{"ID":77998,"post_author":"9208550","post_date":"2018-12-13 14:27:33","post_date_gmt":"0000-00-00 00:00:00","post_content":"","post_title":"Health Information Technology for the Physician Office Laboratory (POL)","post_excerpt":"","post_status":"draft","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"","to_ping":"","pinged":"","post_modified":"2018-12-13 14:27:33","post_modified_gmt":"2018-12-13 19:27:33","post_content_filtered":"","post_parent":0,"guid":"https:\/\/www.limsforum.com\/?post_type=ebook&p=77998","menu_order":0,"post_type":"ebook","post_mime_type":"","comment_count":"0","filter":"","_ebook_metadata":{"enabled":"on","private":"0","guid":"21B547A3-C4AA-48A5-90D9-BF0D0A64DCC0","title":"Health Information Technology for the Physician Office Laboratory (POL)","subtitle":"","cover_theme":"nico_10","cover_image":"https:\/\/www.limsforum.com\/wp-content\/plugins\/rdp-ebook-builder\/pl\/cover.php?cover_style=nico_10&subtitle=&editor=John+Jones&title=Health+Information+Technology+for+the+Physician+Office+Laboratory+%28POL%29&title_image=https%3A%2F%2Fupload.wikimedia.org%2Fwikipedia%2Fcommons%2Fe%2Fe3%2FMedical_Laboratory_Scientist_US_NIH.jpg&publisher=LiMSwiki.org","editor":"John Jones","publisher":"LiMSwiki.org","author_id":"2","image_url":"","items":{"e0bf845fb58d2bae05a846b47629e86f_type":"article","e0bf845fb58d2bae05a846b47629e86f_title":"Health Level 7","e0bf845fb58d2bae05a846b47629e86f_url":"https:\/\/www.limswiki.org\/index.php\/Health_Level_7","e0bf845fb58d2bae05a846b47629e86f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHealth Level 7\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t The Reference Information Model (RIM) is an important component of the HL7 v3.0 standard and is based on XML.\nHealth Level Seven (HL7) is an international non-profit volunteer-based organization involved with the development of international health care informatics interoperability standards.[1] The HL7 community consists of health care experts and information scientists collaborating to create standards for the exchange, management, and integration of electronic health care information.\nThe term \"HL7\" is also used to refer to some of the specific standards created by the organization (e.g., HL7 v2.x, v3.0, HL7 RIM).[2] HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. v2.x of the standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world.[3] \n\nContents\n\n1 History \n2 Standards \n\n2.1 Reference Information Model (RIM) \n2.2 Clinical Document Architecture (CDA) \n2.3 Clinical Context Object Workgroup (CCOW) \n2.4 Fast Healthcare Interoperability Resources (FHIR) \n\n\n3 Further reading \n4 External links \n5 References \n\n\n\nHistory \nThe International Organization for Standardization (ISO) got involved with standardizing network exchanges of data between computers around 1979, creating the Open Systems Interconnect (OSI) standards model. These formal OSI standards ranged across seven levels, from OSI Level 1 (physical layer, e.g. communication over coaxial cable) to OSI Level 7 (application layer, e.g. communication between clinical software). By 1981, researchers at University of California - San Francisco had created a proprietary protocol that unbeknownst to them at the time fit under the OSI Level 7 model. The protocol was developed for clinical purposes such that \"computers exchanged several core messages, including the synchronization of patient admission-discharge-transfer information, orders from clinical areas, and the display of textual results to the clinical areas.\"[4] \nBy 1985, Simborg Systems (which developed hospital information systems) sought to have a non-proprietary protocol created because \"standardization efforts at the time was either fragmented, in a different direction or with a different scope.\"[4] This led to a push to create a new standards organization, with initial meetings occurring at the end of March 1987. The meetings produced the term \"HL7\" and prompted a non-profit organization to be created, eventually known as Health Level Seven International. Version 1.0 of the HL7 specification was released in October 1987. The direction of HL7 was largely led by Simborg Systems; however, with greater practical use seen in furthering the protocol and non-profit, the first non-Simborg Systems chairperson, Ed Hammond, took the reigns in 1989.[4] By June 1990, Version 2.1 was published and included mechanisms for results reporting and billing. By the early- to mid-1990s news of HL7 was beginning to spread to international clinical sectors, particularly parts of Europe, including Netherlands, Germany, Canada, Japan, Australia, and the United Kingdom.[4][5]\nIn June 1994 the American National Standards Institute (ANSI) awarded Health Level 7 International status as an accredited standards developer. Version 2.2 became an official ANSI standard in February 1996. HL7 had roughly 1,700 members from various health care industries around the globe by the late 1990s.[5]\nVersion 3.0 of the HL7 standard was released in late 2005, which internationalized it and made it more consistent and precise.[6] Where the 2.x standards eventually received wide adoption for their flexibility and available implementation options, the 3.0 standards, in contrast, departed from that flexibility in order to be more \"definite and testable, and provide the ability to certify vendors' conformance.\"[7] In 2009, Corepoint Health reported that most HL7 messaging was occurring using 2.3 and 2.3.1 models, with 3.0-based messages representing only a tiny fraction of all interfaces[8]; in 2012 Corepoint Health's Rob Brull estimated that more than 90 percent of all healthcare systems were still utilizing 2.x models.[9] That trend continued, with several experts proclaiming the standard to be more or less a failure.[10][11]\nIn early 2012, HL7 announced the HL7 FHIR (Fast Healthcare Interoperability Resources) initiative, which would utilize the best aspects of both 2.x and 3.0 standards, optimally resulting in a standard that is 20 percent the size of 3.0 but still meet the operation requirements of 80 percent of systems using the standard.[12] FHIR is being built on RESTful web services and provides modular, extensible \"resources\" to provide some flexibility but within a more fixed framework.[13] In December 2014, HL7 announced the Argonaut Project, meant \"to hasten current FHIR development efforts in order to create practical and focused guidelines and profiles for FHIR by the spring of 2015.\"[14]\n\nStandards \nIn total HL7 develops conceptual standards (e.g., HL7 RIM), document standards (e.g., HL7 CDA), application standards (e.g., HL7 CCOW), and messaging standards (e.g., HL7 v2.x and v3.0). Messaging standards are particularly important because they define how information is packaged and communicated from one party to another. Such standards set the language, structure, and data types required for seamless integration from one system to another.[15] Business use of the HL7 standards requires a paid organizational membership in HL7, Inc. HL7 members can access standards for free, and non-members can buy the standards from HL7 or ANSI.\nHL7 v2.x and 3.0 are the primary standards from the organization. They provide a framework for data exchange among clinical and healthcare systems in an ideal format. The 2.x standards are flexible, with several implementation options, loosely geared towards \"clinical interface specialists\" working to move clinical data in the application space. The 3.0 standards are designed to be more fixed, precise, and international, geared towards governments and end users of clinical applications.[8] \nWhile HL7 v2.x and 3.0 are the primary standards, a few other important standards and components are associated with HL7, as detailed below.\n\nReference Information Model (RIM) \nThe Reference Information Model (RIM) is an important component of the HL7 Version 3 standard. RIM expresses the data content needed in a specific clinical or administrative context and provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages.[16] The standard is accepted as official by the ISO as ISO\/HL7 21731; the original was approved in 2006, with a revised version appearing in 2014.[17]\n\nClinical Document Architecture (CDA) \nThe Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure, and semantics of clinical documents for exchange.[18] The standard is accepted as official by the ISO as ISO\/HL7 27932; the most current version comes from 2009.[19]\n\nClinical Context Object Workgroup (CCOW) \nThe Clinical Context Object Workgroup (CCOW) family of standards are designed to enable disparate applications to share user context and patient context in real-time, particularly at the user-interface level. CCOW implementations typically require a CCOW vault system to manage user security between applications. The primary standard under CCOW is the Context Management Specifications (CCOW), which \"serves as the basis for ensuring secure and consistent access to patient information from heterogeneous sources.\"[20] This standard is accepted as official by ANSI as ANSI\/HL7 CMS V1.6.\n\nFast Healthcare Interoperability Resources (FHIR) \nThe Fast Healthcare Interoperability Resources (FHIR) standard was announced in 2012 and has been in development since. FHIR is being built on RESTful web services and provides modular, extensible \"resources\" to provide some flexibility but within a more fixed framework. The fundamental principles of FHIR are[21]:\n\n prioritize implementers as the target user of the standard;\n provide a flexible framework for interoperability;\n limit complexity to where it's most needed;\n keep conformance requirement minimal but also provide varying degrees of rigor;\n leverage open source development principles;\n make the standard available without cost;\n support multiple exchange architectures;\n leverage common web technologies;\n make the standard forward and backward compatible; and\n design, publish, and implement associated specifications using widely available tools.\nFurther reading \n Introduction to HL7 Standards\n Spronk, Ren\u00e9 (05 September 2014). \"The Early History of Health Level 7\". Ringholm BV. http:\/\/www.ringholm.com\/docs\/the_early_history_of_health_level_7_HL7.htm .   \nExternal links \n Health Level 7 International\n HL7 Wiki\n HL7 FHIR\nReferences \n\n\u2191 \"About Health Level Seven International\". Health Level Seven International. http:\/\/www.hl7.org\/about\/index.cfm . Retrieved 02 March 2012 .   \n\n\u2191 \"Healthcare Interoperability Glossary\". Corepoint Health. http:\/\/www.corepointhealth.com\/resource-center\/healthcare-interoperability-glossary#H . Retrieved 02 March 2012 .   \n\n\u2191 Shaver, Dave. \"The HL7 Evolution - Comparing HL7 Versions 2 and 3\" (PDF). Corepoint Health. http:\/\/www.corepointhealth.com\/sites\/default\/files\/whitepapers\/hl7-v2-v3-evolution.pdf . Retrieved 02 March 2012 .   \n\n\u2191 4.0 4.1 4.2 4.3 Spronk, Ren\u00e9 (05 September 2014). \"The Early History of Health Level 7\". Ringholm BV. http:\/\/www.ringholm.com\/docs\/the_early_history_of_health_level_7_HL7.htm . Retrieved 17 February 2015 .   \n\n\u2191 5.0 5.1 Di Lima, Sara N.; Johns, Lisa T.; Liebler, Joan Gratto (1998). A Practical Introduction to Health Information Management. Jones & Bartlett Learning. ISBN 9780834212312. https:\/\/books.google.com\/books?id=vX_zVaMlR8sC&pg=PA90 . Retrieved 17 February 2015 .   \n\n\u2191 Shaver,Dave (17 February 2015). \"What Is HL7 Version 3 or V3?\". HL7 Standards. http:\/\/www.hl7standards.com\/blog\/2006\/10\/05\/what-is-hl7-version-3-or-v3\/ .   \n\n\u2191 \"HL7 Version 3 Product Suite\". Health Level 7 International. 15 May 2014. http:\/\/www.hl7.org\/implement\/standards\/product_brief.cfm?product_id=186 . Retrieved 18 February 2015 .   \n\n\u2191 8.0 8.1 Shaver, Dave (2009). \"The HL7 Evolution: Comparing HL7 Version 2 to Version 3, Including a History of Version 2\" (PDF). Corepoint Health. http:\/\/www.corepointhealth.com\/sites\/default\/files\/whitepapers\/hl7-v2-v3-evolution.pdf . Retrieved 18 February 2015 .   \n\n\u2191 McNickle, Michelle (25 April 2012). \"8 common questions about HL7\". Healthcare IT News. HIMSS Media. http:\/\/www.healthcareitnews.com\/news\/8-common-questions-about-hl7 . Retrieved 18 February 2015 .   \n\n\u2191 Morin, Jeanluc (04 January 2011). \"Will HL7 V3 Adoption Take Off in 2011? 5 Points and 1 Caveat\". Caristix Blog. Caristix. http:\/\/caristix.com\/blog\/2011\/01\/will-hl7-v3-adoption-take-off-in-2011\/ . Retrieved 18 February 2015 .   \n\n\u2191 Grieve, Grahame (15 August 2011). \"HL7 needs a fresh look because V3 has failed\". Health Intersections Blog. Health Intersections Pty. Ltd. http:\/\/www.healthintersections.com.au\/?p=476 . Retrieved 18 February 2015 .   \n\n\u2191 McKenzie, Lloyd (February 2012). \"HL7\u2019s Next Generation Standard is Coming: Keep Calm, Carry On\". Healthcare Information Management & Communications Canada 26 (1). http:\/\/www.healthcareimc.com\/node\/515 . Retrieved 18 February 2015 .   \n\n\u2191 Brull, Rob (26 March 2013). \"5 Things to Know About HL7 FHIR\". HL7 Standards Blog. HL7 Standards. http:\/\/www.hl7standards.com\/blog\/2013\/03\/26\/hl7-fhir\/ . Retrieved 18 February 2015 .   \n\n\u2191 Kern, Christine (12 December 2014). \"HL7 Advancing FHIR\". Health IT Outcomes. Jameson Publishing. http:\/\/www.healthitoutcomes.com\/doc\/hl-advancing-fhir-0001 . Retrieved 18 February 2015 .   \n\n\u2191 Kim, Katherine (July 2005). \"Creating Clinical Data Standards in Health Care: Five Case Studies\" (PDF). California HealthCare Foundation. http:\/\/www.kathykim.com\/sitebuildercontent\/sitebuilderfiles\/ClinicalDataStandardsInHealthCare.pdf . Retrieved 02 March 2012 .   \n\n\u2191 \"HL7 Reference Information Model\". Health Level 7 International. http:\/\/www.hl7.org\/implement\/standards\/rim.cfm . Retrieved 17 February 2015 .   \n\n\u2191 \"ISO\/HL7 21731:2006\". International Organization for Standardization. http:\/\/www.iso.org\/iso\/home\/store\/catalogue_ics\/catalogue_detail_ics.htm?csnumber=40399 . Retrieved 17 February 2015 .   \n\n\u2191 Boone, Keith W. (2011). The CDA Book. Springer Science & Business Media. pp. 17\u201321. http:\/\/books.google.com\/books?id=rwa6DDB4jY8C&pg=PA17 . Retrieved 17 February 2015 .   \n\n\u2191 \"ISO\/HL7 27932:2009\". International Organization for Standardization. http:\/\/www.iso.org\/iso\/iso_catalogue\/catalogue_tc\/catalogue_detail.htm?csnumber=44429 . Retrieved 17 February 2015 .   \n\n\u2191 \"Product CCOW\". HL7 Wiki. Health Level 7 International. 27 October 2010. http:\/\/wiki.hl7.org\/index.php?title=Product_CCOW . Retrieved 17 February 2015 .   \n\n\u2191 \"Fundamental Principles of FHIR\". HL7 Wiki. Health Level 7 International. 16 September 2014. http:\/\/wiki.hl7.org\/index.php?title=Fundamental_Principles_of_FHIR . Retrieved 18February 2015 .   \n\n\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Health_Level_7\">https:\/\/www.limswiki.org\/index.php\/Health_Level_7<\/a>\n\t\t\t\t\tCategories: Communication protocols and standardsHealth informaticsHealth standardsStandards organizationsHidden category: Pages using duplicate arguments in template calls\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 24 August 2016, at 21:42.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 7,020 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","e0bf845fb58d2bae05a846b47629e86f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Health_Level_7 skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Health Level 7<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:552px;\"><a href=\"https:\/\/www.limswiki.org\/index.php\/File:HL7_Reference_Information_Model.jpg\" class=\"image wiki-link\" target=\"_blank\" data-key=\"b8e925aa26de89f4ff8ca5fc5541ac42\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f8\/HL7_Reference_Information_Model.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/www.limswiki.org\/index.php\/File:HL7_Reference_Information_Model.jpg\" class=\"internal wiki-link\" title=\"Enlarge\" target=\"_blank\" data-key=\"b8e925aa26de89f4ff8ca5fc5541ac42\"><\/a><\/div>The Reference Information Model (RIM) is an important component of the HL7 v3.0 standard and is based on XML.<\/div><\/div><\/div>\n<p><b>Health Level Seven<\/b> (<b>HL7<\/b>) is an international non-profit volunteer-based organization involved with the development of international health care informatics interoperability standards.<sup id=\"rdp-ebb-cite_ref-HL7About_1-0\" class=\"reference\"><a href=\"#cite_note-HL7About-1\" rel=\"external_link\">[1]<\/a><\/sup> The HL7 community consists of health care experts and information scientists collaborating to create standards for the exchange, management, and integration of electronic health care information.\n<\/p><p>The term \"HL7\" is also used to refer to some of the specific standards created by the organization (e.g., HL7 v2.x, v3.0, HL7 RIM).<sup id=\"rdp-ebb-cite_ref-HL7BatchProtocol_2-0\" class=\"reference\"><a href=\"#cite_note-HL7BatchProtocol-2\" rel=\"external_link\">[2]<\/a><\/sup> HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. v2.x of the standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> \n<\/p>\n\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The <a href=\"https:\/\/www.limswiki.org\/index.php\/International_Organization_for_Standardization\" title=\"International Organization for Standardization\" target=\"_blank\" class=\"wiki-link\" data-key=\"116defc5d89c8a55f5b7c1be0790b442\">International Organization for Standardization<\/a> (ISO) got involved with standardizing network exchanges of data between computers around 1979, creating the Open Systems Interconnect (OSI) standards model. These formal OSI standards ranged across seven levels, from OSI Level 1 (physical layer, e.g. communication over coaxial cable) to OSI Level 7 (application layer, e.g. communication between clinical software). By 1981, researchers at University of California - San Francisco had created a proprietary protocol that unbeknownst to them at the time fit under the OSI Level 7 model. The protocol was developed for clinical purposes such that \"computers exchanged several core messages, including the synchronization of patient admission-discharge-transfer information, orders from clinical areas, and the display of textual results to the clinical areas.\"<sup id=\"rdp-ebb-cite_ref-HL7Hist1_4-0\" class=\"reference\"><a href=\"#cite_note-HL7Hist1-4\" rel=\"external_link\">[4]<\/a><\/sup> \n<\/p><p>By 1985, Simborg Systems (which developed <a href=\"https:\/\/www.limswiki.org\/index.php\/Hospital_information_system\" title=\"Hospital information system\" target=\"_blank\" class=\"wiki-link\" data-key=\"d8385de7b1f39a39d793f8ce349b448d\">hospital information systems<\/a>) sought to have a non-proprietary protocol created because \"standardization efforts at the time was either fragmented, in a different direction or with a different scope.\"<sup id=\"rdp-ebb-cite_ref-HL7Hist1_4-1\" class=\"reference\"><a href=\"#cite_note-HL7Hist1-4\" rel=\"external_link\">[4]<\/a><\/sup> This led to a push to create a new standards organization, with initial meetings occurring at the end of March 1987. The meetings produced the term \"HL7\" and prompted a non-profit organization to be created, eventually known as Health Level Seven International. Version 1.0 of the HL7 specification was released in October 1987. The direction of HL7 was largely led by Simborg Systems; however, with greater practical use seen in furthering the protocol and non-profit, the first non-Simborg Systems chairperson, Ed Hammond, took the reigns in 1989.<sup id=\"rdp-ebb-cite_ref-HL7Hist1_4-2\" class=\"reference\"><a href=\"#cite_note-HL7Hist1-4\" rel=\"external_link\">[4]<\/a><\/sup> By June 1990, Version 2.1 was published and included mechanisms for results reporting and billing. By the early- to mid-1990s news of HL7 was beginning to spread to international clinical sectors, particularly parts of Europe, including Netherlands, Germany, Canada, Japan, Australia, and the United Kingdom.<sup id=\"rdp-ebb-cite_ref-HL7Hist1_4-3\" class=\"reference\"><a href=\"#cite_note-HL7Hist1-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-PractDiLama_5-0\" class=\"reference\"><a href=\"#cite_note-PractDiLama-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>In June 1994 the <a href=\"https:\/\/www.limswiki.org\/index.php\/American_National_Standards_Institute\" title=\"American National Standards Institute\" target=\"_blank\" class=\"wiki-link\" data-key=\"9a3da6ae9a20adfa068187109b058ff4\">American National Standards Institute<\/a> (ANSI) awarded Health Level 7 International status as an accredited standards developer. Version 2.2 became an official ANSI standard in February 1996. HL7 had roughly 1,700 members from various health care industries around the globe by the late 1990s.<sup id=\"rdp-ebb-cite_ref-PractDiLama_5-1\" class=\"reference\"><a href=\"#cite_note-PractDiLama-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Version 3.0 of the HL7 standard was released in late 2005, which internationalized it and made it more consistent and precise.<sup id=\"rdp-ebb-cite_ref-HL730_6-0\" class=\"reference\"><a href=\"#cite_note-HL730-6\" rel=\"external_link\">[6]<\/a><\/sup> Where the 2.x standards eventually received wide adoption for their flexibility and available implementation options, the 3.0 standards, in contrast, departed from that flexibility in order to be more \"definite and testable, and provide the ability to certify vendors' conformance.\"<sup id=\"rdp-ebb-cite_ref-HL7Three_7-0\" class=\"reference\"><a href=\"#cite_note-HL7Three-7\" rel=\"external_link\">[7]<\/a><\/sup> In 2009, Corepoint Health reported that most HL7 messaging was occurring using 2.3 and 2.3.1 models, with 3.0-based messages representing only a tiny fraction of all interfaces<sup id=\"rdp-ebb-cite_ref-CH09_8-0\" class=\"reference\"><a href=\"#cite_note-CH09-8\" rel=\"external_link\">[8]<\/a><\/sup>; in 2012 Corepoint Health's Rob Brull estimated that more than 90 percent of all healthcare systems were still utilizing 2.x models.<sup id=\"rdp-ebb-cite_ref-8Common_9-0\" class=\"reference\"><a href=\"#cite_note-8Common-9\" rel=\"external_link\">[9]<\/a><\/sup> That trend continued, with several experts proclaiming the standard to be more or less a failure.<sup id=\"rdp-ebb-cite_ref-Cari11_10-0\" class=\"reference\"><a href=\"#cite_note-Cari11-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-HI11_11-0\" class=\"reference\"><a href=\"#cite_note-HI11-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>In early 2012, HL7 announced the HL7 FHIR (Fast Healthcare Interoperability Resources) initiative, which would utilize the best aspects of both 2.x and 3.0 standards, optimally resulting in a standard that is 20 percent the size of 3.0 but still meet the operation requirements of 80 percent of systems using the standard.<sup id=\"rdp-ebb-cite_ref-FHIR12_12-0\" class=\"reference\"><a href=\"#cite_note-FHIR12-12\" rel=\"external_link\">[12]<\/a><\/sup> FHIR is being built on RESTful web services and provides modular, extensible \"resources\" to provide some flexibility but within a more fixed framework.<sup id=\"rdp-ebb-cite_ref-HL7StandardFHIR_13-0\" class=\"reference\"><a href=\"#cite_note-HL7StandardFHIR-13\" rel=\"external_link\">[13]<\/a><\/sup> In December 2014, HL7 announced the Argonaut Project, meant \"to hasten current FHIR development efforts in order to create practical and focused guidelines and profiles for FHIR by the spring of 2015.\"<sup id=\"rdp-ebb-cite_ref-FHIRArgo_14-0\" class=\"reference\"><a href=\"#cite_note-FHIRArgo-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Standards\">Standards<\/span><\/h2>\n<p>In total HL7 develops conceptual standards (e.g., HL7 RIM), document standards (e.g., HL7 CDA), application standards (e.g., HL7 CCOW), and messaging standards (e.g., HL7 v2.x and v3.0). Messaging standards are particularly important because they define how information is packaged and communicated from one party to another. Such standards set the language, structure, and data types required for seamless integration from one system to another.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Business use of the HL7 standards requires a paid organizational membership in HL7, Inc. HL7 members can access standards for free, and non-members can buy the standards from HL7 or <a href=\"https:\/\/www.limswiki.org\/index.php\/ANSI\" title=\"ANSI\" class=\"mw-redirect wiki-link\" target=\"_blank\" data-key=\"682431568a190846c1164f8943aedded\">ANSI<\/a>.\n<\/p><p>HL7 v2.x and 3.0 are the primary standards from the organization. They provide a framework for data exchange among clinical and healthcare systems in an ideal format. The 2.x standards are flexible, with several implementation options, loosely geared towards \"clinical interface specialists\" working to move clinical data in the application space. The 3.0 standards are designed to be more fixed, precise, and international, geared towards governments and end users of clinical applications.<sup id=\"rdp-ebb-cite_ref-CH09_8-1\" class=\"reference\"><a href=\"#cite_note-CH09-8\" rel=\"external_link\">[8]<\/a><\/sup> \n<\/p><p>While HL7 v2.x and 3.0 are the primary standards, a few other important standards and components are associated with HL7, as detailed below.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Reference_Information_Model_.28RIM.29\">Reference Information Model (RIM)<\/span><\/h3>\n<p>The Reference Information Model (RIM) is an important component of the HL7 Version 3 standard. RIM expresses the data content needed in a specific clinical or administrative context and provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages.<sup id=\"rdp-ebb-cite_ref-RIM_16-0\" class=\"reference\"><a href=\"#cite_note-RIM-16\" rel=\"external_link\">[16]<\/a><\/sup> The standard is accepted as official by the ISO as ISO\/HL7 21731; the original was approved in 2006, with a revised version appearing in 2014.<sup id=\"rdp-ebb-cite_ref-ISO21731_17-0\" class=\"reference\"><a href=\"#cite_note-ISO21731-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Clinical_Document_Architecture_.28CDA.29\">Clinical Document Architecture (CDA)<\/span><\/h3>\n<p>The Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure, and semantics of clinical documents for exchange.<sup id=\"rdp-ebb-cite_ref-CDABook_18-0\" class=\"reference\"><a href=\"#cite_note-CDABook-18\" rel=\"external_link\">[18]<\/a><\/sup> The standard is accepted as official by the ISO as ISO\/HL7 27932; the most current version comes from 2009.