Health Insurance Portability and Accountability Act

GVSU HIPAA Website and Training
Student Health Records and HIPAA


HIPAA Overview

The U.S. federal regulation commonly referred to as "HIPAA" or the "Privacy Rule" establishes a foundation of protection for the privacy of individual health information. This rule does not replace any other Federal, State or local law that grants even greater privacy protections, and health care entities are free to be more protective. The Privacy Rule:

  • Gives patients more control over their health information
  • Sets boundaries on the use and release of health records.
  • Establishes safeguards that must be achieved to protect the privacy of health data
  • Holds violators accountable with civil and criminal penalties
  • Strikes a balance when public responsibility supports disclosure of some information, for example, to protect public health

Further development of the HIPAA regulations include the "Security Rule" that addresses administrative, physical and technical safeguard requirements for electronic health information.


HIPAA Brief History

The Health Insurance Portability and Accountability Act (HIPAA) of 1996, U.S. Public Law 104-191, included requirements to develop and adopt national standards for privacy protection of individually identifiable health information and for electronic health care transactions

The privacy protection standards were developed by the U.S. Department of Health and Human Services, Office of Civil Rights (HHS, OCR), published in December of 2000, and modified into a final rule in August of 2002 after extensive public comment. The final rule, "Standards for Privacy of Individually Identifiable Health Information," required compliance by April 14, 2003 for health care providers, health plans, and health care clearinghouses with an extension of one year for small health plans. This regulation is codified in 45 CFR 164 Security and Privacy, Subpart E Privacy of Individually Identifiable Health Information, 164.500 - 164.534.

These regulations were modified and expanded in February of 2003. A new section was added to 45 CFR 165: Subpart C Security Standards for the Protection of Electronic Protected Health Information, 164.302-164.318. This Subpart is commonly referred to as the "Security Rule" or "Security Standard" and required compliance by April 20, 2005.

*Based on guidance posted on the US Office of Civil Rights website, last revised May 16, 2006, at http://www.hhs.gov/ocr/hipaa/privacy.html and on the US Centers for Medicare and Medicaid website, last modified May 06, 2008, at http://www.cms.hhs.gov/SecurityStandard/


Implications For Research

HIPAA sets standards for how health care information flows from health care providers, health plans, and health care clearinghouses. Researchers requiring use and access of this information will be impacted indirectly because of the regulations on this flow.

Researchers will be required to obtain use and access to medical information from these "covered entities" in the following ways:

  1. Presenting valid authorization forms signed by the individual.
  2. Obtaining approval of an Institutional Review Board or Privacy Board for a waiver of authorization.
  3. Contracting for a "limited data set" with a valid "data use agreement"
  4. Representing that their research use is allowed without authorization
    1. Subjects are deceased
    2. The data they require does not identify the subjects (it is "de-identified")
    3. They are employed by the covered entity and are preparing to do research.


What it Means for Researchers and HRRC Members:

  • The HRRC reviews HIPAA related research protocols at the same time as the regular IRB review
  • Deidentification of health information before it is given to researchers is recommended by as the best way to ensure privacy
  • Researchers must submit any needed HIPAA authorization forms with their application (or renewal / revision) form to the HRRC


Why Should Researchers Be Aware of the HIPAA Privacy Rule?

The Privacy Rule regulates the way certain health care groups, organizations, or businesses, called covered entities under the Rule, handle the individually identifiable health information known as protected health information (PHI). Researchers should be aware of the Privacy Rule because it establishes the conditions under which covered entities can use or disclose PHI for many purposes, including for research. Although not all researchers will have to comply with the Privacy Rule, the manner in which the Rule protects PHI could affect certain aspects of research.

It is important to understand that many research organizations that handle individually identifiable health information will not have to comply with the Privacy Rule because they will not be covered entities. The Privacy Rule will not directly regulate researchers who are engaged in research within organizations that are not covered entities even though they may gather, generate, access, and share personal health information. For instance, entities that sponsor health research or create and/or maintain health information databases may not themselves be covered entities, and thus may not directly be subject to the Privacy Rule. However, researchers may rely on covered entities for research support or as sources of individually identifiable health information to be included in research repositories or research databases. The Privacy Rule may affect such independent researchers, as it will affect their relationships with covered entities.

http://privacyruleandresearch.nih.gov/pdf/HIPAA_Privacy_Rule_Booklet.pdf (NIH publication)

For additional information on how to comply with the HIPAA regulations see the HIPAA FAQs.