Articles:  Should therapist locator systems offer a BAA?  &
Life during wartime: the coronavirus psychology 
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HIPPA

Business Associate Agreement

Should therapist locator systems offer a BAA?

By Michael G. Conner, Psy.D.
April 13, 2021 - Last updated: April 12, 2021

As the developer of a website functionally equivalent to Psychology Today’s therapist locator, I understand the technology of these systems, intranet text communication and referral technology. I also know the vulnerabilities of that technology.

A therapist locator site touches significant information provided by the public. Information collected through interactions with a therapist locator system can be time-stamped, viewed, digitally recorded and saved using the system’s hosting platform. All that data could be aggregated, correlated, analyzed, viewed, saved, published and sold – legitimately or not. Without a business associate agreement (BAA), healthcare providers and the public are defenseless, denied information about privacy and security incidents.

Many therapists do not understand that they are covered entities who must adhere to HIPAA and protect patients’ protected health information. Therapist locator service companies offer services that covered entities (therapists) pay them to provide.

Therapist locator services should be designed so that personally identifiable information (PII) and protected health information (PHI) gathered through use of the site are kept implicitly and explicitly private and secure.

Business intelligence (BI) software and advanced database tools and artificial intelligence can be used to connect the identity of individuals using a locator website with the reasons people have for contacting providers.

Even if PII does not reveal a patient’s health care history, it is PHI when linked to a health condition or request for care for a health condition. A patient’s name or email alone can be considered PHI if it is in any way associated with a healthcare provider.

Database technology combined with business information software can calculate and express associations between individuals, providers and services for a health condition within a statistical level of certainty. That creates vulnerability to an incident at best and a breach of privacy at worst.

Either way, therapists could be held legally responsible for patients’ loss of privacy.

A referral-site business should offer BAAs to the professionals listed, have clear HIPAA policies and procedures in place to assure data security, privacy and integrity. Periodic review and testing for vulnerability is crucial. The therapist locator I built does that.

Professional liability insurance does not cover data privacy, security, integrity, or investigation of

incidents pertaining to electronic health records or any other electronic information gathering,

storage, or processing service. Imagine what an “antisocial” engineer working for a large

therapist locator service could do with database and network access permissions!

BAAs for health data-handling services are required by federal regulation to assure providers are informed of significant data-handling incidents. With a breach – and no BAA – providers might be held responsible for the breach. They are responsible to report incidents.

Healthcare operations support businesses are not covered entities under HIPAA; they provide services for covered entities. Failing to obtain a BAA does not relieve covered entities of their responsibilities or alleged responsibilities under state and federal law.

With no BAA, healthcare operations support services can post disclaimers and terms of use in self-protective language that indemnify, hold harmless, waive rights to trial, limit liability, or establish jurisdiction. Common disclaimers have specific broad language that website owners are not responsible for, such as “other harmful components,” which would include databases exploited by malicious software, cyber espionage, etc.

Psychology Today operates a huge public data-handling business that does business in every state and internationally. This begs several questions: “Where is Psychology Today data and information stored? Where is the security hub? Who has access to resources in their network?

Psychology Today functionality allows therapists to communicate with other therapist-subscribers. This illustrates that these functions are health care support operations because PII and PHI are inherently available.

Few therapist locators in America or elsewhere offer BAA’s to HIPAA-covered entities. There are healthcare data businesses in India that offer BAAs. Psychology Today is a corporation chartered in the Cayman Islands.

Maybe therapist locators are so big or so small that no regulatory agency has mandate or resources to learn what data they can and do collect and what they are doing with that data. Or, have these businesses developed in a world too poorly informed or too busy to notice there is a problem?

HIPAA-responsible psychologists should strive to protect the public by requiring BAAs from businesses that touch potential patient data, especially those that:

* display professional profiles,
* support electronic communication between patients and healthcare professionals and
* provide internal electronic communication for referrals.
Mental health professionals’ associations should establish standards that protect patients.

An expanded version of this article is available from the lead author.
 

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Michael G. Conner, Psy.D., is a psychologist in private practice and an owner of Private Practice Cloud LLC, a healthcare operations business that supports The American Mental Health Alliance. He also is a member of the board of directors of Mentor Research Institute (MRI). His email address is: conner@bendpsychology.com
Michaele P. Dunlap, Psy.D., president of MRI, also contributed to this article.

Public Transport Passenger

Life during wartime: the coronavirus psychology

By Katrina Wood, Ph.D.
April 12, 2021

We are engaged in a war. Not a typical war where an enemy is clearly identifiable. We’re up against an invisible enemy – the COVID-19 virus.

The conflict requires something unique and brutally wrenching from its civilians: isolation and physical disconnection. 

 The collective life force has been stopped dead in its tracks now for more than a year. Society’s mental wellness clearly has declined.

