The proposed rule setting processes for the accounting of disclosures of protected health information is way before its time and should be withdrawn, according to the Healthcare Billing & Management Association.

"Perhaps in five years, after practice management and EMR systems have evolved further and affordable, more sophisticated capabilities can be incorporated into these systems, the proposed capabilities may begin to appear and/or have a likely chance of being successfully developed and delivered," the association contends in a comment letter to the HHS Office for Civil Rights.

The proposed rule assumes that provider I.T. systems have the capability to identify when PHI has been accessed and by whom, and that HIPAA's "minimum necessary" requirements have been incorporated into existing software, according to HBMA. "While both capabilities existing within many established hospital software products, less than half of all medical practice products (so-called 'practice management' systems) possess either or both of these capabilities."

Nor does any current electronic records product record the reason a patient's PHI was accessed, according to the association's letter.  Further, such capability would be costly to create, implement and operate.

HHS/OCR simply doesn't understand how often PHI can be accessed, HBMA contends, and it lists 19 distinct times during the course of a simple office visit that a patient's PHI would be accessed. "Each of those 19 'touches' would add another interruption to the workflow and require a separate interaction with the practice's system--even if there is no other reason to access the system at that juncture," according to the comment letter. "Hospital inpatients would have-literally--hundreds of 'accesses' per day."

If HHS/OCR does move forward on the regulations, HBMA recommends implementation be deferred until 2015 or later. The association's complete comment letter is available here.


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