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The HIPAA Privacy Rule’s “Right of Access” provision requires providers to make patient medical records available for viewing, inspecting, and copying. In early 2019, the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) launched a HIPAA Right of Access enforcement initiative. 

 

A recent study by citizen.com revealed that since the initiative was launched, provider Right of Access compliance has increased.  

How Did the Study Measure Provider Right of Access Compliance?

To measure provider right of access compliance, Citizen compiled a scorecard for 820 healthcare providers.

 

A wide range of healthcare providers were assessed for the study, from single physician practices to large, integrated healthcare delivery systems.

 

The “grade” Citizen assigned to each provider on the card reflects the providers’ responses to patient requests for access for their healthcare data from the period of 2/10/19 through 2/13/20.

 

The patients who made the requests for access were Citizen users. Based on the feedback these users submitted to Citizen as to the timeliness of the provider’s response, Citizen developed a “compliance score” for each provider. The score ranges from a low of “1” to a high of “5.” 

 

A 1-star rating represents a non-HIPAA compliant response. 2-stars were awarded when requests were eventually resolved satisfactorily, but only after multiple escalations to supervisors. A 3-star rating was given when the request was satisfied with minimal intervention, and a 4-star rating was given to providers that are fully compliant and that gave a seamless response.

 

A 5-star rating was given to those providers who, in providing access, went above and beyond the requirements of HIPAA.

What Were the Results of the Right of Access Compliance Study?

Under the scorecard, only 27% of providers received a “1”; that is, only 27% were not compliant with the HIPAA Right of Access. This figure is a significant improvement from the previous scorecard, which revealed that a majority of providers – 51% – were not compliant with the Right of Access.

 

In addition, the percentage of providers awarded 4 stars for their responses increased from 40% to 67%, and the percentage of providers awarded 5 stars increased from 20% to 28%.

 

Not only are more people being given more timely access to their records, they are paying less for that access as well.

 

Under the Right of Access, providers may charge patients a reasonable, cost-based fee (i.e., costs of reproduction of records, including copying costs and mailing costs) for record production. Only 6% of the 820 healthcare providers on the scorecard actually charged a fee.

 

In addition, the latest scorecard information reveals that providers are not subjecting patients to burdensome paperwork requirements as much as in past years.

 

In previous studies, many healthcare providers required patients to complete a standard form, yet this year, most providers accepted any form of written request and did not require patients to complete a particular form before the request was processed.

 

Citizen attributes the improvements to right of access compliance not only to the enforcement initiative, but to new rules recently published by HHS’ Centers for Medicare and Medicaid Services and the HHS’ Office of the National Coordinator for Health IT, which makes it easier for patients to obtain copies of their healthcare data.


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Telemedicine has been around for years, but as a healthcare service it has been underutilized. Today, virtual visits for medical care have skyrocketed because of the COVID-19 outbreak and other factors.

 

Telehealth is experiencing a revolutionary moment like never before. By the end of 2020, virtual medical care usage is estimated to reach upwards of 1 billion interactions, according to analysts at Forrester Research. 

 

In addition, some restrictions that were barriers to entry before have been lifted in response to the public health pandemic. And in March 2020, the Trump Administration expanded Medicare's coverage allowing beneficiaries to receive more extensive care through telehealth visits. These are done using video and audio applications. 

 

With the advent of stay-at-home orders and social distancing, technology is healthcare's solution for delivering continuous patient care. Tech tools' enable widespread access, bringing an unprecedented reach to a larger patient population.

 

For medical practitioners, the shift of using video platforms to communicate can come with risk and HIPAA compliance concerns. OCR asks that telehealth sessions be conducted in a private environment.  Sometimes this could be achieved with a simple task such as closing an office door or lowering one's voice.  

 

The Office for Civil Rights has issued an announcement, guiding on which audio and video communication platforms are acceptable and not acceptable for patient interactions during the coronavirus pandemic. 

 

As stated officially by OCR on its website:

"OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency."

In this blog post, we will highlight some of the video communication platforms that follow OCR's public health emergency guidance. Of course, keep in mind that compliance regulations might change in upcoming months.

Telehealth video calling platforms to use amid the pandemic

Under OCR's notice, covered healthcare providers can use certain platforms for non-public facing video communications with patients, as these platforms are HIPAA compliant and will enter into Business Associate Agreements (BAAs).

