{"id":13168,"date":"2017-06-28T19:21:04","date_gmt":"2017-06-28T19:21:04","guid":{"rendered":"https:\/\/digital-sentinel.com\/?p=13168"},"modified":"2017-10-01T10:33:06","modified_gmt":"2017-10-01T10:33:06","slug":"safeguard-patient-health-information","status":"publish","type":"post","link":"https:\/\/digital-sentinel.com\/privacy\/safeguard-patient-health-information\/","title":{"rendered":"Safeguard Patient Health Information"},"content":{"rendered":"<header class=\"lxb_af-post_header lxb_af-grid-parade\" role=\"presentation\">\n<h1 class=\"lxb_af-template_tags-get_post_title\">HIPAA Check-up: Your Obligations to Safeguard Third-Party Patient Health Information in medical records produced in litigation<\/h1>\n<div class=\"lxb_af-post_header-meta\">\n<div class=\"lxb_af-post_header-meta-byline_cat_wrap\">\n<div class=\"lxb_af-template_tags-get_post_byline lxb_af-post_meta\">By <span class=\"lxb_af-template_tags-get_authors lxb_af-template_tags-get_authors-get_linked_author_names lxb_af-template_tags-get_authors-get_linked_author_names-get_post_byline-authors\"><a class=\"lxb_af-template_tags-get_author lxb_af-template_tags-get_author-get_authors-author\" href=\"https:\/\/www.privacyandsecuritymatters.com\/author\/jbkoss\/\">John Koss<\/a><\/span> on <time class=\"lxb_af-template_tags-get_post_date lxb_af-template_tags-get_post_date-get_post_byline-date\" datetime=\"2017-05-23 12:00\">May 23, 2017<\/time><\/div>\n<div class=\"lxb_af-template_tags-get_post_categories lxb_af-post_meta\">POSTED IN <a class=\"lxb_af-template_tags-get_post_categories-link lxb_af-post_meta-link\" href=\"https:\/\/www.privacyandsecuritymatters.com\/e-discovery\/\">E-DISCOVERY<\/a>, <a class=\"lxb_af-template_tags-get_post_categories-link lxb_af-post_meta-link\" href=\"https:\/\/www.privacyandsecuritymatters.com\/hipaahitech\/\">HIPAA\/HITECH<\/a>, <a class=\"lxb_af-template_tags-get_post_categories-link lxb_af-post_meta-link\" href=\"https:\/\/www.privacyandsecuritymatters.com\/litigation\/\">LITIGATION<\/a><\/div>\n<\/div>\n<\/div>\n<\/header>\n<div class=\"lxb_af-post_content lxb_af-clear\">\n<p><em><strong>You\u2019ve had your apple a day, but you can\u2019t keep the subpoenas away\u2026\u00a0<\/strong>\u00a0<\/em><\/p>\n<p>And, if your organization is facing a request seeking records or other materials that may contain patient health information (\u201cPHI\u201d), it bears repeating that while <a href=\"https:\/\/www.ecfr.gov\/cgi-bin\/text-idx?SID=fff8da8f1c067c67c8e73621367c2b52&amp;mc=true&amp;node=se45.1.164_1512&amp;rgn=div8\" target=\"_blank\" rel=\"noopener\">HIPAA<\/a> provides a number of methods through which covered entities that hold records containing PHI may produce such records, these guidelines are closely enforced by courts. \u00a0 Read on for your spring check-up.<span id=\"more-6550\"><\/span><\/p>\n<p>By way of reminder, consent of the subject of the PHI is not a prerequisite to its production under HIPAA and the statute offers three litigation-related alternatives to obtaining consent from the subject of the implicated records.\u00a0 Specifically, 45 C.F.R. \u00a7 164.512(e) permits a covered entity to disclose PHI in the course of any judicial or administrative proceeding where:<\/p>\n<ul>\n<li>the party seeking the PHI obtains a court order governing the production of the records;<\/li>\n<\/ul>\n<ul>\n<li>the covered entity receives a written statement and documentation from the party seeking the PHI that it provided notice of the ligation to the subject, identified that the subject\u2019s PHI was implicated in the request, gave the subject an opportunity to object, and received no such objection; or<\/li>\n<\/ul>\n<ul>\n<li>the party seeking the PHI demonstrates the existence of a court-endorsed protective order that prohibits the parties from using or disclosing the PHI for any purpose other than the underlying litigation and requires the return to the covered entity or destruction of the PHI at the end of the litigation.<\/li>\n<\/ul>\n<p>However, as the United States District Court for the District of Kansas recently reiterated, even where the disclosure of PHI is permitted or permissible under HIPAA, any PHI should be produced in \u201cde-identified\u201d redacted format unless the subject of the medical records is a party to the lawsuit or the identity of the subject of the medical records is directly relevant to the claims and issues in the underlying case.\u00a0 <em>See<\/em> <u><a href=\"https:\/\/www.privacyandsecuritymatters.com\/wp-content\/uploads\/sites\/6\/2017\/05\/Duffy-1.pdf\">Duffy v. Lawrence Mem. Hosp<\/a>.<\/u>, 2017 U.S. Dist. LEXIS 49583 (D. Kan. Mar. 31, 2017).<\/p>\n<p>In <a href=\"https:\/\/www.privacyandsecuritymatters.com\/wp-content\/uploads\/sites\/6\/2017\/05\/Duffy-1.pdf\"><u>Duffy<\/u><\/a>, a false claims case, the parties had in place a protective order that the Court acknowledged bound the parties to keep the contents of the medical records produced confidential.\u00a0 However, that was not the end of the inquiry with respect to the production of the records that the Plaintiff argued it needed to show the extent to which the Hospital falsified records to obtain higher Medicare and Medicaid payments.