What is the most likely way that Declan might directly violate the Health Insurance Portability and Accountability Act (HIPAA)?

SCENARIO

Please use the following to answer the next QUESTION:

Declan has just started a job as a nursing assistant in a radiology department at Woodland Hospital.

He has also started a program to become a registered nurse.

Before taking this career path, Declan was vaguely familiar with the Health Insurance Portability and Accountability Act (HIPAA). He now knows that he must help ensure the security of his patients’ Protected Health Information (PHI). Therefore, he is thinking carefully about privacy issues.

On the morning of his first day, Declan noticed that the newly hired receptionist handed each patient a HIPAA privacy notice. He wondered if it was necessary to give these privacy notices to returning patients, and if the radiology department could reduce paper waste through a system of one-time distribution.

He was also curious about the hospital’s use of a billing company. He questioned whether the hospital was doing all it could to protect the privacy of its patients if the billing company had details about patients’ care.

On his first day Declan became familiar with all areas of the hospital’s large radiology department. As he was organizing equipment left in the halfway, he overheard a conversation between two hospital administrators. He was surprised to hear that a portable hard drive containing non-encrypted patient information was missing. The administrators expressed relief that the hospital would be able to avoid liability. Declan was surprised, and wondered whether the hospital had plans to properly report what had happened.

Despite Declan’s concern about this issue, he was amazed by the hospital’s effort to integrate Electronic Health Records (EHRs) into the everyday care of patients. He thought about the potential for streamlining care even more if they were accessible to all medical facilities nationwide.

Declan had many positive interactions with patients. At the end of his first day, he spoke to one patient, John, whose father had just been diagnosed with a degenerative muscular disease. John was about to get blood work done, and he feared that the blood work could reveal a genetic predisposition to the disease that could affect his ability to obtain insurance coverage. Declan told John that he did not think that was possible, but the patient was wheeled away before he could explain why. John plans to ask a colleague about this.

In one month, Declan has a paper due for one his classes on a health topic of his choice. By then, he will have had many interactions with patients he can use as examples. He will be pleased to give credit to John by name for inspiring him to think more carefully about genetic testing.

Although Declan’s day ended with many Questions, he was pleased about his new position.

What is the most likely way that Declan might directly violate the Health Insurance Portability and Accountability Act (HIPAA)?
A . By being present when patients are checking in
B . By speaking to a patient without prior authorization
C . By ignoring the conversation about a potential breach
D . By following through with his plans for his upcoming paper

View Answer

Answer: D

Explanation:

Declan might directly violate the HIPAA Privacy Rule by using John’s name and personal health information (PHI) in his paper without his written authorization. The Privacy Rule protects the confidentiality of PHI that is created, received, maintained, or transmitted by a covered entity or its business associate. PHI includes any information that relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and that identifies the individual or for which there is a reasonable basis to believe can be used to identify the individual1. Declan, as a nursing assistant, is part of the covered entity’s workforce and must comply with the Privacy Rule. He cannot disclose John’s PHI to anyone, including his classmates or instructors, without John’s authorization or a valid exception under the Privacy Rule.

Even if he does not use John’s full name, he may still reveal enough information to make John identifiable, such as his diagnosis, his father’s condition, or his location. This would be an impermissible use and disclosure of PHI, and a potential HIPAA violation. Declan should either obtain John’s written authorization to use his PHI in his paper, or de-identify the information according to the Privacy Rule’s standards2.

Reference: Summary of the HIPAA Privacy Rule

Guidance Regarding Methods for De-identification of Protected Health Information in Accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule