Categoris

HIPAA Security Guidance for Remote Use and Access to Electronic PHI

Monday, January 8, 2007

CMS has issued HIPAA Security Guidance (link to guidance document pdf) for HIPAA covered entities on the risks and possible mitigation strategies for remote use of and access to Protected Health Information (EPHI). The guidance sets forth CMS' minimal compliance expectations for covered entities seeking to safeguard EPHI that is accessed, stored or transported offsite.

This guidance should be useful for those health care facilities and providers to assess current policies and procedures used to maintain the confidentiality of health information.

Attorney-Client Privilege Article

Susan Wong Romaine, an attorney at our firm recently authored an article on attorney-client privilege appearing in the Winter 2006 edition of the Defense Trial Counsel of West Virginia Newsletter. Congratulations to Susan on a great article.

The article, Update on Attorney-Client Privilege, addresses recent changes under the Federal Sentencing Guidelines impacting the policy of federal prosecutors to grant leniency in charging and sentencing for corporation who waive their attorney-client and work product protections. The article also looks at a recent 5th Circuit decision, Willy v. Administrative Review Board, 423 F.3d 483 (5th Cir. 2005), involving a whistleblower lawsuit brought by in-house counsel.

Update on Attorney-Client Privilege

Attorneys typically practice with the confidence that their communications with clients will be protected by the attorney-client privilege. The justification behind this doctrine is fundamental to ensuring attorneys can provide the best possible representation to their clients. Through the protection of the attorney-client privilege, clients can candidly and truthfully confide in their counsel, thus equipping counsel with the necessary knowledge for advising their clients on issues relating to compliance with rules, regulations, the law, and, even more critically, litigation.

Every practicing attorney should know, however, that the attorney client privilege is not as steadfast as it appears. While this doctrine is customarily perceived as a steel-enforced shield from the disclosure of sensitive information, recent developments surrounding the treatment of the attorney-client privilege could lead one to think the shield is actually made of paper. For example, the demise of Enron and birth of Sarbanes-Oxley have sparked practices that have begun to wear away at the safe haven that corporations and attorneys alike have become dependent on for keeping confidential information strictly in the boardroom. Until recently, federal policies encouraged prosecutors to grant leniency in charging and sentencing decisions for corporations that waive their attorney-client and work product protections. Although the United States Sentencing Committee recently voted to delete any such policy from its Sentencing Guidelines, the invasion into protected attorney-client territory is creeping into other realms. For example, proposed Federal Rule of Evidence 502, if enacted, would authorize the disclosure of privileged information to government agencies, but not to private parties. Also, taking into account the recent amendments to the Federal Rules of Civil Procedure which provide for discovery in the electronic sphere, attorneys will have to familiarize themselves with what is and is not privileged in the worlds of metadata, e-mail, and the internet.

While some of the new ways that the attorney-client privilege is being manipulated will present new challenges for attorneys, they are not at a complete disadvantage. Last year, the Fifth Circuit decided that a document protected by the attorney-client privilege was admissible as evidence in a case where a former in-house lawyer sued his former employer for violation of federal whistleblower laws. Willy v. Administrative Review Board, 423 F.3d 483 (5th Cir. 2005). Under the precedent set by this ruling, attorneys have an opportunity to waive the attorney-client privilege. This is significant considering that waiver of the privilege is typically only available to clients.

While changes in the treatment of the attorney-client privilege are certain to continue, attorneys should remember these tips for client communications that likely will not change anytime soon:

  • Always address attorney-client privilege issues with a client in the initial phase of your relationship. While corporate representatives these days often have a strong knowledge of the legal system, they may not fully understand the intricacies of the attorney-client privilege and how innocent actions may result in a waiver.
  • Remember, in the context of a corporation, the attorney-client privilege can be subject to waiver by anyone in management, including officers or directors
    • “New” management can waive the privilege of protecting information that was created when the “old” management was in place. See Commodity Future Trading Comm’n v. Weintraub, 471 U.S. 343 (1985)
  • The attorney-client privilege can extend to non-lawyers whose involvement in a matter facilitates an attorney’s understanding of his or her client’s situation.
    • If you obtain an expert for help in a matter, prepare an engagement letter outlining the expert’s expected role. The letter should state that all communications between the expert and the lawyer and client are incidental to providing legal services and intended to be confidential. The expert should also be advised not to communicate with a client without the lawyer’s direction. See U.S. v. Kovel, 296 F.2d 918 (2nd Cir. 1961).
  • Counsel and clients alike should ensure all records of letters, notes, and conference calls between each other are kept in a secure, marked file and labeled “private” or “confidential attorney-client communication.” Without these simple precautions, a court could find that adequate steps were not taken to preserve the privilege.
By remembering some of these fundamental guidelines for interactions with your clients, you should be equipped to face any new change to the attorney-client privilege.

