HIPAA Health Insurance Portability and Accountability Act

1. 1 of 70 HIPAAHealth Insurance Portability and Accountability Act What part do students play in implementing HIPAA? How does this law affect your student role?

2. 2 of 70 HIPAA regulations were designed to: 1) protect individuals� rights to privacy and confidentiality and 2) assure the security of electronic transfer of personal information The first, protecting privacy and confidentiality rights, is the subject of this instructional program.

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4. 4 of 70 HIPAA applies to us all--in all settings. That means at school, at home, on the shuttle buses, as well as the hospitals and clinics.

5. 5 of 70 After completing this program you will be able to: Discuss the general concepts of HIPAA guidelines Adapt HIPAA guidelines for the various settings in which you might practice throughout the curriculum Discuss the seven patient/client rights regarding his/her health information Differentiate individuals who have a �need to know� from those who don�t. This determines those with whom you can discuss protected health information Discuss application of HIPAA to the student role List legal, professional, and academic consequences of violating HIPAA rules

6. 6 of 70 Why HIPAA?? Genetic advancements - as more is known about our genetic predisposition to diseases, HIPAA will ensure that, for example, an individual is not denied insurance because the company knows that she may eventually develop MS. Marketing - as information is more easily captured concerning, for example, the prescriptions we purchase, HIPAA is designed to prevent marketing of unsolicited products or services based on harvested marketing data. Technology - as information is quickly and sometimes loosely moved around networks, HIPAA standards will hold violators accountable for accidental or intentional �interception� of protected health information (PHI).

7. 7 of 70 Why HIPAA? An Atlanta truck driver lost his job in early 1998 after his employer learned from his insurance company that he had sought treatment for a drinking problem. The late tennis star Arthur Ashe�s positive HIV status was disclosed by a healthcare worker and published by a newspaper without his permission. Tammy Wynette�s medical records were sold to National Enquirer by a hospital employee for $2,610.

8. 8 of 70 When and How Often do I need to be Certified? The law requires that we comply with the regulations and adhere to agency guidelines. The �certificate of compliance� you will receive upon the completion of this program will be sufficient until new or updated policies are developed by the Dept. of Health and Human Services. Be aware that individual agencies may have unique HIPAA policies, and it is your responsibility to know and implement those policies.

9. 9 of 70 What Objectives do the Privacy Regulations Accomplish for Patients? Give patients more control over their health information. Set boundaries on the use and disclosure of health records. Establish appropriate safeguards for all people who participate in or are associated with the provision of healthcare to ensure that they honor patients� rights to privacy of their PHI. Hold violators accountable through civil and criminal penalties. Strike a balance when public responsibility requires disclosure of some forms of data--for example, to protect public health.

10. 10 of 70 With HIPAA we now have new terms and abbreviations to learn!! Protected Health Information (PHI) or Protected Medical Information (PMI) This is any data about the patient that would tend to identify the individual: name, hospital #, SSN, diagnosis, lab results, past or current photos, etc, etc. Privacy Officer (PO) Each facility will have an employee who is responsible for implementing and enforcing this law. Some may have one over a multi-facility network (Seton) others one at each site (St. David�s Partnership). As a nursing student this individual (after your instructor or preceptor) could be your point of information regarding HIPAA. Covered Entity (CE) This includes any health plan, healthcare provider, agency that processes claims, and any company that subcontracts with them are covered by this law.

11. 11 of 70 And more new terms and abbreviations to learn!! Release/Disclosure These are terms used in describing the release of PHI to other CEs for TPO, treatment. payment, or health care operations. Accounting of Disclosure (AOD) The patient has the right to have an AODs for his PHI or PMI. Directory This is CE�s census or list of patients used by volunteers and operators to direct visitors.

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13. 13 of 70 What are the Seven Patient Rights Regarding Privacy of PHI (Protected Health Information) Individuals have the right to: Receive notice of an agency�s privacy practices. Know that an agency will use its PHI ONLY for treatment, payment, operations (TPO), certain other permitted uses and uses as required by law Consent to and control the use and disclosure of their PHI.