<sup id=\"rdp-ebb-cite_ref-ISO27932_19-0\" class=\"reference\"><a href=\"#cite_note-ISO27932-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Clinical_Context_Object_Workgroup_.28CCOW.29\">Clinical Context Object Workgroup (CCOW)<\/span><\/h3>\n<p>The Clinical Context Object Workgroup (CCOW) family of standards are designed to enable disparate applications to share user context and patient context in real-time, particularly at the user-interface level. CCOW implementations typically require a CCOW vault system to manage user security between applications. The primary standard under CCOW is the Context Management Specifications (CCOW), which \"serves as the basis for ensuring secure and consistent access to patient information from heterogeneous sources.\"<sup id=\"rdp-ebb-cite_ref-CCOWWiki_20-0\" class=\"reference\"><a href=\"#cite_note-CCOWWiki-20\" rel=\"external_link\">[20]<\/a><\/sup> This standard is accepted as official by ANSI as ANSI\/HL7 CMS V1.6.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fast_Healthcare_Interoperability_Resources_.28FHIR.29\">Fast Healthcare Interoperability Resources (FHIR)<\/span><\/h3>\n<p>The Fast Healthcare Interoperability Resources (FHIR) standard was announced in 2012 and has been in development since. FHIR is being built on RESTful web services and provides modular, extensible \"resources\" to provide some flexibility but within a more fixed framework. The fundamental principles of FHIR are<sup id=\"rdp-ebb-cite_ref-FHIRPrinc_21-0\" class=\"reference\"><a href=\"#cite_note-FHIRPrinc-21\" rel=\"external_link\">[21]<\/a><\/sup>:\n<\/p>\n<ul><li> prioritize implementers as the target user of the standard;<\/li>\n<li> provide a flexible framework for interoperability;<\/li>\n<li> limit complexity to where it's most needed;<\/li>\n<li> keep conformance requirement minimal but also provide varying degrees of rigor;<\/li>\n<li> leverage open source development principles;<\/li>\n<li> make the standard available without cost;<\/li>\n<li> support multiple exchange architectures;<\/li>\n<li> leverage common web technologies;<\/li>\n<li> make the standard forward and backward compatible; and<\/li>\n<li> design, publish, and implement associated specifications using widely available tools.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hl7.org\/implement\/standards\/index.cfm\" target=\"_blank\">Introduction to HL7 Standards<\/a><\/li>\n<li> <span class=\"citation web\">Spronk, Ren\u00e9 (05 September 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ringholm.com\/docs\/the_early_history_of_health_level_7_HL7.htm\" target=\"_blank\">\"The Early History of Health Level 7\"<\/a>. Ringholm BV<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ringholm.com\/docs\/the_early_history_of_health_level_7_HL7.htm\" target=\"_blank\">http:\/\/www.ringholm.com\/docs\/the_early_history_of_health_level_7_HL7.htm<\/a><\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=The+Early+History+of+Health+Level+7&rft.atitle=&rft.aulast=Spronk%2C+Ren%C3%A9&rft.au=Spronk%2C+Ren%C3%A9&rft.date=05+September+2014&rft.pub=Ringholm+BV&rft_id=http%3A%2F%2Fwww.ringholm.com%2Fdocs%2Fthe_early_history_of_health_level_7_HL7.htm&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hl7.org\/\" target=\"_blank\">Health Level 7 International<\/a><\/li>\n<li> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wiki.hl7.org\/index.php?title=Main_Page\" target=\"_blank\">HL7 Wiki<\/a><\/li>\n<li> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wiki.hl7.org\/index.php?title=FHIR\" target=\"_blank\">HL7 FHIR<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ol class=\"references\">\n<li id=\"cite_note-HL7About-1\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-HL7About_1-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hl7.org\/about\/index.cfm\" target=\"_blank\">\"About Health Level Seven International\"<\/a>. Health Level Seven International<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hl7.org\/about\/index.cfm\" target=\"_blank\">http:\/\/www.hl7.org\/about\/index.cfm<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 02 March 2012<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=About+Health+Level+Seven+International&rft.atitle=&rft.pub=Health+Level+Seven+International&rft_id=http%3A%2F%2Fwww.hl7.org%2Fabout%2Findex.cfm&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HL7BatchProtocol-2\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-HL7BatchProtocol_2-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#H\">\"Healthcare Interoperability Glossary\"<\/a>. Corepoint Health<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"#H\">http:\/\/www.corepointhealth.com\/resource-center\/healthcare-interoperability-glossary#H<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 02 March 2012<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Healthcare+Interoperability+Glossary&rft.atitle=&rft.pub=Corepoint+Health&rft_id=http%3A%2F%2Fwww.corepointhealth.com%2Fresource-center%2Fhealthcare-interoperability-glossary%23H&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-3\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Shaver, Dave. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.corepointhealth.com\/sites\/default\/files\/whitepapers\/hl7-v2-v3-evolution.pdf\" target=\"_blank\">\"The HL7 Evolution - Comparing HL7 Versions 2 and 3\"<\/a> (PDF). Corepoint Health<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.corepointhealth.com\/sites\/default\/files\/whitepapers\/hl7-v2-v3-evolution.pdf\" target=\"_blank\">http:\/\/www.corepointhealth.com\/sites\/default\/files\/whitepapers\/hl7-v2-v3-evolution.pdf<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 02 March 2012<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=The+HL7+Evolution+-+Comparing+HL7+Versions+2+and+3&rft.atitle=&rft.aulast=Shaver&rft.aufirst=Dave&rft.au=Shaver%2C%26%2332%3BDave&rft.pub=Corepoint+Health&rft_id=http%3A%2F%2Fwww.corepointhealth.com%2Fsites%2Fdefault%2Ffiles%2Fwhitepapers%2Fhl7-v2-v3-evolution.pdf&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HL7Hist1-4\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-HL7Hist1_4-0\" rel=\"external_link\">4.0<\/a><\/sup> <sup><a href=\"#cite_ref-HL7Hist1_4-1\" rel=\"external_link\">4.1<\/a><\/sup> <sup><a href=\"#cite_ref-HL7Hist1_4-2\" rel=\"external_link\">4.2<\/a><\/sup> <sup><a href=\"#cite_ref-HL7Hist1_4-3\" rel=\"external_link\">4.3<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation web\">Spronk, Ren\u00e9 (05 September 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ringholm.com\/docs\/the_early_history_of_health_level_7_HL7.htm\" target=\"_blank\">\"The Early History of Health Level 7\"<\/a>. Ringholm BV<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ringholm.com\/docs\/the_early_history_of_health_level_7_HL7.htm\" target=\"_blank\">http:\/\/www.ringholm.com\/docs\/the_early_history_of_health_level_7_HL7.htm<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 17 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=The+Early+History+of+Health+Level+7&rft.atitle=&rft.aulast=Spronk%2C+Ren%C3%A9&rft.au=Spronk%2C+Ren%C3%A9&rft.date=05+September+2014&rft.pub=Ringholm+BV&rft_id=http%3A%2F%2Fwww.ringholm.com%2Fdocs%2Fthe_early_history_of_health_level_7_HL7.htm&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-PractDiLama-5\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-PractDiLama_5-0\" rel=\"external_link\">5.0<\/a><\/sup> <sup><a href=\"#cite_ref-PractDiLama_5-1\" rel=\"external_link\">5.1<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation book\">Di Lima, Sara N.; Johns, Lisa T.; Liebler, Joan Gratto (1998). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=vX_zVaMlR8sC&pg=PA90\" target=\"_blank\"><i>A Practical Introduction to Health Information Management<\/i><\/a>. Jones & Bartlett Learning. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" target=\"_blank\">ISBN<\/a> 9780834212312<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/books.google.com\/books?id=vX_zVaMlR8sC&pg=PA90\" target=\"_blank\">https:\/\/books.google.com\/books?id=vX_zVaMlR8sC&pg=PA90<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 17 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=A+Practical+Introduction+to+Health+Information+Management&rft.aulast=Di+Lima%2C+Sara+N.%3B+Johns%2C+Lisa+T.%3B+Liebler%2C+Joan+Gratto&rft.au=Di+Lima%2C+Sara+N.%3B+Johns%2C+Lisa+T.%3B+Liebler%2C+Joan+Gratto&rft.date=1998&rft.pub=Jones+%26+Bartlett+Learning&rft.isbn=9780834212312&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DvX_zVaMlR8sC%26pg%3DPA90&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HL730-6\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-HL730_6-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Shaver,Dave (17 February 2015). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hl7standards.com\/blog\/2006\/10\/05\/what-is-hl7-version-3-or-v3\/\" target=\"_blank\">\"What Is HL7 Version 3 or V3?\"<\/a>. <i>HL7 Standards<\/i><span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hl7standards.com\/blog\/2006\/10\/05\/what-is-hl7-version-3-or-v3\/\" target=\"_blank\">http:\/\/www.hl7standards.com\/blog\/2006\/10\/05\/what-is-hl7-version-3-or-v3\/<\/a><\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=What+Is+HL7+Version+3+or+V3%3F&rft.atitle=HL7+Standards&rft.aulast=Shaver%2CDave&rft.au=Shaver%2CDave&rft.date=17+February+2015&rft_id=http%3A%2F%2Fwww.hl7standards.com%2Fblog%2F2006%2F10%2F05%2Fwhat-is-hl7-version-3-or-v3%2F&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HL7Three-7\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-HL7Three_7-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hl7.org\/implement\/standards\/product_brief.cfm?product_id=186\" target=\"_blank\">\"HL7 Version 3 Product Suite\"<\/a>. Health Level 7 International. 15 May 2014<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hl7.org\/implement\/standards\/product_brief.cfm?product_id=186\" target=\"_blank\">http:\/\/www.hl7.org\/implement\/standards\/product_brief.cfm?product_id=186<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=HL7+Version+3+Product+Suite&rft.atitle=&rft.date=15+May+2014&rft.pub=Health+Level+7+International&rft_id=http%3A%2F%2Fwww.hl7.org%2Fimplement%2Fstandards%2Fproduct_brief.cfm%3Fproduct_id%3D186&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-CH09-8\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-CH09_8-0\" rel=\"external_link\">8.0<\/a><\/sup> <sup><a href=\"#cite_ref-CH09_8-1\" rel=\"external_link\">8.1<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation web\">Shaver, Dave (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.corepointhealth.com\/sites\/default\/files\/whitepapers\/hl7-v2-v3-evolution.pdf\" target=\"_blank\">\"The HL7 Evolution: Comparing HL7 Version 2 to Version 3, Including a History of Version 2\"<\/a> (PDF). Corepoint Health<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.corepointhealth.com\/sites\/default\/files\/whitepapers\/hl7-v2-v3-evolution.pdf\" target=\"_blank\">http:\/\/www.corepointhealth.com\/sites\/default\/files\/whitepapers\/hl7-v2-v3-evolution.pdf<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=The+HL7+Evolution%3A+Comparing+HL7+Version+2+to+Version+3%2C+Including+a+History+of+Version+2&rft.atitle=&rft.aulast=Shaver%2C+Dave&rft.au=Shaver%2C+Dave&rft.date=2009&rft.pub=Corepoint+Health&rft_id=http%3A%2F%2Fwww.corepointhealth.com%2Fsites%2Fdefault%2Ffiles%2Fwhitepapers%2Fhl7-v2-v3-evolution.pdf&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-8Common-9\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-8Common_9-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">McNickle, Michelle (25 April 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healthcareitnews.com\/news\/8-common-questions-about-hl7\" target=\"_blank\">\"8 common questions about HL7\"<\/a>. <i>Healthcare IT News<\/i>. HIMSS Media<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.healthcareitnews.com\/news\/8-common-questions-about-hl7\" target=\"_blank\">http:\/\/www.healthcareitnews.com\/news\/8-common-questions-about-hl7<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=8+common+questions+about+HL7&rft.atitle=Healthcare+IT+News&rft.aulast=McNickle%2C+Michelle&rft.au=McNickle%2C+Michelle&rft.date=25+April+2012&rft.pub=HIMSS+Media&rft_id=http%3A%2F%2Fwww.healthcareitnews.com%2Fnews%2F8-common-questions-about-hl7&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Cari11-10\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-Cari11_10-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Morin, Jeanluc (04 January 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/caristix.com\/blog\/2011\/01\/will-hl7-v3-adoption-take-off-in-2011\/\" target=\"_blank\">\"Will HL7 V3 Adoption Take Off in 2011? 