Question

Case Presentation

The confidentiality of medical information became an agenda item for Congress when electronic data systems became widely adopted throughout the United States. The increased use of computers in health care had created the capacity for critical health care information to be efficiently shared among health care providers and among insurance companies. Advocates for patient confidentiality and information privacy argued that the ease of information sharing through electronic transmission of records would result in personal health information becoming available to a wide variety of interested parties. Access to this information could result in a variety of actions, including denial of coverage through employer-sponsored plans to individuals or family members with chronic or debilitating conditions. Other unfavorable outcomes from the unrestricted sharing of private health information could also result, such as the sale of mailing lists of individuals with particular medical conditions to companies with a commercial interest in obtaining those lists.

The intent of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 was to limit the ability of employers to deny health insurance coverage to their employees based on preexisting medical conditions. In the formulation of a policy response, the intervention chosen by Congress was to limit access to health care information to only parties with a legitimate role in the financing and delivery of services, specifically health care providers, insurance companies, and third-party contractors.17 Through HIPAA, Congress directed the United States Department of Health and Human Services (USDHHS) to implement the policy by developing privacy rules that protect electronically transmitted health information. These rules cover any entity that must have access to this information for legitimate purposes and provide guidelines for determining access to and disclosure of protected health information. Criminal and financial penalties are provided for proven HIPAA violations, including federal prison sentences for perpetrators and fines of up to $250,000. Investigations and prosecutions of HIPAA violations are the responsibility of the United States Department of Justice.17

One of the federal agencies tasked with public review and reporting for federal policies is the United States Government Accounting Office (GAO). The GAO has published different reviews of HIPAA at the request of government officials over the years since passage of the statute, and these reports are publically available on the GAO website. A recent review18 documents the ongoing issues of implementation of this widespread policy that governs the electronic transmission of health care information. HIPAA provides broad guidelines for the protection of patient information that must be interpreted for implementation. Covered entities targeted by the statute are expected to develop HIPAA-compliant policies that govern the treatment of protected health information in their organizations and during transactions with contracted third parties. The GAO report notes there is still much guidance to be issued by USDHHS to assist these entities in complying with HIPAA guidelines. This guidance will be created through USDHHS rule-making authority and will be publicly available for comment and feedback by affected organizations and the general public during the rule-making process.

Case Analysis

This case demonstrates some of the major components of the health policy concept. HIPAA is the result of public concerns about the privacy of health care data. The electronic transmission of data potentially involves disparate entities, persons, and companies across a variety of states. This called for a federal response because the federal government is responsible for regulating interstate commerce. However, insurance, including health insurance, is regulated at the state level as a part of state responsibilities. This federal law, meant to address the confidentiality of health data as it is transmitted electronically across the country, is the result of a public process of information exchange and negotiation among different levels of government and a variety of interested parties. The rules and regulations created by federal agencies tasked with implementing this law are under continuous review as is expected with the dynamic political processes that exist in the United States.

Please answer the following questions pertaining to the Case Study.

Question 1: What does the phrase “covered entities” refer to?

Question 2: How can the student nurse ensure they are remaining HIPAA compliant when in a clinical setting?

Answer 1

1: Covered entities refer to the intent of HIPAA was to limit the ability of employers to deny the health insurance coverage to there employees based on preexisting medical conditions.In the formulation of a policy response,the intervention chosen by congress was to limit access to healthe care information to the partities with alegimate role in the financing and delivery of services specially health care providers,insurance companies and third party contractors.departement of health implement some policicies by devoloping some privacy rules and protect the electronic informations.so covered entities are the electronic information about a patient's treatement,poperations and payment in the health care system provided by someone.

2: Student nurse can check that the clinical settings have the security for the patient informations through the medical coders in the settings,the coders should do coding under this HIPAA LAW,this federal law meant to adress the confidentiality of health data as it is transmitted through elecronically as codes by medical coders.