The Health Insurance Portability and Accountability Act (HIPPA), signed into law by President Bill Clinton on August 21, 1996, has been routinely considered a model piece of privacy legislation. Prior to its creation, a patchwork of both state and federal laws governed the communication, distribution, and use of medical data for the purposes of patient care and financial payment. Inconsistencies in these laws allowed for the access of these data without any authorization, including personal sanctioning of sharing, from the individual whose data was to be used for the purposes of assessing anyone's potential for production and maintenance. This was especially relevant in the realm of financial lending and insurance whereby lenders and insurers can bypass personal subjective assessments to view medical history as a means of assessing stability - determining if a candidate would be sustainable enough to produce a capital gain. This also affected employment opportunities with production being a function of health often selecting for those without or with minimal complications, that even if left undisclosed can easily be evident through this quick access. Most importantly, individuals lost control over who and where that information was to go and were never notified of its distribution and the level of access the recipients were to have. A loss of control over one's own data was abundant - a critical problem that has become a greater point of contention in the present. These problems required interventions that would make it easier for communication of health plans, claims, and access to those who should have the need and right to see them.While respect for healthcare privacy has been a consistent moral imperative among those in the healthcare field, one's own health is extremely interconnected with access to services and employment required for survival, hence the distribution of this information has become a critical part of economic sustenance. Even if there were minimal health issues that could be managed successfully with limited chances for a complication, having access to that information in the eyes of those not able to determine these intricacies provided an easy opportunity to label and select against. The establishment of HIPPA guaranteed federal protection for all citizens of their personal health information; allowing one to control its distribution, access, and most importantly the level of information sharing to be done. This meant that if employers were to request personal health information as a means of assessing one's capability - individuals had the right to refuse and protected against being discriminated against guaranteed by law. While there are still continuous cases of employer discrimination, whereby records are accessed without permission or denied after review of records - the fact that these cases exist is evidence of HIPPA working as intended. <h3 id="the-invisible-rules-within-hippa-does-it-structuring-personal-and-digital-health-privacy-for-our-time">The Invisible Rules Within HIPPA: Does It Structuring Personal and Digital Health Privacy For Our Time?</h3>While HIPPA has had a total of 5 major rules that govern physical and digital health data, there are 2 main ones that are designed for patient use and personal data protection while the remainder is meant to simplify the process of billing and identification of all parties involved in the patient care and management through the course of the stay - including the provider, health institution and insurance services involved.(1) The Security Rule: As the use of electronic health records began to become widespread and mainstream - necessary protection was mandated in response to ease of access of limited control that patients would have over their data. Electronic Health Records began to run on a closed system that could be shared among systems with the same programs while also be able to be accessed by anyone working in the system or who has access to the system without proper request procedure needing to be filed. The Security Rule that was completed in 2003 to be officially complied with over the following couple of years created mechanisms for the protection, storage, accessibility, and distribution of these records within each system. These rules mandated both physical and technical securities with both software and hardware. This was expanded by the addition of the (2) The Privacy Rule: After HIPPA's establishment, the Privacy Rule also referred to as the Standards for Privacy of Individually Identifiable Health Information established 4 years after its initial ratification in September of 2000 provided increased protection for patient data in research and clinical environments. Going into complete effect in 2004 - it provided limitations on disclosures that individuals were permitting the