Will HIPAA be a Barrier to Spread of Teleradiology?
Privacy Requirements Cause Concern
By Julie Crawshaw
At first blush, the health insurance portability and Accountability Act (HIPAA) of 1996 appears to add privacy to teleradiology’s problems. After all, the proposed rule recognizes that "a clear and consistent set of privacy standards would improve the effectiveness and efficiency of the health care system." Is there a way to accomplish this when images are floating all over the place?
Diana Haramboure, Vice President of Healthcare Consulting at Data Dimensions, a Bellevue, Wash-based company that works with members of the health care industry to prepare for HIPAA implementation, points out that HIPAA mandates developing procedures for data security.
"I think they are calling for guidelines’ because they don’t want to say If you do these 10 things, then you’ll be fine.’ The government wants to tell people the kinds of things they should do and leave it up to individuals to figure out how to do them because being too prescriptive would create risk and liability." Haramboure says that under HIPAA, penalties for violating patient privacy range from $50,000 and one year in jail, to $250,000 and 10 years in jail.
Just who can and can’t see transmitted medical information remains an issue yet to be clearly defined. "There’s a lot of paranoia because of the ambiguous interpretation of the requirements," says Mark Bakken, Executive Vice President of U.S. Radiology Partners. "Interpreting HIPAA is more art than science. You’re seeing some manufacturers claiming they have the only HIPAA-approved server available, but all servers require security and firewalls."
He adds that, teleradiologically speaking, HIPAA’s privacy requirement is a red herring. "It’s almost impossible to interrupt an image travelling over phone lines because the lines are proprietary," he says. Modems are point-to-point operations and cannot be "hacked into" like databases. Even Internet transmission requires security codes to enter the server that contains the image.
Bakken points out that medical privacy is far more endangered by moving text that anyone can read and understand than in moving an image that only has meaning to a radiologist. "It would be quite a stretch to say that there’s a group of radiologists trying to hack into images, especially when the images ultimately result in a written report," Bakken says.
Ultimately, an image is just an image until somebody interprets what it means. Since medical information fears are founded on how somebody is going to adversely use the information, the image has no value until someone makes a written interpretation. "It’s the written information people should be concerned about, which brings us to the issue of hospital databases, physician databases, and insurance company databases," Bakken says.
Bakken observes that teleradiology offers huge benefits from the quality of medicine, and operational and financial standpoints. "Teleradiology allows us to move from a hard copy film into a digital format—which is by many measurements a better way to hold it, because you can manipulate the image to get better reads and it saves money."
One example is the Picture Archived Communications Systems (PACS), which store, move, and file electronic images. PACS consolidate information, reduce or eliminate film costs, and allow the image to be manipulated for a better read.
"The biggest problem with hard copy is that somewhere along the line it becomes worthless and has to be done over again," Bakken says. "Doing it electronically allows the techs to do their jobs instead of being file clerks."
He sees the concern over HIPAA regulations as more related to PACS than to teleradiology per se. Bakken argues that storing hard copies of films creates more interference exposure, because hard copy file rooms aren’t protected by a security guard whereas the PACS have firewalls and security systems built-in. "There are far more benefits to electronic security than there are risks," Bakken says.
Though the benefits of teleradiology would seem to fit hand in glove with the need for specialist medicine in Third World countries with largely rural populations, this just isn’t happening. "There’s hardly any teleradiology going on in rural areas of the Third World. In the early 1990s, Harvard set up a teleradiology center and offered its services to the rest of the world, but it just hasn’t played out the way they thought it would," Johnson says. "It’s altruistic and makes for good press, but it just doesn’t pay."
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