Practice Management

HIPAA: Understanding Need to Know vs Minimum Necessary

HIPAA: Understanding Need to Know vs Minimum Necessary

11 Jan 2022
5 min
HIPAA Need to Know vs Minimum Necessary

HIPAA need to know vs minimum necessary is a widely discussed topic debating what the law actually encompasses.

HIPAA breaches impacted nearly 49 million people last year, but what happens if someone in your organization violates HIPAA regulations?

The fines begin at $100, but in the most extreme circumstances can cost $1.5 million per year.

Clearly, your organization needs to avoid HIPAA violations. You need to educate your employees on complying with HIPAA. The best place to start is the focus of the law: “minimum necessary.” In this brief HIPAA compliance guide, we’ll explain “minimum necessary,” and how to use the phrase “need to know” to educate your staff. Read on for how to implement a solid HIPAA compliance strategy in your organization.

What is HIPAA?

HIPAA stands for the Health Insurance Portability and Accountability Act. This law protects patients’ personal information from being shared unnecessarily. This information is defined as protected health information (PHI).

HIPAA outlines when practitioners can and cannot share data within and between organizations. The law outlines six scenarios when practitioners can share PHI:

  1. Requesting information needed to treat a patient
  2. Patients requesting their own data
  3. Requesting information with the patient’s permission
  4. Requesting information required for HIPAA Administrative Simplification Rules compliance
  5. PHI requests from the Department of Health and Human Services to enforce compliance with HIPAA
  6. Requesting information to otherwise comply with the law

These situations can be summarised as requesting PHI when necessary or with the patient’s permission. Conversely, practitioners should not access PHI if unnecessary or without patient permission.

However, that alone is not a clear enough indicator of how much information should be accessible and when. Further, it’s impossible to define every scenario where information cannot be shared.

For this reason, the law instead offers this principle: “minimum necessary.” Minimum necessary is a guideline for how much PHI medical professionals can share or access.

This simple phrasing can still cause confusion. For this reason, many organizations use the phrase “need to know” in its place. Here’s how the terms relate.

Further Reading:

HIPAA Need to Know vs Minimum Necessary

Minimum necessary means that practitioners only share or access the minimum amount of PHI necessary to do their work.

For example, imagine a doctor sending PHI to an orthopedics manufacturer. The minimum necessary PHI the manufacturer needs only includes health records of the affected area. Sending unrelated records, such as vaccination history, would be a violation of HIPAA.

As simple as the “minimum necessary” rule seems, the term has caused confusion.

In one famous case from years ago, a nurse told a practitioner to wear gloves before treating a patient because they had an infectious condition. Didn't the nurse share the minimum necessary amount of PHI to keep everyone safe?

No. They could have told the practitioner to wear gloves without stating the condition.

To address the confusion around this phrase, many organizations internally adopt “need to know” instead. This phrase is more common in day-to-day life. It clearly expresses that only information you or others need to know should be shared or accessed.

Hence, “HIPAA need to know” is not a phrase that comes from the law itself. But it is commonly used in place of “minimum necessary” to make the law clearer.

You’ll frequently find it in medical seminars, handbooks, and guidelines. It has been adopted to help medical practitioners remain HIPAA compliant.

Information Protected Under HIPAA

Which patient data does PHI include? The following are common examples of PHI:

  • Medical records
  • Test results
  • Prescription data
  • Communication records with practitioners

PHI also covers personal data not specifically related to medical care. For example, a nurse recently violated HIPAA rules by contacting a patient using contact information she had earlier seen. While not medical data, this is still PHI and the nurse used it improperly.

Data groups outside of medical history that still come under PHI include:

  • Name
  • Address
  • Contact information
  • Social security number
  • Payment information
  • Medical appointment schedule

In summary, any personal data belonging to a patient comes under PHI. These are all protected from access and sharing beyond the minimum amount necessary.

Complying With HIPAA

How can you ensure all within your organization comply with HIPAA, and don’t end up costing you a hefty fine? The best approach is threefold: training, policies, and accountability.

Training for HIPAA Compliance

Your staff need to all receive training in the details of HIPAA. Educate them in depth on the details of the law, and which information it protects.

Whether via seminars, frequent memos, or other means, regularly remind them what “minimum necessary” means. Make sure they’re well-trained enough to understand the mistake the nurse in the previous example made. Then, they’ll be in the best position not to make it themselves.

Policies for HIPAA Compliance

Besides education, implement policies that make it clear how you uphold HIPAA. For example, with online PHI (ePHI), have explicit policies for labeling, categorization, and storage. Then, when staff go to access data they need, they won’t stumble upon other irrelevant data.

Accountability Systems for HIPAA Compliance

Your employees should understand there are consequences for breaching HIPAA. To do this, you need policies that openly monitor their behavior.

For example, institute a tracking system that logs who has accessed what information. If file access is openly monitored, employees are less likely to try and access data they shouldn’t.

And if someone does breach HIPAA, do they know what will happen? Will an employee lose their job in all cases or just some? Explicitly outline your company's accountability policies so your staff know how to behave and what to expect.

Keeping Third Parties Compliant

As already illustrated, medical organizations depend on third parties. Third parties deliver supplies, manufacture prosthetics, and enable online communication and data storage.

But last year, 90% of the ten largest HIPAA breaches came from third-party vendors. This illustrates the importance of only working with partners you can trust.

How can you ensure your partners respect HIPAA laws as well as they should?

The starting point is to never share PHI with third parties unnecessarily. Only ever pass on the minimum necessary PHI for them to fulfill their role. And choose providers known for upholding HIPAA, not ones with a history of breaches.

Third-Party Software

However, we live in the digital age. Patient records and even consultations are increasingly moving online. Software that enables this both streamlines and centralizes your organization’s data.

To use software like this, you have to share all of your patient data. For virtual meeting software, this includes not just medical but scheduling data. And the software is hosting countless confidential conversations containing your patients’ PHI.

While digital healthcare solutions are beneficial, organizations need to be careful they’re choosing a trustworthy partner.

How to Identify Trustworthy Third Parties

To find a trustworthy and custom software application development services provider, find one specifically made for the medical field. Scheduling apps or programs made for a variety of sectors won’t necessarily have the HIPAA compliance needed.

The best software you can use to manage PHI and virtual meetings is one designed with HIPAA in mind. These tools are designed with privacy in mind and exclusively utilize HIPAA-compliant forms. They solely integrate with other software that adheres to HIPAA regulations.

In fact, the best software offers tools to make compliance easier.

They offer secure file sharing so that you know PHI stays secure in communication. They prevent users from accessing data they don’t need to, whether that be conversations or medical records. And their form-building tools are secure and HIPAA compliant.

Does your provider offer all of these tools, and so secure?

To check, ask them about their HIPAA compliance. The best providers proudly share their HIPAA compliance information. If they don't, they're a risky choice.

For example, we at Upvio pride ourselves on being a trustworthy software provider for the medical sector. We offer all of these benefits and more to allow all practices to embrace digital care. If you have any questions about how we maintain such high security standards, feel free to get in touch.

Further Reading:

Combat HIPAA Risk With the Right Partner

With a better understanding of HIPAA need to know vs minimum necessary, your organization can ensure staff stay above board. But without trustworthy third parties, your efforts could easily be compromised.

Are you looking for a partner just as compliant as you are?

You’ve found us.

At Upvio, all our products streamline your services without risking your compliance. We recognize the importance of the law and will work with you to keep patient data secure. Move your whole system online while keeping it as private as ever.

To see for yourself, try a demo of our software today!

Up the Ante with Upvio

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