sharing off only via certain forms - the ones which are signed commonly by everyone during healthcare visits. It further goes onto allow patients to obtain copies of their own records, inspect and permit any changes for accuracy by using certain request forms for this purpose. The remaining rules that serve to streamline patient care through ensuring provider and system compensation while preventing patient overbilling are: (A) Transactions Rule - more relevant in the eyes of the payers and lenders behind the scenes, this rule mandates the use of standard codes referred to as the ICD (International Classification of Diseases), HCPCD (Healthcare Common Procedures Coding System), CPT (Current Procedural Terminology) or NDC (National Drug Codes) codes; all of which are used to standardize diagnosis, medication, treatment and follow-up services over the scope of a variety of provider and payer systems. This essentially standardizes the language that is used to create efficient and accurate transactions. (B) Identifiers Rule - Designed for simplification, this rule mandates that providers, health plans, and the insurance payers (either federal medicare/Medicaid or private third party) all have specific standard numbers for communication and documentation purposes. Finally, if there is any failure in compliance of accurate reporting of negligence in protecting patient data either by the provider/system or limiting transparency in the eyes of the patient then policies of the (C) Enforcement Rule (also known as the breach notification rule) are used. The enforcement rule defines various tiers of penalties for infractions of rules while also defining reporting and investigation methods for any violation. This serves as an extra layer of protection by defining sanctions and monetary or potentially greater consequences under the law. They outline a certain length of time by which an infraction must be investigated and appropriately resolved per the reccomendations that are defined within the law.Given the constantly changing technological landscape since the time of HIPPA's establishment, there have been routine additions to the original provisions in an effort to increase transparency and allow further command of one's own healthcare. Since the law's inception, far more efficient electronic health record systems have been developed and continue to be consolidated over a large range of hospital systems - allowing for opportunities for greater access and transparency. Most recently, in April of 2021, the United States Government has now required all healthcare organizations to make accessible all patient's medical records electronically without any charge. This includes all doctor authored notes, reasons for treatment plans, and assessments of patients' conditions - all to be that can be reviewed by patients. Prior to this, the last change in 2013 was the (D) Omnibus Rule, created to better consolidate healthcare systems by mandating certain structures to be developed that collect updated agreements from all involved business associates that a part of the patient care payment process to comply with HIPPA, strengthening the brevity of the existing security rule.Given these recent changes, it can be seen that this trend towards increased protections for data has been continually advancing alongside a push for increased personal access to better the transparency of that data for those who are sanctioned to have access to it under HIPPA. These two paradigms can often be seen in conflict with each other as more access can leave greater room for unwanted dissemination. <h3 id="data-protection-under-hippa-are-there-any-exceptions">Data Protection Under HIPPA, Are There Any Exceptions? - </h3>(MAY NEED MORE TECHNICAL KNOWLEDGE ON THIS ASPECT)A very important point to note is that only those providers and employees working in a health system that is receiving compensation through insurance coverage are bound by HIPPA - meaning caretakers and health systems who are directly involved in reimbursement for patient care are responsible for adhering to the HIPPA laws. This means that those who are not covered by insurance are not in breach of this privacy law if they are to share various points of patient data - such as certain providers on medical talk shows. While these providers can still be in breach of state laws, the inconsistencies with those and federal protections can leave many areas to justify no breach and subsequent portions of medical stories that may not have been sanctioned by the patient themselves.While the sector of healthcare delivery is where HIPPA was developed to better protections for health data security, other health-related sectors including fitness &amp; nutrition are not covered. Even while having personal data inputted by users, protections mandating security, personal