Nebraska Statewide Telehealth
Network Privacy and Security
Reta Studnicka
[email protected]
Laura Meyers
[email protected]
Mission of the Nebraska Statewide
Telehealth Network (NSTN)
• To increase the quality, availability and
accessibility of health care throughout the state
of Nebraska, particularly as it impacts the rural
population within the state.
• To create video-conferencing capability allowing
the rural areas of the State to have access to
other health providers and information without
the need for extensive travel within a Private
Network.
Patient Benefits
•
•
•
•
Decreases travel time
Lowers job absenteeism
Cost savings
Provides earlier disease
intervention: Screening
opportunities
• Increased availability of
local follow-up care may
decrease ALOS in tertiary
center
Community Benefits
 Improves Quality of
Medical Services
 Strengthens Ties to
Specialty Care
 Increases Confidence
in Local Providers
 Alleviates Isolation of
Rural Providers
 Increases Diagnostic
Resources
Provider Benefits
• Potential for decreasing
outmigration
• Enhances clinical support
• Increased referral
opportunities
• Provides the opportunity
to enhance and
supplement the services
provided at existing
outreach clinics
Provider Benefits
• Easy access to
continuing education
• Opportunities to
consult with other
professionals, even
internationally
Nebraska Telehealth Network
Lynch
45
Valentine
Gordon
31
17
Chadron
75
Ainsworth
Atkinson
5
Bassett
8
1
O’Neill
57 S
Osmond
B
Hemingford
12
64
Plainview
Neligh
49
3
Alliance
J 67 Scottsbluff
Gering
Sioux City, Iowa
aa
Creighton
21
H
77
Pender
63
Wayne
Tilden
74
Norfolk
C Burwell
Bridgeport
78
Westpoint
50
81
Winneabago
52
Oakland
2 Albion
58
Ord
Broken Bow
13
60
Oshkosh
Sidney
69
41
Kimball
Columbus
E
Genoa
30
Q
53
Ogallala
14
Callaway
North Platte
P
51
iv
32
Gothenburg
34
Grant
Kansas Critical Access Hospitals
St. Paul
70
20
Cozad
42
Kearney
Lexington
vii
Central City
16
40 Six T1s 82
Rural Hospitals
Regional Hub Hospital
39
Imperial
T-1 Connection
Single T-1 Connection between Hub Hospitals
Aggregate T-1 Connection between Hub Hospitals
ByranLGH/HHA FastEthernet
DFS T-1 connection
Cable connection
Benkleman
M
Holdrege 38
46 O
McCook
10
Oberlin, Ks
cc
Revised: 11/29/2005 LLR s:\networking\state network\telehealth\nebraska telehealth network 11292005
15
Norton, Ks
Alma
Cambridge
bb
Franklin
Phillipsburg, Ks dd
Smith
Center ee
Mankato
vii
Henderson
29
Hebron
Superior
Ainsworth
Albion
Alliance
Alma
Atkinson
Auburn
Aurora
Bassett
Beatrice
Benkelman
Blair
Bridgeport
Broken Bow
Callaway
Cambridge
Central City
Chadron
Brown County
Boone County
Box Butte General
Harlan County Health Sys
West Holt
Nemaha County
Memorial
Rock County
Beatrice Community
Dundy County
Memorial Community
Morrill County
Jennie Melham
Callaway District
Tri-Valley Health System
Litzenberg Memorial
Chadron Community
19.
20.
21.
22.
23.
24.
25.
26.
27.
Columbus
Cozad
Creighton
Crete
David City
Fairbury
Falls City
Franklin
Fremont
Columbus Community
Cozad Community
Creighton Area
Crete Area
Butler Area
Jefferson County
Community Medical Ctr.
Franklin County
Fremont Area
Hospitals From Other States
Norton County Hospital
Decatur County Hospital
Phillips County Hospital
Jewell County Hospital
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
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47.
48.
49.
50.
51.
52.
53.
54.
Friend
Geneva
Genoa
Gordon
Gothenberg
Grand Island
Grant
Hastings
Hebron
Henderson
Holdrege
Imperial
Kearney
Kimball
Lexington
Lincoln
Lincoln
Lynch
McCook
Minden
Nebraska City
Neligh
Norfolk
North Platte
Oakland
Ogallala
Omaha
Warren Memorial
Fillmore County
Genoa Community
Gordon Memorial
Gothenberg Memorial
St. Francis Medical Center
Perkins County
Mary Lanning Memorial
Thayer County
Henderson Health Services
Phelps Memorial
Chase County
Good Samaritan Health Sys
Kimball County
Tri-County
Bryan/LGH
St. Elizabeth's
Niobrara Valley
Community Hospital
Kearney County
St. Mary's
Antelope Memorial
Faith Regional Health Srvcs
Great Plains Regional Medical Ctr
Oakland Memorial
Ogallala Community Hospital
Methodist Hospital
72
Syracuse
36
Fairbury
9
Beatrice
48
Nebraska City
73
Tecumseh
Auburn
Falls City
24
71
6
A
Pawnee City 62
ff
ff
Nebraska Public Health Depts.