Health 2.0: EMR Innovation from the ground up

How about this for EMR GMR innovation. Graham Walker, a Stanford med student, has built his own web 2.0 mock up of a better EMR interface. A great example of what web 2.0 might bring to health care in 2007 and beyond. I'll be interested to read the comments from physicians and others who have to work with EMR software on a day to day basis.

Watch the screencast demo and then test it out for yourself.

Courtesy of Matthew Holt at the The Health Care Blog.

Good Things Happen When You Do Good

Friday, January 5, 2007

Lately I haven't had time to blog much because of a busy work schedule and the holidays. Again too much to blog about and too little time. However, I couldn't pass this up.

A simple lesson from the Hero of Harlem that has universal application. Quoting Mr. Autrey, "Good things happen when you do good." Such a powerful and simple message.

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Blawg Review #88: Tickling The Ivories

Monday, December 18, 2006

Blawg Review #88 is up at David Harlow's HealthBlawg with a mention and link to the Healthcare Blogging Summit.

David, very nicely composed. In keeping with the theme -- you know the "key" to good health care isn't "black and white." Although the Healthcare Blogging Summit was a small but diverse group I was encouraged by the words of Richard G. Petty, MD who reminded during one of the panel discussions that the Age of Enlightenment was the creation of no more than 1,000 people.

Time's Person of the Year: The Power of the Information Age Public

Sunday, December 17, 2006

Time Magazine's recognizes the power of those who now create, control and collaborate with content online and the incredible influence that it is having around the world. This year's Time Magazine's person of the year is "you."

Over the last couple of years since beginning my Health Care Law Blog in 2004 I've gained a good understanding of the "online content creating community" and it has changed the way that I communicate, work and learn. If it hasn't already -- I predict it will change you too.

Some interesting stats for a perspective on where all this might be headed. The Pew Internet & American Life Project found in 2004 that 44% Internet users were creating content for the online world. The November 2005 Pew Internet Report, "Teen Content Creators and Consumers," found that 57% of teens now create content for the the internet. The new generation will create continued demand (and content) that will influence us all.

One statistic that I mentioned earlier this year (courtesy of Denise Howell) was that "Among 21 year olds, 61% of web content created by someone they know." I'm not sure where this stat comes from and whether it was from the Pew report -- but if accurate it goes to show that the public is not only creating content but using and relying on content by those who they personally know. Along these same lines, this past week I attended the Healthcare Blogging Summit and Steve Rubel commented that 68% agreed that the people we trust is "a person like me."

The HealthTrain: The Open Healthcare Manifesto (full Report Version 0.1) discussed at the Healthcare Blogging Summit provides some interesting material for discussion of what impact open published media will have on the health care industry. The Manifesto presents the idea that understanding and learning is grounded in human conversation and that these new technologies allow this to happen easier and with more impact. Time's article recognizes what the Manifesto refers to as the change from "traditional command and control" forms of communication. The Manifesto outlines a set of principles to guide those in health care as we move forward with this online social experiment.

My favorite section of Time's online article on the Person of the Year:

. . . The answer is, you do. And for seizing the reins of the global media, for founding and framing the new digital democracy, for working for nothing and beating the pros at their own game, Time's Person of the Year for 2006 is you.

Sure, it's a mistake to romanticize all this any more than is strictly necessary. Web 2.0 harnesses the stupidity of crowds as well as its wisdom. Some of the comments on YouTube make you weep for the future of humanity just for the spelling alone, never mind the obscenity and the naked hatred.

But that's what makes all this interesting. Web 2.0 is a massive social experiment, and like any experiment worth trying, it could fail. There's no road map for how an organism that's not a bacterium lives and works together on this planet in numbers in excess of 6 billion. But 2006 gave us some ideas. This is an opportunity to build a new kind of international understanding, not politician to politician, great man to great man, but citizen to citizen, person to person. It's a chance for people to look at a computer screen and really, genuinely wonder who's out there looking back at them. Go on. Tell us you're not just a little bit curious.
I do agree with ProBlogger's comments that Time gets the linkbaiter of the year award (brilliant PR move if Time factored this into its decision). Watch the stats on this Technorati graph. The article is already topping Techmeme.

UPDATE: Fard Johnmar at HealthcareVox also looks at Time's "Person of the Year" announcement from a health care perspective.