access, and systems to maintain transparency of access are not required. Unlike when HIPPA was first established, technology has allowed individuals to become more aware of what kind of health-related data is relevant to their well-being and the interplay of those data in their own lives. Simple metrics like heart rate and rhythm are now able to be taken on smartwatches and easily shared among friends in the group. Blood pressures and sugars have routinely been taken at local pharmacies while health tracking apps in a rapidly growing fitness sector have individual weight and caloric intake being inputted and tracked on a daily basis. While many of these metrics inputted are done for the purposes of optimizing the app experience for bettering results and creating an appealing user experience, these same metrics are also used to make routine, and sometimes, very important medical decisions in the hospital setting. Despite their importance, the laxity to which these data are given, which are the same metrics being protected under the regulations of HIPPA, underly the collective importance that is placed on health-related data and emphasizes the complexity of privacy that was not present during the development of the law.The continued culture of innovation and entrepreneurship in the technological marketplace continues to evolve new start-ups in the healthcare sector that have arisen to simplify the increasing complexity of health care data. Furthermore, its purpose in optimizing patient care has become a favorable use of resources and continued investment for the use of this data requires that such data be available. Yet the guidelines in HIPPA that cover the specifics of which data are protected have yet to be updated relative to the brevity and complexity of the types of data that can be used to create innovations for the purpose of bettering the healthcare experience. Mainly Protected Healthcare Information (PCI), defined as any data that is a part of an individual's health profile and can be linked to a said individual is said to be covered. This then means that those data that are not identifiable to any person can be used for the purposes of research and innovation development. Therefore while HIPPA protects individual data; on a population scale, there are relatively no legal ramifications if anonymity is maintained. The same format is also used in clinical research involving big data analysis for treatment algorithm optimization or quality improvement whereby blinded data can be shared upon consolidation from electronic medical records.Given these exceptions, an argument can be made for the benefit of sharing all data that is not related to identification yet this is the exact data that HIPPA generally covers. While HIPPA was produced for the purpose of protecting individuals rights to be assessed more objectively in any societal structure necessary for survival and upward mobility, the question becomes that is its relevance diminished if the health-related data is still shared but it cannot be attributed to the individuals from which it was collected regardless of the benefits that its collection can have.<h3 id="should-the-public-care-more-about-their-medical-data">Should The Public Care More About Their Medical Data - </h3>(THIS MIGHT BE TOO OPINIONATED and wanted to ask if I should discuss this here)<h3 id="do-we-need-to-and-more-importantly-want-to-update-hippa">Do We Need To, and More Importantly Want to, Update HIPPA?</h3>Analysis of data has to lead to remarkable strides in creating personalized technological experiences for almost every technology used on the planet. It has allowed individuals to leverage technological analysis of their data to better their own lives and tailor it to the way they perceive to be the best for them while also optimizing their work for outcomes that they desire. Continued innovation in health-related data has been shown to do the same as evidenced by numerous testimonies of how the benefits of being able to track their own healthcare metrics have helped them optimize and tailor lifestyle and nutrition changes for their own benefit. Yet data collection is also concomitantly being used for the purposes of tailoring and targeting individuals for increasing capital gain and users - such as personalized advertisements that can often be seen favorably by the end-user when they choose to click and purchase said product. This same trend could also occur in fitness and healthcare-related communities that may have more negative rather than intended positive outcomes for the end-user. While current regulations under health data privacy permit this under the condition that data remain anonymous, to preempt such outcomes - HIPPA may need to be updated yet only further studies of these trends can inform if the necessary interventions are required.

