The Health Insurance Portability and Accountability Act (HIPAA) requires training to be provided to the workforce on HIPAA policies and procedures, but what is the purpose of HIPAA training? In this article, we explore the benefits of HIPAA training and why it is important not only to provide training to the workforce during onboarding but also to provide periodic refresher training.
What Does HIPAA Say About Employee Training?
HIPAA training for the workforce is detailed in the administrative requirements of the HIPAA Privacy Rule, which states:
“A Covered Entity must train all members of its workforce on the policies and procedures with respect to protected health information required by this subpart and subpart D of this part, as necessary and appropriate for the members of the workforce to carry out their functions within the Covered Entity.”
Training should be provided to all new employees within a reasonable amount of time after an individual joins the workforce and following any material change in policies and procedures. The HIPAA Security Rule also requires Covered Entities and Business Associates to implement a security awareness and training program, although there is no time frame stipulated as to when the security awareness training must be provided.
What is the Purpose of HIPAA Training for the Workforce?
The purpose of HIPAA training is to ensure all members of the workforce that interact with protected health information (PHI) are aware of the policies and procedures covering that information, including the allowable uses and disclosures, how to safeguard that information, patient rights, how to work in a HIPAA-compliant way, and what happens if HIPAA is violated.
Several benefits come from training the workforce on HIPAA and going above and beyond the letter of the law. Sticking to the minimum requirement of providing training on HIPAA specific to an individual role may not be sufficient to explain the importance of HIPAA, and can increase the risk of accidental HIPAA violations.
Reduce the Risk of Accidental HIPAA Violations
If training on policies and procedures is not provided, healthcare employees would likely be unaware of the restrictions HIPAA places on uses and disclosures of PHI, the need to ensure the privacy of patient information. Staff members may also be unaware of patient rights with respect to their PHI. The result would likely be many accidental HIPAA violations.
HIPAA training ensures employees are aware of their responsibilities under HIPAA and helps them to understand that they play an important role in ensuring their employer maintains HIPAA compliance. Any HIPAA violation by an employee, accidental or deliberate, reflects badly on the employer, could result in sanctions and penalties, can damage patient trust in the organization, as well as the organization’s reputation. From an employee’s perspective, any violation of HIPAA could affect their job and future job prospects, so it is important for employers to ensure comprehensive training is provided.
Training Employees Fosters Patient Trust
HIPAA was initially introduced to improve the portability of health insurance, improve efficiency in the healthcare system, and help eliminate waste. Later, privacy and security regulations were introduced. Having a HIPAA compliant workforce helps to improve efficiency which improves the patient experience. Having employees who are aware of the HIPAA Rules and understand patient rights and the need for privacy helps to foster patient trust. Patients, after all, disclose highly sensitive information to their healthcare providers, so they need to be able to trust their healthcare providers will keep that information private and confidential.
If patients do not trust their healthcare providers with their data, they may hold back information, which has the potential to put patient safety at risk.
Reduce the Risk of Data Breaches
Providing HIPAA training can reduce the risk of accidental HIPAA violations, but another HIPAA training requirement is for security awareness training to be provided to the workforce. HIPAA is short on detail as to what training should entail, and this is left to the covered entity or business associate to determine by means of a risk assessment. Security awareness training, especially when provided regularly, can significantly reduce the risk of a data breach. The IT department often focuses on technical measures to secure networks, including antivirus, intrusion detection systems, firewalls, and email security gateways, but the human factor is often neglected and is commonly the cause of data breaches.
According to IBM Security’s 2021 X-Force Threat Intelligence Index, 95% of cybersecurity breaches are the result of human error. By providing security awareness training to the workforce and teaching cybersecurity best practices, risky behaviors can be eliminated and costly data breaches can be prevented.
Demonstrate a Good Faith Effort to Achieve Compliance
HIPAA-regulated entities that provide comprehensive training to employees will be able to reduce the risk of accidental HIPAA violations, but it will not be possible to totally eliminate risk. Rogue employees may deliberately violate HIPAA and steal patient data or may snoop on patient records. Through training, these incidents can be kept to a minimum.
When impermissible access or disclosures of individuals’ protected health information occur, the incidents must be reported to the Secretary of the HHS. The HHS investigates data breaches to determine if they were the result of non-compliance with the HIPAA Rules. The provision of initial training to the workforce on the responsibilities of employees with respect to HIPAA, and the provision of refresher training demonstrates to regulators that the organization has made a good faith effort to achieve compliance. The HHS will be likely to view any HIPAA violation more favorably if comprehensive training has been provided to the workforce, which may see the HHS provide technical assistance in response to a HIPAA violation rather than a financial penalty and other sanctions.
The purpose of HIPAA training is to ensure healthcare employees are aware of their responsibilities under HIPAA to allow them to complete their work duties in a HIPAA-compliant way. HIPAA training helps to improve efficiency, build trust, and avoid accidental HIPAA violations and costly data breaches.
While the HIPAA text does not call for annual training to be provided to the workforce, it is a best practice as it serves to remind employees of the importance of HIPAA compliance and the role each individual plays in ensuring their employer remains HIPAA-compliant.