Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-05T04:52:08.965Z Has data issue: false hasContentIssue false

Becoming a Hybrid Entity: A Policy Option for Public Health

Published online by Cambridge University Press:  01 January 2021

Abstract

When Congress passed HIPAA, it did not intend to constrain public health's data sharing in the same way as clinical or payers. In fact, HIPAA recognizes data sharing with public health as a matter of national priority and shields this function from its reach. However, a health department may offer services that bring it within HIPAA's purview, such as running a Children's Health Insurance Program or a laboratory that bills electronically. When this is the case, HIPAA requires all information and departments be subject to HIPAA unless the public health authority chooses to hybridize. Health departments might re-assess their coverage and elect to become a hybrid entity, thereby restricting HIPAA to only where required and removing barriers to information sharing with communities.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organization, “About Social Determinants of Health,” available at <https://www.who.int/social_determinants/sdh_definition/en/> (last visited March 5, 2019).+(last+visited+March+5,+2019).>Google Scholar
42 U.S.C. § 1320d note (1996).Google Scholar
42 U.S.C. § 1320d-1(a) (1996).Google Scholar
5 C.F.R. § 164.512(b); see also id. at § 164.512(a).Google Scholar
DeSalvo, K. B. et al., “Public Health 3.0: Time for an Upgrade,” American Journal of Public Health 106, no. 4 (2016): 621-622.CrossRefGoogle Scholar
45 C.F.R. § 164.502(a) (2013).Google Scholar
45 C.F.R. § 164.514(b)(2) (2013).Google Scholar
Id. HIPAA also provides an expert determination standard. 45 C.F.R. § 164.514(b)(1) (2013).Google Scholar
See, Office of Civil Rights, Health and Human Services, UMass Settles Potential HIPAA Violations Following Malware Infection, News Release, November 22, 2016, available at <http://wayback.archive-it.org/3926/20170128222809/https://www.hhs.gov/about/news/2016/11/22/umass-settles-potential-hipaa-violations-following-malware-infection.html> (last visited March 5, 2019).+(last+visited+March+5,+2019).>Google Scholar
van Panhuis, W. G et al., “A Systematic Review of Barriers to Data Sharing in Public Health,” BioMed Central Public Health 14 (2014): 1144.CrossRefGoogle Scholar
Wartenberg, D., and Thompson, W. D., “Privacy Versus Public Health: The Impact of Current Confidentiality Rules,” American Journal of Public Health 100, no. 3 (2010): 407-412.CrossRefGoogle Scholar
Hana-Attisha, M., interview by Terry Gross, Fresh Air, National Public Radio, June 25, 2018.Google Scholar
See 42 U.S.C., supra note 3.Google Scholar
45 C.F.R. § 164.103 (2013).CrossRefGoogle Scholar
45 C.F.R. § 164.105(a)(2)(iii)(D) (2013).Google Scholar
45 C.F.R. § 164.105(c)(1) and (2) (2013).Google Scholar
The Network for Public Health Law offers a Hybrid Entity Toolkit that includes legal, policy and practical guidance to understand and implement HIPAA's hybrid entity option. See “Health Information and Data Sharing,” available at <https://www.networkforphl.org/topics__resources/topics__resources/health_information_and_data_sharing/> (last visited March 5, 2019). (last visited March 5, 2019).' href=https://scholar.google.com/scholar?q=The+Network+for+Public+Health+Law+offers+a+Hybrid+Entity+Toolkit+that+includes+legal,+policy+and+practical+guidance+to+understand+and+implement+HIPAA's+hybrid+entity+option.+See+“Health+Information+and+Data+Sharing,”+available+at++(last+visited+March+5,+2019).>Google Scholar
Billman, M., and Dotson, K., “Using Drug Overdose Syndromic Surveillance Data to Impact Local Public Health Action,” Online Journal of Public Health Informatics 10, no. 1 (2018); Indiana State Department of Health, Overdose Prevention: Overdose Response Project Overview, 2018, available at <https://www.in.gov/isdh/27798.htm> (last visited March 5, 2019).CrossRefGoogle Scholar
Indiana State Department of Health, Epidemiology Resource Center: ESSENCE User Guide, v. 1.19 (2017): at 6-8, available at <https://www.in.gov/isdh/files/Indiana%20ESSENCE%20User%20Guide_2017.pdf> (last visited March 5, 2019).+(last+visited+March+5,+2019).>Google Scholar
Id., at 27.Google Scholar
See, Indiana State Department of Health, “What Is HIPAA,” available at <https://www.in.gov/isdh/23501.htm> (last visited March 5, 2019).+(last+visited+March+5,+2019).>Google Scholar
This hypothetical utilizes the HIPAA Privacy Rule's safe harbor method of de-identification. See 45 C.F.R., supra note 7.Google Scholar
Public health authorities may adopt a code of ethics as a way to explicitly state values, commitments and standards. The Principles of the Ethical Practice of Public Health address the balance between information sharing and the importance of protecting individual and community confidentiality, which application could result in a public health department's decision not to make public certain information. Public Health Leadership Society, Principles of the Ethical Practice of Public Health (2002): at 4, available at <https://www.apha.org/-/media/files/pdf/membergroups/ethics/ethics_brochure.ashx> (last visited March 5, 2019). (last visited March 5, 2019).' href=https://scholar.google.com/scholar?q=Public+health+authorities+may+adopt+a+code+of+ethics+as+a+way+to+explicitly+state+values,+commitments+and+standards.+The+Principles+of+the+Ethical+Practice+of+Public+Health+address+the+balance+between+information+sharing+and+the+importance+of+protecting+individual+and+community+confidentiality,+which+application+could+result+in+a+public+health+department's+decision+not+to+make+public+certain+information.+Public+Health+Leadership+Society,+Principles+of+the+Ethical+Practice+of+Public+Health+(2002):+at+4,+available+at++(last+visited+March+5,+2019).>Google Scholar
Sharfstein, J. M., Chrysler, D., Bernstein, J., Armijos, L., Tolosa-Leiva, L., Taylor, H., and Rutkow, L., “Using Electronic Health Data for Community Health: Example Cases and Legal Analysis,” December 2017, available at <http://www.debeaumont.org/EHDforCommunityHealth> (last visited March 5, 2019).+(last+visited+March+5,+2019).>Google Scholar