HIPAA Regulation Compliance on the Heels of y2k

By M. Joseph Cisna
Experior Corporation

The healthcare industry, perhaps one of the most essential sectors of our economy, and certainly one of the largest in terms of Gross Domestic Product, is undergoing an evolution. With the proliferation of managed care, declining reimbursements, and national Medicare legislation and compliance, reliable information is critical now more than ever.

Healthcare information systems have grown and evolved since the 1970s helping hospitals, physician clinics, managed care organizations, and integrated delivery networks to manage their businesses, and more importantly, improve the quality of patient care.

In an era of technological advancement, electronic commerce has emerged as the most important paradigm, not only in healthcare, but also across the spectrum of industries. Software and technology companies - practice management software systems in particular - are capitalizing on e-commerce to offer a number of products and services helping to make practices become more efficient.

As technology progresses, the Internet and web-based applications will become the preeminent factor in electronic claims, patient records, billing systems, and a host of other related areas.

With these innovations, however, come a multitude of associated concerns for both healthcare providers and their patients, namely patient confidentiality. Because more and more confidential patient information is being stored, moved, and handled electronically, it is imperative that precautionary steps are in place to ensure that technology is not compromising patient privacy.

To that end, as mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the U.S. Department of Health and Human Services issued a number of proposed rules including standard EDI formats, standard coding, identifiers, security and privacy.

HIPAA regulations mandate security and privacy provisions to protect the integrity and confidentiality of patient information, EDI standards and national identifiers for providers, payers, employers, and patients. HIPAA security and privacy regulations focus on policy and procedure, mandating technology only as necessary to enforce those policies and procedures.

While 75% of HIPAA security compliance is operational in nature, a close evaluation of computer systems and databases is still vital in determining HIPAA preparedness. Fortunately for medical professionals, once the operational issues are in place, the technology components for enforcement exist today and address many of the core issues involved.

Although these regulations have been public knowledge for some time, the majority of organizations have put all of their energy and resources toward the year 2000 fix, and are now in for the realization that HIPAA may demand even more time and money to ensure compliance.

A number of resources are available on the Internet that highlight the proposed rules and additional information regarding HIPAA. Web sites include the main government source site www.aspe.os.dhhs.gov/admnsimp and the HCFA site at www.hcfa.gov/hipaa/hipaaahm.htm.

Other organizations tracking HIPAA can be found at www.wedi.org, www.hipaacomply.com, www.ehnac.org, and www.afehct.org. There is also the HCFA site, which contains details on the Internet security policy at www.hcfca.gov/security/isecplcy.htm. Implementation guides may also be found at www.wpc-edi.com/hipaa.

In addition to the Internet, healthcare industry consultants such as Beacon Partners, who devote an entire arm of their practice to security and HIPAA compliance (www.beaconpartners.com), may also be an excellent source of knowledge that can help organizations determine where to begin when ensuring HIPAA compliance.

Diligence in complying with these standards now will help alleviate the universal last minute problems, and let medical practices get back to what is important – providing quality patient care.

About Experior

Experior Corporation is a healthcare information systems developer specializing in physician practice management solutions in the mid- to large-sized single- and multi-specialty clinic environment. Founded in 1978, Experior is an independently owned and operated company with a solid history of annual sales growth and product innovation.

At the heart of Experior’s success is its medical management system. This online, integrated software package offers clients complete administrative solutions for patient and financial management. It is a comprehensive suite of more than 20 modules, giving customers instant, enterprise-wide access to information regarding patients and the practice itself. This modular design allows clients the freedom to add functionality as organizational needs grow.

Experior Medical Management System is a trademark of Experior Corporation. All other trademarks are the properties of their respective owners.