55.
56.
57.
58.
59.
60.
61.
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66.
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73.
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77.
78.
79.
80.
81.
82.
Omaha
Omaha
O'Neill
Ord
Osceola
Oskosh
Osmond
Pawnee City
Pender
Plainview
Red Cloud
Schuyler
Scottsbluff
Seward
Sidney
St. Paul
Superior
Syracuse
Tecumseh
Tilden
Valentine
Wahoo
Wayne
West Point
York
Omaha
Winnebago
Grand Island
University of Nebraska Medical Ctr
Alegant Health Immanuel
Avera St. Anthony's
Valley County
Annie Jeffrey
Garden County
Osmond General
Pawnee County
Pender Community
Plainview Public
Webster County
Alegent Health
Regional West Medical Center
Seward Memorial
Memorial Health
Howard County
Broadstone Memorial
Community Memorial
Johnson County Hospital
Tilden Community
Cherry County
Saunders County
Providence
St. Francis
York General
Creighton Hospital
Winnebago Indian Hospital
College Park
Dark Fiber Solutions Network Hubs
i. Lincoln Bryan LGH, 1600 S. 48th
ii. Wilber Head End, 901 N. Main, Wilber
iii. DFS York, 600 ½ Grand Ave, York
80
U
56
44
43 Lincoln
N
22
28
F Crete
Friend
ii
Wilber
v
Nebraska Hospitals
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
55
68
3 T1s
37
Red Cloud
65
26
4
Wahoo
76
R
6 T1s
vii
Seward
York 79 Z
35 L
Hastings
47
Minden
David City
G 23
59
Geneva
University Hub
DFS Network Hub
11
Blair
6T
1s Fremont
I 27
19
Osceola
Grand Island 7
Aurora
K 33
Schuyler
66
54
4 T1
s
Public Health Labs
Nebraska Critical Access Hospitals
aa. Sioux City, Iowa
bb. Norton, Ks
cc. Oberlin, Ks
dd. Phillipsburg, Ks
ff. Mankato, Ks
Dakota City
61
iv. NP GPRMC, 601 W. Leota St., North Platte
v. Geneva Head End, 300 C. St, Geneva
vi. Kearney Head End, 804 Ave. A., Kearney
A. Auburn
B. Hemingford
C. Burwell
Southeast District Health Dept.
Panhandle Public Health Dept.
Loup Basin Public Health Dept
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
East Central District Health Dept.
Public Health Solutions
Butler County Health Dept
Dakota County Health Dept.
Three Rivers Health Dept.
Scotts Bluff County Health Dept.
Central District Health Dept.
South Heartland District Health Dept.
Two Rivers Public Health Dept.
Lincoln-Lancaster County Health Dept.
Red Willow County Health Dept.
West Central District Health Dept.
Sandhills District Health Dept.
Douglas County Health Dept.
North Central District Health Dept.
Columbus
Crete
David City
Dakota City
Fremont
Gering
Grand Island
Hastings
Holdrege
Lincoln
McCook
North Platte
Ogallala
Omaha
O’Neill
U.
Papillion
Sarpy/Cass Dept. of Health and Wellness
X.
Y.
Z.
Wayne
Wisner
York
Northeast Nebraska Public Health Dept.
Elkhorn Logan Valley Public Health Dept.
Four Corners Health Dept.
25
Connection Status Today
• Hub Sites:
–
–
–
–
–
–
–
–
UNMC (Omaha)
St. Elizabeth’s Regional Medical Center (Lincoln)
BryanLGH Medical Center (Lincoln)
St. Francis Medical Center (Grand Island)
Good Samaritan Hospital (Kearney)
Great Plains Regional Medical Center (North Platte)
Faith Regional Health Services (Norfolk)
Regional West Medical Center (Scottsbluff)
Connection Status Today
• Sixty-seven rural hospitals are connected to these hubs.
