Why HIPAA compliance is both a challenge and an opportunity for EMS providers

The Health Insurance Portability Act (HIPAA) was introduced in 1996 to protect private health information and ensure continuous coverage for individuals who navigate employment or insurance changes. Over time, it evolved to address electronic data exchange and is now a key framework for protecting patient privacy throughout the healthcare system.

But for EMS providers, HIPAA compliance presents a unique challenge. Unlike clinics or hospitals, EMS teams operate in dynamic environments, often without the benefits of controlled settings or dedicated privacy infrastructure. If the correct safeguards are not managed using, the on-site documentation, use of mobile devices and inter-agency communications may pose a compliance risk.

But HIPAA is not only a legal obligation. When properly implemented, it can improve interoperability, increase care coordination, and build trust between EMS agencies and their healthcare and public safety partners.

HIPAA’s on-site compliance: General EMS Pain Points

EMS agencies are considered “covering entities” under HIPAA, meaning they are responsible for protecting individually identified health information (called protected health information (PHI)). However, many aspects of EMS operations introduce complexity.

• Mobile data usage: Laptops, tablets and smartphones are now standard in EMS workflows. However, unless these devices are encrypted, password protected, and access control, they may expose PHI to unauthorized access.
• Communicate with partners: The EMS team often shares information with hospitals, police and other stakeholders. Although HIPAA allows data sharing to be used for treatment and operational needs, many providers are still uncertain about what is allowed and what is crossing the line.
• Documentation and reports: HIPAA establishes requirements around how to record, store and transmit patient data. In the context of emergency response, these standards can be difficult to interpret and implement in real time.
• Billing and administrative tools: Software used for claims, accounting or incident review must comply with HIPAA safety standards. If this is not the case, the agent may be unconsciously non-compliant.

Real-world risks and violations

Even a well-intentioned EMS provider may fall into a compliance gap without clear training and protocols. Some common violations include the following.

• Take pictures of patients on personal devices: Even if intended for use in documents, images captured on unsafe personal phones violate HIPAA. In one case, a caregiver was sentenced to jail for unauthorized “self-portraits” with the patient.
• Social Media Posts: Describing an incident or patient online (even if not a name) can inadvertently expose private details that violate HIPAA.
• Lack of risk assessment: HIPAA requires routine risk analysis. An Oklahoma EMS provider was fined $90,000 after being exposed to a ransomware attack that failed to perform a proper security assessment.

The U.S. Department of Health and Human Services Office of Civil Rights (OCR) keeps an up-to-date list of HIPAA enforcement measures and violations – emphasizing how compliance errors lead to legal, financial, and reputational consequences.

Strategies to strengthen compliance

Fortunately, EMS leaders can take clear steps to reduce risks and enhance compliance:

1. Implement a secure communication protocol. Execute strong passwords, perform all PHIs in stationary and transport, and conduct annual review of user access. Ensure that any cloud-based system or mobile tool is HIPAA-compliant.
2. Regular risk assessment. These assessments help identify weaknesses between devices, software, and workflows. HIPAA not only requires formal risk analysis, it can also help prioritize cybersecurity investments.
3. Establish policies around mobile device use and information sharing. Teams should get guidance on allowing for texting, taking photos, or sharing patient information. Clarify what information can be shared with hospitals, law enforcement officers, insurance companies or family members in an emergency.
4. Training regularly. Compliance is a culture, not a list. Regular training courses, especially for new employees, can enhance best practices and reduce unexpected violations.

Beyond Ambulance: HIPAA in Fire and Community Health Program

Many fire departments provide emergency medical services but may not realize they are eligible to be covered entities. If they transmit patient data or medical service costs electronically, HIPAA may apply. Even if the department is not covered by the federal government, it may still comply with state privacy laws and should adopt security practices accordingly.

The rise of community caregivers adds another layer. These programs often involve collaboration with public health departments, social workers, or mental health professionals. Sharing PHI in these partnerships still has to meet HIPAA’s privacy and security requirements. Institutions should consider designating HIPAA privacy officers or working with legal counsel to define a clear data sharing agreement.

Clarify HIPAA misunderstandings in EMS

Despite the long history of HIPAA, many myths still exist. Some common misconceptions include the following.

• myth: EMS providers cannot share PHI in emergency situations.
  fact: HIPAA allows the disclosure of patient care (even without express permission) if in the patient’s best interest.
• myth: HIPAA prohibits the use of mobile tools or cloud platforms.
  fact: These technologies are allowed, but must comply with security standards for access, storage and encryption.
• myth: Patient information cannot be shared with insurance providers.
  fact: PHI can be disclosed for billing and payment purposes as long as only the minimum necessary data are used.

HHS provides ongoing guidance to articulate these issues and help cover entities implement compliant workflows in a variety of clinical and emergency situations.

HIPAA and Data Exchange: Clearing the Chaos

Despite widespread concerns, HIPAA is not a barrier to proper data sharing between EMS and healthcare partners. In fact, both the National EMS Information System (NEMSIS) and the U.S. Department of Health and Human Services confirm that HIPAA supports the safe exchange of patient information for treatment and operations. The 2020 Nemsis white paper, “HIPAA: Imaginative Barrier of Data Exchange,” emphasizes that EMS agencies can share patient data with hospitals, public health departments and other authorized entities, as long as appropriate safeguards are available. Follow-up legal opinions further clarify that HIPAA not only allows, but also encourages two-way information sharing to improve the continuity of care and system performance.

Looking to the future: Proposed changes to HIPAA security rules

In 2024, HHS proposed a major update to HIPAA security rules, which is the most important in more than a decade. These changes are designed to respond to growing cybersecurity threats and the modernization of new digital workflows.

Key suggestions include:

• Forced encryption of electronic PHIduring rest and transportation
• Eliminate the “addressable” assurance categoryenforce certain protections
• Structured risk assessment Regular network and asset inventory reviews
• Multi-factor authentication and vulnerability testing

These updates, if finalized, will require the EMS agency to evaluate and possibly upgrade existing systems and protocols. A detailed summary is available in Federal Gazette.

The most important thing is: HIPAA is not optional – but this is the opportunity

EMS providers work on the frontlines of care. While HIPAA compliance can be complex in unpredictable environments, it is critical to establishing a secure, responsive and connected healthcare system.

By taking positive steps – training staff, hardening systems and reviewing protocols – EMS leaders can not only maintain compliance, but also increase the speed, safety and continuity of the care they provide.

Photo: Ildo Frazao, Getty Images

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