Dhruvil Patel

HIPPA 25 Years On: The Value of Healthcare Privacy In Our Technological Age

<h3 id="the-focus-for-innovation-in-healthcare-has-to-extend-beyond-the-patient">The Focus for Innovation in Healthcare Has to Extend Beyond the Patient</h3>Healthcare as a service has always been unique in its ability to directly impact patients. The effects are tangible. They can be felt. They are lasting and can directly change the course of patients? lives. This has always left a challenge for advancement as immense time is traditionally required to ensure maximum safety and treatment efficacy. These proven methods have been backed by almost half a century of innovation methodology that has delivered widely successful therapeutics from the labs into patients? hands. Yet, the recent pandemic allowed for the adoption of technologies that model and virtually test to develop vaccines and monoclonal antibody treatments in record time.Technology has allowed for innovation in the paradigm of treatment development and care optimization, which is the greatest proportion of the healthcare sector due to its direct impact on patients. But what cannot be ignored, and where new efforts are necessary, are innovating in paradigms that allow for this care to be provided. Healthcare spending has increased considerably in the last few years, with the notable exception of 2020 during the height of the COVID-19 pandemic where costs dramatically decreased due to a shift of focus onto a few essential services. The United States has spent over $3.8 trillion in 2019 with 31% of claimed expenditures being made by hospitals alone. While healthcare service costs make up a large size of this spending, rising costs are not solely due to increased compensation or the cost of therapeutics. A continually growing proportion is due to a lack of scalable and secure logistical and technological infrastructure that has been forced to continue to bear the increasing weight of new technologies that better patient outcomes and care efficiency.A key example is electronic medical records (EMR), as their implementation has allowed for ubiquitous and easy access of metrics to both the physician and more recently the patient. Yet the security protocols did not develop at the same pace as use increased ? leaving continuous holes in security that have resulted in very substantial losses of finances for systems through data breaches. Recent examples included Scripps Health, a nonprofit healthcare provider that experienced an attack in May of 2021 resulting in an expected loss of $106.8 million through ransomware attacks that have stalled efficiencies, revenue flow and costs to repair the damage. The growing complexity of technologies for use by providers and patients will always remain attractive to hospital systems whose primary aim is to better the quality of care, but the quality of the systems that power these tools needs to also proportionally be innovated in and adopted.Given the many roads and problems that have arisen in the current healthcare landscape, what then are the areas to focus on? While most of the focus is on therapeutics, the paradigm of healthcare data has become the basis for making changes in the healthcare setting such as optimizing protocols or implementing new technology. These conversations have even become ubiquitous in the general public, with the advent of data security becoming a primary concern for patients. Luckily, technologies to inherently solve these worries have already been around for a decade.<h3 id="can-automating-trust-security-be-viable-in-healthcare">Can Automating Trust &amp; Security be Viable in Healthcare</h3>The ubiquity of blockchain applications is just now starting to become mainstream. Platforms developed on the ethos of decentralized finance have provided any class of user access to the tools they need to participate in legitimate investment opportunities to grow their wealth. While subsequent applications in the non-fungible token space have opened doors to a variety of virtually owned content that can be trusted to have a legitimate value. Technology like the Ethereum blockchain and Polygon network have allowed platforms for new technologies to be created on them with the drive for allowing storage of value that is ? colloquially referred to as ? immutable. While the last decade may appear to be a long time to have these technologies begin to enter the mainstream, these technologies have been adopted faster than prior innovations of this scale. Adaptations of these technologies in finance have been the largest proportion of new innovations to appear in recent years, but this is of course just the beginning. The reason for this optimism is that decentralization, allowed for by the implementation of blockchain-based technology, has automated trust. Yet the foundation of every system that we participate in requires some form of trust for it to function.With the amount of healthcare data being generated every day the cost for security and maintenance of this data has also increased. What is being paid for is simply the means to trust that this data is remaining privy only to those that can have access to it, but what if all this can be automated? What if there does not need to be a single source to house and secure this data, to protect it from invasion while simultaneously empowering patients to take care of their own data? Thereby eliminating the centralization of this data, and the costs both real and potential that a hospital system can incur.<h3 id="how-can-implementing-blockchains-help-then">How can Implementing Blockchains Help Then?</h3>The implementation of blockchains in securing healthcare data has become a considerable starting point for developers. But not only is development being done on blockchains to secure patients who are actively receiving care, but optimization in the research sphere has also gained steam. Examples include the Canada University Health Network (UHN) which has developed a patient-centred blockchain that functions to allow for proper patient consent for research and storage of subsequent intake and result data on their blockchain, expediting clinical research progress and preventing concerns that results could be tainted by poor data. Iterations of electronic medical records based on a blockchain system that is amenable to tokenization with patients becoming nodes in affirming the patient data in the blockchain have had patents recently accepted to the United States patent service.The main theme among these new rising technologies is the decentralization of the storage of the data. Blockchain-based technologies generate economies that inherently prevent the burden of the cost of securing the data onto one sole party. If hospital systems, for example, can have access too scalable blockchain-based platforms to secure their data ? then the threat of breaches, the infrastructure needed to deliver the data securely, and maintenance of a centralized system would be most likely eliminated. Such areas, while not affecting the patient directly, can help drastically increase resource utilization for bettering patient care, healthcare access and staff satisfaction.<h3 id="conclusion">Conclusion</h3>The focus on lowering healthcare costs and bettering patient outcomes has led to a large focus on findings ways to better deliver and tools and therapeutics to patients. Yet constant implementation of these technologies and methods that are between the provider and patient level is being done on top of an infrastructure that is not being innovated at the same pace over numerous paradigms. Implementations of blockchain technologies have the potential to help alleviate these issues, accelerating innovation in the back end to lower costs while also bettering patient, provider, and staff satisfaction.