5 Points and 1 Caveat\"<\/a>. <i>Caristix Blog<\/i>. Caristix<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/caristix.com\/blog\/2011\/01\/will-hl7-v3-adoption-take-off-in-2011\/\" target=\"_blank\">http:\/\/caristix.com\/blog\/2011\/01\/will-hl7-v3-adoption-take-off-in-2011\/<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Will+HL7+V3+Adoption+Take+Off+in+2011%3F+5+Points+and+1+Caveat&rft.atitle=Caristix+Blog&rft.aulast=Morin%2C+Jeanluc&rft.au=Morin%2C+Jeanluc&rft.date=04+January+2011&rft.pub=Caristix&rft_id=http%3A%2F%2Fcaristix.com%2Fblog%2F2011%2F01%2Fwill-hl7-v3-adoption-take-off-in-2011%2F&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HI11-11\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-HI11_11-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Grieve, Grahame (15 August 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healthintersections.com.au\/?p=476\" target=\"_blank\">\"HL7 needs a fresh look because V3 has failed\"<\/a>. <i>Health Intersections Blog<\/i>. Health Intersections Pty. Ltd<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.healthintersections.com.au\/?p=476\" target=\"_blank\">http:\/\/www.healthintersections.com.au\/?p=476<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=HL7+needs+a+fresh+look+because+V3+has+failed&rft.atitle=Health+Intersections+Blog&rft.aulast=Grieve%2C+Grahame&rft.au=Grieve%2C+Grahame&rft.date=15+August+2011&rft.pub=Health+Intersections+Pty.+Ltd&rft_id=http%3A%2F%2Fwww.healthintersections.com.au%2F%3Fp%3D476&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-FHIR12-12\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-FHIR12_12-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">McKenzie, Lloyd (February 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healthcareimc.com\/node\/515\" target=\"_blank\">\"HL7\u2019s Next Generation Standard is Coming: Keep Calm, Carry On\"<\/a>. <i>Healthcare Information Management & Communications Canada<\/i> <b>26<\/b> (1)<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.healthcareimc.com\/node\/515\" target=\"_blank\">http:\/\/www.healthcareimc.com\/node\/515<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=HL7%E2%80%99s+Next+Generation+Standard+is+Coming%3A+Keep+Calm%2C+Carry+On&rft.jtitle=Healthcare+Information+Management+%26+Communications+Canada&rft.aulast=McKenzie%2C+Lloyd&rft.au=McKenzie%2C+Lloyd&rft.date=February+2012&rft.volume=26&rft.issue=1&rft_id=http%3A%2F%2Fwww.healthcareimc.com%2Fnode%2F515&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HL7StandardFHIR-13\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-HL7StandardFHIR_13-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Brull, Rob (26 March 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hl7standards.com\/blog\/2013\/03\/26\/hl7-fhir\/\" target=\"_blank\">\"5 Things to Know About HL7 FHIR\"<\/a>. <i>HL7 Standards Blog<\/i>. HL7 Standards<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hl7standards.com\/blog\/2013\/03\/26\/hl7-fhir\/\" target=\"_blank\">http:\/\/www.hl7standards.com\/blog\/2013\/03\/26\/hl7-fhir\/<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=5+Things+to+Know+About+HL7+FHIR&rft.atitle=HL7+Standards+Blog&rft.aulast=Brull%2C+Rob&rft.au=Brull%2C+Rob&rft.date=26+March+2013&rft.pub=HL7+Standards&rft_id=http%3A%2F%2Fwww.hl7standards.com%2Fblog%2F2013%2F03%2F26%2Fhl7-fhir%2F&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-FHIRArgo-14\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-FHIRArgo_14-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Kern, Christine (12 December 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healthitoutcomes.com\/doc\/hl-advancing-fhir-0001\" target=\"_blank\">\"HL7 Advancing FHIR\"<\/a>. <i>Health IT Outcomes<\/i>. Jameson Publishing<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.healthitoutcomes.com\/doc\/hl-advancing-fhir-0001\" target=\"_blank\">http:\/\/www.healthitoutcomes.com\/doc\/hl-advancing-fhir-0001<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=HL7+Advancing+FHIR&rft.atitle=Health+IT+Outcomes&rft.aulast=Kern%2C+Christine&rft.au=Kern%2C+Christine&rft.date=12+December+2014&rft.pub=Jameson+Publishing&rft_id=http%3A%2F%2Fwww.healthitoutcomes.com%2Fdoc%2Fhl-advancing-fhir-0001&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-15\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Kim, Katherine (July 2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kathykim.com\/sitebuildercontent\/sitebuilderfiles\/ClinicalDataStandardsInHealthCare.pdf\" target=\"_blank\">\"Creating Clinical Data Standards in Health Care: Five Case Studies\"<\/a> (PDF). California HealthCare Foundation<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.kathykim.com\/sitebuildercontent\/sitebuilderfiles\/ClinicalDataStandardsInHealthCare.pdf\" target=\"_blank\">http:\/\/www.kathykim.com\/sitebuildercontent\/sitebuilderfiles\/ClinicalDataStandardsInHealthCare.pdf<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 02 March 2012<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Creating+Clinical+Data+Standards+in+Health+Care%3A+Five+Case+Studies&rft.atitle=&rft.aulast=Kim%2C+Katherine&rft.au=Kim%2C+Katherine&rft.date=July+2005&rft.pub=California+HealthCare+Foundation&rft_id=http%3A%2F%2Fwww.kathykim.com%2Fsitebuildercontent%2Fsitebuilderfiles%2FClinicalDataStandardsInHealthCare.pdf&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-RIM-16\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-RIM_16-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hl7.org\/implement\/standards\/rim.cfm\" target=\"_blank\">\"HL7 Reference Information Model\"<\/a>. Health Level 7 International<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hl7.org\/implement\/standards\/rim.cfm\" target=\"_blank\">http:\/\/www.hl7.org\/implement\/standards\/rim.cfm<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 17 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=HL7+Reference+Information+Model&rft.atitle=&rft.pub=Health+Level+7+International&rft_id=http%3A%2F%2Fwww.hl7.org%2Fimplement%2Fstandards%2Frim.cfm&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-ISO21731-17\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-ISO21731_17-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iso.org\/iso\/home\/store\/catalogue_ics\/catalogue_detail_ics.htm?csnumber=40399\" target=\"_blank\">\"ISO\/HL7 21731:2006\"<\/a>. International Organization for Standardization<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.iso.org\/iso\/home\/store\/catalogue_ics\/catalogue_detail_ics.htm?csnumber=40399\" target=\"_blank\">http:\/\/www.iso.org\/iso\/home\/store\/catalogue_ics\/catalogue_detail_ics.htm?csnumber=40399<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 17 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=ISO%2FHL7+21731%3A2006&rft.atitle=&rft.pub=International+Organization+for+Standardization&rft_id=http%3A%2F%2Fwww.iso.org%2Fiso%2Fhome%2Fstore%2Fcatalogue_ics%2Fcatalogue_detail_ics.htm%3Fcsnumber%3D40399&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-CDABook-18\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-CDABook_18-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation book\">Boone, Keith W. (2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/books.google.com\/books?id=rwa6DDB4jY8C&pg=PA17\" target=\"_blank\"><i>The CDA Book<\/i><\/a>. Springer Science & Business Media. pp. 17\u201321<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/books.google.com\/books?id=rwa6DDB4jY8C&pg=PA17\" target=\"_blank\">http:\/\/books.google.com\/books?id=rwa6DDB4jY8C&pg=PA17<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 17 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+CDA+Book&rft.aulast=Boone%2C+Keith+W.&rft.au=Boone%2C+Keith+W.&rft.date=2011&rft.pages=pp.%26nbsp%3B17%E2%80%9321&rft.pub=Springer+Science+%26+Business+Media&rft_id=http%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Drwa6DDB4jY8C%26pg%3DPA17&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-ISO27932-19\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-ISO27932_19-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iso.org\/iso\/iso_catalogue\/catalogue_tc\/catalogue_detail.htm?csnumber=44429\" target=\"_blank\">\"ISO\/HL7 27932:2009\"<\/a>. International Organization for Standardization<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.iso.org\/iso\/iso_catalogue\/catalogue_tc\/catalogue_detail.htm?csnumber=44429\" target=\"_blank\">http:\/\/www.iso.org\/iso\/iso_catalogue\/catalogue_tc\/catalogue_detail.htm?csnumber=44429<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 17 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=ISO%2FHL7+27932%3A2009&rft.atitle=&rft.pub=International+Organization+for+Standardization&rft_id=http%3A%2F%2Fwww.iso.org%2Fiso%2Fiso_catalogue%2Fcatalogue_tc%2Fcatalogue_detail.htm%3Fcsnumber%3D44429&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-CCOWWiki-20\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-CCOWWiki_20-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wiki.hl7.org\/index.php?title=Product_CCOW\" target=\"_blank\">\"Product CCOW\"<\/a>. <i>HL7 Wiki<\/i>. Health Level 7 International. 27 October 2010<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/wiki.hl7.org\/index.php?title=Product_CCOW\" target=\"_blank\">http:\/\/wiki.hl7.org\/index.php?title=Product_CCOW<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 17 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Product+CCOW&rft.atitle=HL7+Wiki&rft.date=27+October+2010&rft.pub=Health+Level+7+International&rft_id=http%3A%2F%2Fwiki.hl7.org%2Findex.php%3Ftitle%3DProduct_CCOW&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-FHIRPrinc-21\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-FHIRPrinc_21-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wiki.hl7.org\/index.php?title=Fundamental_Principles_of_FHIR\" target=\"_blank\">\"Fundamental Principles of FHIR\"<\/a>. <i>HL7 Wiki<\/i>. Health Level 7 International. 16 September 2014<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/wiki.hl7.org\/index.php?title=Fundamental_Principles_of_FHIR\" target=\"_blank\">http:\/\/wiki.hl7.org\/index.php?title=Fundamental_Principles_of_FHIR<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 18February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Fundamental+Principles+of+FHIR&rft.atitle=HL7+Wiki&rft.date=16+September+2014&rft.pub=Health+Level+7+International&rft_id=http%3A%2F%2Fwiki.hl7.org%2Findex.php%3Ftitle%3DFundamental_Principles_of_FHIR&rfr_id=info:sid\/en.wikipedia.org:Health_Level_7\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<\/ol>\n\n<!-- \nNewPP limit report\nCached time: 20181213192759\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.604 seconds\nReal time usage: 1.320 seconds\nPreprocessor visited node count: 13390\/1000000\nPreprocessor generated node count: 22117\/1000000\nPost\u2010expand include size: 80461\/2097152 bytes\nTemplate argument size: 31038\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 369.385 1 - -total\n 89.03% 328.864 22 - Template:Citation\/core\n 79.54% 293.815 19 - Template:Cite_web\n 12.40% 45.818 2 - Template:Cite_book\n 5.65% 20.886 1 - Template:Cite_journal\n 5.50% 20.331 30 - Template:Citation\/make_link\n 2.22% 8.200 1 - Template:Citation\/identifier\n 0.56% 2.073 2 - Template:Hide_in_print\n 0.53% 1.961 1 - Template:Only_in_print\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:3385-0!*!0!!en!5!* and timestamp 20181213192758 and revision id 27386\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Health_Level_7\">https:\/\/www.limswiki.org\/index.php\/Health_Level_7<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","e0bf845fb58d2bae05a846b47629e86f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f8\/HL7_Reference_Information_Model.jpg"],"e0bf845fb58d2bae05a846b47629e86f_timestamp":1544729278,"b70673a0117c21576016cb7498867153_type":"article","b70673a0117c21576016cb7498867153_title":"Health Insurance Portability and Accountability Act","b70673a0117c21576016cb7498867153_url":"https:\/\/www.limswiki.org\/index.php\/Health_Insurance_Portability_and_Accountability_Act","b70673a0117c21576016cb7498867153_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHealth Insurance Portability and Accountability Act\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\nThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted by the United States Congress and signed by President Bill Clinton in 1996. Its intended purpose was \"to improve portability and continuity of health insurance coverage in the group and individual markets; to combat waste, fraud, and abuse in health insurance and health care delivery; to promote the use of medical savings accounts; to improve access to long-term care services and coverage; [and] to simplify the administration of health insurance.\"[1]\n\nContents\n\n1 History \n\n1.1 Initial \n1.2 Amendments \n\n\n2 Structure \n\n2.1 Description \n\n\n3 Enforcement \n4 Assessed impact \n5 Audit guidelines and checklist \n6 Further reading \n7 References \n\n\n\nHistory \nInitial \nIn 1994, U.S. President Bill Clinton attempted to overhaul the national health care system but didn't receive the support he needed. In 1995, Senators Nancy Kassebaum (R-KS) and Edward Kennedy (D-MA) introduced a comparatively pared down proposal called the Health Insurance Reform Act of 1995 (S 11028), later referred to informally as the Kassebaum\/Kennedy Bill. The proposal called for health insurance portability for employees, medical savings accounts, increased deductibility of health insurance for the self-employed, and tax breaks for long-term care insurance.[2][3] The legislation successfully made it out of the Senate Labor and Human Resources Committee on August 2, 1995[4], only to be stalled \"because of opposition from conservative senators who shared industry concerns over the group-to-individual portability provisions.