Committee Meetings and Minutes

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HIPAA Task Force Committee

Meeting Minutes

Current Status of Minutes: Final
Date	November 9, 2010
Time	11:00 AM - 1:00 PM
Location	EVC Room 8358

Members Present
Mary Ann Bridges, Rebecca Cole, Sanctions Officer, Susan Corbett, Renee Cornett, Security Officer, Ross Greves, Theresa Harkins, Jana Israel, Eileen Klein, Douglas Mitchell, Training Officer, Marilyn Rehm-Skewis, Support Staff, Robyn Richter, Regina Swearengin, Nancy Walters, Privacy Officer
Guests Present
No guest attendance has been recorded.

Item # 1:	Agenda Item: Approval of Agenda
Presenter	Pat Recek
Discussion	Discussion: None Decision/Actions: Gina Swearengin made a motion to accept the agenda as is. Eileen Klein seconds the motion to accept the agenda as is. Committee approved the agenda

Item # 2:	Agenda Item: II. Confirmation of Email approval of Feb 23, 2010 Meeting
Presenter	Pat Recek
Discussion	Discussion: None Decision/Actions: Email approval.

Item # 3:	Agenda Item: Old Business A. Status of Compliance Reviews Report from Committee Members
Presenter	Pat Recek
Discussion	Discussion: Status of Compliance Reviews: Reviews are being conducted per published schedule (attached). One review from summer was delayed until the fall. Changes to Compliance Review Schedule: * Irvin (Butch) Miller, Department Chair, Professor has replaced Paul Menches with Fire Academy * Estrella Godinez, Department Chair, Occupational Therapy Assistant, has replaced Melanie Reyes for Occupational Therapy Assistant Program Questions from department being audited should be written at the bottom of the report for review. Decisions/Actions: Continue Schedule for Compliance Reviews * Most consistent area of concern is "record retention" for six years. * Some lack of knowledge about state laws on confidentiality. o HIPAA website has been updated and a link is available to state laws. The HS Handbook template now directs students to the HIPAA Website as well as the mandatory HIPAA training. Follow-up Items >Make changes on Compliance Review Schedule to reflect new department representatives and send out to committee members. Person responsible: Marilyn Skewis Deadline: ASAP >Compliance Review will continue as scheduled and members will continue to send a copy of the report to Pat once audit has been completed. Person Responsible: Scheduled Committee Members Deadline: As Completed (Dec. 1 )

Item # 4:	Agenda item: Old Business B: ACC Security Audit Update > HIPAA training for all employees
Presenter	Becky Cole
Discussion	Discussion: >Therese Hawkins reports that ACC underwent an IT security audit last year; the final report has not been released but preliminary review indicates no specific recommendations for the HIPAA committee. The primary recommendations are related to increasing security in IT systems processes and procedures, which my impact HIPAA. >The college will be rewriting an "Acceptable Use" procedure to align with switch to Google and will include a link to HIPAA as part of that procedure. >Other possible developments: * Security series of classes including HIPAA for supervisors New Information Security Officer – Mike Hill Decisions/Actions: None Follow-up Items >HIPAA Training: Request to Mike Midgley to require HIPAA for all employees on an every two years with an automatic reminder. Person responsible: Pat Recek Deadline: 1-1-11 >Consider adding Mike Hill to HIPAA committee. Person responsible: Pat Recek Deadline: Next Meeting

Item # 5:	Agenda Item: Old Business HIPAA Training for all employees
Presenter	Becky Cole
Discussion	Decisions/Action: HIPAA Training for all employees. Current policy is that all employees do HIPAA training upon hire; HS students, faculty, and staff are required to do the training annually. Recent events related to confidentiality/HIPAA support the possibility of having all ACC employees do HIPAA training every two years (similar to ADA). Gerry Tucker indicates that the proposal needs to be presented to Mike Midgley before it can move forward for approval.