Dangerous shaming camps have formed. Coalitions divide people in ways that simply did not happen during the world wars, when physical interaction created a deep sense of unity and everyone was “in this fight together.”

Closer attention must be paid to the far-reaching impact on the psyches of our communities. While survival is critical, we must not underestimate how creating a great social distance takes its toll by separating families, friends and neighbors.

While some say it’s a small price to pay for survival, one cannot minimize the dangerous impact of disconnection. Depression is a debilitating disease with an alarming number of adults being prescribed antidepressants at this time.

U.S. suicide rates have risen sharply in recent decades, a trend that likely continues during the pandemic.

“We’ve never had anything like this — and we know social isolation is related to suicide,” Matthew Nock, a psychology professor at Harvard, told The New York Times.

And while the world stresses, a lack of understanding dominates. Conversely, wartime promoted social connection.

Without the balm of understanding and empathy, insidious disconnection develops on a higher level. The greatest and most dangerous sacrifice at any time is separation and isolation.

During World War II, a primary goal of society was to support one another. Families and strangers in London huddled together in the Underground as bombs fell. People played music, told stories, reassured one another, providing comfort during these dark days. People were more charitable, empathy was heightened and not surprisingly suicides were at an all-time low.

Prisoners of war under the greatest duress inflicted by torture, starvation and severe neglect were at least imprisoned together, albeit in inhumane cells. They were providing each other with support, psychological sustenance, emotional empathy and even humor at times. In person, in the flesh. A valuable sustainable inoculation.

Connection also played a key role in achieving long-term mental stability after the war. Today, our very human condition has been severely ruptured and compromised. The ability to take getaway trips, to work out in a gym, to partake in a group training or go to church, a meeting, to work or school has been upended. The shock and loss are immense.

Children, teens and young adults especially suffer from this lack of essential contact.

Tensions are rising in our homes. Moods have become unstable; patterns of behavior once predictable have become more concentrated. Niggling worries and even irrational thoughts emerge. Free-floating fears and imagination can run rampant. These are somewhat predictable responses to the extreme cocooning forced upon us in the time of a pandemic.

The psyche needs balance, to paraphrase psychoanalyst Carl Jung. Staying at home for extended

periods — without the balm of outdoor activities and normal social intercourse —can and will create

issues. Some of us may be increasingly reluctant to leave home and engage with the outside world

for reasons such as age or comorbidity.

This makes sense up to a point. This setting in of ways, however, can be paralyzing and harmful. Becoming immovable in order “to survive” creates a slow unhealthful insulation.

The Diagnostic and Statistical Manual of Mental Disorders assigns the diagnosis of agoraphobia to individuals who have a disproportionate fear of public places, often perceiving such environments as too open, crowded or dangerous.

Untreated, the condition may become so acute that a sufferer may be unwilling or unable to leave the home. There are many reasons for this manifestation, which typically develops over time. These include childhood trauma or stressful events in adult life. The presence of COVID-19 could prove a tipping point for those who have a proclivity toward being “phobic.”

The need to relate in person is age old: To partake in the marketplace, to sit around a campfire, to have chats in a cafe, to invite a stranger into a conversation. These are not fancy expectations or desires, simply typical ways in which humans relate, share, give and receive love and kindness through in-person daily exchanges. Making wiser connections.

This is not the time to take a stiff-upper-lip approach, at least not in the old-fashioned way. As hugs are not recommended outside the home and touching elbows is the new norm, it is important to work on developing a deeper sense of how to connect – providing compassion for the everyday losses experienced.

Now is the time to collectively grieve, to share our fears intimately, to recognize the depth of painful losses.

Now is the time to find ways to adjust and adapt until we are through the worst. Now is the time to find ways to manage depression and anxiety – realizing that people are not alone in these overwhelming traumatic times.

This is a shared path on which loss needs to be acknowledged openly and loneliness understood, realizing people need one another in ways that perhaps had been taken for granted.

Say hello to your neighbor when glimpsed through a window, or offer a how-are-you wave to pedestrians across the street – it means so much these days.

Maintain physical social interactions when possible. When not, reach out via Zoom or phone or Skype. If you feel strongly about staying indoors, it is important to find ways such as these to remain in contact. The goal is to avoid isolation in order to keep spirits bright, maintaining hope for the brighter future on the horizon.

We will be hugging one another again one day. Meanwhile, commit to ways to hug ourselves and those we can hug. Include teddy bears and our live animals, for they need hugs, too.

Mindful awareness of self-care, combating isolation as its own virus, knowing this to be a dangerous thing when prolonged.

There can never be enough love in our lives, so reach out in all the ways permitted. For there will never be another time as this. Looking back, much may well have been learned and gained.
 

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Katrina Wood, Ph.D., is director of Wilshire Valley Therapy Centers in Los Angeles and Encino, Calif. Her email is: ukwood1@gmail.com.

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