion. This has subsequently helped in eroding the quality of data protection used through the traditional mechanisms. It was thus, that the US Department of Health & Human Services initiated the approach through two dimensions, one emphasizing privacy rules and the other offering mandates for the security rules (HHS, 2017).
HIPAA Privacy Rules
The privacy rules enforced through the HIPAA regulations emphasize national standards implementation. This mostly intends to preserve confidentiality of patients by protecting their medical records as along with their personal health related information. It applies to a wide range of functional departments in the contemporary health care institutions, including health care clearinghouses, health plans as well as transactions conducted electronically in the sector. Detailed in 45 CFR Part 160 as well as Subparts A and E of Part 164 of the HIPAA legislation, the privacy rules principally limit the use and disclosure of information without patients’ authorization. The privacy rules also offer the patients with the right to examine the recorded data of their personal medical information. They may also request for a copy or corrections as and when needed in the record (HHS, 2017). Hence, it can be apparently noted that the privacy policies implemented through the HIPAA rules also focuses on effective patient engagement in the information management system.
Therefore, it provides due attention towards the use of health care information concerning patients and its disclosure to the third party, which is referred as the “protected health information” in the nursing environment. The organizations responsible for ensuring and preserving the privacy of these protected health information are accordingly termed as the “covered entities”. It advocates the use of national standards in this context, which are aligned with the privacy rights of every individual as a control mechanism to ensure confidentiality of the protection of the medical data. The privacy rule works with a dual approach to protect data without inhibiting the flow of decision making in the industry. For instance, on one hand it implements restrictions to the unauthorized use of protected data and information on the medical records of patients. On the other hand, it emphasizes allowing the information that is to be used for the greater good of public’s well-being through high quality care facilities. These two dimensions in the privacy rules applied through HIPAA can be argued as self-contradictory, principally because the rules lack clear explanation of information, which should be considered as protected and those excluding this criteria (HHS, 2017.a).
The rules also do not clearly elaborate on the definition of covered entities, which makes its application subjected to the practitioners’ assumptions, considerations and intentions during the time of disclosing the medical information of patients. However, this rule is considered to have been designed with flexibility in order to adjust with the external environmental needs of the health care industry in the contemporary era. Arguably, this feature allows considerable advantages to the application of the privacy rules under HIPAA, but not without its corresponding shortcomings. This is due to the fact that high degree of flexibility implies increased level of complexities in the implementation processes and dependency on the knowledge as well as skills of the practitioners (HHS, 2017.a). This in turn raises various ethical concerns related to the patients’ overall safety. However, its significance in maintaining efficiency in protecting data and information concerning patients is considerable. It has been mentioned in Sections 261 to 264 of HIPAA, that these rules aim at involving electronic exchange of patients’ information and publicize standards applicable in this context through the implementation of Administrative Simplification Provisions (HHS, 2017.a).
As noted earlier in this section, the defined set of privacy rules under HIPAA covers a wide range of stakeholders, which include health plans, health care providers and health care clearinghouses. Health plans in this regard are noted as significant facets of the privacy rules. This is because it covers the provisions based on which a large number of American workers entitle themselves to health care insurance facilities as well as pay for their health care costs. It is thus that their medical information is sourced through and in coordination with these plans, making it a compulsory inclusion in the policy measure. Correspondingly, the health care providers are individuals and organizations, which are bestowed with the responsibilities to record, store and use or disclose the information related to each of the patient. It is thus necessary for them to be aware of the privacy rights that their patients hold and their limitations in using and/or disclosing the patients’ information with or without their (HHS, 2017.a).
The health care providers are often deemed responsible for executing the claims made by the insurers, besides conducting inquiries on patients’ benefit eligibility or referral authorization. In other words, this particular group of stakeholders involved in the privacy rules of the HIPAA is prone to ethical dilemmas, when using the patients’ medical information, making them a worthy inclusion into the system. The third stakeholder covered by the privacy rules of HIPAA are health care clearinghouses. These individuals refer to those entities obtaining non-standard information concerning the patients’ medical conditions from other serving entities and process them to a standardized version for long term storing. These entities may include billing service providers, community health management information systems, repricing companies, as well as, valuable networks, and switches, concerning with the entire information management system of the contemporary health care sector (HHS, 2017.a).