Some of these are:

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  • GoToMeeting
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Zoom is on this list, but with the recent rise in security attacks from threat actors joining Zoom meetings uninvited, we have seen advice from various  entities to use a different video platform when communicating with patients, until all security and privacy issues with Zoom are fixed. No one wants to deal with Zoom-bombing during an important medical visit. 

It's important to note that these technological tools are third-party providers and they may pose privacy risks. However, using FaceTime, for instance, during the pandemic is not necessarily a compliance violation, depending on a case by case basis. 

What if patient does not have access to video telehealth formats

If the telehealth session is being conducted in good faith during this public health emergency, then OCR permits the use of audio methods like wireless phone, landline phones to conduct the session. If using email or texting, they ask the covered entity to try and utilize safeguards whenever possible, such as secure email or secure texting.  

Avoid using TikTok for telehealth sessions

On the other hand, OCR stated the following public-facing applications are not to be used when providing telehealth services, even during the public health crisis. OCR is not the sole government agency warning about TikTok's security implications. The wildly popular app has come under fire for underage privacy and international security concerns by U.S. lawmakers and security professionals. 

 

Using public-facing communications could be an evidence of bad faith on the part of the provider, which could make the provider liable for OCR enforcement actions. 

Avoid using these platforms for telehealth:

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  • Twitch
  • TikTok

Not only that, the guideline explains to avoid using any public-facing technology, meaning the session can be seen by a group. 

 

For privacy protections and peace of mind, OCR advises to turn to HIPAA compliant technology platforms. There are vendors available, who will enter into a HIPAA Business Associate Agreement with a covered entity.

 

Check with the vendor to see if that's the case. When in doubt, reach out to third-party HIPAA experts to ensure your following compliance regulations as you transition to doing telehealth. 


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A recent study by citizen.com revealed that since the initiative was launched, provider Right of Access compliance has increased.  

How Did the Study Measure Provider Right of Access Compliance?

To measure provider right of access compliance, Citizen compiled a scorecard for 820 healthcare providers.

 

A wide range of healthcare providers were assessed for the study, from single physician practices to large, integrated healthcare delivery systems.

 

The “grade” Citizen assigned to each provider on the card reflects the providers’ responses to patient requests for access for their healthcare data from the period of 2/10/19 through 2/13/20.

 

The patients who made the requests for access were Citizen users. Based on the feedback these users submitted to Citizen as to the timeliness of the provider’s response, Citizen developed a “compliance score” for each provider. The score ranges from a low of “1” to a high of “5.” 

 

A 1-star rating represents a non-HIPAA compliant response. 2-stars were awarded when requests were eventually resolved satisfactorily, but only after multiple escalations to supervisors. A 3-star rating was given when the request was satisfied with minimal intervention, and a 4-star rating was given to providers that are fully compliant and that gave a seamless response.

 

A 5-star rating was given to those providers who, in providing access, went above and beyond the requirements of HIPAA.

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Under the scorecard, only 27% of providers received a “1”; that is, only 27% were not compliant with the HIPAA Right of Access. This figure is a significant improvement from the previous scorecard, which revealed that a majority of providers – 51% – were not compliant with the Right of Access.

 

In addition, the percentage of providers awarded 4 stars for their responses increased from 40% to 67%, and the percentage of providers awarded 5 stars increased from 20% to 28%.

 

Not only are more people being given more timely access to their records, they are paying less for that access as well.

 

Under the Right of Access, providers may charge patients a reasonable, cost-based fee (i.e., costs of reproduction of records, including copying costs and mailing costs) for record production. Only 6% of the 820 healthcare providers on the scorecard actually charged a fee.

 

In addition, the latest scorecard information reveals that providers are not subjecting patients to burdensome paperwork requirements as much as in past years.

 

In previous studies, many healthcare providers required patients to complete a standard form, yet this year, most providers accepted any form of written request and did not require patients to complete a particular form before the request was processed.

 

Citizen attributes the improvements to right of access compliance not only to the enforcement initiative, but to new rules recently published by HHS’ Centers for Medicare and Medicaid Services and the HHS’ Office of the National Coordinator for Health IT, which makes it easier for patients to obtain copies of their healthcare data.


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A wireless phone system performs the same essential routing tasks as a PBX system but does it without the pesky hardware. Instead, wireless systems use a cloud-based system that centralizes all of the call routing. Instead of all your calls getting routed around by on-site, analog or digital switches, the routing happens on a server at a data center.

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Wireless systems offer a wide range of potential benefits, many that you can’t get through a PBX system or only for a fee.

