Date: May 3, 2019
Category: Nursing Essay
Healthcare Policy Analysis

The modern health care industry is affected by the issue of confidentiality. It relates to the manner in which nurses communicate with patients and their families, as well as each other. The breach of patient information is considered a breach of the current code of ethics for nurses. The code stresses the importance of privacy in advocating and promoting the rights of patients. Regardless of the introduction of modern technology, the issues of confidentiality still exist. The patient’s information that is private and confidential remains breached, calling for the need for numerous changes in the healthcare sector. The changes are important as they prompt nurses to keep patients’ information private. Therefore, the policy of the Health Insurance Portability and Accountability Act (HIPAA) is aimed at addressing the challenges of confidentiality as described in this paper.

HIPAA Privacy Rules

HIPAA encompasses privacy rules that are meant to safeguard the patient’s private information. It is also referred to as Protected Health Information (PHI). The law was enacted to protect personal private information. Thus, HIPAA ensures that any health information regarding the private life of a patient is protected. However, it does not matter whether the information is recorded, oral, or written. The law safeguards health information which is created or received through a health plan, life insurer, university, public health authority, or an employer. In addition, the law protects information which relates to the present, past or future of an individual. In all these ways, nurses and other healthcare providers are required to protect health information in whichever medium.

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The privacy rule of HIPAA also ensures that the medical records that relate to healthcare clearinghouses and health plans are protected. In this, other personal health information is protected by health plans, healthcare providers, and healthcare clearinghouses. The services that are conducted electronically are monitored in the duty to protect patient information. The appropriate safeguards are required for the rule to work effectively. In other words, conditions and limits are set on the disclosures and use that cover patients’ rights for confidential information. These include the right to obtain health care records and examine corrections.

According to the rule, the specific health plans should ensure confidential information is protected. Every healthcare provider is also required to transmit health information in connection with certain transactions. Authorization requests are ensured before the information is transmitted electronically. It also guarantees that third parties are not involved in the transmission of personal health information. In the health care clearinghouses, information that is nonstandard is kept in a standard form. In these clearinghouses, individually identifiable information is provided to the healthcare provider or the health plan. Disclosures and uses are availed to help protect the data. These include; value-added networks and billing services, among others that enable the clearinghouses to function in the required manner.

To prevent the breach of confidential information, HIPAA ensures that certain uses and disclosures are authorized. In this, the patient or the individual must provide written authorization for any disclosure of protected information. The information could be related to payment, health, or other operations of healthcare. The authorization should relate to the privacy rule as reflected by HIPAA. Disclosures that require authorization from the patient include the results of a lab test, coverage purposes of a life insurer, or pre-employment physical tests. The authorization should be written in a language that many people can understand. It should contain specific information that needs to be used or disclosed. The individuals who are required to disclose the information should also be specified. The privacy rule expresses other legal permissions such as the right to revoke in writing to ensure that confidential information is kept private.

Roles of HIPAA

HIPAA has been levied with the task of ensuring privacy in the healthcare sector. It also ensures that confidential information does not land in the hands of unauthorized persons. In this, the law preserves health information regardless of the type of transmission. For instance, health information should be protected regardless of whether it is transmitted through paper, verbal, or electronic means. The privacy rule sets the roles of HIPAA and ensures that the baseline requirements, which entail confidentiality, are provided.

Among the roles of HIPAA is to protect the health records of individuals as well as other personally identifiable information which has been created by the specific healthcare or provider. In this, information that is received by business associates or other covered entities should be maintained. It is the role of HIPAA to ensure that the personal health information of individuals is protected. The law ensures that the circumstances covered by entities that disclose or use the information are regulated. For instance, individuals who permit marketing agencies to use their health information are required to submit an authorization form, among other important statements. HIPAA is mandated to provide individual rights such as the extent to which information should be disclosed or used. In this, individuals are also given the right to obtain and examine a copy of the request corrections and health records.

It is the role of HIPAA to take legal actions to individuals in cases where confidential identifiable information is leaked to unauthorized individuals. Even though HIPAA does not provide the right for individuals to file lawsuits, one may still obtain the basis of the suit through breach of confidentiality or the torts of invasion of privacy. In short, the necessary legal actions are taken by the law. The legal actions of HIPAA following the breach of private information require business associates and covered entities to provide the notification. Regarding the protected health information, similar provisions are also available at the Federal Trade Commission (FTC).

HIPAA enforces civil and criminal penalties to individuals who are found with confidential identifiable information. A civil structure that prevents civil violations was established in 2009. The amount of penalty is based on the extent and nature of the violation, as well as the extent and nature of the harm caused by the violation. The time period for corrections is believed to be 30 days or longer, except under the cases of willful neglect. Criminal penalties are also subjected to individuals who are held liable under HIPAA. The specified individuals, covered entities, and others who disclose individually identifiable information face a fine of not less than $50,000. It is apparent that some offenses are committed under false pretenses. In this, the fine is usually increased to $100,000. This fine is inclusive of a five-year jail term. The penalty may be up to ten years in prison with an additional $250,000 if the offense was committed with the intent to transfer, sell, or use health information for profitable means.