Empowering Healthcare Innovation Through the Blockchain: Focusing on The "Back-End" of Healthcare

<div>The Focus for Innovation in Healthcare Has to Extend Beyond the Patient<o:p></o:p>Healthcare as a service has always been unique in its ability to directly impact people. The effects are tangible. They can be felt. They are lasting and can directly change the course of someone’s life. This has always left a lasting challenge for advancement as immense time has always been traditionally required to ensure maximum safety and treatment effect. These proven methods have been backed by almost half a century of innovation methodology that has delivered widely successful therapeutics from the lab into the bedside for patients. Yet, the COVID-19 pandemic allowed for the adoption of technologies that model and virtually test biological environments to develop vaccines and monoclonal antibody treatments in record time.<o:p></o:p>&nbsp;Technology has allowed for innovation in the paradigm of treatment development and care optimization, which is the greatest proportion of services being innovated on within the healthcare sector. But what cannot be ignored, and where new efforts are necessary, are innovating in paradigms that allow for this care to be provided. Healthcare spending has increased considerably in the last few years, with the notable exception of 2020 during the height of the COVID-19 pandemic when costs dramatically decreased due to a shift of focus onto a few essential services. The United States has spent over $3.8 trillion in 2019 with 31% of claimed expenditures being made by hospitals alone. While healthcare service costs make up a large size of this spending, rising costs are not solely due to remuneration for more complex services or the cost of novel therapeutics. Rather a continually growing proportion is due to a lack of scalable and secure logistical and technological infrastructure that has been forced to continue bearing the weight of new iterations of technologies that aim to better patient outcomes and care efficiency.<o:p></o:p>&nbsp;A key example is electronic medical records, as their implementation has allowed for ubiquitous and easy access of metrics to both the physician and more recently the patient (as legislation passed has allowed patients access to all their medical records, including patients' notes and communications between physicians within the charts regarding the patient). Yet security protocols did not develop at the same pace as this digitization – leaving continuous holes in security that have resulted in very substantial losses of finances for systems through data breaches. Examples include Scripps Health, a nonprofit healthcare provider that experienced an attack in May of 2021, resulting in an expected loss of $106.8 million through ransomware attacks that have stalled efficiencies, revenue flow, and costs to repair the damage. The growing complexity of technologies for use by providers and patients will also remain attractive to hospital systems whose primary aim is to better the quality of care, but the quality of the systems that power these tools but also proportionally be innovated in and adopted.<o:p></o:p>&nbsp;Given the many roads and many problems that are continuing to rise in the current healthcare landscape, what then are the areas to focus on? A common question for adopters of innovations within all areas of healthcare, especially due to its direct impact on the patient, is can this implementation be trusted. While most of the focus is on therapeutics, these questions are also routinely being asked about the data that is being used as the basis for making changes in the healthcare setting such as optimizing protocols or implementing new technology. These conversations have even become ubiquitous in the public, with data security becoming of the primary zeitgeists of concern in recent years. Luckily, technologies that help to answer these questions with trusting confidence exist and are poised to start revolutionizing healthcare.<o:p></o:p>&nbsp;Can Automating Trust &amp; Security be Viable in Healthcare<o:p></o:p>The ubiquity of blockchain applications is just now starting to become mainstream. Platforms developed on the ethos of decentralized finance have provided any class of user access to the tools they need to participate in legitimate investment opportunities to grow their wealth. While subsequent applications in the non-fungible token space have opened doors to a variety of virtually owned content that can be trusted to have a legitimate value. Technology like the Ethereum blockchain and polygon network have allowed platforms for new technologies to be created on them with the drive for allowing storage of value that is – colloquially referred to as – immutable. While the last decade may appear to be a long time to have these technologies to begin to enter the mainstream, these technologies have been adopted faster than prior innovations of this scale. Adaptations of this technology in finance have been the largest proportion of new solutions to appear in recent years, but the ubiquity of applications can extend far beyond. The reason is that decentralization, allowed for by the implementation of blockchain-based technology, has automated trust and the foundation of every system that we participate in requires some form of trust for it to function.