Healthcare Privacy in the United States is a relatively recent development. The first federal laws relating to it were not passed until 1974 as part of the Privacy Act. However, there have been great strides forward in its evolution. Since then, there has been the introduction of the Health Insurance and Portability Accountability in 1996. This is one of the first healthcare laws in the world that actively sought to ensure the safety of the Private Health Information (PHI) of individuals.
PHI refers to any information that is held by a covered entity. It covers the entity’s health status, payment for healthcare, and other details that may be linked to an individual. Some of the 18 fields of ePHI include:
- Social security number
1974 Privacy Act
The Privacy Act was passed in 1974. This was done to create a Code of Fair Information Practice. The main purpose of the code is to police the gathering, management, use, and sharing of personally identifiable information about individuals being held by US federal agencies. The following protections of private personal information were added in the act:
- Outlawed sharing personally identifiable information held by federal agencies in a system if permission has not been provided by the concerned individual. However, there are some codified exceptions to this.
- Individuals were given enhanced rights of access to agency records that are being held concerning them.
- Power is allocated to individuals to have agency records amended if found to be incorrect.
- Implemented a code of fair information practices that obligate agencies to adhere to statutory norms for the gathering, management, and sharing of records.
This was the first federal legislation to add some protection to the Private Healthcare Information of US Citizens. However, it was not until the 1996 passing of the Healthcare Portability and Accountability Act that legislation specific to the protection of PHI was introduced.
The HIPAA Privacy Rule
HIPAA stands for the Health Insurance and Accountability Act. The HIPAA Privacy Rule puts in place national standards to ensure that individuals’ medical records are protected.
HIPAA was first introduced to the US Senate as the Kennedy-Kassebaum Act. It made it through Congress and was enacted into law by the Clinton administration later that same year. Along with the protection of PHI, it was also drawn up to ensure that workers would maintain their healthcare cover when they were moving from one company to a different company.
Cybersecurity was still in its infancy in the mid to late 1990s. Despite this, there were specific references in the legislation to the protection of the electronic transmission of healthcare data. There were more amendments over the years to further bolster the security of PHI in the digital world.
Safeguard healthcare coverage for individuals who are undergoing a period of transition in their professional lives.Initially, the main protections that added were:
- Guarantee the necessary standards are in place for electronic healthcare transactions and state national identifiers for providers, health insurance plans, and employers.
- Set up guidelines for pre-tax medical spending accounts.
- Put in place rules for group health plans and company-owned life insurance plans.
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HIPAA Rules and Regulations
The main rules added over the years were as follows:
- HIPAA Privacy Rule: This created federal standards to safeguard individuals’ medical records and other personal health information. It applies to health plans, health care clearinghouses, and those health care providers that carry out specific health care transactions electronically.
- HIPAA Security Rule: This stated that medical workers must protect patients’ electronically stored ePHI by using appropriate administrative, physical, and technical security measures to ensure the confidentiality, integrity, and security of this data.
- Omnibus Rule 2013: This was introduced on January 25, 2013, when the HIPAA Omnibus Rule was published in the Federal Register. This move led to the final changes to the HIPAA privacy and security rule. It also implemented changes for enforcement, breach notification rules, and the Genetic Information Nondiscrimination Act (GINA).
- HITECH ACT: The HITECH Act required healthcare groups to implement electronic health records and better healthcare privacy as well as security systems for healthcare data. It did so by introducing financial incentives for adopting EHRs and higher punitive measures for breaches of the HIPAA Privacy and Security Rules.
While the Data Privacy Act (1974) was the first legislation that was introduced to protect and private information, the first health-sector specific measures were witnessed with the introduction of HIPAA in 1996. The measures established at that time have been bolstered in the amendments to it since then.
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Allowed Use and Disclosure
Under HIPAA regulations, a covered entity is allowed to use and disclose protected health information without their authorization. This is applicable for the following purposes or situations:
- Health oversight activities
- Victims of abuse, neglect, or domestic violence
- When required by law
- Public health activities
- Law enforcement
- Essential government functions
- Judicial and administrative operations
- Cadaveric organ or tissue donation
- Identification of deceased or lost persons
- Workers’ compensation
To comply with the HIPAA Security rules, all covered entities need to ensure confidentiality, integrity, and availability of all electronically protected health information to healthcare privacy .
With the ongoing evolution of technology and the increased efforts of cyber criminals to obtain PHI then it is prudent to expect that further changes to HIPAA will be necessary going forward.
Disclaimer: The statements, opinions, and data contained in these publications are solely those of the individual authors and contributors and not of Credihealth and the editor(s).
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