 

The switch to a modern, cloud-based system makes a bunch of exciting features available. Video conferencing tops the list. With businesses relying on remote workers, video conferencing helps maintain team unity. Many providers bundle this feature in a standard part of their service package.

 

You can also take advantage of call recording services, which lets you monitor customer service calls. That lets you coach your team when they fall away from best practices. You can also record client meetings to keep track of orders or new service contract particulars.

 

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Standard features you get with wireless systems include:

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Of course, no system lacks flaws. So, let’s move on to the pitfalls.

Wireless System Pitfalls

As with all other cloud-based applications, a wireless phone system depends on a stable broadband connection. If your broadband service is sketchy, the quality of your calls will end up equally sketchy. You could expect fade-outs, distorted speech, or dropped calls.

 

The good news is that broadband quality and reliability has come a very long way in the last few years and most people can count on having sufficient bandwidth to support calls that are indistinguishable from land-line calls.

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PBX systems create several pitfalls.

You’ll pay a hefty fee for the hardware and installation. That’s before you even get into the cost for the service and lines. Since cloud-based systems have no hardware, you pay no hardware or installation fees.

 

Each individual line you get from the service provider costs money (they are usually purchased in groups of 23) and you’ll pay an additional per minute rate for each call.

 

By comparison, wireless systems typically charge a small fee for each number and either a low, per minute rate for domestic calls or an unlimited calling plan.

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For many businesses, a wireless system makes a lot of sense.

You get a wide range of additional features you can’t get with PBX. You avoid steep hardware and installation costs. You can even dodge long-distance fees with a little bit of effort.

 

For any business with access to good broadband, it’s something of a no-brainer.

 

 

 


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The study Bridging the Chasm: Effect of Health Information Exchange on Volume of Laboratory Testingconcluded that doctors order fewer lab tests when they have access to a patient’s electronic medical records.

 

The above Archives study:

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  • Determined that the overall number of tests ordered for each patient in the study fell from an average of 7 to 4 with their HIE implementation.

These results seem to support the generally accepted mantra that a by-product of adoption of EHRs and participation in HIEs will be a reduction in the ordering of redundant tests.

 

It is, however, in direct contrast to another recent study that was published in Health Affairs, Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests.

 

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  • Point-of-care electronic access to electronic imaging results, sometimes through an electronic health record, was associated with a 40-70 percent greater likelihood of an imaging test being ordered. Physicians without such access ordered imaging in 12.9 percent of visits, while physicians with access ordered imaging in 18.0 percent of visits.
  • Women received more imaging studies overall than men, perhaps reflecting their use of mammograms and ultrasound studies–but not more advanced imaging.
  • Surgeons and other specialists were more likely to order imaging tests than primary care physicians.

 

This conclusion flies in the face of the assertion that access to electronic medical records will reduce the number of tests required. That fundamentally doesn’t make sense, does it? If you have access to information at your fingertips, why would you need to run the test again?

 

The second study didn’t delve into the physician behavior behind the increase in tests ordered, so let’s do a little brainstorming:

 

  • Perhaps the physicians surveyed are chronic offenders to ordering repeat tests and this is a behavior that needs to be modified/ re-learned.
  • What if there is a financial benefit to the physician for self-referrals to affiliated imaging centers? Again, a behavior that may need to be modified.
  • What if the quality of the report resulting from the previous image does not leave the physician comfortable with determining the appropriate course of action?

While some EHRs and HIEs are able to support links to the actual image result, the majority of results based clinical documentation tools are only able to support the actual communication of the dictated report.

 

Do we know that was the case with the EHRs that the above physicians were using? No, but think about it.

 

If the access to the EHR included the actual image and the dictated report what else would be needed? Because they have access to an EHR which likely facilitates the test ordering process, it would be much easier and quicker to reorder the test than to try to retrieve the actual original image.

 

So, what am I proposing that we conclude from the above study? Remember: it makes a clear distinction between physicians with EHRs and those without.

 

Those with EHRs most likely do not receive or have easy access to a paper file, so they may not get the actual image to review.

 

Those without EHRs rely on a more manual process such as pulling a file to read the report then viewing the image. They have to request the result manually if they don’t have it.

 

I’m suggesting that some of the issue may lie with what is actually available via the EHR, i.e. can you access the actual image or just the dictated report? I’m sure the ease of reordering the test on-line via the EHR vs. requesting the original report be faxed is contributing to the duplication of tests.

 

I think there is definitely the opportunity to improve care and reduce costs with the utilization of a quality EHR application that can provide the necessary clinical information in the format(s) necessary to make an educated decision.


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