Challenges for privacy management in small healthcare practices

Small healthcare practices across the United States face regulatory requirements, technological challenges, and financial constraints that make privacy management difficult. While larger healthcare systems have the resources to dedicate entire teams to HIPAA compliance and data security, smaller practices must find creative ways to protect patient information while juggling multiple operational demands.

As the AMA Journal of Ethics states, "Despite brisk advances in science and technology and a bounty of medical knowledge, tools, and techniques to enhance patient care, [US physicians] struggle against a complex collection of economic and business hurdles and obstacles imposed by the health care system." This challenge is more when it comes to implementing privacy management systems that meet federal requirements while remaining financially feasible for smaller operations. According to Data privacy in healthcare: Global challenges and solutions, "Despite the presence of robust regulatory frameworks, the increasing integration of EHRs and digital tools has significantly amplified the risk of data breaches and unauthorized access."

The financial reality of privacy compliance

One of the barriers facing small healthcare practices is the financial burden associated with privacy management. The AMA Journal of Ethics further explains that "Numerous financial obstacles confront physicians in the US today. There are, for example, increasing threats of lawsuits that result in escalating malpractice insurance premiums, and soaring practice overhead costs. Physicians also face unfunded legal mandates, including the HIPAA confidentiality regulations."

This financial constraint is made worse by limited cybersecurity budgets. According to Chapter 18 of Roadmap to Successful Digital Health Ecosystem, "A recent study in the US reported that a typical cybersecurity budget is 6% or less of the information technology (IT) budget of healthcare institutions. This is considered a relatively small amount and constrains the cybersecurity posture of institutions."

Small practices often cannot invest in essential privacy management components such as staff training programs, regular compliance audits, specialized privacy management software, or dedicated privacy personnel. The result is a challenging environment where practices must do more with less, often compromising their privacy protections.

The American Academy of Orthopaedic Surgeons reinforces this concern, noting that "Beyond financial pressures, independent practices face a labyrinth of regulatory requirements and administrative tasks that divert time and resources away from patient care." This observation shows how privacy compliance isn't just a financial issue—it's a resource allocation challenge that affects the mission of healthcare delivery.

Balancing multiple responsibilities

In small healthcare practices, privacy officers balance privacy compliance duties with other administrative responsibilities. This juggling act presents challenges that larger organizations rarely face. For instance, a privacy officer might also serve as the office manager or billing coordinator, requiring time management skills to ensure all responsibilities receive attention.

This multitasking approach, while economically necessary, can create vulnerabilities in privacy protection. When attention is divided among multiple functions, the depth of focus on privacy management may suffer, potentially leading to oversights or delayed responses to privacy concerns. As noted in Chapter 18 of Roadmap to Successful Digital Health Ecosystem, "The primary goal of healthcare practitioners working in the medical field is helping people, and it is this mindset that can be used against them in social engineering attacks, for instance. For practitioners, anything (e.g., security protection) that comes between them and caring for their patients can cause irritations."

Emerging challenges and industry perspectives

Small healthcare practices' challenges continue to evolve, particularly in data security and privacy. In December 2023, Medical Economics sat down with North American Healthcare Practice Leader Peter Reily, to discuss the challenges medical practices will face in 2024. His insights provide a perspective on the ongoing nature of these challenges.

"I think the practice of medicine continues to evolve and faces a number of challenges and opportunities at the same time. I would be remiss if I didn't mention one of the big challenges is going to continue to be that with data security and privacy. Medical practices need to seek both legal and risk-management advice on how to handle those, because that's not going to go away," Reily explains.

Privacy and security challenges are not temporary hurdles to overcome but ongoing operational requirements that demand attention and resources. For small healthcare practices, this means developing long-term strategies for HIPAA compliance while managing the competing demands of patient care, administrative tasks, and operational costs. Chapter 18 of Roadmap to Successful Digital Health Ecosystem reinforces this urgency, stating that "Cybersecurity threats to healthcare institutions and patient safety are real. Security incidents have several adverse consequences to patients and institutions, as well as patient safety. Therefore, cybersecurity must be a priority and institutions must make the investments needed to protect their patients."

Without proper safeguards, small practices face risks including data breaches, fines, and loss of patient trust.  As emphasized in Chapter 18 of Roadmap to Successful Digital Health Ecosystem, "Patient data need to be available to authorized people on time. Security breaches may lead to unavailability of patient data and could decrease quality of care or result in inadequate treatment."

Technology infrastructure

The technological gap between small and large healthcare organizations represents one of the challenges in privacy management. As noted in Chapter 18 of Roadmap to Successful Digital Health Ecosystem, "Small healthcare facilities are less likely to have dedicated IT personnel which adds to the difficulty of obtaining the necessary expertise to meet the Security Rule requirements."

The HIPAA Security Rule Compliance in Small Healthcare Facilities: A Theoretical Framework provides insight into this:

"General IT competence has been shown to be important in the effective implementation of information security. IT competence might include the generation, updating, and use of security policies, or having the means to monitor unauthorized or suspicious access to PHI. If these competencies exist, it is reasonable that overall Security Rule compliance is more likely to occur. However, small healthcare facilities are less likely to have dedicated IT personnel which adds to the difficulty of obtaining the necessary expertise to meet the Security Rule requirements."

