The “P” in HIPAA stands for Portability, not Privacy

People do not have a clear understanding of how HIPAA is put into practice. HIPAA, which stands for Health Insurance Portability and Accountability Act, was established in 1996 as an act to provide consumers with a national standard for handling our medical information. The word “privacy” is not in the name of the act.

The “P” stands for ‘portability,” which reflects the purpose of this act: HIPAA was developed to “modernize the flow of healthcare information” (https://www.hipaajournal.com/is-it-a-hipaa-violation-to-ask-for-proof-of-vaccine-status/). To be clear, HIPAA does not result in your health information being totally private and protected; rather, the key purpose is to manage how your health information is handled and transmitted. Here’s how it works.
     
With this act we are able to access our own medical records, authorize others to access our information with our permission and receive disclosure notification when our health information is shared. There are many organizations and companies receiving our health information that have nothing to do with our actual healthcare and everything to do with covering the cost. We are more familiar with signing forms that allow our doctors to share information with other healthcare providers and our health insurance companies. These groups are called “covered identities.”

But we are less familiar with other companies and organizations (beyond the covered entities) who have access to our health information. They are identified as “non-entities.”

1. Credit card companies: If you have travel insurance coverage with your credit card, take a look at your credit card notices about disclosure. They have access to your health information. If you are ill or have an injury while traveling, your credit card company covers the costs. Your privacy goes out the window.
2. Employers

• Worker’s Compensation: If you have a work-related injury or illness, you have no choice but to file the claims through Worker’s Compensation. Now your employer has access to some of your health information.
• Employers may require drug-testing, pre-employment physicals and periodic physicals for high-risk positions (i.e., exposure to chemicals or working with heavy equipment). There are loopholes and some health information is exposed (https://www.policygenius.com/blog/who-controls-your-health-data-a-guide-to-your-rights/)

1. Life, Long-term Care and Disability Insurances, and even Auto and Home Insurance companies: If you want coverage for life, long-term care or disability insurance, you must provide health information upfront as part of the application process. For certain claims with home or auto insurance, your health information might be revealed (https://www.gocompare.com/life-insurance/access-to-medical-records/).
2. Social Security has access to your health records and can obtain them quickly, since this is a requirement for people participating in the disability program: Social Security Disability Program or SSDA  (https://www.ssa.gov/disability/professionals/hipaa-cefactsheet.htm)
3. Law Enforcement: If the police need to identify or locate a suspect, fugitive, material witness, or missing person, they can access health information. They obtain this information through subpoenas, attorney letters, or the individual or family (https://www.hhs.gov/hipaa/for-professionals/faq/disclosures-for-law-enforcement-purposes/index.html)

How do these companies and organizations obtain your health information? It is easy. All your health information (including prescriptions) is stored in what is called “clearinghouses.” Remember signing the form that allows your health information to be shared with your health insurance? Well, your health information needs to be “transported” somehow. Clearinghouses are electronic stations or hubs that allow healthcare practices to transmit electronic claims to insurance carriers in a secure way that protects patient health information.
     
This system maintains your Protected Health Information (PSI), which includes 18 elements such as name & demographics, your SS #, dates of all admissions & discharges to hospitals, ERs  rehabilitation centers, etc. But the clearinghouses also maintain a list of all your diagnoses and prescriptions. Yes, they are secure and you have given your permission to disclose this information, but these clearinghouses are also accessed by the above-noted non-entities. For example, when a physician wants to purchase disability insurance coverage (to protect income and family), the clearinghouse provides all this personal health information to the insurance company in order to determine acceptance or denial of the insurance.    
   
There is misinformation in regard to privacy and HIPAA on the other end, such as the times when we find ourselves unable to obtain updates about a family member’s medical condition. However, there are circumstances when a physician can use his/her clinical judgment to disclose information and yet we mistakenly hear “It’s a HIPAA Violation” when it is not (https://betterhealthwhileaging.net/hipaa-basics-and-faqs-for-family-caregivers/).
     
This applies to COVID vaccine status as well. When people ask the question – “Is it a HIPAA Violation to Ask about COVID Vaccines?”- the answer: is “No.” According to the HIPAA Journal: "Any organization can ask any employee, customer, or relevant third party whether or not they have been vaccinated against COVID-19 without violating HIPAA. However, before asking the question, organizations should be prepared for how they will respond to individuals´ answers, or how they will respond if an individual refuses to answer the question” (https://www.hipaajournal.com/is-it-a-hipaa-violation-to-ask-for-proof-of-vaccine-status/). Reminder: The sole purpose of HIPAA is portability, not privacy. Thus, the question can be asked without violation, but caution must be taken as to “how” the information is utilized (For example, one cannot infringe on protocols of the American Disability Act). This is where people get mixed up about privacy and HIPAA.
     
With COVID-related health issues, we are dealing with a public health crisis, and communicable diseases are reportable to the departments of health for our safety. “Protecting the privacy of individually-identifiable health data and promoting the public’s health often seem at odds, but health data are the lifeblood of public health practice “
(https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/abs/health-information-privacy-and-public-health/0D5035F5D7853DAA740921CE8263C0C7).
     
Here in NYS, the following guideline was set on June 15, 2021: Individuals must present their vaccination records if a business or organization requires it. “Unvaccinated or unknown vaccination status individuals who are over the age of four must continue to present proof of a recent negative diagnostic COVID-19 test result and wear masks within the venue” (https://www.governor.ny.gov/news/governor-cuomo-announces-covid-19-restrictions-lifted-70-adult-new-yorkers-have-received-first).
     