Individuals who leak confidential information are entitled to covered entities; which include; health care clearinghouses, health plans, and healthcare providers, as noted in the above context. An individual can also be held liable under HIPAA as reflected by the principles of corporate criminal liability. The individuals who are held liable under HIPAA through a covered entity can be charged with aiding or conspiracy and abetting. The legal actions conducted by HIPAA to individuals for leaking confidential health information are regulated by the Department of Justice. Nurses and other healthcare providers are aware of the legal actions that relate to the privacy of patients. Therefore, the violation of this law is believed to have occurred with the consent of the health care provider. It is perceived to be a criminal liability, whereby certain actions should be taken in relation to the HIPAA statute.

HIPAA Exceptions

HIPAA has a number of exceptions that relate to the manner in which it conducts its roles. The law is not applicable in cases where personally identifiable information is passed through writing or by oral means owing to the fact that it is difficult to provide evidence through the mentioned exceptions. In this, the flow of information is vital to the modernization of general health. The health standards are also improved through the flow of information that is ensured by HIPAA.

The disclosure of personal health information is allowed by HIPAA in cases health oversight activities are concerned. Some of the oversight health activities that are allowed by the law include; inspections, investigations, and disciplinary actions. The law also allows the disclosure of personally identifiable information through public health activities that are aimed at controlling or preventing disease. For example, healthcare providers are allowed to disclose confidential information while providing or making reports to the NYS Department. Reports that concern the child abuse are authorized by HIPAA.

In other cases, the disclosure of personal confidential information is allowed; for instance, if it complies with the requirements of HIPAA. According to the rules of HIPAA, the release of confidential health information is considered abuse. The victims of the abuse feel neglected by society in cases where their health information is disclosed. To prevent this from occurring, HIPAA ensures that information can be disclosed in cases where the individual provides an agreement. Thus, the most serious harm can be prevented, especially in cases where professional judgment is required. Generally, the exceptions of HIPAA are evident following administrative or judicial proceedings. Therefore, a court order requiring disclosure is respected. For instance, the efforts to locate or identify a suspect can prompt the data to be disclosed. In a case of rape, the victim of offense needs a health examination to determine whether he or she could be suffering from an infectious disease. The information should be disclosed following a court order.

HIPAA Policies

HIPAA encompasses policies that require the law to work effectively. The policies are applicable to healthcare providers and health plans. The policies cover drug insurers, health, Medicaid, health protection organizations, dental, Medicare, long-term insurers, and medical supplement insurers. Through the policies of HIPAA, the roles of the law are ensured. The law protects the integrity, confidentiality, and availability by providing appropriate and reasonable steps while addressing the importance of protecting confidentiality.

HIPAA ensures that individuals and healthcare providers protect confidential health information by following the specifications and policies of the law. In this, a contract is formed between healthcare providers and the law, preventing them from violating the policies. The privacy policies of HIPAA are reinforced and augmented through support components. The discretion of information is reserved through procedures that should be modified in relation to the standards of HIPAA.

HIPAA Healthcare Stakeholders

HIPAA is surrounded by healthcare stakeholders such as dentists, institutional providers, and physicians. The major players in this field include; institutional and non-institutional providers. All these medical providers are entitled to ensure that personally identifiable information is not disclosed. The breach of this information is believed to be an essential step by the law. Other organizations and individuals are required to protect the law. For instance, normal health practices should be tackled despite the numerous challenges of leaking confidential health information. In cases where the symptoms of a disease are known by the larger population, it becomes difficult for healthcare to convince the relatives of the patient, as well as the friends.

Health plans pay or provide the cost of Medicare by sticking to normal health practices. Managed care organizations, private health insurers, health programs, or governmental payers form the largest part of healthcare stakeholders. Health programs such as Medicare, Medicaid, or veterans affairs ensure that the roles and policies of HIPAA are achieved. Te healthcare clearinghouses are, in most cases, referred to as billing services and ensure that the standards of the law are met. As noted earlier, healthcare providers such as doctors, hospitals, and other health care facilities and professionals help to provide treatment.

Healthcare Clearinghouses

Health care clearinghouses form part of the covered entities, as discussed earlier in the context mentioned above. These entities could be transmitted by another person and often receive non-standard information. The entities also process the information into a standard form. The clearinghouses encompass a section of the applicable rule provision. In this, the use and disclosure of health information are protected, especially in the cases of information processing. The healthcare clearinghouses transmit billing information and typical claims. These activities are conducted by players in the healthcare system. While handling these activities, healthcare providers are required to reformat and submit health information to the company. The information should not be breached. As a rule, an average patient does not require clearinghouses since its function is believed to be invisible.

HIPAA Business Associates

The business associates of HIPAA have a number of roles that are performed on behalf of the covered entities. Some of these functions include; utilization review claims processing, data analysis, and billing services. Even though the services of the business associates are limited, some of them include; financial services, legal, accounting, accreditation, data aggregation, actuarial and administrative.

 

The modern health care is affected by the issue of confidentiality. It relates to the manner in which nurses communicate with patients and their families, as well as each other. Regardless of the introduction of modern technology, the issues of confidentiality still exist. The patient’s information that is private and confidential remains breached, calling for the need for numerous changes in the healthcare sector. HIPAA encompasses privacy rules meant to safeguard a patient’s private information. HIPAA has been levied with the task of ensuring privacy in the healthcare sector. It also ensures that confidential information does not land in the hands of unauthorized persons. HIPAA encompasses policies that require the law to work effectively. The policies are applicable to healthcare providers and health plans. HIPAA has a number of exceptions and aspects that relate to the manner in which it conducts its roles.