When it comes to providing high-quality patient care, most American hospitals simply don’t. That’s if the recent round of five-star rankings from CMS are to be believed. About 1,700 hospitals (39%) earned just three out of five stars, an “average” rating, FierceHealthcare reported.
Paper records persist despite healthcare's steady move to purely electronic documentation. Although paper records are simpler to secure than electronic records in some ways—you can't phish your way into a locked file cabinet—they also can't be encrypted. If a paper record is left out on a desk, there's little that can be done to prevent an unauthorized individual from reading it or even taking it. Papers can easily be misplaced or lost. They can be mixed up with another patient's records—or other unrelated papers—on a desk or be put back in the wrong file. And papers can all too easily fall unnoticed out of a file while being taken from one place to another.
Paper is still generated at multiple points, from new patient information forms to medical records that must be printed in part or whole if another provider's EHR system isn't interoperable. Keeping track of paper and ensuring it stays secure remains a challenge for privacy officers, but it can be managed through sound policies and alert staff.
Medical records that exist only on paper and are not digitized will be kept in a folder system. Staff may need access to these records for reference or to make copies, Ruelas says. That means paper records can pass through many hands throughout their lifetime, leaving them vulnerable to simple breaches.
Despite the security headaches caused by electronic information, electronic files can be protected against casual viewing by unauthorized individuals through proper encryption. Paper has no such protection, Frank Ruelas, MBA, principal of HIPAA College in Casa Grande, Arizona, says. "Paper records, unlike electronic records, are immediately readable," he warns. "One doesn't need an electronic interface along with a login and passwords."
You also can't easily track paper and log how many people have looked at it. An electronic file may leave a trace even if it's deleted, but a missing paper won't be noticed until someone actually goes looking for it. "Unlike electronic systems, paper documents can be seen and taken by someone without leaving a trace," Kate Borten, CISSP, CISM, HCISSP, founder of The Marblehead Group in Marblehead, Massachusetts, says. And although electronic records are more likely to be involved in large-scale breaches, there can still be paper record breaches involving thousands of patients, she says.
Q: If my medical waste includes PHI, do I need a BAA with our waste management vendor?
A: Yes. For example, clinics and hospitals contracting with bio-waste disposal vendors that dispose of IV bags execute a BAA with the bio-waste disposal vendors. It's no different than the requirement to execute a BAA with a document shredding vendor. If the vendor will come in contact with PHI, a BAA is in order.
Editor's note: Apgar is president of Apgar & Associates, LLC, in Portland, Oregon. He is also a BOH editorial advisory board member. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions. Opinions expressed are that of the author and do not represent HCPro or ACDIS. Email your HIPAA questions to Associate Editor Nicole Votta at nvotta@hcpro.com.
It's no secret that hospitals struggle with assigning the most appropriate status for patients, and this challenge is compounded by CMS' frequent changes to its regulations and guidance. To combat incorrect patient status assignments, one hospital has developed a system that rewards employees for speaking up when they suspect a patient's status is incorrect.