In summary, there is widespread misunderstanding of HIPAA, its Privacy Rule and the use of our health information (https://privacyrights.org/consumer-guides/health-privacy-hipaa-basics). People are quick to toss out the phrase – “It’s a HIPAA violation” – when they really have no understanding of its function.
      
For more information, visit the website: https://betterhealthwhileaging.net/hipaa-basics-and-faqs-for-family-caregivers/

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.


Pandemic Highlights7/1/2021
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I started out writing about the highlights of COVID-19 and with each highlight, the outcome was “people need to get vaccinated.” We have the good fortune in this country of access to the vaccine, and yet we still have large numbers of the population not vaccinated. In the beginning it was understandable that people were concerned about the unknowns of the vaccine, but now there are over 2.5 billion people who are vaccinated world-wide.

For those of us who understand epidemiology, we know the reason for this dilemma has nothing to do with being rational. For example, people think nothing of hopping in and out of their cars, which runs a much higher risk of injury or dying than being vaccinated. People are uninformed about public health and safety. Don’t we benefit from safe drinking water, uncontaminated medications, and food labels? The solution to many of our problems and confusion about the pandemic would be resolved if people got vaccinated. People from other countries, who do not have the access to vaccines like we do in the U.S., think of our citizens as foolish and privileged. If people cared about others, our society and our future, they would get vaccinated.
      
The more we read about the dynamics of the virus, there seems to be conflicting and confusing reports. To help clarify what is going on: It’s not that the science is wrong. But rather, the virus is brand new to homo sapiens and it has caused a large-scale crisis worldwide. As with anything new and on such a massive scale, there is a learning curve. Bottom line, we simply have to remember that we are living through a pandemic. Shouldn’t we be grateful that we are among the living? Worldwide – as of this moment – 3.8 million people have died from COVID-19. We are fortunate to have vaccines that are highly effective and are keeping us safe.
      
As I write this, NYS (mid-June) is lifting most of its COVID restrictions because the “70% vaccination benchmark” has been reached (meaning 70% of NY’s population has had one vaccine). But in contrast we are also “crossing the 600,000 milestone” of deaths from COVID in the U.S., which reminds us that the virus is still spreading and that there are still too many people unvaccinated.
      
Let’s address some of the highlights. With all the issues that crop up about COVID, the solution to the problem is prevention from getting ill, which means getting vaccinated:

1. The bad news is that we have variants. The good news is that the vaccines are highly effective in protecting against these variants, thus far. This gives us another reason to support getting vaccinated (https://www.medscape.com/viewarticle/953057?src=mkm_covid_update_210614_MSCPEDIT&uac=64796DZ&impID=3441982&faf=1).
2. Large numbers of patients (100,000s) are seeking medical attention (physical and mental) for post-COVID health problems. We just do not know how long or how severe these problems will be. Again, to prevent the continued problems and complications of COVID, all factors point to getting vaccinated (https://www.nytimes.com/2021/06/15/health/covid-19-patients.html).
3. The Antiviral Program for Pandemics is not just for the coronavirus, but for viruses that could cause future pandemics. Our current vaccines for COVID-19 were more readily developed because scientists were already researching this area years ago.
4. Although we are in the infancy of research, pregnant woman are safely getting vaccinated with no complications such as preterm delivery or other adverse pregnancy outcomes (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html). In contrast, the various risks related to the COVID illness during pregnancy are more severe than the vaccination risks. This includes the fact that the risk of getting a more severe case of the disease during pregnancy is much higher. The fact that pregnant women are being vaccinated demonstrates a high safety level.
5. A federal judge in Texas has dismissed a lawsuit from 117 Houston Methodist Hospital workers who refused to get a COVID-19 vaccine. It was considered a "frivolous lawsuit” and the judge upheld the hospital's policy that the vaccination requirement didn't break any federal law. Methodist is trying to do their business of saving lives without giving them the COVID-19 virus," he wrote. "It is a choice made to keep staff, patients, and their families safer.” (https://www.medscape.com/viewarticle/953040?src=mkm_covid_update_210614_MSCPEDIT&uac=64796DZ&impID=3441982&faf=1).
6. Some businesses are choosing proof of vaccination in order to operate. This includes numerous healthcare facilities (mandatory for employees), wedding venues, some fitness centers, or places where retreats and workshops are being held. These businesses do not want to run the risk of a COVID outbreak for both safety reasons and economic purposes (it could destroy their reputation if word got out about a COVID outbreak ).
7. Because not everyone is vaccinated, we have the predicament of “Do we wear a mask or not?” If you are vaccinated, the answer is often clearer for some situations, such as not needing a mask at a gathering where everyone is vaccinated. But in public places, where there is a mix of vaccinated and unvaccinated people, it becomes muddy. Overall, it’s a good idea to wear a mask when there is a situation that presents with a higher risk for viral transmission, such as large gatherings in closed spaces with poor ventilation and people who are not vaccinated.

  
It makes sense to wear a mask
(https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/personal-social-activities.html#event):

• When using public transportation (planes, trains, buses, etc.)
• When using gym and fitness facilities where heavy breathing takes place in tight quarters
• When the business or organization requires the protocol (after all, a restaurant can post “no shoes; no shirt; no service”)
• When a person who is not vaccinated will be around multiple unknown parties of people indoors, and especially if social distancing is a challenge.
• In settings where yelling, chanting or singing takes place
• When a person is immunocompromised or has other health risks
• When a person is currently not feeling well and wants to be careful
• When traveling to unknown areas where there might be outbreaks of COVID-19
• When traveling to areas that are known to be experiencing outbreaks of COVID-19 variants (https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html)

In my professional opinion, not being vaccinated for COVID-19 (unless contraindicated, of course) is a foolish and selfish decision.

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.