Understanding HIPAA: Your Rights, Records, and the Path to Safer Care
- EvaluCare
- May 26
- 6 min read
“The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, was enacted on August 21, 1996. Sections 261 through 264 require the Secretary of HHS to publicize standards for the electronic exchange, privacy, and security of health information, collectively known as the Administrative Simplification provisions.” HHS.gov
Nearly three decades later, HIPAA remains the cornerstone of patient privacy and data security in the United States. Yet, beyond its well‐publicized Privacy and Security Rules lies a powerful, often overlooked principle: patients, not providers, own their complete medical record.
This blog explores HIPAA’s origins and goals, clarifies its core exemptions (Treatment, Payment, and Health Care Operations), and offers practical guidance on obtaining and sharing your data.
We’ll also explain why ensuring complete, accurate records matters for safety and how EvaluCare’s team of quality and clinical experts can help you review your care for hidden errors or negligence to help you answer questions you may have about the safety of your care.
1. The Origins and Goals of HIPAA
1.1 Historical Context
In the mid‐1990s, Congress recognized two pressing healthcare challenges:
Portability of Coverage: Workers needed protections when changing jobs, preventing lapses in health insurance for themselves and dependents.
Rising Administrative Costs: Fragmented billing systems and inconsistent data standards drove up costs and errors in claims processing.
HIPAA’s Title I addressed coverage portability, while Title II—the Administrative Simplification provisions, targeted the second problem by mandating:
National Standards for Electronic Transactions (claims, eligibility checks, remittance advices)
Unique Identifiers for providers, health plans, and employers
Privacy and Security Rules to protect health information in an increasingly digital environment HHS.gov
1.2 Core Goals of HIPAA
HIPAA’s Administrative Simplification provisions pursue three main objectives:
Enhance Efficiency & Cost‑Effectiveness: Standardize electronic transactions to reduce paperwork and errors.
Safeguard Privacy: Give individuals control over their personal health information (PHI).
Strengthen Security: Require administrative, physical, and technical safeguards for electronic PHI.
By balancing the need for information flow with stringent protections, HIPAA laid the groundwork for modern health information exchange.
2. You Own Your Health Record
A revolutionary aspect of HIPAA’s Privacy Rule is the clear affirmation that patients own their health information:
Right to Inspect & Copy: Under 45 CFR § 164.524, individuals may inspect and obtain copies of PHI in a designated record set, including medical and billing records, typically within 30 days of request (with a possible 30‑day extension).
Right to Amend: If you identify inaccuracies, you can request an amendment—covered entities must respond within 60 days.
Right to an Accounting of Disclosures: You can ask for a log of when and why your PHI was shared, excluding Treatment, Payment, and Operations (TPO) uses. These additional disclosures outside of exemptions, require a patient’s authorization to share.
Understanding these rights is the first step toward active engagement in your own care.
3. HIPAA’s “TPO” Exemptions: Treatment, Payment, Operations
HIPAA’s Privacy Rule permits covered entities (health plans, providers, clearinghouses) to use and disclose PHI without patient authorization for Treatment, Payment, and Health Care Operations—collectively known as TPO HHS.gov:
Treatment:
Consultations among clinicians: A specialist can review your records to provide expert advice.
Care coordination: Nurses share wound‐care notes with therapists.
Care management: Requiring the careful management between providers of care.
Payment:
Claims processing: Your insurer needs PHI to adjudicate and pay provider claims.
Coverage decisions: Utilization review teams assess medical necessity.
Health Care Operations:
Quality assessment & improvement: Reviewing infection rates, readmissions, or adverse events falls here.
Training & education: Using de‐identified PHI to educate staff.
Credentialing: Verifying staff qualifications via patient records.
Quality activities, such as root cause analyses of errors or performance improvement projects, are explicitly included under Operations HHS.gov. If you have been harmed as a result of an error in care, quality departments will review your records and perform a quality review and/or causal analysis. This process ensures systems issues as well as care issues are identified and acted on to improve care.
Why it matters: Without TPO exemptions, clinicians and organizations would require patient authorization for each routine data exchange, paralyzing day‑to‑day care.
