HIPAA Rules for Healthcare Clearinghouses Change with New Bill

A new bill (H.R. 4613) has been passed to the U.S House of Representatives by Congresswoman Cathy McMorris Rodgers (R-Washington) that proposes amendments to the Health Information Technology for Economic and Clinical Health (HITECH) Act and HIPAA Rules for healthcare sector clearinghouses.

The Ensuring Patient Access to Healthcare Records Act of 2017 aims to modernize the operation of healthcare clearinghouses in healthcare, promote access to and the leveraging of health information, and enhance treatment, quality improvement, research, public health and other tasks.

Healthcare clearinghouses are bodies that transform data from one format to another, converting non-standard data to standard data factors or vice versa. Healthcare clearinghouses are thought of as HIPAA-covered bodies, although in some instances they can act as business associates. The bill – Ensuring Patient Access to Healthcare Records Act of 2017 – would see all healthcare clearinghouses treated as covered bodies.

Healthcare clearinghouses obtain health data from a wide variety of sources, therefore they could maintain a complete set of records for each patient. If patients are permitted to obtain copies of their health records from healthcare clearinghouses, it could make it more straightforward for patients treated by multiple providers to obtain a full set of their health records.

Rodgers said:  “Whether it’s because of a move to a new state, switching providers, an unexpected visit to the emergency room, or a new doctor, patients must track down their own records from numerous different sources based on what they can or cannot remember. It shouldn’t be this burdensome. Our bill gives patients the ability to see a snapshot of their health records at just a simple request, allowing them to make better, more informed healthcare decisions in a timely manner.”

While the bill could enhance data access for patients, it has been mooted that patients are unlikely to benefit. Healthcare clearinghouses may have longitudinal health records from many sources, but in many cases, they only have claims data rather than a complete set of clinical data. Even if patients could be supplied with copies, it may not prove to be particularly useful.

Patients can choose which healthcare groups they use, but since a healthcare clearinghouse is not selected by patients, they are unlikely to know which healthcare clearinghouses actually hold their data. Patients don’t normally have any dealings with healthcare clearinghouses.

The bill will “allow the use of claims, eligibility, and payment data to produce reports, analyses, and presentations to benefit Medicare, and other similar health insurance programs, entities, researchers, and health care providers, to help develop cost saving approaches, standards, and reference materials and to support medical care and improved payment models.”

This is not the first instance where the Ensuring Patient Access to Healthcare Records Act has been introduced. None of the earlier versions of the bill have made it to the floor and have attracted huge criticism. In his Healthcare Blog, Adrian Gropper, MD expressed worry in relation to a previous version of the bill (Senate bill S.3530).

Gropper said : “Extending Covered Entity status to data brokers seems like a quantitative shift and possibly a benefit to patients. But the deceptive part is that unlike today’s Covered Entities (hospitals, pharmacies, and insurance companies), data brokers do not have to compete for the patient’s business,”  “By giving the infrastructure business the right to use and sell our data without consent or even transparency, we are enabling a true panopticon – an inescapable surveillance system for our most valuable personal data.”