\"[2] \nWith desire to get some sort of health care reform legislation passed, Clinton referenced the stalled bill in his January 1996 State of the Union address on several occasions. Though some feared the ploy by Clinton would ultimately sink the bill, it inevitably resulted in bipartisan cooperation so no one side could take credit for the bill.[4] On February 7, 1996, the two parties agreed to further discuss the legislation in the House and Senate. This resulted in several events: the House of Representatives created an alternative bill (HR 3103) that drew on characteristics of S 11028, passing on March 28; the Senate passed a version of the original S 11028 on April 23 but without controversial attachments like medical savings accounts. However, differences between the House and Senate bills caused problems. \"The House bill, for example, included provisions allowing for medical savings accounts, a limit on monetary damages in medical malpractice lawsuits and a reduction in states' authority to regulate health insurance purchasing pools created by small businesses.\"[2] Additionally, a provision on mental health coverage was found on the Senate bill that was omitted from the House version. It took several weeks of debating to make concessions on these topics. \nA Republican-led compromise was offered on June 10, however debate raged on. It wasn't until a July 25 compromise between Kennedy and Ways and Means Committee Chairman Bill Archer (R-TX) on medical savings accounts that momentum shifted. Provisions on mental illness and medical malpractice were eventually dropped from the proposal on July 31, with both House and Senate agreeing on the final version on August 1 and August 2 respectively.[2] On August 21, 1996, the legislation was signed into law by President Clinton and codified as Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA).[5][1]\n\nAmendments \nThe administrative simplification provisions in HIPAA meant more work had to be done in regards to the legislation. The U.S. Department of Health and Human Services (HHS) began work on the HIPAA Privacy Rule in 1999, \"which set out detailed regulations regarding the types of uses and disclosures of personally identifiable health information that are permitted by the covered entities.\"[6] However, large volumes of comments and Executive branch changes in 2000 slowed the process down.[6] Several more years of corrections and requests for comments followed, culminating in the release of the Final Rule on August 14, 2002 as 45 CFR Part 160 and Subparts A and E of Part 164.[7] Most health plans were expected to be in compliance by April 14, 2003, though some exceptions existed.\nDespite the Privacy Rule, many still argued that the legislation wasn't suitable enough to prevent mishandling of personal health information and that it was impeding research.[6] These concerns mixed with few incidents of enforcement in the first few years after the 2003 compliance date prompted additional review by the HHS.[8] On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement, to be effective March 16, 2006.[9] \nAdditional updates to the enforcement rule came with the Health Information Technology for Economic and Clinical Health Act (HITECH) Act, enacted on February 17, 2009. The Act added \"several provisions that strengthen the civil and criminal enforcement of the HIPAA rules\" by adding categories of violations and tier levels of penalty amounts.[9] HIPAA and the HITECH statutes were further revised in January 2013 (effective March 26, 2013) \"to strengthen the privacy and security protection for individuals\u2019 health information,\" update the Breach Notification Rule, \"strengthen the privacy protections for genetic information,\" and revise other portions of HIPAA rules \"to improve their workability and effectiveness.\"[10]\n\nStructure \nHIPAA is divided into five titles, each with their own subtitles[1]:\nTitle I: Health Care Access, Portability, and Renewability\n\nSubtitle A - Group Market Rules\nSubtitle B - Individual Market Rules\nSubtitle C - General and Miscellaneous Provisions\nTitle II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform\n\nSubtitle A - Fraud and Abuse Control Program\nSubtitle B - Revisions to Current Sanctions for Fraud and Abuse\nSubtitle C - Data Collection\nSubtitle D - Civil Monetary Penalties\nSubtitle E - Revisions to Criminal Law\nSubtitle F - Administrative Simplification\nSubtitle G - Duplication and Coordination of Medicare-Related Plans\nTitle III: Tax-Related Health Provisions\n\nSubtitle A - Medical Savings Accounts\nSubtitle B - Increase in Deduction for Health Insurance Costs of Self-Employed Individuals\nSubtitle C - Long-Term Care Services and Contracts\nSubtitle D - Treatment of Accelerated Death Benefits\nSubtitle E - State Insurance Pools\nSubtitle F - Organizations Subject to Section 833\nSubtitle G - IRA Distributions to the Unemployed\nSubtitle H - Organ and Tissue Donation Information Included With Income Tax Refund Payments\nTitle IV: Application and Enforcement of Group Health Plan Requirements\n\nSubtitle A - Application and Enforcement of Group Health Plan Requirements\nSubtitle B - Clarification of Certain Continuation Coverage Requirements\nTitle V: Revenue Offsets\n\nSubtitle A - Company-Owned Life Insurance\nSubtitle B - Treatment of Individuals Who Lose United States Citizenship\nSubtitle C - Repeal of Financial Institution Transition Rule to Interest Allocation Rules\nDescription \nTitle I of HIPAA contains three subtitles that protect health insurance coverage for workers and their families when they change or lose their jobs. \nTitle II of HIPAA contains seven subtitles. One of the most important for expanding HIPAA is Subtitle F, the Administrative Simplification (AS) provisions, requiring the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Title II also addresses the security and privacy of health data, with the intent of improving the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the U.S. health care system.\nTitle III of HIPAA modifies the Internal Revenue Code (IRC) to revise available tax deductions for health insurance, clarify how pre-tax money could be applied health payments, and regulate long-term care services and how they're contracted. Other tax-related issues like IRA distribution and organ donor tax refund payments are covered by this title, in total spread out over eight subtitles.\nTitle IV of HIPAA modifies both the IRC and the Public Health Service Act (PHSA) to describe requirements for and enforcement of how group health plans could legally manage and cover patients' pre-existing conditions as well as their continuation of coverage. This information is supplied over two subtitles.\nTitle V of HIPAA contains three subtitles that amend the IRC concerning miscellaneous issues such as interest deductions on loans related to company-owned life insurance, how individuals who lose their U.S. citizenship shall be treated tax-wise, and the removal of certain limitations on interest allocation.\n\nEnforcement \nOn February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement. It became effective on March 16, 2006. The Enforcement Rule set civil money penalties for violating HIPAA rules and established procedures for investigations and hearings for HIPAA violations. Before the enforcement rule, the deterrent effects of the legislation seemed negligible, with few prosecutions for violations.[8] Enforcement operations were ratcheted up further with the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009, which greatly increased the financial penalties that could be applied to entities in non-compliance.[11]\nBy the end of 2014, the U.S. Department of Health and Human Resources (HHS) reported investigating 106,522 HIPAA complaints against national pharmacy chains, major health care centers, insurance groups, hospital chains and other small providers since April 2003. The HHS reported 23,314 of those cases had been resolved by requiring changes in privacy practice or by corrective action. 10,566 cases were investigated and found that HIPAA was followed correctly. Another 68,412 cases were found to be ineligible for enforcement because, for example, a violation occurred before HIPAA became effective, a case was withdrawn by the pursuer, or an activity did not actually violate the rules.[12]\nAccording to the HHS, the most commonly investigated compliance issue, by order of frequency, have been[12]:\n\n incorrectly used or revealed protected health information (PHI);\n insufficient protection mechanisms for PHI;\n insufficient mechanisms for patients to access their PHI;\n insufficient administrative protections and tools for managing electronic PHI; and\n usage and disclosure of more PHI than minimally necessary.\nThe HHS also stated the entities most likely to be responsible for infractions, by order of frequency, have been[12]:\n\n private practices;\n general hospitals;\n outpatient facilities;\n pharmacies; and\n health plans (group health plans and health insurance issuers).\nAssessed impact \nThe enactment of HIPAA caused major changes in the way physicians and medical centers operate. The complex legalities and potentially stiff penalties associated with HIPAA, as well as the increase in paperwork and the cost of its implementation, were causes for concern among physicians and medical centers. Many of those concerns were expressed in an August 2006 paper published in the journal Annals of Internal Medicine.[13] It mentioned a University of Michigan study that demonstrated how the implementation of the HIPAA Privacy rule resulted in a drop from 96 percent to 34 percent in the proportion of follow-up surveys completed by study patients being followed after a heart attack.[14] \nBy 2013, views on the impact of HIPAA were mixed. Leon Rodriguez, director of the HHS' Office for Civil Rights said of HIPAA:\n\nWhereas many thought HIPAA would \"bankrupt\" healthcare, shut down research, and otherwise paralyze the industry, instead the industry has learned the benefits of the transaction and code set standards through the ease of electronic transactions. And the balance of the [HIPAA] Privacy and Security protections have paved the way to real benefits for consumers through greater access to quality care.[11] \nIn an article for the Houston Chronicle, writer and business consultant Lisa Dorward stated the following for patients requesting personal health information:\n\nDirect cost to patients is minimal; health care institutions can charge the patient only for copying and postage costs for delivery of the documents. On the other hand, costs to health care providers are high and can strain already overburdened budgets. Some clinics and hospitals have had to reconstruct or remodel existing registration areas to comply with HIPAA's privacy regulations.[15] \nWriting for the Loyola Consumer Law Review, attorney and legal writer Anna Colvert wrote:\n\nGenerally, HIPAA is considered a step in the right direction regarding patient privacy, and it has resulted in more descriptive and detailed privacy policies; however, it has not improved the online privacy practices of these organizations. While HIPAA is a solid foundation in protecting patients\u2019 healthcare information there is more work to be done...\"[16] \nA May 2013 Computerworld reported on a survey conducted by the Ponemon Institute that found 51 percent of respondents believed \"HIPAA compliance requirements can be a barrier to providing effective patient care\" and 59 percent \"cited the complexity of HIPAA requirements as a major barrier to modernizing the healthcare system.\"[17]\n\nAudit guidelines and checklist \nMain article: Health Insurance Portability and Accountability Act\/Audit guidelines and checklist\nFor those auditing computer systems and IT environments for their compliance with the Health Insurance Portability and Accountability Act and other regulations, a set of guidelines and checklist items may be useful. \n\r\n\nClick the link above for the full set of guidelines and checklist items as they relate to HIPAA.\n\nFurther reading \n \"Public Law 104 - 191 - Health Insurance Portability and Accountability Act of 1996\". U.S. Government Publishing Office. http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-104publ191\/content-detail.html .   \n \"S. 1028 (104th): Health Insurance Reform Act of 1995\". GovTrack.us. Civic Impulse, LLC. https:\/\/www.govtrack.us\/congress\/bills\/104\/s1028 .   \n \"Bill Makes Health Insurance \u2018Portable\u2019\". CQ Almanac 1996 52: 6-28\u20136-39. 1997. http:\/\/library.cqpress.com\/cqalmanac\/document.php?id=cqal96-1092479 .   \nReferences \n\n\n\u2191 1.0 1.1 1.2 \"Public Law 104 - 191 - Health Insurance Portability and Accountability Act of 1996\". U.S. Government Publishing Office. http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-104publ191\/content-detail.html . Retrieved 11 February 2015 .   \n\n\u2191 2.0 2.1 2.2 2.3 \"Bill Makes Health Insurance \u2018Portable\u2019\". CQ Almanac 1996 52: 6-28\u20136-39. 1997. http:\/\/library.cqpress.com\/cqalmanac\/document.php?id=cqal96-1092479 . Retrieved 12 February 2015 .   \n\n\u2191 \"S. 1028 (104th): Health Insurance Reform Act of 1995\". GovTrack.us. Civic Impulse, LLC. https:\/\/www.govtrack.us\/congress\/bills\/104\/s1028 . Retrieved 12 February 2015 .   \n\n\u2191 4.0 4.1 Hiebert-White, Jane (September-October 1996). \"Who Won What in the Kassebaum\/Kennedy Struggle?\" (PDF). Health Progress 77 (5). https:\/\/www.chausa.org\/docs\/default-source\/health-progress\/health-policy---who-won-what-in-the-kassebaumkennedy-struggle-pdf.pdf?sfvrsn=0 . Retrieved 12 February 2015 .   \n\n\u2191 Starr, Paul (22 August 1996). \"The Signing of the Kennedy-Kassebaum Bill\". The Electronic Policy Network. Archived from the original on 29 January 1998. https:\/\/web.archive.org\/web\/19980129180414\/http:\/\/epn.org\/library\/signing.html . Retrieved 12 February 2015 .   \n\n\u2191 6.0 6.1 6.2 Institute of Medicine (US) Committee on Health Research and the Privacy of Health Information: The HIPAA Privacy Rule (2009). Nass, S. J.; Levit, L. A.; Gostin, L. O.. ed. Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research. National Academies Press. Bookshelf ID NBK9576. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK9576\/ . Retrieved 12 February 2015 .   \n\n\u2191 \"The Privacy Rule\". U.S. Department of Health and Human Services. http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/administrative\/privacyrule\/ . Retrieved 12 February 2015 .   \n\n\u2191 8.0 8.1 Stein, Rob (5 June 2006). \"Medical Privacy Law Nets No Fines\". The Washington Post. http:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2006\/06\/04\/AR2006060400672.html . Retrieved 28 February 2012 .   \n\n\u2191 9.0 9.1 \"The HIPAA Enforcement Rule\". U.S. Department of Health and Human Services. http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/administrative\/enforcementrule\/index.html . Retrieved 12 February 2015 .   \n\n\u2191 Office for Civil Rights, Department of Health and Human Services (25 January 2013). \"Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules\" (PDF). Federal Register 78 (17). http:\/\/www.gpo.gov\/fdsys\/pkg\/FR-2013-01-25\/pdf\/2013-01073.pdf . Retrieved 12 February 2015 .   \n\n\u2191 11.0 11.1 Solove, Daniel J. (April 2013). \"HIPAA Turns 10: Analyzing the Past, Present and Future Impact\". Journal of AHIMA 84 (4): 22\u201328. http:\/\/library.ahima.org\/xpedio\/groups\/public\/documents\/ahima\/bok1_050149.hcsp?dDocName=bok1_050149 . Retrieved 11 February 2015 .   \n\n\u2191 12.0 12.1 12.2 \"Enforcement Highlights\". U.S. Department of Health and Human Services. 15 January 2015. Archived from the original on 11 February 2015. https:\/\/web.archive.org\/web\/20150211170207\/http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/enforcement\/highlights\/index.html . Retrieved 11 February 2015 .   \n\n\u2191 Wilson, Jennifer Fisher (2006). \"Health Insurance Portability and Accountability Act Privacy Rule Causes Ongoing Concerns among Clinicians and Researchers\". Annals of Internal Medicine 145 (4): 313\u20136. doi:10.7326\/0003-4819-145-4-200608150-00019. PMID 16908928.   \n\n\u2191 Armstrong, David; Kline-Rogers, Eva; Jani, Sandeep M.; Goldman, Edward B.; Fang, Jianming; Mukherjee, Debabrata; Nallamothu, Brahmajee N.; Eagle, Kim A. (2005). \"Potential Impact of the HIPAA Privacy Rule on Data Collection in a Registry of Patients With Acute Coronary Syndrome\". Archives of Internal Medicine 165 (10): 1125\u20139. doi:10.1001\/archinte.165.10.1125. PMID 15911725. http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=486568 . Retrieved 11 February 2015 .   \n\n\u2191 Dorward, Lisa. \"The Positive and Negative Effects of HIPAA Employment Laws\". Houston Chronicle. Hearst Newspapers, LLC. http:\/\/smallbusiness.chron.com\/positive-negative-effects-hipaa-employment-laws-18500.html . Retrieved 11 February 2015 .   \n\n\u2191 Colvert, Anna (2013). \"HIPAA'S Influence on Consumers: Friend or Foe?\". Loyola Consumer Law Review 25 (4): 431\u2013447. http:\/\/lawecommons.luc.edu\/lclr\/vol25\/iss4\/6\/ . Retrieved 11 February 2015 .   \n\n\u2191 Mearian, Lucas (07 May 2013). \"HIPAA rules, outdated tech cost U.S. hospitals $8.3B a year\". Computerworld.com. Computerworld, Inc. http:\/\/www.computerworld.com\/article\/2496995\/healthcare-it\/hipaa-rules--outdated-tech-cost-u-s--hospitals--8-3b-a-year.html . Retrieved 11 February 2015 .   \n\n\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Health_Insurance_Portability_and_Accountability_Act\">https:\/\/www.limswiki.org\/index.php\/Health_Insurance_Portability_and_Accountability_Act<\/a>\n\t\t\t\t\tCategories: Health informaticsHealth standardsRegulatory information\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 20:55.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 19,205 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","b70673a0117c21576016cb7498867153_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Health_Insurance_Portability_and_Accountability_Act skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Health Insurance Portability and Accountability Act<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"floatright\"><a href=\"https:\/\/www.limswiki.org\/index.php\/File:HIPAA_Screenshot.png\" class=\"image wiki-link\" target=\"_blank\" data-key=\"f43d76e7dcca207ca031bdff3314d856\"><img alt=\"HIPAA Screenshot.png\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/6\/66\/HIPAA_Screenshot.png\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a><\/div>\n<p>The <b>Health Insurance Portability and Accountability Act of 1996<\/b> (<b>HIPAA<\/b>) was enacted by the United States Congress and signed by President Bill Clinton in 1996. Its intended purpose was \"to improve portability and continuity of health insurance coverage in the group and individual markets; to combat waste, fraud, and abuse in health insurance and health care delivery; to promote the use of medical savings accounts; to improve access to long-term care services and coverage; [and] to simplify the administration of health insurance.\"<sup id=\"rdp-ebb-cite_ref-HIPAAGPO_1-0\" class=\"reference\"><a href=\"#cite_note-HIPAAGPO-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Initial\">Initial<\/span><\/h3>\n<p>In 1994, U.S. President Bill Clinton attempted to overhaul the national health care system but didn't receive the support he needed. In 1995, Senators Nancy Kassebaum (R-KS) and Edward Kennedy (D-MA) introduced a comparatively pared down proposal called the Health Insurance Reform Act of 1995 (S 11028), later referred to informally as the Kassebaum\/Kennedy Bill. The proposal called for health insurance portability for employees, medical savings accounts, increased deductibility of health insurance for the self-employed, and tax breaks for long-term care insurance.<sup id=\"rdp-ebb-cite_ref-CQHIPAAHist_2-0\" class=\"reference\"><a href=\"#cite_note-CQHIPAAHist-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11028Legal_3-0\" class=\"reference\"><a href=\"#cite_note-11028Legal-3\" rel=\"external_link\">[3]<\/a><\/sup> The legislation successfully made it out of the Senate Labor and Human Resources Committee on August 2, 1995<sup id=\"rdp-ebb-cite_ref-HiebertHIPAA_4-0\" class=\"reference\"><a href=\"#cite_note-HiebertHIPAA-4\" rel=\"external_link\">[4]<\/a><\/sup>, only to be stalled \"because of opposition from conservative senators who shared industry concerns over the group-to-individual portability provisions.\"<sup id=\"rdp-ebb-cite_ref-CQHIPAAHist_2-1\" class=\"reference\"><a href=\"#cite_note-CQHIPAAHist-2\" rel=\"external_link\">[2]<\/a><\/sup> \n<\/p><p>With desire to get some sort of health care reform legislation passed, Clinton referenced the stalled bill in his January 1996 State of the Union address on several occasions. Though some feared the ploy by Clinton would ultimately sink the bill, it inevitably resulted in bipartisan cooperation so no one side could take credit for the bill.<sup id=\"rdp-ebb-cite_ref-HiebertHIPAA_4-1\" class=\"reference\"><a href=\"#cite_note-HiebertHIPAA-4\" rel=\"external_link\">[4]<\/a><\/sup> On February 7, 1996, the two parties agreed to further discuss the legislation in the House and Senate. This resulted in several events: the House of Representatives created an alternative bill (HR 3103) that drew on characteristics of S 11028, passing on March 28; the Senate passed a version of the original S 11028 on April 23 but without controversial attachments like medical savings accounts. However, differences between the House and Senate bills caused problems. \"The House bill, for example, included provisions allowing for medical savings accounts, a limit on monetary damages in medical malpractice lawsuits and a reduction in states' authority to regulate health insurance purchasing pools created by small businesses.\"<sup id=\"rdp-ebb-cite_ref-CQHIPAAHist_2-2\" class=\"reference\"><a href=\"#cite_note-CQHIPAAHist-2\" rel=\"external_link\">[2]<\/a><\/sup> Additionally, a provision on mental health coverage was found on the Senate bill that was omitted from the House version. It took several weeks of debating to make concessions on these topics. \n<\/p><p>A Republican-led compromise was offered on June 10, however debate raged on. It wasn't until a July 25 compromise between Kennedy and Ways and Means Committee Chairman Bill Archer (R-TX) on medical savings accounts that momentum shifted. Provisions on mental illness and medical malpractice were eventually dropped from the proposal on July 31, with both House and Senate agreeing on the final version on August 1 and August 2 respectively.<sup id=\"rdp-ebb-cite_ref-CQHIPAAHist_2-3\" class=\"reference\"><a href=\"#cite_note-CQHIPAAHist-2\" rel=\"external_link\">[2]<\/a><\/sup> On August 21, 1996, the legislation was signed into law by President Clinton and codified as Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA).<sup id=\"rdp-ebb-cite_ref-StarrHIPAA_5-0\" class=\"reference\"><a href=\"#cite_note-StarrHIPAA-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-HIPAAGPO_1-1\" class=\"reference\"><a href=\"#cite_note-HIPAAGPO-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Amendments\">Amendments<\/span><\/h3>\n<p>The administrative simplification provisions in HIPAA meant more work had to be done in regards to the legislation. The <a href=\"https:\/\/www.limswiki.org\/index.php\/United_States_Department_of_Health_and_Human_Services\" title=\"United States Department of Health and Human Services\" target=\"_blank\" class=\"wiki-link\" data-key=\"efa106bcbb93039b1a6c3c596daedec3\">U.S. Department of Health and Human Services<\/a> (HHS) began work on the HIPAA Privacy Rule in 1999, \"which set out detailed regulations regarding the types of uses and disclosures of personally identifiable health information that are permitted by the covered entities.\"<sup id=\"rdp-ebb-cite_ref-PrivRule_6-0\" class=\"reference\"><a href=\"#cite_note-PrivRule-6\" rel=\"external_link\">[6]<\/a><\/sup> However, large volumes of comments and Executive branch changes in 2000 slowed the process down.<sup id=\"rdp-ebb-cite_ref-PrivRule_6-1\" class=\"reference\"><a href=\"#cite_note-PrivRule-6\" rel=\"external_link\">[6]<\/a><\/sup> Several more years of corrections and requests for comments followed, culminating in the release of the Final Rule on August 14, 2002 as 45 CFR Part 160 and Subparts A and E of Part 164.<sup id=\"rdp-ebb-cite_ref-HHSFinalPriv_7-0\" class=\"reference\"><a href=\"#cite_note-HHSFinalPriv-7\" rel=\"external_link\">[7]<\/a><\/sup> Most health plans were expected to be in compliance by April 14, 2003, though some exceptions existed.\n<\/p><p>Despite the Privacy Rule, many still argued that the legislation wasn't suitable enough to prevent mishandling of personal health information and that it was impeding research.<sup id=\"rdp-ebb-cite_ref-PrivRule_6-2\" class=\"reference\"><a href=\"#cite_note-PrivRule-6\" rel=\"external_link\">[6]<\/a><\/sup> These concerns mixed with few incidents of enforcement in the first few years after the 2003 compliance date prompted additional review by the HHS.<sup id=\"rdp-ebb-cite_ref-SteinFines_8-0\" class=\"reference\"><a href=\"#cite_note-SteinFines-8\" rel=\"external_link\">[8]<\/a><\/sup> On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement, to be effective March 16, 2006.<sup id=\"rdp-ebb-cite_ref-HHSEnfo_9-0\" class=\"reference\"><a href=\"#cite_note-HHSEnfo-9\" rel=\"external_link\">[9]<\/a><\/sup> \n<\/p><p>Additional updates to the enforcement rule came with the <a href=\"https:\/\/www.limswiki.org\/index.php\/Health_Information_Technology_for_Economic_and_Clinical_Health_Act\" title=\"Health Information Technology for Economic and Clinical Health Act\" target=\"_blank\" class=\"wiki-link\" data-key=\"89c9e20984bbda2e628b6d1d28ec3ad5\">Health Information Technology for Economic and Clinical Health Act<\/a> (HITECH) Act, enacted on February 17, 2009. The Act added \"several provisions that strengthen the civil and criminal enforcement of the HIPAA rules\" by adding categories of violations and tier levels of penalty amounts.<sup id=\"rdp-ebb-cite_ref-HHSEnfo_9-1\" class=\"reference\"><a href=\"#cite_note-HHSEnfo-9\" rel=\"external_link\">[9]<\/a><\/sup> HIPAA and the HITECH statutes were further revised in January 2013 (effective March 26, 2013) \"to strengthen the privacy and security protection for individuals\u2019 health information,\" update the Breach Notification Rule, \"strengthen the privacy protections for genetic information,\" and revise other portions of HIPAA rules \"to improve their workability and effectiveness.