4. Obtaining and Sharing Your Records
4.1 How to Request Your Record
Identify the Covered Entity: The hospital, clinic, or health plan holding your data.
Submit a Written Request: Many organizations offer online forms or patient portals. If you need a form and are interested in having your medical care reviewed by an organization like EvaluCare, a templated medical records request for is available.
Verify Your Identity: Expect to show photo ID to protect your privacy.
Pay Permitted Fees: Reasonable copying and postage charges may apply.
A reminder that depending on an organization, obtaining your record could take hours to weeks.
Trends:
Electronic Portals: Increasingly, providers offer Open Notes, giving real‑time access to visit notes, lab results, and imaging. This often doesn’t include your entire record and often only includes data associated with care at that provider.
Data Completeness: Fragmentation persists when you see providers on separate EHRs, your health system record may omit outside imaging or specialty notes unless you authorize data exchange. When you provide your consent to treat, you are also often asked to provide your authorization for sharing data freely among providers. This is important because although data for treatment meets the exemption under HIPAA, additional information not related to the treatment may be beneficial to share.
4.2 Sharing Across Providers
Within Integrated Systems: Providers on the same EHR platform often view your entire record seamlessly.
Across Disparate Systems: You may need to check the “Share My Record” box or sign a general release allowing manual or electronic transfer to outside specialists.
Health Information Exchanges (HIEs): Regional HIEs facilitate data sharing among unaffiliated providers, requiring patient opt‑in in some states. Opting-in will allow free information exchange, which will improve data exchange on care.
Pro‑Tip: Always ask if the clinic, hospital, or rehab center is on the same system as your primary physician. If not, sign data‑sharing permissions to avoid gaps.
5. The Complexity of Medical Records
Medical records are not simply chronological notes, they encompass:
Structured Data: Lab values, vital signs, medication orders, problem lists.
Unstructured Data: Clinician narratives, consultation letters, operative reports.
Imaging & Waveforms: X‑rays, MRIs, EKG tracings.
Device Data: Ventilator logs, infusion pump records.
Jargon & Abbreviations add another layer of opacity: eGFR, TID, q6h, “trace protein.” For patients and families, deciphering these details can be overwhelming. To make sense of a a complex medical record requires expertise from quality and medical professionals, as in many ways it is another language that must be translated into a patient care narrative.
6. EvaluCare: Your Partner in Record Review
When adverse outcomes occur, it’s often unclear whether incomplete, fragmented, or inaccurate documentation contributed to harm. EvaluCare brings together:
Quality Experts (former Chiefs of Quality, Infection Prevention, Continuous Improvement experts and more)
Clinical Leaders (experienced physicians, nurses)
Hospital & Health System Executive Leaders: Experience overseeing and managing quality of care for complex healthcare organizations
They provide:
Comprehensive Data Assembly: When you provide your records to us, we look at medical care across facilities, imaging center, and lab.
Data Validation: Checking for missing notes, inconsistent entries, missed findings, and more.
Clinical Analysis: Determining if care met accepted standards, and whether documentation lapses masked errors.
Report & Recommendations: Delivering an objective, compassionate report to guide next steps, be it legal recourse, systemic improvement, or personal closure.
Only this level of expertise can navigate the intricacies of HIPAA, EHRs, and clinical content to uncover hidden risks and champion safer care.
7. Conclusion: Empowerment Through Knowledge
HIPAA was born out of a need to modernize healthcare administration while fiercely guarding patient privacy. Its Administrative Simplification provisions enabled clinicians to share vital data for TPO, without undue burden. Yet, the law’s greatest innovation is recognizing patients as rightful owners of their medical records—empowering individuals to inspect, copy, and control how their information flows.
Your Action Plan:
Request your complete record.
Authorize sharing among all your providers.
Review it thoroughly, using patient portals (seek expert help if needed).
Amend errors or omissions.
If you believe incomplete records or documentation lapses led to medical errors, EvaluCare stands ready to help you reconstruct the full picture, identify gaps, and pursue the answers, and accountability you deserve. Because safer care begins with complete, accurate information.
For more information or to request a medical care review, visit EvaluCare’s Medical Care Review Services:https://www.evalucare.net/medical-care-review-services
Learn more at www.EvaluCare.net or email info@EvaluCare.net
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