HIPAA Policy

HIPAA and Health IT

HIPAA is a federal law that protects the privacy of your personal health information. At the same time, it allows health care providers and certain related operations enough access to the information they need to do their jobs effectively. HIPAA includes several rules and provisions that set guidelines and requirements for the administration and enforcement of HIPAA.

The relevant ones for the implementation of health information technology and the exchange of protected health information in an electronic environment are the Privacy Rule and the Security Rule, as well as the HITECH Act which further enforced the two in 2009.

*State laws may have more stringent requirements than federal laws, however, in cases of conflict, federal
law supersedes state law.

Highlights Of The Privacy Rule, The Security Rule, and the HITECH Act

1. The Privacy Rule, applies to protected health information (PHI) in any form whether paper, oral, electronic, etc. While it requires covered entities to put in place “administrative, physical, and technical safeguards” for protecting PHI, it differs from the Security Rule in that it discusses the cases in which PHI can be used, when authorization is required and what are patients’ rights with respect to their health information. (Page 8335 of the final Security Rule)
   Summary of Privacy Rule

1. The Security Rule applies only to protected health information in electronic form (E-PHI) and builds on the Privacy Rule requirements of “administrative, physical, and technical safeguards.”Unlike the Privacy Rule which is more concerned about patients’ rights and how health information is used and released, the Security Rule sets standards on the processes and technical security measures that should be taken to keep PHI private.It discusses acceptable ways to “implement basic safeguards to protect E-PHI from unauthorized access, alteration, deletion, and transmission.” (Page 8335 of the final Security Rule)* Under the Security Rule, paper to-paper faxes, person-to-person telephone calls, video teleconferencing, or messages left on voice-mail do not count as E-PHI because they did not exist in electronic form before the transmission.Thus those activities are not covered by [the Security Rule]” (Page 8342 of the final Security Rule). In contrast, the Privacy Rule applies to all forms of PHI.In particular, it calls for attention to:
   • risk analysis and management
   • administrative, technical, and physical safeguards
   • organizational requirements
   • policies, procedures, and documentation requirementsSecurity Rule Guidance MaterialThe US Department of Health & Human Services (HHS) now also offers a Security Risk Assessment (SRA) tool to help organizations ensure they are compliant with HIPAA’s administrative, technical, and physical safeguards and to expose areas where their PHI may be at riskThe figure below gives you an idea of the security measures covered by the Security Rule. (from the paper “Reassessing Your Security Practices in a Health IT Environment: A Guide for Small Health Care Practices”)
2. The HITECH Act essentially added teeth to the HIPAA Privacy and Security Rules by specifying levels of violations and penalties for violations. It also requires periodic audits to ensure that covered entities and business associates are complying with the HIPAA Privacy and Security Rules and Breach Notification.

Who Is Required To Comply With HIPAA?

Not all operations that handle health-related information must follow HIPAA law (such as many schools, state agencies, law enforcement agencies, or municipal offices). Under HIPAA the 2 groups that must follow HIPAA rules are

• covered entities – health care providers, health plans, and health clearing houses
• business associates – a person or group providing certain functions or services for a covered entity which require access to identifiable health information, such as a CPA firm, an attorney, or an independent medical transcriptionist
  More business associate FAQs here

Doctors By Video, LLC would be considered the business associate of a covered entity that uses Doctors By Video, LLC to communicating private health information with a client.

Is A Software Vendor Considered a Business Associate Under HIPAA?

It depends. If a vendor or subcontractor transmits, maintains, or has routine access to protected health information (PHI) when providing its services to a covered entity then it is considered a business associate. For example, a vendor that hosts the software containing patient information on its own server or accesses patient information when troubleshooting the software, then it is considered a business associate and must have a business associate agreement with the covered entity as specified under the HIPAA Privacy Rule 45 C.F.R. § 164.504(e).

The only exception under HITECH section 13408 is in the case of a data transmission organization that acts as a conduit, in that it only transports information but does not access it, such as the US Postal Service or its electronic equivalent — Internet Service Providers (ISPs), a telecommunication company, etc.

While these may have access to PHI, they only access PHI on a random or infrequent basis as necessary for the performance of the transportation service or as required by law: “[D]ata transmission organizations that do not require access to protected health information on a routine basis would not be treated as business associates” (p. 22)

While Doctors By Video, LLC never has access to any information, health or otherwise, that you may observe, transmit, or receive by using Doctors By Video, LLC, it is still considered a business associate because it is used to transmit private health information over the Internet. To be HIPAA-compliant, a covered entity using Doctors By Video, LLC for this purpose must have a Business Associate agreement with Doctors By Video, LLC.

U.S. Department of Health on Software Vendors

How is HIPAA involved in your use of video conferencing?

Videoconferencing may involve the electronic exchange of health information which is protected under HIPAA law. Security considerations with video conferencing may involve making sure unauthorized third parties cannot record or “listen in” on a video conferencing session, making sure recorded video conferencing sessions are stored and identified in a secure and proper manner, or having a procedure for initiating and receiving video calls. Other video collaboration features affecting security may include text chat, screen-sharing, and file transfer.

Videoconferencing would only be one small piece to consider when establishing and maintaining HIPAA-compliant IT security standards as described by the Privacy Rule and the Security Rule.

