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What is HIPAA?

What is HIPAA?

HIPAA, short for the Health Insurance Portability and Accountability Act, is a federal law established in 1996 to protect sensitive patient health information from being disclosed without the patient's knowledge or consent. It sets national standards for safeguarding personal health data and ensures its confidentiality, integrity, and availability. Compliance with HIPAA regulations is overseen by the Department of Health and Human Services' Office for Civil Rights (OCR).


The scope of HIPAA

HIPAA applies to several entities within the healthcare industry. These entities include healthcare providers, health plans, healthcare clearinghouses, and business associates. Each entity must adhere to the specific rules and regulations outlined by HIPAA to ensure the protection and privacy of patient data.


Understanding protected health information (PHI)

To comply with HIPAA, any individual or organization working with protected health information (PHI) must adhere to the law's regulations. PHI is created when health data is combined with personally identifiable information, including names, geographical identifiers, phone numbers, email addresses, medical record numbers, and social security numbers, among others. When stored electronically, PHI is referred to as ePHI.

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HIPAA rules and regulations

HIPAA has several rules that govern the protection and use of PHI: 


Privacy rule

The privacy rule outlines how PHI can be used and disclosed. It requires patients' consent to use and disclose their health information, with certain exceptions. The rule also sets standards for the privacy practices of covered entities and their business associates.


Security rule

The security rule establishes standards for protecting ePHI. It requires entities to implement measures to ensure the confidentiality, integrity, and availability of ePHI. This includes conducting risk assessments, implementing safeguards, and training employees on security procedures. 


Breach notification rule

The breach notification rule requires covered entities to report any breaches of unsecured PHI to affected individuals, the OCR, and, in certain cases, the media. A breach is the unauthorized acquisition, access, use, or disclosure of PHI that compromises its security or privacy. Notifications must be provided without unreasonable delay and within specific timeframes, depending on the number of affected individuals.


Enforcement rule

The enforcement rule establishes the procedures and penalties for HIPAA violations. Penalties vary depending on the severity of the violation, ranging from lack of knowledge to willful neglect. Fines can be significant, especially for willful neglect violations.


Individual rights under HIPAA

HIPAA grants individuals certain rights regarding their health information. These rights include the right to access and obtain copies of their medical records, the right to request corrections to their records, and the right to request restrictions on the use and disclosure of their PHI. 

Individuals also have the right to request confidential communications, receive an accounting of disclosures, and file complaints regarding HIPAA violations. 


Common HIPAA risks and violations

Failure to comply with HIPAA regulations can lead to significant penalties and reputational damage. Some of the most common HIPAA risks and violations include:


Keeping unsecured records

Leaving sensitive documents unsecured, whether physical or digital, can expose them to unauthorized access. Proper security measures, such as secure workspaces and password protection, mitigate this risk.


Unencrypted data

While encryption is not mandatory under HIPAA, it is highly recommended. Encrypting data adds an extra layer of protection, ensuring that it remains unreadable even if it is compromised without proper authorization.


Hacking and phishing campaigns

Hackers and phishing campaigns often target healthcare organizations. Keeping antivirus software updated, and regularly changing passwords can help protect against these threats.


Loss or theft of devices

The loss or theft of devices containing PHI can lead to significant breaches. Encrypting data on devices, implementing remote wipe capabilities, and ensuring physical security measures can help mitigate this risk.


Sharing PHI

Employees may unintentionally share sensitive information with unauthorized individuals. Educating employees about handling sensitive data confidentially and restricting access to authorized personnel can help prevent accidental disclosures.


Lack of employee training

Employees may unknowingly work with PHI without understanding the potential consequences of mishandling it. Regularly educating employees on HIPAA regulations, their responsibilities, and the importance of data security can help reduce the risk of violations.


Unauthorized access

Employees not authorized to access PHI may still be able to do so, compromising its security. Implementing proper access controls, such as user authentication and role-based permissions, can help prevent unauthorized access.

See also: HIPAA Compliant Email: The Definitive Guide 

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