Implementing HIPAA Through Effective Regional Collaboration · NCHICA Walter G. Suarez, MD, MPH President and CEO Midwest Center for HIPAA Education Presented at the ... – Forums

Regional SNIP AffiliatesRegional SNIP Affiliates::Implementing HIPAA Through Implementing HIPAA Through

Effective Regional CollaborationEffective Regional Collaboration

Holt Anderson, Executive DirectorHolt Anderson, Executive DirectorNCHICANCHICA

Walter G. Suarez, MD, MPHWalter G. Suarez, MD, MPHPresident and CEOPresident and CEO

Midwest Center for HIPAA EducationMidwest Center for HIPAA Education

Presented at thePresented at theto the to the

Annual HIMSS Conference and ExhibitionAnnual HIMSS Conference and ExhibitionSan Diego, CASan Diego, CA

February 10, 2003February 10, 2003

•• WEDI and SNIPWEDI and SNIP

•• Why Regional Efforts are ImportantWhy Regional Efforts are Important

•• Organizational Characteristics of an RSAOrganizational Characteristics of an RSA

•• Core Functions of RSAsCore Functions of RSAs

•• A Tour Through the RSA World!A Tour Through the RSA World!

•• Additional ResourcesAdditional Resources

RSAsRSAs: : A Journey Through Regional A Journey Through Regional HIPAA Collaborations in the USHIPAA Collaborations in the US

WEDI & SNIPWEDI & SNIP

•• Workgroup on Electronic Data InterchangeWorkgroup on Electronic Data Interchange– Named in 1996 HIPAA Law– Official advisor to the National Committee on Vital &

Health Statistics (NCVHS) & DHHS

•• Strategic National Implementation ProcessStrategic National Implementation Process– Formed by WEDI in 2000– Receives Industry Input– Develops strategies, tools (including education) for

HIPAA implementation

http://snip.http://snip.wediwedi.org.org

•• Health care is delivered locallyHealth care is delivered locally•• The business of health care also happens The business of health care also happens

locallylocally•• Most transactions and data exchanges Most transactions and data exchanges

happens between local organizationshappens between local organizations•• There are local policies and laws affecting There are local policies and laws affecting

the implementation of HIPAAthe implementation of HIPAA

HIPAA HIPAA -- The Importance of The Importance of REGIONALREGIONAL CollaborationCollaboration

•• For TCS, payers and providers need to coordinate For TCS, payers and providers need to coordinate

testing / implementation effortstesting / implementation efforts

•• For Privacy and Security, the local health care For Privacy and Security, the local health care

industry benefits from working together to industry benefits from working together to

interpret federal and state laws and develop interpret federal and state laws and develop

common templates and sample documentscommon templates and sample documents


Bottom lineBottom line

Organizations gain significantly by Organizations gain significantly by CollaboratingCollaborating at the at the RegionalRegional levellevel

Think Nationally….Think Nationally….Plan and Implement Regionally!Plan and Implement Regionally!


•• Broad InvolvementBroad Involvement

•• Clear Vision and FocusClear Vision and Focus

•• Committed LeadershipCommitted Leadership

•• TrustTrust

Ingredients for Successful Regional Ingredients for Successful Regional CollaborationsCollaborations

•• Joint “ownership”Joint “ownership”

•• Joint accountabilityJoint accountability

•• No dominant playerNo dominant player

•• Balanced interestsBalanced interests

•• No hidden agendasNo hidden agendas

•• Neutral meeting groundNeutral meeting ground

TrustTrust

•• Organizational StructuresOrganizational Structures

– Independent Alliances, Coalitions,

Collaboratives

– Public-private non-profit partnerships

– Government-sponsored Initiatives

– Private non-profit organizations

Organizational Characteristics Organizational Characteristics of Regional Effortsof Regional Efforts

•• Key ParticipantsKey Participants

– Providers groups (large, small, urban, rural)

– Private payers (HMOs, Indemnity, BCBS)

– Public payers (Medicare, Medicaid)

– Employers (purchaser coalitions, state)