Item # 6:	Agenda Item: Old Business: C: HIPAA Training Module Update
Presenter	Pat Recek
Discussion	Discussion: A new HIPAA training module for students and faculty is in the process of development by the Seton and St. David's-should be approved this month. * Will review and perhaps adapt for non-HS employees-may be more appropriate to have two versions of the training. Discussion included: * Improving the HIPAA process by recommending the training be added to policies & procedures * Linking HIPAA to email, facebook * HIPAA Training listed under Supervisor Series, Professional Development - Will contact Laura Niles to determine if name can be changed to HIPAA Training to make it easier for non-supervisors to locate on Professional Development website. Other discussion: Student Accommodations ADA- Security OSD Accommodations ESH Committee Campus Manager Accommodations Decisions/Actions: Re-educate faculty & Staff on HIPAA Committee recommends the following to do annual training based on the amount and frequency of contact with PHI * Health Sciences faculty, students, and staff * Campus Police * Child Development * Human Resources * EHS * Records management * Some departments may be able to choose 1 or 2 years depending on their situation. * Eileen Klein made recommendations not to make OSD accommodations without an accommodations letter. * Identify if IT receives training every year. * Training Module purchased by MSDS that will provide ACC to choose or design a training program. Follow-up Items: >A draft for recommendations for college wide HIPAA Training will be submitted to the HIPAA Committee and the committee members will be able to make recommendations before moving forward. Person responsible: Pat Recek Deadline: by email >IT training schedule Person responsible: Becky Cole Deadline: Next meeting >MSDS Training Module or other training use for the model. Person responsible: Becky Cole Deadline: Next meeting >Change listing for HIPAA Training as a training for supervisors and as a training for staff.-Note that this was completed the week of Nov. Person responsible: Becky Cole Deadline: Next meeting

Item # 7:	Agenda item: New Business: Social Media and implications for HIPAA
Presenter	Pat Recek
Discussion	Discussion: * Posted information on facebook sites * Free Speech * Ethical Responsibility Decisions/Actions: None Follow-up Items: >Ethical responsibility guidelines search Person responsible: Gina Swearengin Deadline: Next meeting

Item # 8:	Agenda item: HIPAA Events: Sonography
Presenter	Pat Recek
Discussion	Discussion: Students posted information on Facebook that included clinical site, date, and unusual diagnosis- multiple students Decisions/Actions: Formal notification process followed by program. Student placed on probation Student completed a second HIPAA Training Follow-up Items: None

Item # 9:	Agenda item: HIPAA Events: Dental Hygiene
Presenter	Pat Recek
Discussion	Discussion: Event : material reproduced in duplication displayed full PHI that on the faculty's copy was "redacted." Reviewed steps that led to breach of HIPAA Duplication site reviewed information and printing of information Copies were retrieved and shredded Notification was sent to covered entity (doctor). Responsibility of notification to subjects identified in content is left to the covered entity (doctor). Decisions/Actions: Future printing will be done locally. A Proof copy will be submitted before final printing. The responsibility of the notification of patients identified is with the covered entity (doctor). No further follow-up will be performed by Dental Hygiene Follow-up Items: None

Item # 10:	Agenda item: HIPAA Events: HITT
Presenter	Pat Recek
Discussion	Discussion: Clinical agency asked the student to be removed and classified it as a HIPAA event.. Student recognized a physician and voiced information concerning the doctor – not patient information. Decisions/Actions: Student was placed on probation Student redid HIPAA training Notification process followed with clinical agency. Follow-up Item: None

Item # 11:	Agenda item: HIPAA Events: Associate Degree Nursing
Presenter	Pat Recek
Discussion	Decisions/Actions: Student Failed/Withdrew seeking re-admission In reporting on student for withdrawal faculty left patient information in student file. With re-application file was opened to find patient information. Faculty was disciplined and new procedures were applied to future reports. Follow-up Items: None

Item # 12:	Agenda Item: HIPAA Events: Vocational Nursing
Presenter	Pat Recek
Discussion	Discussion: Information on patient was used in student report Formal notification process followed. Student conference. Decisions/Actions: None Follow-up Items: None

Item # 13:	Agenda item: Miscellaneous
Presenter	Becky Cole
Discussion	Discussion: Becky Cole reported that the results of the immunization and titers are being received by her department: bill will have name, what test performed, results. Concerns that the paperwork will be passed around with more than one person viewing results. Recommendation: * Authorization/Release form to be signed by faculty Decisions/Actions: Committee supports use of authorization form. Follow-up Items >Encrypted information for ACC and if attachments are also encrypted Person responsible: Theresa Harkins Deadline: Next meeting

Item # 14:	Other Information
Presenter
Discussion	Next Meeting Date: To be announced Time: 11:30- 1:00 Location: EVC, 3401 Webberville Road Austin, Texas 78702

Austin Community College
5930 Middle Fiskville Rd.
Austin, Texas 78752-4390
512.223.4ACC (4222)