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Supreme Court Reaffirms Affirmative Action Policies Institutions Grapple with New HIAA Regulations "Operation Tipoff 2" Bioterrorism Exercise Offers Educational Lessons Family Medicine: Trying to Fill the Ranks Current & Choice: 'Prime Time Innovations in Medical Education: The Arts as a Teacher A Word from the President: Educational Diversity is a Compelling Interest Viewpoint: Loan Help for Researchers
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Institutions Grapple With New HIPAA RegulationsMore than three months after the April 14 deadline for complying with the Health Insurance Portability and Accountability Act (HIPAA) privacy rule, reactions by teaching hospitals, medical schools, and affiliated institutions around the country are mixed. While some have adopted a "wait and see" attitude, others have implemented significant changes in their daily practices. As efforts are made to come into compliance and assess the impact of HIPAA's sometimes complex patient privacy requirements, some institutions are worried about how the new rule will affect education of residents, medical students, and other health professions students. HIPAA creates national standards to protect individuals' personal health information and gives patients increased access to their medical records. It covers health plans, healthcare clearinghouses, and most healthcare providers who conduct certain financial and administrative transactions electronically. The privacy rule regulates how these "covered entities" may use and disclose identifiable health information for both routine and non-routine purposes, and defines the training of workforce members as a "routine purpose." Student trainees are considered to be part of the workforce. Community concernsSome medical school officials say that it is too early to gauge the effect of the regulations on their institutions' medical education activities. "My institution has not faced any substantial problems so far as a direct result of HIPAA," said Michael Prislin, M.D., associate dean for student affairs at the University of California at Irvine. "Since it has just gone into effect, it's really difficult to know exactly how it will play out. But there are a lot of concerns, and six months from now we might have a better idea." One concern, he said, is the possible effect of the new regulations on community-based practices' participation in medical education activities. These types of practices, particularly smaller ones, might see their involvement in medical education as an unnecessary burden and may opt to stop training students and residents. "That's one of our primary fears," Dr. Prislin added. "When people in community-based practices understand that they need to do certain things to make their students HIPAA compliant, they might see [their involvement with them] as another hassle, and not worthwhile." Paperwork, efficiency concernsThe effect of the new regulations on direct patient care is another area of concern. "Residents were already overburdened with paperwork requiring hours of time that could have been used for direct patient care 30 years ago," said John Repke, M.D., FACOG, professor and chairman of the Department of Obstetrics and Gynecology at Pennsylvania State University College of Medicine. "With the increased regulations involving clinical research, scholarship and research training for residents will become almost impossible," Dr. Repke said. "The papers required for Institutional Review Board approval of study protocols … will now more than double in order to comply with HIPAA. The motivation for residents to engage in clinical research and the motivation of mentors to assist them in this process will collapse under the weight of this well-intended but ill-conceived bureaucracy." In addition to the reduced efficiency the privacy rule has introduced to health care, the expenses involved in becoming HIPAA compliant also might have a negative effect on the training of residents, according to Dr. Repke. "I would also speculate that this effect will exponentially increase when the first HIPAA-related litigation sees the light of day," he said. Duplicate trainingThe fact that every student and resident working at a specific site may have to undergo the site's own HIPAA-compliance training could result in practices conducting the same training several times, and in students receiving similar training repeatedly. Such scenarios may already be taking place, as there is no provision in the current privacy rule or in the Department of Health and Human Services' HIPAA guidance explicitly allowing one site to meet the obligation to train its staff by accepting training provided elsewhere. Because of this, a rotation site could require medical students and residents to undergo its own HIPAA privacy training, despite the fact that they may already have received the same training at another site. In some cases the repeated training may not be that substantial, since training requirements at small sites, such as a physician's office, are minimal. AAMC's FAQsIn response to the frequently asked questions that have been raised concerning HIPAA's impact on resident and medical student training, the AAMC has compiled a document that answers the most commonly asked questions about the impact of the privacy rule on residents and medical students. "Sometimes a lack of information regarding the actual HIPAA requirements can cause people to go overboard as they try to protect patient privacy," said Ivy Baer, director and regulatory counsel in the AAMC's Division of Health Care Affairs. Institutions may go beyond what is required in the regulations, Baer explained. "It is possible for individual institutions to develop policies that are even more restrictive than what the privacy regulations require, perhaps because of a desire to be cautious, or maybe because state law requirements are more stringent and must be followed," she added. Despite concerns, most agree that HIPAA should not be seen as an impediment. "I don't think anybody disputes the value of what HIPAA is trying to achieve," said Dr. Prislin. "It's like a lot of things that have happened in health care, and it's actually a good policy, despite the fact that the solution is relatively draconian." - Suria Santana |
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