<o:p></o:p>&nbsp;With the ubiquity of healthcare data being generated every day, from users' own biofeedback metrics such as the apple watch to at-home blood tests and glucose measurements and new metrics being generated and stored in the hospital – the cost for security and maintenance of this data has also increased. What is being paid for is simply the means to trust that this data is remaining privy only to those that can have access to it, but what if all this can be automated? What if there does not need to be a single source to house and secure this data, to protect it from invasion while simultaneously empowering patients to take care of their own data? Thereby eliminating the centralization of this data, and the costs both real and potential that a hospital system can occur.<o:p></o:p>&nbsp;How can Implementing Blockchains Help Then?<o:p></o:p>The implementation of blockchains in securing healthcare data has become a considerable starting point for developers. But not only is development being done on blockchains to secure patients who are actively receiving care, but optimization in the research sphere has also gained steam. Examples include the Canada University Health Network (UHN) which has developed a patient-centered blockchain that functions to allow for proper patient consent for research and storage of subsequent intake and result data on their blockchain, expediting clinical research progress and preventing concerns that results could be tainted by poor data. Iterations of electronic medical records that are being developed on a blockchain-based system and are amenable to tokenization with patients become nodes in affirming the patient data in the blockchain have had patents recently accepted to the United States patent system.<o:p></o:p>&nbsp;The main theme among these new rising technologies is the decentralization of the storage of data. Blockchain-based technologies generate economies that inherently prevent the burden of the cost of securing the data onto one sole party. If hospital systems, for example, can have access to scalable blockchain-based platforms to secure their data – then the threat of breaches, the infrastructure needed to deliver the data securely, and maintenance of a centralized system would be most likely eliminated. Such areas, while not affecting the patient directly, can help drastically increase resource utilization for bettering patient care, healthcare access, and staff satisfaction.<o:p></o:p>&nbsp;Conclusion:<o:p></o:p>The focus on lowering healthcare costs and bettering patient outcomes has led to a large focus on findings new ways to better deliver tools and therapeutics to patients. Yet constant implementation of these technologies and methods is being done on an infrastructure that is not experiencing innovation at the same pace over numerous paradigms. Implementation of blockchain technologies has the potential to help alleviate these issues, accelerating innovation in the back end to lower costs while also bettering patient and provider satisfaction. </div>

Premium reporting on technology, startups, VC funding, and software from Techfastly tagged with Healthcare. Read about trends and strategies for Healthcare.

Healthcare

Blockchain formats have the potential to reduce the cost of healthcare by automating the very processes that are set up to ensure the security and privacy of health systems.

Blockchain in Healthcare

Empowering Healthcare Innovation Through the Blockchain

The Health Insurance Portability and Accountability Act (HIPPA), signed into law by President Bill Clinton on August 21, 1996, has been routinely considered a model piece of privacy legislation. Prior to its creation, a patchwork of both state and federal laws governed the communication, distribution, and use of medical data for patient care and finances. Inconsistencies in these laws allowed the access of these data without any authorization, including personal sanctioning of sharing, from the individual whose data was to be used for the purposes of assessing anyone's potential for production and maintenance.

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