This expertise gap represents a widespread challenge. According to Chapter 18 of Roadmap to Successful Digital Health Ecosystem, research shows that "In one study of small medical practices, the lack of expertise was the most commonly reported barrier to having an information security policy."

Many small practices operate with basic data management systems or, in some cases, still rely on paper records. This limited technological capability creates multiple vulnerabilities and operational challenges. Practices struggle to track and monitor access to patient information effectively, implement automated privacy safeguards, maintain secure backup systems, and generate audit trails.

Practical solutions within constraints

Despite these challenges, small healthcare practices can develop effective strategies to protect patient information within their technological and financial limitations. Chapter 18 of Roadmap to Successful Digital Health Ecosystem emphasizes the importance of strategic resource allocation: "Institutions need to continuously identify their security risks and risk tolerance and, consequently, prioritize their cybersecurity activities to maximize the impact of each dollar spent."

Peter Reily offers practical advice for small healthcare practices: "Take a hard look at your risk practices, your protocols, your checklist to make sure that your delivery of care is optimal, because that will if nothing else, if you do have some issues with losses, that is a way to mitigate those costs." This approach recognizes that good practices and procedures throughout a practice can lead to better outcomes both clinically and from an insurance perspective.

However, Reily also emphasizes the importance of taking data security seriously: "But that particular issue around data security is one that I think too many practices still do not take seriously enough. They don't buy adequate protection, and they don't avail themselves to the resources that are there." 

The responsibility for privacy protection extends beyond internal operations. Even when reviewing patient records sent from hospitals, those records become the receiving practice's responsibility to protect. This expanded scope of responsibility requires practices to consider privacy implications in all aspects of their operations.

The importance of continuous monitoring cannot be overstated. As noted in Chapter 18 of Roadmap to Successful Digital Health Ecosystem, "It is critical to adequately monitor for anomalous behaviour or activities that are potential attempts of security breach. Once an attack is detected, it is critical to implement appropriate actions regarding the cybersecurity incident and recover to normal operations in a timely manner."

Technology solutions for resource-conscious practices

While technology solutions may be beyond the reach of many small practices, targeted investments in specific areas can provide privacy protection improvements. Using secure email platforms like Paubox can help maintain HIPAA compliance while streamlining patient communications, providing a cost-effective way to enhance privacy protection in daily operations.

For billing operations, implementing dedicated healthcare billing software ensures secure processing of sensitive financial and medical information while reducing manual errors. 

According to Data privacy in healthcare: Global challenges and solutions, emerging technologies offer promising solutions: "AI and ML can automate compliance monitoring and enhance breach detection, while semantic ontologies support data harmonization by standardizing how information is interpreted across systems." While these technologies may seem beyond the reach of small practices today, understanding their potential can help practices plan for future investments and partnerships.

Building support networks

Reily emphasizes the importance of building strong advisory relationships: "Practices need to be mindful of the social inflation and other challenges that are impacting nearly all sorts of medical practices all the way through the largest health care institutions. And so they need to be having some candid and probably more frequent dialogue with trusted advisors to the medical practice, from insurance professionals like myself, to legal counsel, and accountants."

This approach recognizes that privacy management is not solely an internal challenge but requires external expertise and support. By building relationships with trusted advisors who understand the unique challenges facing small healthcare practices, practices can access specialized knowledge and guidance that would otherwise be unavailable.

Chapter 18 of Roadmap to Successful Digital Health Ecosystem supports this collaborative approach, noting that effective risk management requires "making a proper balance between handling risk and retaining necessary benefits of data or systems."

Partnerships with Managed Security Service Providers (MSSPs) can offer small practices access to enterprise-level cybersecurity expertise and monitoring capabilities at a fraction of the cost of building internal capabilities. These providers can help practices implement continuous monitoring, threat detection, and incident response services that would otherwise be financially out of reach.

As noted in Data privacy in healthcare: Global challenges and solutions, addressing these challenges effectively requires a coordinated effort: "Addressing healthcare data privacy challenges requires harmonized global regulations, advanced technological tools, and international collaboration." While small practices may not operate on a global scale, they can benefit from understanding these broader trends and seeking partnerships that provide access to advanced tools and expertise at a more manageable scale and cost.

Read also: How MSPs and MSSPs overcome rural healthcare technology challenges

FAQs

How does staff turnover affect privacy management in small healthcare practices?

High turnover makes it difficult to maintain consistent HIPAA training and enforce policies effectively.

What role does patient education play in protecting health information?

Educating patients about secure communication and data-sharing practices reduces risks of accidental disclosures.

Can small practices share resources for privacy compliance?

Yes, practices can collaborate through consortiums or local networks to pool resources for training, audits, and IT support.

How do malpractice risks intersect with privacy breaches?

A privacy breach can increase liability exposure and compound malpractice claims.