14. 14 of 70 Seven Rights�continued Access their protected health information (PHI), except for psychotherapy notes (they might be charged for copies) Request amendment or addendum to their PHI (not always granted) Receive accountings of disclosures File privacy complaints to agency officer

15. 15 of 70 HIPAA Restricts Sharing PHI Personal information cannot be released to individuals or companies interested in marketing ventures, without the patient�s written permission. For example: Names of patients on antihypertensive drugs cannot be released to a company marketing nutritional products to lower blood pressure. Names and addresses of pregnant women cannot be provided to infant formula companies. Contact information of previous patients cannot be used to raise money for a hospital building campaign.

16. 16 of 70 How do students assure patients� rights to privacy and confidentiality?

17. 17 of 70 Who has Access to PHI?The �Need-to-Know� Principle PHI should be shared with as few individuals as needed to ensure patient care and then only to the extent demanded by the individual�s role. For example, the nursing assistant �needs to know� only the facts concerning the patient�s current admission. As a nursing student, you will discuss PHI only as it applies to your education or your patient�s care.

18. 18 of 70 Protecting your patient�s PHI Take all reasonable steps to make sure that individuals without the �need to know� do not overhear conversations about PHI. DO NOT conduct discussion about PHI in elevators or cafeterias. Do not let others see your computer screen while you are working. Be sure to log out when done with any computer file.

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20. 20 of 70 In the student role you are NOT to photoduplicate or fax patient documents in the process of working with your patient�s PHI. As an employee of an agency you must use the agencies� security procedures to transmit PHI.

21. 21 of 70 Destroying PHI/PMI DO NOT put notes with PHI/PMI in the trash or paper recycle cans. A paper shredder is available in the Learning Center for these materials.

22. 22 of 70 Consequences of HIPAA Violations In addition to federal laws, failure to comply with HIPAA also violates Nursing�s Code of Ethics Texas Board of Nurse Examiners Standards of Practice School of Nursing�s academic and scholarly policies

23. 23 of 70 Potential Consequences of HIPAA Violations Legal consequences Civil or criminal penalties Fines plus imprisonment Professional consequences: Disciplinary action by the Board of Nurse Examiners Academic consequences: Reprimands Loss of points toward grade or failure of course Dismissal from School of Nursing

24. 24 of 70 Application of HIPAA to Common Situations Facing Nursing Students

25. 25 of 70 Johnny, an active 4 year old, breaks his arm after falling from a climbing form at his daycare. As the nursing student caring for him after the casting, you know that he is HIV positive. Your daughter attends the same daycare. You alert some of the other moms at that center. What�s wrong with this scenario? Who in this setting has a �need to know� the HIV status of this child?

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27. 27 of 70 Found PHI While working a 3-11 shift in the city/county health clinic, you see some patient data in the trash can. What should you do?

28. 28 of 70 No, this is not the best response. You will want to protect the PHI better than this.

29. 29 of 70 Well�this is an option, but maybe over-kill at this stage. You should either tell your instructor or preceptor (tell the head nurse or unit manager only if your instructor or preceptor are not available). They will see that the individual responsible gets further education.

30. 30 of 70 Yes, this is the best option. You should either tell your instructor or preceptor (tell the head nurse or unit manager only if your instructor or preceptor are not available). They will see that the individual responsible gets further education.

31. 31 of 70 No, this is not the best response. You�re thinking in the correct direction, but you don�t want to stick your hand into any hospital trash can. You will want to tie up this bag, label it, and get someone to take it to a shredder. As a nursing student your best action would be to discuss with your instructor or preceptor.

32. 32 of 70 No, this is not the best response. This is NOT a good way to win friends for you or the School! Unless you are finding consistent HIPAA violations that after reporting are not being corrected, let the agency have a shot at re-educating its staff OR STUDENTS.