Healthcare Blogging Summit 2006

Washington DC is the place to be for health care bloggers. Tomorrow the first Healthcare Blogging Summit is being held in conjunction with the Consumer Health World expo. I'll be participating as a panel member on the "Facts and Issues" session. I'm looking forward to meeting in person a number of health care bloggers that I regularly follow though RSS.

My family and I arrived over the weekend for a short holiday weekend before the conference. We took the kids to the National Zoo on Saturday with friends who came into the city from Martinsburg (don't miss the PandaCAM - we watched it for weeks before we came) . Today we spent time along the Mall at the Smithsonian where 6 year olds (and 2 year old sisters and adult parents) are in heaven - dinosaurs, mummies, rockets, airplanes, etc.

While reviewing information form the conference I thought it would be helpful to aggregate a few of the pre-conference (and post-conference) posts and interesting posts/topics that might come up at the conference. If you have one that you would like added please email me. Heck, I might even try out some live blogging during the event. (REMEMBER: If you blog about the event tag it as Healthcare Blogging Summit or HBS2006.)

Preconference Discussion:

  • Carol Kirshner at Driving In Traffic and Josh Hallett at Hyku comment on a recent Florida story about a disgruntled patient and the impact it might have on the Florida hospital involved. I'd like to pose a hypothetical to Nick Jacob and ask him how he'd respond to this on his blog. Nick's response during his panel session was to point out Windber current infection rate is 1% while the national average is 8%.
  • Fard Johnmar at Envision Solutions has released highlights from the "Taking the Pulse of the Healthcare Blogsphere" survey conducted this past summer. The press release includes the following highlight information (download the survey results here):
    • 214 healthcare bloggers took at least a portion of the survey, which was fielded between July 31 and September 29, 2006. 171 answered every question in the poll.
    • 61% of respondents write about their personal experiences.
    • 39% of those surveyed hide their identity to protect their privacy, patient confidentiality or themselves. (As a health lawyer interested in privacy issues this stat interests me)
    • Nearly 40% of healthcare bloggers report that the most important reason they decided to start their blog was to share their opinions or educate others.
  • Business Blogs Now highlights the Summit and the growing number of health professional bloggers.
  • Spare Change talks about the conference location and the "Taking the Pulse of the Healthcare Blogosphere." I agree that the Omni is a great location with wonderful services and I'm interested to see the results of the survey being unveiled tomorrow.
  • Unity Stoakes of Organized Wisdom will be attending and bring the perspective of one of the new Web 2.0 health companies.
Conference Thoughts:

Enjoyed Steve Rubel's presentation which looked at the Galaxy, Stars, Planets, Shooting Stars, etc. of health care bloggers. I was especially struck by the statistics he provided on "who do you trust" and the fact that 68% are "persons like yourself." He also had a great slide showing the shift from 1992-2002 corporate built web to todays 2002 and beyond web built by individuals. He used information from Comscore Media Metrix and a chart from Washington Post article, "New Trends in Online Traffic."

Steve also pointed out that he believes that blogging as an activity has peaked as a result of statistics he provided using Technorati. The chart showed the leveling off of post volume over the last few months. It will be interesting to see if this trend continues.

More to come . . .

Post Conference Discussion:

Note:
If you are going to be in Washington Monday evening don't miss the Blogger Wonk starting at 7pm at Open City. I'm sorry I'll have to pass because we have to be back in Charleston WV Tuesday a.m. and plan to leave right after the conference. So fare on the RSVP list are: Katya Andresen, Leslie Jump, Debbie Weil, Josh Hallett, Marianne Richmond, TrisGrier, CK (Christina Kerley), Dmitriy Kruglyak, Fard Johnmar, Carol Kirshner, Shahid N. Shah, Craig Lefebvre and I'm sure many more . . .

Swiss Army Knife: Lost and Found

Monday, December 4, 2006

A simple example of today's live web from fellow Charleston blogger and friend, Rick Lee.

This would not and could not have happened a few years ago. Change is happening as the web becomes the way we create content, share information, communicate, collaborate, network, learn, buy anything, distribute content and even find your swiss army knife.

Next week I am attending and participating as a panelist at the first Healthcare Blogging Summit in DC. You can bet I plan to use the swiss army knife example to show the utility of today's online world and what it may bring to health care.

Note: Learn something everyday -- before this post I had never used Searchbug which was mentioned in the comments to Rick's post. Frightening how much it knows.

End of Life Care - Science and Religion

Running A Hospital has an interesting look at the legal and ethical issues faced by health care providers these days. The post, When is Death? points to a story from the Boston Globe involving a current case at Beth Israel Deaconess Medical Center.

As medical science and genetic issues continue to progress our society will have to address more of these types of legal, moral and social (and religious) issues.

More discussion and commentary over at Kevin, M.D. and TailRank.