How does Doctors By Video, LLC allow you to comply with the HIPAA Privacy and Security Rules?

Doctors By Video, LLC has several characteristics that make it easy to protect the confidentiality of protected health information:

1. Peer-to-Peer sessions

Doctors By Video, LLC uses a managed peer-to-peer architecture, where video (and other media) are streamed directly from endpoint to endpoint. Information is never stored on any Doctors By Video, LLC servers or intercepted by Doctors By Video, LLC in any way. The Doctors By Video, LLC management server is only used for address lookup, connection brokering, and system/user administration. This prevents information leakage between point A and point B.

1. Encryption

Encryption adds another layer of security for our services. All Doctors By Video, LLC traffic is encrypted with FIPS 140-2 certified 256-bit Advanced Encryption Standard. Non of our servers have access to the decryption keys. This keeps your videoconference absolutely confidential.

1. Local File Storage (of non-streaming media)

Doctors By Video, LLC will not allow users to record video conferences and keep chat history that could be regarded as electronic protected health information (e-PHI). These files are blocked on a user’s computer and are not accessible to Doctors By Video, LLC. Covered entities may securely save recorded conferences or chat histories to their own HIPAA compliant electronic health record (EHR) system if available.

Is Doctors By Video, LLC certified for use under HIPAA?

Certification of health technology is regulated under the HITECH Act by the Office of the National Coordinator for Health Information Technology (ONC) in collaboration with the National Institute of Standards and Technology (NIST). HIPAA rules do “not assume the task of certifying software and off-the-shelf products” (p. 8352 of the Final Security Rule) neither do they set criteria for or accredit independent agencies that do HIPAA certifications.

In short, this means that the third-party HIPAA certification groups you may use are not regulated by any federal accreditation agency.

Currently, HITECH only provides for the testing and certification of Electronic Health Records (EHR) programs and modules. The certification is generally used to qualify health operations for Medicare and Medicaid EHR Incentive Programs.

Doctors By Video, LLC is not an EHR software or module.

Does Doctors By Video, LLC Offer A HIPAA Business Associate Contract?

Doctors By Video, LLC signs HIPAA Business Associate Agreements with our clients.

U.S. Department of Health on Business Associate Agreements

Does data have to be encrypted to be HIPAA compliant?

The Security Rule does not require encryption if an entity can prove it is not reasonable or appropriate to do so. However, it is a good idea to encrypt data whenever possible because in the case that there is a data breach, proper encryption exempts HIPAA-covered entities from the Breach Rule (section 13402 of the HITECH Act), which requires notification of PHI that has not been secured (i.e. encrypted) according to the security guidance publication (74 FR 19006 on April 27, 2009):“While covered entities and business associates are not required to follow the guidance, the specified technologies and methodologies, if used, create the functional equivalent of a safe harbor, and thus, result in covered entities and business associates not being required to provide the notification otherwise required by section 13402 in the event of a breach.” (p. 19008)

Encryption processes that have been tested and meet the guidance standard:(i) “Valid encryption processes for data at rest are consistent with NIST Special Publication 800–111, Guide to Storage Encryption Technologies for End User Devices.” (p. 19009-10)(ii) “Valid encryption processes for data in motion are those that comply with the requirements of Federal Information Processing Standards (FIPS) 140–2. These include, as appropriate, standards described in NIST Special Publications 800–52, Guidelines for the Selection and Use of Transport Layer Security (TLS) Implementations; 800–77, Guide to IPsec VPNs; or 800–113, Guide to SSL VPNs, and may include others which are FIPS 140–2 validated.” (p. 19009-10)

Doctors By Video, LLC does not store any of your data. All Doctors By Video, LLC traffic is encrypted with FIPS 140-2 compliant 256-bit Advanced Encryption Standard.

Official Documentation For HIPAA

HIPAA – Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, the complete suite of HIPAA Administrative Simplification Regulations can be found at 45 C.F.R.Part 160, Part 162, and Part 164

The Privacy Rule – “Standards for Privacy of Individually Identifiable Health Information” and is found at 45 CFR Part 160 and Subparts A and E of Part 164.

The Security Rule – “Security Standards for the Protection of Electronic Protected Health Information” and is found at 45 CFR Part 160 and Subparts A and C of Part 164.

Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules – 45 C.F.R. Parts 160 and 164

What You Need To Know About Our BAA Agreement With Zoom & Whereby

Due to the user’s familiarity with Zoom, and its ability to provide an updated and secured network, we have executed a Business Associate Agreement (BAA) with Zoom and Whereby. The agreement ensures that the necessary security controls are implemented on the account we provide to you and satisfy the HIPAA Security Rule:

End-to-end encryption is used to secure all communications.

Two types of authentication are used on the account:

OAuth 2.0, for authenticating a user context; and

JSON Web Tokens (JWT) for authenticating server-to-server apps.

Access control measures are enabled.

Cloud Recording is disabled.

Encrypted chat is enabled.

The setting “Require Encryption for 3rd Party Endpoints (H323/SIP)” is enabled for all members of our account.

Text messages will be encrypted.

Offline messages will only be available after all parties initiate a cryptographic key exchange.

*ATTRIBUTES: VSEE.com | The US Department of Health & Human Services | © 2021 Doctors By Video LLC.