HIPAA Security Rules
Similar to the privacy rules, the security rules also operate on the same set of principles and strategies to ensure highest protection to the patient’s information, and safeguard their confidentiality rights. This particular set of rules principally emphasizes the administrative, technical and, physical needs to maintain the privacy of patients’ information. Hence, it is included under HIPAA in its 45 CFR Part 160 and Subparts A along with C of Part 164 (HHS, 2017.b). While the privacy rules set standards of using and disclosing patients’ information, the security rules are intended fundamentally to safeguard the industry stakeholders. This includes the patients, insurance providers and policy makers from the possibilities of frauds or breaches in the system. It therefore, has a substantial role to play in the information management system for the health care industry. This particular mechanism functions with extensive inclusion of technological innovation, taking into consideration the various procedural aspects of the electronic protected health information (e-PHI), the electronic exchange system used to manage the information. Keeping similarities with the privacy rules of the HIPAA, these security rules cover the health plans, the health care clearinghouses along with the parties, who are directly or indirectly involved with the transferring of the information. This also involves the business associates linked to the health care industry and the information management system used in the context. It was following the HITECH Act of 2009 that the applicability of the security rules were expanded to cover business associates, with due consideration to their roles in the modern day health care system (HHS, 2017.c).
In this context, business associates are referred to those covered entities, as defined in the HIPAA rules, which collectively represent the health care service providers. These business associates are also in charge of collecting, recording, reporting and preserving patients’ information for future referrals or uses. To be noted in this regards, considering the health care industry structure in the present context, outsourcing can be observed as an ongoing trend. Thus, it gradually helps in obtaining considerable attention and preferences amid the health care clearinghouses, health plans and health care providers. It is thus that the entire chain of operation does not necessarily remain limited within the context of the health care professionals. It also extends to profit seeking business entities, which are defined as the business associates in the security rules of the HIPAA. Their functions in the sector may involve the use and disclosure of the protected information about patients’ medical conditions, making them a liable party in the process of implementing HIPAA security rules (HHS, 2017.d).
The general rules applicable through HIPAA security measures therefore include ensuring confidentiality of the information recorded and shared with the business associates. In addition, it also involves information, which is shared internally within the health care industry. To assure confidentiality, it is essential for these groups to pay due attention towards forecasting any possibilities of data breaches and other risks that might hinder the privacy rights of the patients. This can lead to causing serious damages to the insurer as well as the provider. It is important for the health care organizations and practitioners following this rule, to have well-aligned workforce, which is adequately aware regarding their rights and permissions when using patients’ information (HHS, 2017.c).
These rules, thus apply to protect the patients as well as other stakeholders from a reasonably anticipated misuse of patient information through continuous monitoring of the covered entities. However, these security rules are limited on several grounds with its seemingly demanding objectives to ensure transparency within the overall health care system. For instance, it offers a general perspective to the needs and forms of risk management techniques that the health care service providers can take into consideration in the larger context. It therefore offers insignificant emphasis to the size, capability along with the complexity involved in the overall process of information recording and preserving, which differs substantially from one organization to another (HHS, 2017.c).
Correspondingly, the health care providers may witness different developmental needs with regards to their technical strengths and hardware as well as software infrastructure. These security policies also do not take into consideration any cost variables involved with the transparent use of information within the industry, which may be time consuming and inefficient in case of emergency situations. Moreover, being almost completely reliant on technology maintenance and advancement, the effectiveness of these rules remain subjected to malwares as well as unauthorized hacking (HHS, 2017.c).
