Run, Hide, Fight

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Several active shooter situations have been tragically chronicled in the news recently. We have received a number of questions from clients regarding the concept of Run, Hide, Fight (published by the U.S. Department of Homeland Security (DHS)).  While the thought of an active shooter in your workplace may seem remote, you can prepare for such an event.

Concept – Run, Hide, Fight is comprised of three basic actions.

  1. Run from the area if you can.
  2. Hide if you cannot run.
  3. Fight if all else fails.

Run, Hide, Fight is Not a Normal Response – While this concept makes common sense, our brains will often cause us to be frozen and/or unable to act or think clearly when confronted with a volatile situation.  Freezing is not a choice, but rather a built-in instinct that automatically happens went confronted by external threats.

Sometimes freezing is brief and other times it persists. This can reflect the particular situation you are in, but also your individual predisposition. Some people naturally have the ability to think through a stressful situation, or to even be motivated by it, and will more readily run, hide or fight as required. But for others, additional help is needed.

Run, Hide, Fight Requires Discussion, Planning, and Training – Since freezing is a normal response, there is a need for discussion and plannign to help train the mind to respond differently.

For more information on the Run, Hide, Fight concept, along with planning and training information, see the article in the March 2016 issue of the Advisor.

End of Support for Windows 7 and 8

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Microsoft has announced its timetable regarding the end of support for Windows 7 and Windows 8.  These dates may seem distant, but you will want to begin planning now, so that you can complete a transition prior to the end of support.

Transition planning is important, because after support ends, security updates are no longer provided.  Without security updates, your computer/network will be vulnerable to external hacking attempts and potential malware intrusion.  Under HIPAA’s Security Rule, you are required to take measures that reduce such risks, including updating software with security patches, and ending use of software that is no longer being supported by the manufacturer.

Windows continues to offer security updates through what it terms the “Extended Support” time frame.

  • For Windows 7, Service Pack 1, extended support will end on January 14, 2020.
  • For Windows 8, (current latest version 8.1), extended support will end on January 10, 2023.

You should work with your IT department/vendor to plan upgrades to operating systems/software as appropriate prior to the end of extended support dates.  Due to limitations of hardware, this may sometimes require the purchase of new equipment that is capable of running the new operating system or software.   For this reason, budgeting concerns also play a key role.

Refer to the March 2016 issue of the Advisor for additional information on this topic.

Disclosure of PHI Obtained From Other Providers

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Patients have the right to request a copy of their medical record, and covered entities must provide it and include any information that was created by, or obtained from other healthcare providers that is contained in the patient record.

The Privacy Rule states:

“A covered entity is required to provide access to protected health information in accordance with the rule regardless of whether the covered entity created such information or not… In order to assure that an individual can exercise his or her access rights, we do not require the individual to make a separate request to each originating provider.

If the individual directs an access request to a covered entity that has the protected health information requested, the covered entity must provide access.”

The inclusion of other providers’ information is not exclusive to patient access rights. For example, if a hospital requests a patient’s full medical record for treatment purposes, then the entire contents of the medical record, including records that were created by other providers, should be included.

Health and Human Services has posted the following question and answer that addresses the issue in a more general manner, rather than only referring to patient requests:

“Question – A provider might have a patient’s medical record that contains older portions of a medical record that were created by another previous provider.  Will the HIPAA Privacy Rule permit a provider who is a covered entity to disclose a complete medical record even though portions of the record were created by other providers?

Answer – Yes, the Privacy Rule permits a provider who is a covered entity to disclose a complete medical record including portions that were created by another provider, assuming that the disclosure is for a purpose permitted by the Privacy Rule, such as treatment.”

While a covered entity may deny access to information that was received from someone under a promise of confidentiality (if access would be reasonably likely to reveal the source of the information), a covered entity may not deny access to PHI when the information has been obtained from a healthcare provider. If a patient authorizes disclosure of his/her PHI, or disclosure is otherwise permitted by the Privacy Rule, a provider may not restrict disclosure of PHI based on who created it.

Acceptable/Responsible Use

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Once a workforce member is granted access to a practice’s information systems (including computer hardware, software, email, voice mail, internet, telephone, cell phone, laptops, or other electronic equipment or service made available to employees or paid for by the practice), it is everyone’s responsibility to ensure that the systems are utilized in an acceptable manner following basic rules of conduct.

Acceptable Use applies to the use and disclosure of proprietary and patient information, computer or other devices (includes mobile and other computing or storage devices), and network resources. Some basic responsibilities include:

  • Protecting proprietary information, such as business practices, financial information and intellectual property of the practice.
  • Using or disclosing business and patient information only as necessary to perform assigned duties.
  • Promptly reporting any theft, loss or unauthorized disclosure of proprietary or patient information.
  • Exercising good judgment in the use of the information system (this includes internet access and the sites visited).
  • Ensuring that local, state, federal, or international law is not violated while utilizing the practice’s information system.

It is helpful if acceptable or responsible use expectations are outlined in an employee handbook, or otherwise clearly communicated to workforce members.  Some organizations may also require users to sign an acknowledgement (often called an “acceptable use policy”) to ensure understanding of the policies.

Sanctions or penalties must be uniformly imposed if anyone should cause harm to the information system, use or disclose information in an unauthorized manner, or violate regulatory requirements. Sanctions may include disciplinary actions up to, and including termination of employment.  Workforce members should also be warned that certain actions that violate privacy requirements might subject them to prosecution and/or monetary penalties by regulatory agencies, such as the Office for Civil Rights.

Communicating compliance responsibilities to workforce members, and informing them of sanctions that will be imposed for failure to meet them, helps ensure the security of your practice’s information system.

Disclosure to Medical/Dental Device Companies

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We are often asked whether a patient authorization is required in order to disclose protected health information (PHI) to a medical or dental device company. Similarly, practices have asked whether device companies will be considered business associates of the practice. The answer to both questions lies in whether or not the device company is considered a healthcare provider, as defined by the Privacy Rule.

A healthcare provider is defined as an entity that furnishes, bills or is paid for healthcare in the normal course of business.

If the device company provides healthcare (care, services or supplies related to the health of an individual), the company will be considered a healthcare provider (and must comply with HIPAA requirements as a covered entity). A patient authorization is not required in order to disclose PHI to other healthcare providers that are involved in the treatment of a patient. Nor is a business associate agreement required with such entities.

For more detailed information, please see the article “Medical & Dental Device Companies” in the December 2015 Advisor.

Hazard Communication Workplace Labeling

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When the Hazard Communication Standard was updated in 2012, the burden of providing chemical hazard labeling was shifted from employers to the manufacturers and distributors of hazardous chemical products. Previously, employers had to supplement manufacturer labels to indicate hazard warnings for health, fire, reactivity and special hazards, along with a notation of the name of the product and an indication of the target organs. After December 1, 2015, manufacturers will have to ship products with a compliant label that includes pictograms, hazard statements, etc.

For the rare circumstances in which the manufacturer label is not on a container, the employer will have to provide workplace labeling. A common example of this situation is when an employer orders a large bottle of a product (such as isopropyl alcohol), and then pours it into smaller containers/pumps/dispensers for use throughout the workplace.

The standard defines workplace labeling as:

Product identifier and words, pictures, symbols, or combination thereof, which provide at least general information regarding the hazards of the chemicals, and which, in conjunction with the other information immediately available to employees under the hazard communication program, will provide employees with the specific information regarding the physical and health hazards of the hazardous chemical.

For more information on how to accomplish workplace labeling when it is required, refer to the article in the December 2015 issue of the American Practice Advisor.