
Notification of Enforcement Discretion for telehealth remote communications - siculars
https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
======
DoofusOfDeath
I wonder if this change would be a net win for U.S. healthcare:

\- Healthcare regulations (HIPPA, insurance coverage, etc.) are updated to
make this the new normal.

\- Each household is supplied with a decent-quality thermometer, BP cuff, and
camera-enabled ear/eye/throat scope. I.e., only 1 step down in quality from
what physicians have in the offices. Rudimentary training is given to any
interested adult for using these, _under the supervision of a physician_.

\- When someone gets sick, they schedule a Skype-like call with their doctor's
office. During that call, the doctor/nurse guides someone else in the
household to use those devices as appropriate to gather the data. Based on
those results and interviewing the patient, the doctor then provides guidance,
and perhaps sends a prescription to the pharmacy / blood lab, and/or asks the
patient to come to the office for a more thorough exam.

I would imagine that benefits everyone involved, and perhaps reduces the risk
of infections spread at the doctor's office.

~~~
alfiedotwtf
> Each household is supplied with a decent-quality thermometer, BP cuff, and
> camera-enabled ear/eye/throat scope.

I think you’re overestimating the capabilities of most people to follow
instructions.

... video conferencing doesn’t work at the best of times with IT worker
meetings. Good luck with the general populace

~~~
randallsquared
> ... video conferencing doesn’t work at the best of times with IT worker
> meetings.

As recently as three years ago I would have agreed, but video chat is now
quite reliable in my experience.

~~~
TrueDuality
In general I agree but every video chat platform requires a stable and
relatively fast / low latency internet connection to be be stable. On lower
end hardware the encoding of some platforms is also an issue.

I suspect without other changes a switch to this as a default means of getting
initial care or appointments might negatively impact people that are already
disenfranchised.

~~~
ArtDev
That's where they can drive to a Telehealth clinic. They are very useful in
other situations where a patient nerds to see a specialist but cannot travel.

Meanwhile, the internet isn't even considered a utility. Which is especially
absurd, in light of recent events.

~~~
DoofusOfDeath
> They are very useful in other situations where a patient _nerds_ to see a
> specialist ...

That's a fabulous Freudian slip!

------
Optimal_Persona
This is a relief! For the last 2 weeks I've been scrambling to kludge together
Zoom for Healthcare and Skype for Business meetings for 90 clinicians/social
workers at my agency so they can keep seeing clients and bill services.

~~~
supdatecron
What's your plan now, given this news?

------
lalaland1125
This will save a lot of lives. It will simultaneously increase the capacity of
our health system while also significantly decreasing exposure risk.

------
inerte
I posted this
[https://news.ycombinator.com/item?id=22601270](https://news.ycombinator.com/item?id=22601270)
as an Ask HN couple days ago but since this thread has more traction, I wonder
if I can get your input here. The text:

Ask HN: My mom is a pediatrician. Best temporary remote consultation ideas?

Due to coronavirus my mom wants to avoid kids and their parents coming to her
office. The current situation is hopefully temporary, so I don't want to
commit to a long term product. Her consultations are usually 20 minutes,
sometimes longer. She obviously won't be able to diagnose a lot of conditions
without being close and in contact with her patients, but I believe a lot can
still be done remotely. For some children, she might have to give
prescriptions, which she currently does on a piece of paper only.

She has a secretary that can help juggling the video conferences.

Any ideas how she can handle her daily work?

Here's my current approach:

\- 2 links that open distinct Zoom calls

\- Secretary calls patient, somehow asks them to load a webpage (a short url
service or sms or email)

\- Patient joins one of the links, consultation starts

\- Meanwhile, secretary calls next patient, asks them to load second link and
wait

\- Once the first consultation is over, my mom joins the second link one, and
secretary is calling for the next patient in line

\- Prescriptions are written and either mailed or parents can pick up at her
office (maybe on a plastic bag?)

I use Zoom at work but I know how to setup things. Her clients would probably
rely on their mobile apps. If it matters, she's from Brazil and we need
clients localized to pt-BR.