\"<sup id=\"rdp-ebb-cite_ref-FR01073_10-0\" class=\"reference\"><a href=\"#cite_note-FR01073-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Structure\">Structure<\/span><\/h2>\n<p>HIPAA is divided into five titles, each with their own subtitles<sup id=\"rdp-ebb-cite_ref-HIPAAGPO_1-2\" class=\"reference\"><a href=\"#cite_note-HIPAAGPO-1\" rel=\"external_link\">[1]<\/a><\/sup>:\n<\/p><p><b>Title I<\/b>: Health Care Access, Portability, and Renewability\n<\/p>\n<dl><dd>Subtitle A - Group Market Rules<\/dd>\n<dd>Subtitle B - Individual Market Rules<\/dd>\n<dd>Subtitle C - General and Miscellaneous Provisions<\/dd><\/dl>\n<p><b>Title II<\/b>: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform\n<\/p>\n<dl><dd>Subtitle A - Fraud and Abuse Control Program<\/dd>\n<dd>Subtitle B - Revisions to Current Sanctions for Fraud and Abuse<\/dd>\n<dd>Subtitle C - Data Collection<\/dd>\n<dd>Subtitle D - Civil Monetary Penalties<\/dd>\n<dd>Subtitle E - Revisions to Criminal Law<\/dd>\n<dd>Subtitle F - Administrative Simplification<\/dd>\n<dd>Subtitle G - Duplication and Coordination of Medicare-Related Plans<\/dd><\/dl>\n<p><b>Title III<\/b>: Tax-Related Health Provisions\n<\/p>\n<dl><dd>Subtitle A - Medical Savings Accounts<\/dd>\n<dd>Subtitle B - Increase in Deduction for Health Insurance Costs of Self-Employed Individuals<\/dd>\n<dd>Subtitle C - Long-Term Care Services and Contracts<\/dd>\n<dd>Subtitle D - Treatment of Accelerated Death Benefits<\/dd>\n<dd>Subtitle E - State Insurance Pools<\/dd>\n<dd>Subtitle F - Organizations Subject to Section 833<\/dd>\n<dd>Subtitle G - IRA Distributions to the Unemployed<\/dd>\n<dd>Subtitle H - Organ and Tissue Donation Information Included With Income Tax Refund Payments<\/dd><\/dl>\n<p><b>Title IV<\/b>: Application and Enforcement of Group Health Plan Requirements\n<\/p>\n<dl><dd>Subtitle A - Application and Enforcement of Group Health Plan Requirements<\/dd>\n<dd>Subtitle B - Clarification of Certain Continuation Coverage Requirements<\/dd><\/dl>\n<p><b>Title V<\/b>: Revenue Offsets\n<\/p>\n<dl><dd>Subtitle A - Company-Owned Life Insurance<\/dd>\n<dd>Subtitle B - Treatment of Individuals Who Lose United States Citizenship<\/dd>\n<dd>Subtitle C - Repeal of Financial Institution Transition Rule to Interest Allocation Rules<\/dd><\/dl>\n<h3><span class=\"mw-headline\" id=\"Description\">Description<\/span><\/h3>\n<p>Title I of HIPAA contains three subtitles that protect health insurance coverage for workers and their families when they change or lose their jobs. \n<\/p><p>Title II of HIPAA contains seven subtitles. One of the most important for expanding HIPAA is Subtitle F, the Administrative Simplification (AS) provisions, requiring the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Title II also addresses the security and privacy of health data, with the intent of improving the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the U.S. health care system.\n<\/p><p>Title III of HIPAA modifies the Internal Revenue Code (IRC) to revise available tax deductions for health insurance, clarify how pre-tax money could be applied health payments, and regulate long-term care services and how they're contracted. Other tax-related issues like IRA distribution and organ donor tax refund payments are covered by this title, in total spread out over eight subtitles.\n<\/p><p>Title IV of HIPAA modifies both the IRC and the Public Health Service Act (PHSA) to describe requirements for and enforcement of how group health plans could legally manage and cover patients' pre-existing conditions as well as their continuation of coverage. This information is supplied over two subtitles.\n<\/p><p>Title V of HIPAA contains three subtitles that amend the IRC concerning miscellaneous issues such as interest deductions on loans related to company-owned life insurance, how individuals who lose their U.S. citizenship shall be treated tax-wise, and the removal of certain limitations on interest allocation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Enforcement\">Enforcement<\/span><\/h2>\n<p>On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement. It became effective on March 16, 2006. The Enforcement Rule set civil money penalties for violating HIPAA rules and established procedures for investigations and hearings for HIPAA violations. Before the enforcement rule, the deterrent effects of the legislation seemed negligible, with few prosecutions for violations.<sup id=\"rdp-ebb-cite_ref-SteinFines_8-1\" class=\"reference\"><a href=\"#cite_note-SteinFines-8\" rel=\"external_link\">[8]<\/a><\/sup> Enforcement operations were ratcheted up further with the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009, which greatly increased the financial penalties that could be applied to entities in non-compliance.<sup id=\"rdp-ebb-cite_ref-Solove10_11-0\" class=\"reference\"><a href=\"#cite_note-Solove10-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>By the end of 2014, the U.S. Department of Health and Human Resources (HHS) reported investigating 106,522 HIPAA complaints against national pharmacy chains, major health care centers, insurance groups, hospital chains and other small providers since April 2003. The HHS reported 23,314 of those cases had been resolved by requiring changes in privacy practice or by corrective action. 10,566 cases were investigated and found that HIPAA was followed correctly. Another 68,412 cases were found to be ineligible for enforcement because, for example, a violation occurred before HIPAA became effective, a case was withdrawn by the pursuer, or an activity did not actually violate the rules.<sup id=\"rdp-ebb-cite_ref-HHSEnforceArch_12-0\" class=\"reference\"><a href=\"#cite_note-HHSEnforceArch-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>According to the HHS, the most commonly investigated compliance issue, by order of frequency, have been<sup id=\"rdp-ebb-cite_ref-HHSEnforceArch_12-1\" class=\"reference\"><a href=\"#cite_note-HHSEnforceArch-12\" rel=\"external_link\">[12]<\/a><\/sup>:\n<\/p>\n<ol><li> incorrectly used or revealed protected health information (PHI);<\/li>\n<li> insufficient protection mechanisms for PHI;<\/li>\n<li> insufficient mechanisms for patients to access their PHI;<\/li>\n<li> insufficient administrative protections and tools for managing electronic PHI; and<\/li>\n<li> usage and disclosure of more PHI than minimally necessary.<\/li><\/ol>\n<p>The HHS also stated the entities most likely to be responsible for infractions, by order of frequency, have been<sup id=\"rdp-ebb-cite_ref-HHSEnforceArch_12-2\" class=\"reference\"><a href=\"#cite_note-HHSEnforceArch-12\" rel=\"external_link\">[12]<\/a><\/sup>:\n<\/p>\n<ol><li> private practices;<\/li>\n<li> general hospitals;<\/li>\n<li> outpatient facilities;<\/li>\n<li> pharmacies; and<\/li>\n<li> health plans (group health plans and health insurance issuers).<\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"Assessed_impact\">Assessed impact<\/span><\/h2>\n<p>The enactment of HIPAA caused major changes in the way physicians and medical centers operate. The complex legalities and potentially stiff penalties associated with HIPAA, as well as the increase in paperwork and the cost of its implementation, were causes for concern among physicians and medical centers. Many of those concerns were expressed in an August 2006 paper published in the journal <i>Annals of Internal Medicine<\/i>.<sup id=\"rdp-ebb-cite_ref-WilsonAnnals_13-0\" class=\"reference\"><a href=\"#cite_note-WilsonAnnals-13\" rel=\"external_link\">[13]<\/a><\/sup> It mentioned a University of Michigan study that demonstrated how the implementation of the HIPAA Privacy rule resulted in a drop from 96 percent to 34 percent in the proportion of follow-up surveys completed by study patients being followed after a heart attack.<sup id=\"rdp-ebb-cite_ref-Armstrong_14-0\" class=\"reference\"><a href=\"#cite_note-Armstrong-14\" rel=\"external_link\">[14]<\/a><\/sup> \n<\/p><p>By 2013, views on the impact of HIPAA were mixed. Leon Rodriguez, director of the HHS' Office for Civil Rights said of HIPAA:\n<\/p>\n<blockquote>Whereas many thought HIPAA would \"bankrupt\" healthcare, shut down research, and otherwise paralyze the industry, instead the industry has learned the benefits of the transaction and code set standards through the ease of electronic transactions. And the balance of the [HIPAA] Privacy and Security protections have paved the way to real benefits for consumers through greater access to quality care.<sup id=\"rdp-ebb-cite_ref-Solove10_11-1\" class=\"reference\"><a href=\"#cite_note-Solove10-11\" rel=\"external_link\">[11]<\/a><\/sup><\/blockquote> \n<p>In an article for the <i>Houston Chronicle<\/i>, writer and business consultant Lisa Dorward stated the following for patients requesting personal health information:\n<\/p>\n<blockquote>Direct cost to patients is minimal; health care institutions can charge the patient only for copying and postage costs for delivery of the documents. On the other hand, costs to health care providers are high and can strain already overburdened budgets. Some clinics and hospitals have had to reconstruct or remodel existing registration areas to comply with HIPAA's privacy regulations.<sup id=\"rdp-ebb-cite_ref-DorwardHIPAA_15-0\" class=\"reference\"><a href=\"#cite_note-DorwardHIPAA-15\" rel=\"external_link\">[15]<\/a><\/sup><\/blockquote> \n<p>Writing for the <i>Loyola Consumer Law Review<\/i>, attorney and legal writer Anna Colvert wrote:\n<\/p>\n<blockquote>Generally, HIPAA is considered a step in the right direction regarding patient privacy, and it has resulted in more descriptive and detailed privacy policies; however, it has not improved the online privacy practices of these organizations. While HIPAA is a solid foundation in protecting patients\u2019 healthcare information there is more work to be done...\"<sup id=\"rdp-ebb-cite_ref-Colvert_16-0\" class=\"reference\"><a href=\"#cite_note-Colvert-16\" rel=\"external_link\">[16]<\/a><\/sup><\/blockquote> \n<p>A May 2013 <i>Computerworld<\/i> reported on a survey conducted by the Ponemon Institute that found 51 percent of respondents believed \"HIPAA compliance requirements can be a barrier to providing effective patient care\" and 59 percent \"cited the complexity of HIPAA requirements as a major barrier to modernizing the healthcare system.\"<sup id=\"rdp-ebb-cite_ref-Mearian_17-0\" class=\"reference\"><a href=\"#cite_note-Mearian-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Audit_guidelines_and_checklist\">Audit guidelines and checklist<\/span><\/h2>\n<div class=\"rellink relarticle mainarticle\">Main article: <a href=\"https:\/\/www.limswiki.org\/index.php\/Health_Insurance_Portability_and_Accountability_Act\/Audit_guidelines_and_checklist\" title=\"Health Insurance Portability and Accountability Act\/Audit guidelines and checklist\" target=\"_blank\" class=\"wiki-link\" data-key=\"696695ca2ef0d0aa853c4e3efba250c4\">Health Insurance Portability and Accountability Act\/Audit guidelines and checklist<\/a><\/div>\n<p>For those auditing computer systems and IT environments for their compliance with the Health Insurance Portability and Accountability Act and other regulations, a set of guidelines and checklist items may be useful. \n<br \/>\n<\/p><p>Click the link above for the full set of guidelines and checklist items as they relate to HIPAA.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li> <span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-104publ191\/content-detail.html\" target=\"_blank\">\"Public Law 104 - 191 - Health Insurance Portability and Accountability Act of 1996\"<\/a>. U.S. Government Publishing Office<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-104publ191\/content-detail.html\" target=\"_blank\">http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-104publ191\/content-detail.html<\/a><\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Public+Law+104+-+191+-+Health+Insurance+Portability+and+Accountability+Act+of+1996&rft.atitle=&rft.pub=U.S.+Government+Publishing+Office&rft_id=http%3A%2F%2Fwww.gpo.gov%2Ffdsys%2Fpkg%2FPLAW-104publ191%2Fcontent-detail.html&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/li>\n<li> <span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.govtrack.us\/congress\/bills\/104\/s1028\" target=\"_blank\">\"S. 1028 (104th): Health Insurance Reform Act of 1995\"<\/a>. <i>GovTrack.us<\/i>. Civic Impulse, LLC<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.govtrack.us\/congress\/bills\/104\/s1028\" target=\"_blank\">https:\/\/www.govtrack.us\/congress\/bills\/104\/s1028<\/a><\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=S.+1028+%28104th%29%3A+Health+Insurance+Reform+Act+of+1995&rft.atitle=GovTrack.us&rft.pub=Civic+Impulse%2C+LLC&rft_id=https%3A%2F%2Fwww.govtrack.us%2Fcongress%2Fbills%2F104%2Fs1028&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/li>\n<li> <span class=\"citation Journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/library.cqpress.com\/cqalmanac\/document.php?id=cqal96-1092479\" target=\"_blank\">\"Bill Makes Health Insurance \u2018Portable\u2019\"<\/a>. <i>CQ Almanac 1996<\/i> <b>52<\/b>: 6-28\u20136-39. 