• Nineteen public health departments will be connected
(15-17 are connected at this time)
• Also have connections to all but one bioterrorism lab
• Omaha hospitals: Immanuel, Bergan Mercy, Creighton,
Childrens, Methodist, Midlands, The Nebraska Medical
Center
• Other connections on the horizon: Winnebago Indian
Hospital and Tecumseh State Correctional Institution
Network Uses: Clinical
• Clinical Consults
–
–
–
–
–
–
Rehabilitation Therapy
Disease Management
Emergent Care: Trauma, EPC, Mental Health
Family Advocacy Network: abuse and sexual abuse
Deaf and Hard of Hearing
On the horizon: Telepharmacy and Teledentistry
Services Approved for
Reimbursement
•
•
•
•
•
•
Consultations (CPT Codes 99241-99275)
Office or Other Outpatient Visits (99201-99215)
Individual Psychotherapy (90804-90809)
Pharmacologic Management (90862)
Psychiatric Diagnostic Interview Exams (90801)
End Stage Renal Disease (HCPCS codes G0308,
G0309, G0311, G0312, G0314, G0317, G0318)
Sites Approved for Reimbursement
•
•
•
•
•
Hospitals (inpatient/outpatient)
Critical Access Hospitals
Physician/Practitioner Offices
Rural Health Clinics
Federally Qualified Health
Centers
Network Uses: Education
• Education
–
–
–
–
–
–
CMEs and CEUs
Grand Rounds
EMS Continuing Training/Considering Initial Training
RN/Allied Health Professional Degree Programs
Community Education/Support Groups
www.netelehealth.org
Network Uses: Other
•
•
•
•
Administrative Meetings
Health Alert Network
Routine Testing
Lung Surgery “Scared
Straight”
• Language Interpretation
Network Uses at This Time
• Telehealth Education and Training
– On-Going
•
•
•
•
•
•
Conducting Clinical Consults for Practitioners
Peripheral Devices
Creating a Telehealth Business Plan
Privacy and Security
Community Mental Health and Telehealth
Electronic Health Records
The NSTN: Current Decision Making
Structure, Priorities, Committees
• Network Advisory Committee
• Network Operations Group
• NSTN Education Committee
– Scheduling
– Website
– Evaluation
• Privacy & Security Subcommittee
HIPAA PRIVACY, SECURITY, and
TELEHEALTH
Covered Entities that must comply with the
HIPAA Privacy and Security Standards
• Health Care Providers
• Health Plans
• Health Care Clearinghouses
A Reminder….
The HIPAA Privacy Regulation ensures
that covered entities will comply with the
HIPAA Privacy standards to protect
patient’s health information from nonpermitted uses and disclosures. For many
covered entities, this required the
development and implementation of over
50 new policies and procedures with
related forms!
Adding Telehealth Policies:
Telehealth Encounters Must Protect Patient Health
Information
•
•
•
•
•
Proper patient admission/registration
Notice of Privacy Rights and Practices
Acknowledgement
Telehealth Visit Consent Form
Providing a Private and Secure Telehealth
Transmission
• Providing a Private and Secure physical location
for the telehealth encounter
• Authorized personnel in attendance for
telehealth medical visit
...couple of more requirements
• Properly credentialed healthcare providers
(Recommendation to credential as you would all “in
person” healthcare providers)
• Organized Healthcare arrangements
“OHCA” – with the properly credentialed
healthcare providers
HIPAA SECURITY REGULATION
• Ensures that covered entities will comply with
the HIPAA standards to protect the
confidentiality, integrity and availability of
Electronic Protected Health Information (EPHI).
• In the final rule, CMS divides security into three
categories – these implementation specifications
may be Required or Addressable:
 Administrative safeguards (164.308)
 Physical safeguards (164.310)
 Technical safeguards (164.312)
Required vs. Addressable
Required
• Must implement the specification in order to
successfully implement the standard
Addressable
• Consider the specification, and implement if
reasonable and appropriate
• If not, document why it would not be reasonable
and appropriate to implement the specification;
and
• Implement an equivalent alternative measure if
reasonable and appropriate
Security Standards
• Protect against any reasonably anticipated
threats or hazards to the security or integrity of
such information
• Protect against any reasonably anticipated uses
or disclosures of such information that are not
permitted or required under the security
standards
• Ensure compliance with the security standards
by the workforce
• Ensure confidentiality, integrity and availability of
all EPHI the covered entity creates, receives,
maintains, or transmits
Next Steps
Coordination between Privacy and
Security Officer within the organization
Include Telehealth when performing the
required HIPAA Security Risk Analysis
Include Telehealth when considering Risk
Management
Include Telehealth when developing and
implementing Policies and Procedures
Nebraska Statewide Telehealth Network
Privacy and Security Subcommittee Goals:
• Conduct the HIPAA Security Risk Analysis
for the NSTN
• Develop policy and procedure templates
for Privacy and Security that are
applicable to telehealth for the NSTN
• Gather input from NSTN providers for best
practices regarding privacy and security
Questions?
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