– Public health

– Vendors


Key Regional Participants Include:Key Regional Participants Include:•• Medical SocietyMedical Society•• Hospital AssociationHospital Association•• Association of Health PlansAssociation of Health Plans•• Nurses AssociationNurses Association•• Health Information Management Assn.Health Information Management Assn.•• Association of Local Health DirectorsAssociation of Local Health Directors•• Association of PharmacistsAssociation of Pharmacists•• State AgenciesState Agencies•• Bar AssociationBar Association•• VendorsVendors

•• Methods of SupportMethods of Support

– In-kind contributions/voluntary leadership and

participation

– Membership support

– State and Federal Government support

– Project revenues (education, products, other)

– Grants

– Vendor support


•• Education and TrainingEducation and Training

– HIPAA Review and Comment Process

• As rules come out, regional efforts convene local

working groups to evaluate and submit comments

– HIPAA Regional Education Coordination Efforts

• Privacy training requirements

– General HIPAA Overview Seminars

• “HIPAA Essentials”; “HIPAA 101”; “HIPAA Intro”

Core Functions of Regional Core Functions of Regional CollaborationsCollaborations

•• Education and Training (cont)Education and Training (cont)

– Specific HIPAA Workshops

• HIPAA “Countdown” file for extension campaign

• Transactions and Code Sets Final Rule

• HIPAA Privacy Final Rule

– “Custom” HIPAA Training

• HIPAA for Hospitals and Clinics, Long-term care,

Pharmacies, Other


•• Education and Training (cont)Education and Training (cont)

– Future HIPAA Education Needs and Opportunities

• Privacy Evaluation Assessment

• Security Implementation

• National Unique Identifiers

• Claims Attachments

• Compliance and Enforcement`


•• Local Organizational ResourcesLocal Organizational Resources

– TCS working groups

– Forums for Privacy Officers

– Forums for Security Officers

– Forums for HIPAA Project Officers/Directors


•• HIPAA Tools for Local Groups HIPAA Tools for Local Groups -- TCSTCS

– HIPAA Assessments Tools

– Provider readiness assessments

– Payer testing readiness surveys

– Common local “companion guides” for

implementation of HIPAA Transactions

(addressing the issue of situational elements)

– Local trading partner agreements templates


•• HIPAA Tools for Local Groups HIPAA Tools for Local Groups –– P&SP&S

– HIPAA Assessments Tools

– HIPAA Checklists

– Local Privacy Forms

• Patient Consent (for states with Consent Laws)

• Notice of Privacy Practice

• Patient Authorization

• Other Administrative Forms (for Patient Rights)



– Interpretation and Implementation Strategies of

the HIPAA Patient Rights

• Administrative forms, employee training and policies

and procedures for:

– Access to records, request of amendments,

restrictions, confidential communications

– Accounting of disclosures

– Filing complaints



– Business Associate Review and Agreements

– Administrative Requirements

• Privacy Officers

• Policies and Procedures

• Training

– State Preemption Analysis

• Core HIPAA Requirements

• HIPAA “Exceptions”


SNIP Regional EffortsSNIP Regional Efforts

Keys to Achieving HIPAA Keys to Achieving HIPAA ComplianceCompliance

State and Regional InitiativesState and Regional Initiatives

NJNJ SStrategic HHIPAA/Healthcare OOrganization & RRegional EEffort

NJ SHORENJ SHORE

MMidid--AAtlantic tlantic HHIPAA IPAA IInitiativenitiative

HIPAA Action Workgroup of Kentucky

DeliverablesDeliverables•• Awareness and Educational SessionsAwareness and Educational Sessions

•• Work GroupsWork Groups

•• WorkshopsWorkshops

•• Training MaterialsTraining Materials

•• White PapersWhite Papers

•• Preemption AnalysisPreemption Analysis

•• Sample DocumentsSample Documents

•• Gap Analysis & Planning ToolsGap Analysis & Planning Tools

State and Local GovernmentsState and Local Governments

HIPAA GIVESHIPAA GIVES

Building & Sharing Tools through Building & Sharing Tools through HIPAAHIPAA GGovernment overnment IInformation nformation

VValue alue EExchange for xchange for SStatestates

Founded By:North Carolina Department of Health & Human Services HIPAA Office North Carolina Healthcare Information & Communications Alliance, Inc. (NCHICA)Keane, Inc.

