Use and Disclosure of Protected Health Information: Difference between revisions

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 #An authorization for a use or disclosure of psychotherapy notes may only be combined with another authorization for use or disclosure of psychotherapy notes. '''Is psychotherapy notes policy deleted as a separate stand-alone policy and being incorporated into unmc policy # 6059, access to designated record set'''?
 == Definitions ==
+===Affiliated Covered Entity (ACE)===
+Legally separate covered entities that designate themselves as a single covered entity for the purpose of HIPAA Compliance. Current ACE members are: The Nebraska Medical Center, UNMC Physicians, UNMC, University Dental Associates, Bellevue Medical Center and Nebraska Pediatric Practice, Inc. d/b/a Children’s Specialty Physicians. ACE membership may change from time to time. The Notice of Privacy Practices lists current ACE members. Access and amendment rights apply to designated record sets throughout the ACE.
+===Designated Record Set (DRS)===
+Includes medical records and billing records about Individuals maintained by or for UNMC/ACE and any other record used by an ACE entity to make decisions about Individuals. Exact duplicates of records maintained by business associates are not considered part of the DRS.
+===Health Care Operations
+The following activities related to the Organization's functions as a health care provider and sponsor of a self-insured health plan:
+#Quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines, provided that the obtaining of generalizable knowledge is not the primary purpose of any studies resulting from such activities, otherwise these activities may be classified as research if PHI is included;
+#Population-based activities relating to improving health or reducing health care costs;
+#Protocol development;
+#Contacting health care providers and patients with information about treatment alternatives;
+#Case management and care coordination;
+#Patient safety activities;
+#Risk assessment;
+#Reviewing the competence or qualifications and accrediting/licensing of health care providers;
+#Training health care professionals;
+#Conducting or arranging for medical review, legal services, and auditing functions (including fraud and abuse detection and compliance programs);
+#Business planning and development;
+#Business management activities
+#General administrative and business functions;
+#Insurance activities relating to the renewal of a contract of health insurance;
+#Evaluating healthcare provider and plan performance;
+#Resolution of internal grievances; and
+#Fundraising (see restrictions below).
+===Health Information Exchange (HIE)===
+The electronic movement of health-related information among organizations according to nationally recognized standards. The goal of a HIE is to facilitate health care providers’ access to and retrieval of clinical data to provide safer, timelier, efficient, effective and equitable patient-centered care. Health Information exchange organizations (HIOs) provide the capability to electronically move information between disparate health care information systems.
+===Individual===
+The person who is the subject of the PHI. Personal representatives of the Individual have the same rights as the Individual under HIPAA (i.e., they “step into the shoes” of the Individual). Personal representatives include the legal guardian and anyone else authorized by law to act on behalf of the Individual. (See Nebraska Medicine Consents and Permits policy, MS14).
+===Payment===
+Activities undertaken by a health care provider or health plan to obtain premiums, to determine or fulfill its responsibility for coverage and provision of benefits under the health plan or to obtain or provide reimbursement for the provision of health care. Some of these types of activities include determinations of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts), billing, collection activities, claims management, medical necessity determinations, utilization review activities including pre-certification and pre-authorization of services, disclosure to consumer reporting agencies related to collection of premiums or reimbursement and health care data processing related to the above-listed activities.
+===Personal Representative ===
+A person who, under HIPAA or State law, is empowered to act or exercise rights on behalf of an Individual. (See Nebraska Medicine Consents and Permits policy, MS14)
+===Protected Health Information (PHI)===
+Individually identifiable health information including demographic information, collected from an Individual, whether oral or recorded in any medium, that:
+*is created or received by UNMC/ACE; and
+*relates to the past, present or future physical or mental health or condition of an Individual; the provision of health care to an Individual; or the past, present or future payment for the provision of health care to an Individual and identifies the Individual or with respect to which there is a reasonable basis to believe the information can be used to identify the Individual.
+PHI includes genetic information, which includes information about the following items (and excludes information about an Individual’s sex or age):
+*an Individual’s genetic tests;
+*the genetic tests of an Individual’s family members; or
+*the manifestation of a disease or disorder in such Individual’s family members (i.e., family medical history); or
+*any request for, or receipt of, genetic services (e.g., genetic test, genetic counseling, genetic education), or participation in clinical research which includes genetic services by the Individual or any family member of the Individual.
+PHI excludes:
+*individually identifiable health information of a person who has been deceased for more than fifty (50) years.
+*education records covered by the Family Educational Rights and Privacy Act (FERPA); and
+*employment records held by UNMC in its role as employer.
+===Research ===
+A systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalized knowledge. Generalized knowledge is knowledge that can be applied to populations outside the population served by the ACE.
+===Sale of Protected Health Information ===
+Disclosure of Protected Health Information by a covered entity or business associate, if applicable, where the covered entity or business associate directly or indirectly receives remuneration from or on behalf of the recipient of the PHI in exchange for the PHI.
+===Treatment===
+The provision, coordination or management of health care and related services by one or more health care providers including the coordination or management of health care by a health care provider with a third party, consultation between health care providers relating to a patient, or the referral of a patient for health care from one health care provider to another.
+===Workforce===
+Employees, medical staff, volunteers, trainees, and other persons whose conduct, in the performance of work for Nebraska Medicine/UNMC, is under the direct control of Nebraska Medicine/UNMC, whether or not they are paid by Nebraska Medicine/UNMC.
 ==Additional Information==
 *Contact the [mailto:debrbishop@nebraskamed.com Privacy Officer] or the [mailto:privacy@nebraskamed.com Privacy Office] at 402-559-5136 '''is this phone # still correct?'''
 *UNMC Policy No. 6058, [[Notice of Privacy Practices]]
-*UNMC Policy No. 6066, [[Psychotherapy Notes]]
+'''*UNMC Policy No. 6066, [[Psychotherapy Notes]] is this being deleted or kept? If being kept, it should be reviewed, even if not changed.'''
 *[https://unmcredcap.unmc.edu/redcap/surveys/?s=94TLJCCAAT Request for Electronic Health Data] Form
 *[http://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html Uses and Disclosures for Treatment, Payment, and Health Care Operations]