Tuesday, July 16, 2013


Never events refer to hospital mishaps in procedures and patient identification which often lead to severe complications, loss of a limb and/or death. Perhaps the term should also be applied to privacy rules:

It is forbidden:

The Privacy Rule allows a covered entity to de-identify data by removing all 18 elements that could be used to identify the individual or the individual's relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity also must have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following:

  1. Names.
  2. All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census:
    1. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people.
    2. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000.
  3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older.
  1. Telephone numbers.
  2. Facsimile numbers.
  3. Electronic mail addresses.
  4. Social security numbers.
  5. Medical record numbers.
  6. Health plan beneficiary numbers.
  7. Account numbers.
  8. Certificate/license numbers. **
  9. Vehicle identifiers and serial numbers, including license plate numbers. **
  10. Device identifiers and serial numbers. **
  11. Web universal resource locators (URLs).
  12. Internet protocol (IP) address numbers.
  13. Biometric identifiers, including fingerprints and voiceprints.
  14. Full-face photographic images and any comparable images.
  15. Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re-identification.

These categories are subject to fines, and penalties and in some cases prison sentences for violations (if repeated, and uncorrected)

It extends to insurance agents, insurers, Medicare, providers, hospitals and other health care entities, including health information exchanges,health benefit exchanges, government web sites (CMS, Medicaid), Social Security Records,social media, blogs, including archived storage media, cloud storage, and the Internal Revenue Service should they act as an enforcement agency for the terms of the individual mandate (subject to final rulings of the  affordable care act.

In essence HIPAA extends privacy rules to anyone in contact with digitized or written information about patients, INCLUDING NAVIGATORS. Let us anticipate they will be trained in HIPAA regulations.

Covered entities may also use statistical methods to establish de-identification instead of removing all 18 identifiers. The covered entity may obtain certification by "a person with appropriate knowledge of and experience with generally accepted statistical and scientific principles and methods for rendering information not individually identifiable" that there is a "very small" risk that the information could be used by the recipient to identify the individual who is the subject of the information, alone or in combination with other reasonably available information. The person certifying statistical de-identification must document the methods used as well as the result of the analysis that justifies the determination. A covered entity is required to keep such certification, in written or electronic format, for at least 6 years from the date of its creation or the date when it was last in effect, whichever is later.



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