1997<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/library.cqpress.com\/cqalmanac\/document.php?id=cqal96-1092479\" target=\"_blank\">http:\/\/library.cqpress.com\/cqalmanac\/document.php?id=cqal96-1092479<\/a><\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Bill+Makes+Health+Insurance+%E2%80%98Portable%E2%80%99&rft.jtitle=CQ+Almanac+1996&rft.date=1997&rft.volume=52&rft.pages=6-28%E2%80%936-39&rft_id=http%3A%2F%2Flibrary.cqpress.com%2Fcqalmanac%2Fdocument.php%3Fid%3Dcqal96-1092479&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-HIPAAGPO-1\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-HIPAAGPO_1-0\" rel=\"external_link\">1.0<\/a><\/sup> <sup><a href=\"#cite_ref-HIPAAGPO_1-1\" rel=\"external_link\">1.1<\/a><\/sup> <sup><a href=\"#cite_ref-HIPAAGPO_1-2\" rel=\"external_link\">1.2<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-104publ191\/content-detail.html\" target=\"_blank\">\"Public Law 104 - 191 - Health Insurance Portability and Accountability Act of 1996\"<\/a>. U.S. Government Publishing Office<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-104publ191\/content-detail.html\" target=\"_blank\">http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-104publ191\/content-detail.html<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 11 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Public+Law+104+-+191+-+Health+Insurance+Portability+and+Accountability+Act+of+1996&rft.atitle=&rft.pub=U.S.+Government+Publishing+Office&rft_id=http%3A%2F%2Fwww.gpo.gov%2Ffdsys%2Fpkg%2FPLAW-104publ191%2Fcontent-detail.html&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-CQHIPAAHist-2\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-CQHIPAAHist_2-0\" rel=\"external_link\">2.0<\/a><\/sup> <sup><a href=\"#cite_ref-CQHIPAAHist_2-1\" rel=\"external_link\">2.1<\/a><\/sup> <sup><a href=\"#cite_ref-CQHIPAAHist_2-2\" rel=\"external_link\">2.2<\/a><\/sup> <sup><a href=\"#cite_ref-CQHIPAAHist_2-3\" rel=\"external_link\">2.3<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation Journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/library.cqpress.com\/cqalmanac\/document.php?id=cqal96-1092479\" target=\"_blank\">\"Bill Makes Health Insurance \u2018Portable\u2019\"<\/a>. <i>CQ Almanac 1996<\/i> <b>52<\/b>: 6-28\u20136-39. 1997<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/library.cqpress.com\/cqalmanac\/document.php?id=cqal96-1092479\" target=\"_blank\">http:\/\/library.cqpress.com\/cqalmanac\/document.php?id=cqal96-1092479<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 12 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Bill+Makes+Health+Insurance+%E2%80%98Portable%E2%80%99&rft.jtitle=CQ+Almanac+1996&rft.date=1997&rft.volume=52&rft.pages=6-28%E2%80%936-39&rft_id=http%3A%2F%2Flibrary.cqpress.com%2Fcqalmanac%2Fdocument.php%3Fid%3Dcqal96-1092479&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-11028Legal-3\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-11028Legal_3-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.govtrack.us\/congress\/bills\/104\/s1028\" target=\"_blank\">\"S. 1028 (104th): Health Insurance Reform Act of 1995\"<\/a>. <i>GovTrack.us<\/i>. Civic Impulse, LLC<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.govtrack.us\/congress\/bills\/104\/s1028\" target=\"_blank\">https:\/\/www.govtrack.us\/congress\/bills\/104\/s1028<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 12 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=S.+1028+%28104th%29%3A+Health+Insurance+Reform+Act+of+1995&rft.atitle=GovTrack.us&rft.pub=Civic+Impulse%2C+LLC&rft_id=https%3A%2F%2Fwww.govtrack.us%2Fcongress%2Fbills%2F104%2Fs1028&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HiebertHIPAA-4\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-HiebertHIPAA_4-0\" rel=\"external_link\">4.0<\/a><\/sup> <sup><a href=\"#cite_ref-HiebertHIPAA_4-1\" rel=\"external_link\">4.1<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Hiebert-White, Jane (September-October 1996). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.chausa.org\/docs\/default-source\/health-progress\/health-policy---who-won-what-in-the-kassebaumkennedy-struggle-pdf.pdf?sfvrsn=0\" target=\"_blank\">\"Who Won What in the Kassebaum\/Kennedy Struggle?\"<\/a> (PDF). <i>Health Progress<\/i> <b>77<\/b> (5)<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.chausa.org\/docs\/default-source\/health-progress\/health-policy---who-won-what-in-the-kassebaumkennedy-struggle-pdf.pdf?sfvrsn=0\" target=\"_blank\">https:\/\/www.chausa.org\/docs\/default-source\/health-progress\/health-policy---who-won-what-in-the-kassebaumkennedy-struggle-pdf.pdf?sfvrsn=0<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 12 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Who+Won+What+in+the+Kassebaum%2FKennedy+Struggle%3F&rft.jtitle=Health+Progress&rft.aulast=Hiebert-White%2C+Jane&rft.au=Hiebert-White%2C+Jane&rft.date=September-October+1996&rft.volume=77&rft.issue=5&rft_id=https%3A%2F%2Fwww.chausa.org%2Fdocs%2Fdefault-source%2Fhealth-progress%2Fhealth-policy---who-won-what-in-the-kassebaumkennedy-struggle-pdf.pdf%3Fsfvrsn%3D0&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-StarrHIPAA-5\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-StarrHIPAA_5-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Starr, Paul (22 August 1996). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/19980129180414\/http:\/\/epn.org\/library\/signing.html\" target=\"_blank\">\"The Signing of the Kennedy-Kassebaum Bill\"<\/a>. The Electronic Policy Network. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/epn.org\/library\/signing.html\" target=\"_blank\">the original<\/a> on 29 January 1998<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/web.archive.org\/web\/19980129180414\/http:\/\/epn.org\/library\/signing.html\" target=\"_blank\">https:\/\/web.archive.org\/web\/19980129180414\/http:\/\/epn.org\/library\/signing.html<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 12 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=The+Signing+of+the+Kennedy-Kassebaum+Bill&rft.atitle=&rft.aulast=Starr%2C+Paul&rft.au=Starr%2C+Paul&rft.date=22+August+1996&rft.pub=The+Electronic+Policy+Network&rft_id=https%3A%2F%2Fweb.archive.org%2Fweb%2F19980129180414%2Fhttp%3A%2F%2Fepn.org%2Flibrary%2Fsigning.html&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-PrivRule-6\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-PrivRule_6-0\" rel=\"external_link\">6.0<\/a><\/sup> <sup><a href=\"#cite_ref-PrivRule_6-1\" rel=\"external_link\">6.1<\/a><\/sup> <sup><a href=\"#cite_ref-PrivRule_6-2\" rel=\"external_link\">6.2<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation book\">Institute of Medicine (US) Committee on Health Research and the Privacy of Health Information: The HIPAA Privacy Rule (2009). Nass, S. J.; Levit, L. A.; Gostin, L. O.. ed. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK9576\/\" target=\"_blank\"><i>Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research<\/i><\/a>. National Academies Press. Bookshelf ID NBK9576<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK9576\/\" target=\"_blank\">http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK9576\/<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 12 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Beyond+the+HIPAA+Privacy+Rule%3A+Enhancing+Privacy%2C+Improving+Health+Through+Research&rft.aulast=Institute+of+Medicine+%28US%29+Committee+on+Health+Research+and+the+Privacy+of+Health+Information%3A+The+HIPAA+Privacy+Rule&rft.au=Institute+of+Medicine+%28US%29+Committee+on+Health+Research+and+the+Privacy+of+Health+Information%3A+The+HIPAA+Privacy+Rule&rft.date=2009&rft.pub=National+Academies+Press&rft_id=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK9576%2F&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HHSFinalPriv-7\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-HHSFinalPriv_7-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/administrative\/privacyrule\/\" target=\"_blank\">\"The Privacy Rule\"<\/a>. U.S. Department of Health and Human Services<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/administrative\/privacyrule\/\" target=\"_blank\">http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/administrative\/privacyrule\/<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 12 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=The+Privacy+Rule&rft.atitle=&rft.pub=U.S.+Department+of+Health+and+Human+Services&rft_id=http%3A%2F%2Fwww.hhs.gov%2Focr%2Fprivacy%2Fhipaa%2Fadministrative%2Fprivacyrule%2F&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-SteinFines-8\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-SteinFines_8-0\" rel=\"external_link\">8.0<\/a><\/sup> <sup><a href=\"#cite_ref-SteinFines_8-1\" rel=\"external_link\">8.1<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation web\">Stein, Rob (5 June 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2006\/06\/04\/AR2006060400672.html\" target=\"_blank\">\"Medical Privacy Law Nets No Fines\"<\/a>. The Washington Post<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2006\/06\/04\/AR2006060400672.html\" target=\"_blank\">http:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2006\/06\/04\/AR2006060400672.html<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 28 February 2012<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Medical+Privacy+Law+Nets+No+Fines&rft.atitle=&rft.aulast=Stein%2C+Rob&rft.au=Stein%2C+Rob&rft.date=5+June+2006&rft.pub=The+Washington+Post&rft_id=http%3A%2F%2Fwww.washingtonpost.com%2Fwp-dyn%2Fcontent%2Farticle%2F2006%2F06%2F04%2FAR2006060400672.html&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HHSEnfo-9\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-HHSEnfo_9-0\" rel=\"external_link\">9.0<\/a><\/sup> <sup><a href=\"#cite_ref-HHSEnfo_9-1\" rel=\"external_link\">9.1<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/administrative\/enforcementrule\/index.html\" target=\"_blank\">\"The HIPAA Enforcement Rule\"<\/a>. U.S. Department of Health and Human Services<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/administrative\/enforcementrule\/index.html\" target=\"_blank\">http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/administrative\/enforcementrule\/index.html<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 12 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=The+HIPAA+Enforcement+Rule&rft.atitle=&rft.pub=U.S.+Department+of+Health+and+Human+Services&rft_id=http%3A%2F%2Fwww.hhs.gov%2Focr%2Fprivacy%2Fhipaa%2Fadministrative%2Fenforcementrule%2Findex.html&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-FR01073-10\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-FR01073_10-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Office for Civil Rights, Department of Health and Human Services (25 January 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/FR-2013-01-25\/pdf\/2013-01073.pdf\" target=\"_blank\">\"Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules\"<\/a> (PDF). <i>Federal Register<\/i> <b>78<\/b> (17)<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/FR-2013-01-25\/pdf\/2013-01073.pdf\" target=\"_blank\">http:\/\/www.gpo.gov\/fdsys\/pkg\/FR-2013-01-25\/pdf\/2013-01073.pdf<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 12 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Modifications+to+the+HIPAA+Privacy%2C+Security%2C+Enforcement%2C+and+Breach+Notification+Rules+Under+the+Health+Information+Technology+for+Economic+and+Clinical+Health+Act+and+the+Genetic+Information+Nondiscrimination+Act%3B+Other+Modifications+to+the+HIPAA+Rules&rft.jtitle=Federal+Register&rft.aulast=Office+for+Civil+Rights%2C+Department+of+Health+and+Human+Services&rft.au=Office+for+Civil+Rights%2C+Department+of+Health+and+Human+Services&rft.date=25+January+2013&rft.volume=78&rft.issue=17&rft_id=http%3A%2F%2Fwww.gpo.gov%2Ffdsys%2Fpkg%2FFR-2013-01-25%2Fpdf%2F2013-01073.pdf&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Solove10-11\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-Solove10_11-0\" rel=\"external_link\">11.0<\/a><\/sup> <sup><a href=\"#cite_ref-Solove10_11-1\" rel=\"external_link\">11.1<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Solove, Daniel J. 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Retrieved 11 February 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=HIPAA+Turns+10%3A+Analyzing+the+Past%2C+Present+and+Future+Impact&rft.jtitle=Journal+of+AHIMA&rft.aulast=Solove%2C+Daniel+J.&rft.au=Solove%2C+Daniel+J.&rft.date=April+2013&rft.volume=84&rft.issue=4&rft.pages=22%E2%80%9328&rft_id=http%3A%2F%2Flibrary.ahima.org%2Fxpedio%2Fgroups%2Fpublic%2Fdocuments%2Fahima%2Fbok1_050149.hcsp%3FdDocName%3Dbok1_050149&rfr_id=info:sid\/en.wikipedia.org:Health_Insurance_Portability_and_Accountability_Act\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-HHSEnforceArch-12\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-HHSEnforceArch_12-0\" rel=\"external_link\">12.0<\/a><\/sup> <sup><a href=\"#cite_ref-HHSEnforceArch_12-1\" rel=\"external_link\">12.1<\/a><\/sup> <sup><a href=\"#cite_ref-HHSEnforceArch_12-2\" rel=\"external_link\">12.2<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150211170207\/http:\/\/www.hhs.gov\/ocr\/privacy\/hipaa\/enforcement\/highlights\/index.html\" target=\"_blank\">\"Enforcement Highlights\"<\/a>. 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