Importance of Patient Safety with HIPAA Rules
As can be observed through the summaries about the HIPAA rules, patient safety holds the center point of discussion in both the cases. Although, significance have been delivered to protect the interests of other stakeholders in the sector. In this particular context, it is to be noted that the rules enacted through the implementation of the HIPAA regulations include five title segregations in its policy documentation. Title I of the HIPAA rules emphasizes the insurance needs of American workers, especially at the time when they change their jobs. IT, therefore allows the workers to shift their health insurance coverage from one workplace to another without having to incur extra cost of give up the assured amount. It also prohibits the health care plans as well as providers from denying the coverage to employees suffering from specific diseases with pre-existing conditions. Apparently thus, the rules included in this title consider safety of the patients with the highest degree of significance, as its ultimate objective (Techtarget Network, 2017).
Title II correspondingly focuses on maintaining the overall transparency in the process of conducting any transactions. Additionally, it involves the patients or the covered entities in the health care sector to emphasize the concepts of Administrative Simplification. From a general perspective, it may be observed to be more inclined towards safeguarding the covered entities. On the other hand, from a closer observation, the higher degree of safety assured to the patients from fraudulent practices become more apparent. It is with a similar objective that Title III was enacted through the HIPAA rules emphasizing tax related policy measures and medical care guidelines followed by the covered entities (Techtarget Network, 2017).
Title IV in this context can be further argued as an extension to Title I, which focuses on the needs and scopes to reform the health care insurance provisions. This is primarily done to suffice the requirements of insures having pre-existing condition as well as those preferring continued coverage. As this title also emphasizes the protection and interests of the patients, it also justifies the idea that HIPAA rules have been formulated with concern towards patients’ safety at the onset. Correspondingly, the regulations listed under Title V of HIPAA dictate the treatment of insurance policies owned by individuals, who lost their citizenship permit in the US owing to tax charges as well as those owned by life insurance companies. In this context as well, the value attributions to patients’ interests can be apparently observed (Techtarget Network, 2017).
Contextually, HIPAA is also referred as the Public Law 104-191 having two key purposes, with one concentrating on the continuity of health care coverage for US citizens and workers either when they lose their jobs It also takes into consideration the hazards when individuals with pre-existing medical conditions are denied insurance coverage and thus, acting in the greater interests of the patients. Simultaneously, it also aims at the reduction of the administrative cost burdens, in addition to the expenses incurred during health care delivery. Therefore, HIPAA rules not only concentrate on standardizing the electronic processing systems for the transmission and reporting of transactions involving the covered entities. IT also ensures mitigation of the chances of frauds, wastes as well as abuses in the greater context within the industry, which strengths the notion that these rules provide utmost significance towards ensuring patients’ safety through the health care operations (Techtarget Network, 2017). Nonetheless, researchers as well as experts from the field have been of the view that HIPAA rules act more like a set of guidelines rather than a set of legal statutes that would entail the happenings of the current situation and dictate the do’s and don’ts to protect patients’ information from being misused.
Limitations and Development Needs in HIPAA
Over the past years, since its enactment under Clinton administration, various questions have been raised concerning its effectiveness in assuring transparency within the health care context. This involves, in keeping with the needs and requirements of both the patients as well as the service provider groups. , It has been effective enough in raising the level of awareness amid the patients concerning their rights to confidentiality and privacy. In addition, besides making the covered entities informed about their limited roles and responsibilities to ensure data protection, it has nearly submerged the industry functioning into lengthy paper works. Owing to the extensive amount of importance offered to technology inclusion in the process of data protection and information management in the sector, the HIPAA rules also mandate proper training be delivered to the human resources. This includes individuals working within the industry as well as taking measures to inform the stakeholders regarding the policy changes being made. This requires substantial costs to be incurred, making it unlikely to suit the cost effectiveness demanded in the industry context presently (Kumekawa, 2005). At often instances, it also makes the information serving processes quite complex and time consuming too. For instance, in case of emergency situations within the medical context, such as organ transplantation or blood transfusion, the healthcare providers may seek for additional information on the donor(s) from the hospital. This are again subjected to authorization and a series of paper works (Kumekawa, 2005). These dilemmas are not unique to the medical processes, wherein the applicability and effectiveness of the HIPAA rules to safeguard patients to their best interests become questionable.