<\/p>\n<p>The issue of de-identification arose in association with the Hospital\u2019s motion to modify a previous discovery order compelling it to produce more than 15,000 patient records responsive to the Plaintiff\u2019s document requests.\u00a0 As grounds for the motion, the Hospital represented that responding to the Plaintiff\u2019s requests as contemplated by the Court\u2019s discovery order would take 8,982 working hours and cost $230,000, including redactions that would take ten reviewers fourteen days at a cost of $37,259.50.\u00a0 The Plaintiff argued that there was no need for redaction because the Plaintiff was bound under the terms of the stipulated protective order to keep patient information produced confidential.<\/p>\n<p>While the Plaintiff made a creative argument given the scope of 45 C.F.R. \u00a7 164.512(e), she missed the key distinction between medical records specific to one of the parties in the underlying case and those of third parties.\u00a0 Specifically, the Court stated that, while it had \u201cfull confidence in the parties\u2019 adherence to the terms of the protective order,\u201d the medical records at issue related to patients who were not parties to the action and whose personal confidential information the Defendant had a legal duty to safeguard.\u00a0 For this reason, the Court directed the Defendant to produce the records only after redacting any PHI.<\/p>\n<p><strong>Doctor\u2019s Orders<\/strong><\/p>\n<p>So the lesson is clear: if your organization maintains vast amounts of records that contain PHI of\u00a0any kind, be they medical records, clinical trial-related materials, correspondence with governmental agencies or other sensitive materials, even where a protective order is in place, make sure to consider and discuss with counsel redacting any PHI in records to be produced wherever the records involve unrelated third party subjects.\u00a0 Remember, this is true even where records may not contain full names (or names at all), social security numbers, or birth\/death dates.<\/p>\n<p><strong>Your HMO (\u201cHIPAA Maintenance and Organization\u201d)<\/strong><\/p>\n<p>What PHI should covered entities\u00a0be watchful for, even within materials that are not medical records in the tradition sense, to ensure produced records are de-identified?\u00a0 Be on the lookout for the following:<\/p>\n<ul>\n<li>Names<\/li>\n<\/ul>\n<ul>\n<li>All geographic subdivisions smaller than a state, including street address, city, county, precinct, zip code, and their equivalent geocodes<a href=\"https:\/\/www.privacyandsecuritymatters.com\/2017\/05\/hipaa-spring-check-up-your-obligations-to-safeguard-third-party-patient-health-information-in-medical-records-produced-in-litigation\/?utm_source=Mintz+Levin+-+Privacy+%26+Security+Matters&amp;utm_campaign=2433e49696-RSS_EMAIL_CAMPAIGN&amp;utm_medium=email&amp;utm_term=0_10d73bc5a8-2433e49696-73123209#_ftn1\" name=\"_ftnref1\">[1]<\/a>\/<\/li>\n<\/ul>\n<ul>\n<li>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<\/li>\n<\/ul>\n<ul>\n<li>Telephone numbers<\/li>\n<\/ul>\n<ul>\n<li>Fax numbers<\/li>\n<\/ul>\n<ul>\n<li>Electronic mail addresses<\/li>\n<\/ul>\n<ul>\n<li>Social security numbers<\/li>\n<\/ul>\n<ul>\n<li>Medical record numbers<\/li>\n<\/ul>\n<ul>\n<li>Health plan beneficiary numbers<\/li>\n<\/ul>\n<ul>\n<li>Account numbers<\/li>\n<\/ul>\n<ul>\n<li>Certificate\/license numbers<\/li>\n<\/ul>\n<ul>\n<li>Vehicle identifiers and serial numbers, including license plate numbers<\/li>\n<\/ul>\n<ul>\n<li>Device identifiers and serial numbers<\/li>\n<\/ul>\n<ul>\n<li>Web Universal Resource Locators (URLs)<\/li>\n<\/ul>\n<ul>\n<li>Internet Protocol (IP) address numbers<\/li>\n<\/ul>\n<ul>\n<li>Biometric identifiers, including finger and voice prints<\/li>\n<\/ul>\n<ul>\n<li>Full face photographic images and any comparable images<\/li>\n<\/ul>\n<ul>\n<li>Any other unique identifying number, characteristic, or code (including clinical trial numbers)<\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.privacyandsecuritymatters.com\/2017\/05\/hipaa-spring-check-up-your-obligations-to-safeguard-third-party-patient-health-information-in-medical-records-produced-in-litigation\/?utm_source=Mintz+Levin+-+Privacy+%26+Security+Matters&amp;utm_campaign=2433e49696-RSS_EMAIL_CAMPAIGN&amp;utm_medium=email&amp;utm_term=0_10d73bc5a8-2433e49696-73123209#_ftnref1\" name=\"_ftn1\">[1]<\/a>\/\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 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; and (2) the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>HIPAA Check-up: Your Obligations to Safeguard Third-Party Patient Health Information in medical records [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":13170,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[37,62],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v18.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Safeguard Patient Health Information - Digital Sentinel<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/digital-sentinel.com\/privacy\/safeguard-patient-health-information\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Safeguard Patient Health Information - Digital Sentinel\" \/>\n<meta property=\"og:description\" content=\"HIPAA Check-up: Your Obligations to Safeguard Third-Party Patient Health Information in 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