Patient Advocates and COVID-19: Does HIPAA Still Matter?

Patient Advocates and COVID-19: Does HIPAA Still Matter?
| by Debby Deutsch

It goes without saying that within the last couple of weeks our world has been turned upside down as a result of the COVID-19 virus. Once the initial shock wears off, however, we realize that life still goes on and we need to adapt to new norms as we go about our personal and professional lives. Healthcare in general, and Patient Advocacy in particular, are at the forefront of the efforts to deal with this pandemic. But we will all need to come up with new ways to cope with the ever-evolving rules and processes imposed on the healthcare system, while we strive to continue to provide a high level of service to our clients.

Nine days ago, we accompanied a client to a clinical visit, a standard service within our practice. At the end of the visit, we were told by clinical staff that the protocols were constantly changing — in some instances, hourly. We were told to expect changes, including the patient themselves will not be seen in clinic, except for very special situations. Suddenly, a major challenge surfaced.

“HHS has relaxed enforcement of HIPAA compliance. Now, industry-standard visual communication software can be utilized during this pandemic to service patients.”

Fortunately, the federal government COVID-19 Task Force assigned to guide the nation through this pandemic has addressed this, somewhat. Telehealth has been around for a while, but acceptance has been somewhat hampered by both acceptance from the patient and adherence to HIPAA regulations. Patients are used to, and comfortable, with face to face interaction with their health care professional, for a variety of reasons. This is a very expensive process and telehealth was designed to lower the cost of routine visits. However, patients understandably view this as an inferior response to their individual needs. Additionally, it is easy to ensure HIPAA compliance within the clinician’s office, but harder to ensure with electronic communication.

To this end. Health and Human Services, under the direction of President Trump, has relaxed enforcement of HIPAA compliance. Now, industry standard visual communication software can be utilized during this pandemic to service patients.

The following is directly from the HHS directive to this effect:

Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.  Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. 

Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.

Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products.  The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA.

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • Google G Suite Hangouts Meet

So what does this mean for the Patient Advocate? How do you use this technology to continue servicing your patients, without direct contact with them? Fortunately, it has become common to use applications such as Facetime or Skype to communicate with family members scattered throughout the nation. Grandparents, in particular, need to become familiar with Facetime if they ever want to speak to their grandkids.

“Moving forward, all patient advocates, whether solo practitioners or larger organizations, should seriously consider virtual support as an option. Not only does this allow the patient advocate to continue servicing clients in this current, chaotic environment, it will allow them to be more productive.”

Zoom has become a well-accepted video conferencing application for many businesses and is particularly well suited for patient advocates. The standard free version of Zoom is not advertised as HIPAA compliant, you need to pay for that, but it is probably okay under the current relaxed rules described above. The reason Zoom works well is that it is easy for even a novice user to set up a multi-party conversation, where everyone can see other participants and interact freely without having direct contact.

A recent example of how we used Zoom just this week involved a client based in Minnesota, requiring assistance for his mother, who has been health compromised due to recent hospitalization and sepsis infection. The 62 year old patient lives in Delevan WI, with 5 adult kids in Minneapolis and Chicago. Kids had set up a tag-team in an effort to have a 24/7 presence at mom’s house, which they could see within a week this was not sustainable. The original plan was to travel to the home of the mother for intake, with the accompaniment one of our nurse advocates, and bring her son in on a telephone call. We would then assess the situation, develop a care plan, and execute the plan with appropriate advocacy support. Normally, this would have routinely happened in the patient’s living room — standard operating procedure prior to the onset of the pandemic. However, in this case, our nurse advocate had recently returned from a visit to one of the West Coast hotspots and was on her final day of self-quarantine. We set up Zoom for all participants and we were able to do the intake virtually. We discovered, in the intake, that mom was severely compromised due to comorbidities and was not in a safe environment, as her spouse was not practicing safe procedures recommended for this pandemic. We were further able, in this virtual session, to identify another family member who would assume care for the mother in their home in IL and arrange transportation through another family member to get her there within a few hours. All of this was done virtually and successfully.

Moving forward, all patient advocates, whether solo practitioners or larger organizations, should seriously consider virtual support as an option moving forward. Not only does this allow the patient advocate to continue servicing clients in this current, chaotic environment, but it will also allow them to be more productive moving forward. This will make it easier for the advocate to grow their business by being able to service more clients with less cost.