33. 33 of 70 Your Best Friend

34. 34 of 70 No, this is not the best response. Did you say she was your best friend? Unless she is consistently violating a patient�s rights to protect his/her PHI, you will want to help each other when you slip.

35. 35 of 70 Really now!!! I am going to get the Agency�s HIPAA Officer after the both of you!

36. 36 of 70 Yes, this is a good option. Help her recall her responsibilities to the patient�s right to confidentiality and privacy.

37. 37 of 70 Patient�s Question

38. 38 of 70 Yes, this is the correct response. Recall that HIPAA gives patients/clients the right (right #3) to control the use and disclosure of their PHI. It is within her rights to have her name removed from the list. Furthermore, most agencies have special forms for this.

39. 39 of 70 Correct, BUT report it and let the right person take care of the details. Most agencies will have special forms for this. The best response is �B�

40. 40 of 70 No, this is a reasonable request. Recall that HIPAA gives patients the right (right #3) to direct use and disclosure of their PHI. It is within her rights to have her name removed from the list. Most agencies will have special forms for this.

41. 41 of 70 Consulting Physician Calls

42. 42 of 70 No, this is not the correct response. After instituting reasonable safeguards that it is Dr. Han, you should give her the information that she requests. Recall that PHI can be shared with other caregivers for TPO (treatment, payment, & agency operation) without getting additional approval from the patient.

43. 43 of 70 Yes, this is the correct response. It is not a violation of HIPAA if you institute reasonable assurances to protect the security of the patient information and then disclose to another person who has a �need to know.� Recall that PHI can be shared with other caregivers for TPO (treatment, payment, & agency operation) without getting additional approval from the patient.

44. 44 of 70 Patient�s Spouse Wants to Read the Chart

45. 45 of 70 No, this is not the correct response. You recall that the patient has the right to decide how her PHI can be disclosed. As a student, any question about HIPAA or how to deal with patients or their families should be referred to your faculty or preceptor.

46. 46 of 70 Well�you�re right, but as a student you might want to consult with your instructor or preceptor before dealing with the patient�s husband.

47. 47 of 70 Yes, this is the correct response. It is always the best policy that as a student you refer your questions to your instructor or preceptor. In emergencies, if they aren�t available, speak to the head nurse or unit manager.

48. 48 of 70 A FINAL REVIEW Answer the following true-false questions

49. 49 of 70 Patients have a right to see their chart?

50. 50 of 70 You�re right!

51. 51 of 70 No, that�s not right. Do you need to review?

52. 52 of 70 Patients can ask that parts of their health record be amended?

53. 53 of 70 You�re right!

54. 54 of 70 No, that�s not right. Do you need to review?

55. 55 of 70 All PHI is in the patient�s chart?

56. 56 of 70 You�re right!

57. 57 of 70 No, that�s not right. Do you need to review?

58. 58 of 70 I can talk with my instructor about my patient�s medical history?

59. 59 of 70 You�re right!

60. 60 of 70 No, that�s not right. Do you need to review?

61. 61 of 70 As a nursing student questions or concerns about HIPAA policies or infractions should be directed to your instructor or preceptor.

62. 62 of 70 You�re right! You can also talk with the agency�s privacy officer, but as a nursing student it is best to check with your faculty or preceptor first.

63. 63 of 70 No, that�s not right. Do you need to review?

64. 64 of 70 Personal digital assistants (PDAs), clipboards, floppy disks, zip disks and CD-ROMs used for storing PMI, careplans, process recordings, or patient assessments forms must be protected as we protect the patient�s chart?

65. 65 of 70 You�re right! Any format that contains PHI needs your special attention.

66. 66 of 70 No, that�s not right. Do you need to review?

67. 67 of 70 Complying with HIPAA guidelines is an important part of a healthcare provider�s role. As a nursing student, failure to comply can result in academic, professional, civil, or criminal consequences.

68. 68 of 70 You�re right!

69. 69 of 70 No, that�s not right. Do you need to review?

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