Thanks for any insights!

~~~
hedora
What about people that need help to install an app on their phone?

Zoom is probably a reasonable default, but fallbacks to popular consumer stuff
might help.

------
GordonS
The same thing is happening in the UK, or at least parts of it. I have an
appointment coming up, and got a phonecall telling me it would now be done
over video link.

The person for very apologetic, but I was like, "Can I have this all the time
please?!".

~~~
kube-system
My small regional health insurer here in the US has offered a couple different
remote appointment options for several years now. It doesn't replace regular
checkups, but it is very convenient when traveling, or for minor concerns.

------
cortesoft
Seems like the prudent thing to do, to remove any barriers to the access of
health care.

------
teh_infallible
Translation: we are weakening HIPPA privacy protections because, virus.

Never mind that a “health emergency” should not really be uncharted territory
for a healthcare system, but that’s America for you.

~~~
wtallis
In some cases, this is just allowing providers to use the same software for
telehealth, but now without paying extra for the edition that's certified as
HIPAA compliant. Eg. Google's G Suite products don't function any differently
if your organization signs a Business Associate Agreement with Google. So as
long as healthcare providers are still careful, there doesn't have to be any
weakening of privacy, just a reduction in red tape and a (temporary)
destruction of the market for overpriced specialty telehealth software
services.

~~~
viraptor
It doesn't work any different for the clients, but it may have different
features enabled on the backend. For example Google does live transcribing of
the conversation on meet/hangouts. Where does it end up with/without hipaa may
be significant.

~~~
supdatecron
> For example Google does live transcribing of the conversation on
> meet/hangouts.

Can you provide a link to this? I was unaware of it and can't find the
feature. I did find that Hangouts Meet offers video recording...

~~~
wtallis
Hangouts Meet lets you turn on closed captions that are generated on the fly.
I'm not aware of any way to save that transcription, so I don't see how it's a
privacy concern.

~~~
viraptor
That's the distinction I mean though: You don't see a way to save it, but it
doesn't mean Google doesn't keep the record. What prevents that from happening
on calls on amounts which didn't sign HIPAA contracts?

~~~
wtallis
> You don't see a way to save it, but it doesn't mean Google doesn't keep the
> record. What prevents that from happening on calls on amounts which didn't
> sign HIPAA contracts?

Google's regular G Suite already has terms of service and a privacy policy
that appear to me to rule out any obviously HIPAA-violating use of data. _If_
they collect anything from Hangouts Meet, the terms are clear that you still
own the data and Google can only use it as necessary to provide the service to
you. Absent any evidence to the contrary, it seems reasonable to take Google's
legal documents at face value and conclude that there's no functional
difference for G Suite core services whether or not you sign a HIPAA agreement
with them. It certainly strains credulity to suggest that Google would offer
stronger privacy guarantees to HIPAA covered entities than to ordinary
enterprise customers, and not even advertise as such.

It's fine to say you don't trust Google. It's not reasonable to insinuate that
they violate their published terms of service and privacy policies. It's
absurd to suggest that the extra penalties associated with HIPAA would be the
deciding factor for them to refrain from committing those crimes only against
that narrow slice of their customers.

~~~
viraptor
It's not only the company violations that we need to worry about. "provide a
service" can mean different things. Are phrases where the transcription wasn't
clear sent to people for verification and training? Are transcriptions saved
for unsupervised learning? Even if they're not shared with third parties
explicitly, what happens when the company itself is breached?

------
etaioinshrdlu
Glad they noted not to perform telehealth over TikTok.

~~~
therealcamino
I'm not finding much to laugh about these days, but this made me laugh --
thanks.

------
tomohawk
It's amazing how much regulation has to be set aside to deal with the
pandemic.

~~~
ArtDev
The internet is still not considered a utility in the US. So, it's not just
regulation that blocks progress, many times it's lack of regulation.

There are a lot of people in the US still without reliable internet. Thanks to
a lack of basic regulations on an essential utility.

~~~
kube-system
Being a utility doesn't make something HIPAA compliant. And being a utility
doesn't make it any more accessible. There are millions in the US who do not
count water and sewer among their utilities.