•• Establish SolicitationEstablish Solicitation--free, Webfree, Web--based Clearinghouse for Exchanging based Clearinghouse for Exchanging State Developed HIPAA Deliverables such as:State Developed HIPAA Deliverables such as:

• Scope Documents

• RFP Samples

• PMO Organizational Structures

• Budget Frameworks

• Work Plan Templates

• Assessment Tools

• Sample Policies & Procedures

• Training Materials

•• Provide a Conference Call and Listserv Forum for States to Provide a Conference Call and Listserv Forum for States to Discuss/Resolve Issues Related to HIPAA ImplementationDiscuss/Resolve Issues Related to HIPAA Implementation

HIPAA GIVES: GOALSHIPAA GIVES: GOALS

HIPAA GIVES: PARTICIPANTSHIPAA GIVES: PARTICIPANTS

•• Who Can Join:Who Can Join:– State & Local Government/Services

– State/Community Affiliated Health Care Providers

– State Universities

– Medicaid Fiscal Agents

– Vendors Sponsored by State Government Participants

•• HIPAA Program/Project Managers & Staff From All HIPAA Program/Project Managers & Staff From All 50 States Currently Participating50 States Currently Participating

•• Current Activities:Current Activities:– Gather Deliverables to Share on the Web Site

– Conduct HIPAA-related Focus Groups• Public Health

• City and County HIPAA Group (Affiliated)

– Partner with NAHDO to Implement Listserv

– Member of WEDI SNIP Steering Committee

HIPAA GIVES: ACTIVITIESHIPAA GIVES: ACTIVITIES

HIPAA GIVES:WEB SITEHIPAA GIVES:WEB SITE

HIPAA GIVES: WEB SITEHIPAA GIVES: WEB SITE






HIPAA GIVES WEB SITEHIPAA GIVES WEB SITE

www.hipaagives.orgwww.hipaagives.org

Practice Management Systems Practice Management Systems DirectoryDirectory

www.hipaa.org/pmsdirectory

Payer Implementation Schedules and Payer Implementation Schedules and Companion Guide TemplateCompanion Guide Template

WEDI and CAQH CollaborationWEDI and CAQH Collaboration

•• Development of public Web site for publication Development of public Web site for publication

of dates when HIPAA transactions can be of dates when HIPAA transactions can be

processed by major payersprocessed by major payers

•• Development of common template for Development of common template for

publication of payers Companion Guides to publication of payers Companion Guides to

make it easier for providers to find information to make it easier for providers to find information to

implement the business rules for transactionsimplement the business rules for transactions

•• Web site [TBD]Web site [TBD]

Other AlliesOther Allies

ResourcesResources

snip.wedi.orgsnip.wedi.org

•• SNIP web site: SNIP web site: snip.snip.wediwedi.org.org

•• SNIP Regional listserv: SNIP Regional listserv: regional@[email protected]

•• SNIP Regional Efforts Contacts:SNIP Regional Efforts Contacts:– Holt Anderson, North Carolina Health Information and

Communication Alliance [email protected]

– Walter Suarez, Minnesota Health Data Institute

[email protected]

How to Get InvolvedHow to Get Involved

MCHEMCHEMidwest Center for HIPAA EducationMidwest Center for HIPAA Education

www.mche.us.comWalter Suarez, MD, MPH

President and CEO2850 Metro Drive, Suite 118

Bloomington, MN 55425Voice: 952-854-3401Fax: 952-814-4805

[email protected]

NCHICANCHICANorth Carolina Healthcare Information & North Carolina Healthcare Information &

Communications Alliance, Inc.Communications Alliance, Inc.

www.nchica.orgwww.nchica.orgHolt Anderson, Executive Director

P.O. Box 13048Research Triangle Park, NC 27709-3048

Voice: 919.558.9258 or 800.241.4486Fax: 919.558.2198

[email protected]