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. 45. 46. 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. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 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?