HIPAA’s minimum necessary standard in complex care coordination scenarios

In complex situations where a patient may be seeing multiple specialists or transitioning between different care settings, the minimum necessary standard helps maintain privacy and prevents excessive sharing of sensitive details. For example, a doctor treating a patient with a broken leg doesn’t need access to the patient's psychiatric history unless it’s directly relevant to their immediate treatment. 

What is the minimum necessary standard?

HHS guidance defines the minimum necessary standard as, “...a key protection of the HIPAA Privacy Rule, is derived from confidentiality codes and practices in common use today. It is based on sound current practice that protected health information should not be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function.”

When a covered entity like a hospital or health clinic handles protected health information (PHI), they must take reasonable steps to make sure that they use or disclose only as much information as is necessary to achieve the intended purpose. For instance, if a doctor needs access to a patient's medical record for treatment, they can access the information necessary to provide care. However, if the need is for a less direct purpose—like administrative tasks—the standard ensures that access is more restricted to protect the patient’s privacy.

The standard doesn’t apply in all situations. For example, it’s not used when sharing information for treatment purposes directly between healthcare providers, or when disclosing information to patients about their own health. It also doesn’t apply when disclosures are mandated by other laws, or needed for compliance checks by the Department of Health and Human Services.

The complex nature of care coordination

Care coordination is defined in the guidance document for the uses and disclosures of care coordination as “Case management and care coordination are among the activities listed in paragraph (1) of the definition of health care operations.  45 CFR 164.501.  For example, if Covered Entity A provides health insurance to an individual who receives access to the provider network of another plan provided by Covered Entity B, Covered Entity A is permitted to disclose an individual’s PHI to Covered Entity B for care coordination, without the individual’s authorization.”

Care coordination can, however, become complex due to several factors. For instance, patients with multiple chronic conditions may see various specialists, each prescribing different medications and treatments, which makes managing their care particularly challenging. Transitions of care, such as when a patient is discharged from the hospital to home care or a rehabilitation facility, require coordination so that treatment plans are followed correctly.

Examples of complex care coordination include: 

• Managing care for a patient with multiple chronic conditions such as diabetes, heart disease, and depression, requires coordination among various specialists.
• Multiple healthcare providers and family members are involved in coordinating care for an elderly patient transitioning from a hospital to a rehabilitation facility.
• Organizing treatment for a cancer patient who requires surgery, chemotherapy, and radiation therapy, involves coordination between surgeons, oncologists, and radiologists.
• Coordinating post-discharge care for a patient who has undergone major surgery, involving home healthcare providers, physical therapists, and primary care physicians.
• Managing care for a child with special needs, involving pediatricians, therapists, school personnel, and family support services.
• Organizing mental health care for a patient with severe mental illness transitioning from inpatient to community care, involves psychiatrists, social workers, community care teams, and family members.

In these scenarios, the HIPAA minimum necessary standard requires that any use or disclosure of PHI in care coordination must be limited to the minimum amount needed to accomplish the intended purpose.

How to ensure care communications remain compliant with the standard

1. Use cutting-edge data segmentation within electronic health records to control access to sensitive PHI. This ensures that healthcare providers only access the specific segments of a patient’s record that are necessary for their particular treatment tasks.
2. Deploy software that dynamically adjusts access permissions based on the specific care context. For example, a healthcare provider treating a physical injury would not have access to unrelated psychiatric records unless it directly pertains to their immediate treatment needs.
3. Regularly perform specialized audits to assess adherence to the minimum necessary standard. Review past communications and disclosures to pinpoint any instances of excessive information sharing.
4. Adopt encryption standards for all digital communications involving PHI, such as using HIPAA compliant emails and HIPAA compliant text messaging.
5. Introduce systems that grant healthcare providers access to PHI only when it is needed and only for as long as necessary to complete the required care or treatment task. This limits unnecessary exposure to sensitive information.
6. Incorporate tools that automatically obscure unnecessary information during data access in your EHR and other systems managing PHI. The extent of data visibility can be adjusted based on the user’s role and the specific context of the access.
7. Provide targeted training that focuses on practical, scenario-based learning for different roles within the healthcare team. This helps staff understand precisely which pieces of information they need for varied healthcare situations, reinforcing adherence to the minimum necessary standard.
8. Use artificial intelligence tools to scrutinize PHI requests and determine if the requested information adheres to the minimum necessary standard. These AI systems can offer real-time advice to staff, helping them limit the scope of disclosed information appropriately.
9. Establish a system that generates real-time alerts when attempts to access PHI do not meet the minimum necessary criteria. These alerts can encourage users to reassess their information needs and adjust their requests accordingly.
   
   

FAQs

What is the Privacy Rule? 

The Privacy Rule is a set of standards under HIPAA that governs the protection of individuals' medical records and other personal health information by setting requirements for its use and disclosure.

What are the minimum necessary criteria? 

The minimum necessary criteria require that healthcare providers and organizations access, use, or disclose only the least amount of protected health information needed to accomplish a specific task.

What is PHI? 

Protected health information, refers to any information in a medical record or a conversation about care that can be used to identify an individual, which is held or transmitted by covered entities or their business associates.