The privacy principles have been followed within the health care contexts since long time back. Medical professionals are encouraged to take their Hippocratic Oath even today, with the sole intention that they will work in the best interests of their patients and the greater good of the community. Implementation of the HIPAA standards under such circumstance has, therefore, contributed to raising confusions amid the industry players, concerning their rights, obligations and roles in managing patients’ medical information. As noted above, privacy policies enacted through the HIPAA guidelines function with a dual objective. This mostly includes safeguarding the patients by limiting and controlling the uses and/or disclosure of their medical information. On the other hand, it emphasizes decision making efficiency in terms of both time and costs. As a matter of fact, the intensive level of record keeping denotes considerable paper and desk jobs, making it a time consuming process. Hence, it acts in opposition of the objective of being cost and time efficient in nature. HIPAA, in the greater context, have also emphasized punishing and penalizing the one responsible for breaching confidentiality and serving patients’ information to identity thieves as well as members to the general public. Thus, its failure to gain pace over the new kind of privacy threats raised by continuously evolving health care technology has undermined its effectiveness substantially. Experts in the field thus have been raising questions concerning the effectiveness of the HIPAA guidelines in the present context of digital health care (Hsieh, 2014).
Strategically as well, the HIPAA regulations impose considerable burdens on the health care organizations to strengthen the administrative control on information transfer and perseverance. It is based on the assumption that with increased level of strictness in administrative surveillance measures, perceived as well as real breaches of patients’ information can be effectively mitigated. Nonetheless, it has been of limited help in the real life context and has only increased legislative pressures on these organizations (Glenn & Monteith, 2014). Stating precisely, at the present context, with little reforms made to the initial policy framework of HIPAA. In addition, this involves various limitations come onto the surface, mostly in terms of high costs, insignificant benefits as well as consequences for the health care organizations owing to the economic. Furthermore, it also includes administrative and legal challenges that the system imposes (Kapushion, 2003). It is thus that the entire system indicates towards developmental needs to align with the changing notions in the healthcare sector with continuous influences by digital innovation. Although, it attempts to function in the modern day context, the assumptions, principles and the values considered for the policy designing under HIPAA is more traditional or conventional in nature. It is thus that the HIPAA guidelines need to be more competitive and less concentrated to prove effective in the present phenomenon to ensure information safety to the patients (Kapushion, 2003).
Conclusions and Recommendations
Through the research, varied limitations and weaknesses of the HIPAA guidelines were identified, with regards to its efficiency in ensuring patients’ safety at the highest extent. For instance, HIPAA is noted to be based on the modern platform of technology guided health care practices, accepting the role of digital information management mechanisms. It provides due attention towards patients’ safety, not without discarding the moral and ethical issues witnessed by the health care providers and insurers in the sector. This offered the policy framework of HIPAA to be functional from a dual perspective, ideally suitable for the current context. However, at the functional level, implementation of the HIPAA security and privacy rules have been criticized for raising confusions and complexities in the strategic processes of decision making. It is perceived to raise legislative burdens on the health care organizations besides leading to cost and time related challenges. Sufficiency of technological resources to continuously update itself and manage to forecast potential threats to privacy and confidentiality of patients have also been limited in its current applications. Thus, it affects the inadequate virtue to ensure patients’ safety. Therefore, it is essential for HIPAA system to be reframed with greater emphasis to the nature of the health care industry today and the role of information management therein. In addition, steps must be taken to adapt digital innovation processes and change management approaches through the HIPAA regulations.
At the current phase, the HIPAA guidelines are quite complex and are tightly knitted to obtain strict surveillance on information circulations practices conducted within the industry. It accordingly specifies certain rules and legislatives that would help in determining the penalties to be served by the entities found guilty of breaching information security of the patients. Nonetheless, the strict and centralized mechanism through which the HIPAA security and privacy rules are implemented, limits the capacity of the framework to identify, forecast and respond to such crisis situations in an effective manner. It is thus suggestive that the HIPAA framework be re-examined to identify and exclude unnecessary regulations besides permitting a more flexible way of implementation with a lessened degree of centralization.
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