Federal Regulations to Ease Access to Healthcare Records Raising Privacy Concerns
Landmark medical information-sharing rules, proposed this year by the Department of Health and Human Services, are intended to make it easier for people to see their medical records, manage their illnesses, and understand their treatment choices. The rules would require health providers to send medical information to third-party services after a patient has authorized the data exchange pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Several groups, including the American Medical Association and the American College of Obstetricians and Gynecologists, have warned regulators that people who authorize outside services to obtain their medical records could open themselves up to serious data abuses.
HIPAA, which limits how health providers and insurers may use and share medical records, applies only to “covered entities,” as defined in the Act to include health plans, healthcare clearinghouses, and any health care provider who transmits health information in any form in connection with transactions for which the Secretary of HHS has adopted standards under HIPAA.
The third-party services alluded to in the Department of Health and Human Services’ recently proposed rules would not be subject to HIPAA, as they fall outside of the “covered entities” under the Act.
The new rules are emerging just as Amazon, Apple, Google and Microsoft are racing to capitalize on health data and capture a bigger slice of the health care market. According to the Department of Health and Human Services, the idea is to treat medicine as a consumer service, so people can shop for doctors and insurers on their smartphones as easily as they pay bills, check bus schedules or buy plane tickets.
But according to the American Medical Association, patients simply may not realize that their genetic, reproductive health, substance abuse disorder, mental health information can be used in ways that could ultimately limit their access to health insurance, life insurance or even be disclosed to their employers. Without federal restrictions in place, the AMA argues, consumer apps would be free to share or sell sensitive details like a patient’s prescription drug history and other personal medical information, which could lead to higher insurance rates or job discrimination.
The regulations are expected to become final this year. Health providers and health record vendors will have two years to comply with the new requirements. Electronic health record vendors that impede data-sharing — a practice called “information blocking” — could be fined up to $1 million per violation. Doctors accused of information blocking could be subject to federal investigation.
Collective Bargaining Session Completed as ECMC, Nurses Agree to Four-Year Contract
Earlier this summer, 7,200 union members at Kaleida Health affiliated with CWA Local 1168, IUOE Local 17 and 1199 SEIU came to a three-year labor agreement with Kaleida. Now, another member of Great Lakes Health, Erie County Medical Center Corp. (ECMC), has signed a major labor agreement with its nurses.
Nurses at ECMC have approved a new four-year contract, which covers members of the New York State Nurses Association that work for the hospital and Terrace View, a 390-bed long-term care facility owned by ECMC. The deal covers more than 1,200 nurses, and replaces a seven-year deal that expired on December 31, 2018. ECMC is the region’s primary trauma center, and one of its largest hospitals. With revenue in 2018 of $647 million, the ECMC campus includes a 573-bed medical center.
Members voted on Aug. 28-29 to ratify the new deal, with the hospital board of directors unanimously approving the contract Aug. 30. Highlights of the contract include a 3 percent wage increase annually; health care coverage maintained, with a 15 percent contribution; and the addition of 45 new nursing positions that allow union input at units throughout the hospital. The previous contract included annual increases that averaged 2 percent. “This contract is a huge win for the patients of the Erie County Medical Center, and the nurses who work day and night to care for the community,” said Chiqkena Collins, a registered nurse at the hospital.
In a prepared statement, union members and ECMC CEO Thomas Quatroche Jr. said the contract offers competitive wages and incentives that enhance the hospital’s ability to recruit, while continuing its financial stability and growth.
Employers Prepare For New Legal Requirements as School Year Begins
In 2018, New York State adopted new regulations for employers, with the aim of countering sexual harassment in the workplace. The first set of compliance deadlines were set last fall. Employers last October needed to be sure their sexual harassment prevention policies were in order and that all employees were aware one existed in their workplace.
By this October 9, employers are required to have hosted in some capacity an interactive prevention training. Employees, through the training, must be made aware of what harassment is, how to prevent it and how to avoid it. They also should be informed of courses of action they must take if harassment is reported. Harassment can be reported through the employer and on a state website. The law extends to all employees, and certain non-employees, including independent contractors, “gig” workers, and temporary workers. Also included are persons providing equipment repair, cleaning services, or any other services provided pursuant to a contract with the employer.
As the school year begins, the state’s change in vaccination and immunizations law has come into full effect. Prompted by spikes regionally and nationally in measles occurrences, legislators amended public health law in June to mandate that all children who attend school must be vaccinated. The amendment eliminated all religious exemptions for current and future students.
When the amendment was first adopted, many parents and school district officials were left with questions as to how the amendment would affect them. Added guidance released August 16 by the state Department of Health has helped to alleviate much of the confusion.
According to the department, students must be vaccinated unless it “may be detrimental to the child’s health” as determined by a medical professional. The DOH added that children will be assessed if they are fully immunized upon their enrollment in school, as well as annually. According to the guidance released in August, in some instances for this academic year only, high school students are given a pass for required immunizations which weren’t mandatory before the summer of 2014. Students who do qualify for an exemption must be reported to the statewide immunization system within 14 days after a medical professional’s approved clearance.
The Department of Health says the amendment aligns New York with national immunization recommendations and guidelines.
The Dignity for All Students Act, passed in 2010 in an effort to provide public school students with a safe and supportive environment, gives schools the ability to investigate discriminatory practices or occurrences. However, no private right of action was created under the Act, according to a 2012 Court of Appeals decision.
A new change to the New York State Human Rights Law allows a claim for discrimination or harassment by public school students. The amended NYSHRL will apply to a broad range of discrimination claims by students, including discrimination based on race, color, religion, disability, national origin, sexual orientation, gender identity or expression, and sex. The change also allows these cases to be examined by the Division of Human Rights (DHR).
As it does not cost anything to file a claim with the DHR and one does not need an attorney to file a claim with the DHR, this will likely be the most common course of action for students who have been discriminated against. Once a claim is filed with the DHR, the DHR assigns an investigator to investigate the matter. The investigations often involve requests for paper and electronic files and interviews of witnesses. If the outcome of this investigation is a finding of “probable cause” to suspect that discrimination has occurred, the DHR will schedule an administrative trial. An administrative law judge (ALJ) will preside over the administrative trial during which both sides will have the chance to question witnesses under oath and present evidence. The ALJ will then issue a decision and, if discrimination is found, have the power to award monetary damages to the complaining student.
Prepared by Eric W. Marriott