CCE Theses and Dissertations

Information Privacy as Required By The Health Insurance Portability and Accountability Act of 1996 (HIPAA): Awareness and Barriers to Compliance as Experienced by Small Health Care Practitioners in Rural West Virginia

Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Graduate School of Computer and Information Sciences


Steven D. Zink

Committee Member

Marlyn Kemper Littman

Committee Member

James D. Cannady


Physicians have sworn to uphold patient trust and privacy since the time of Hypocrites. Given today's technological innovations and electronic access to medical information, an oath to uphold privacy is not enough. Unlike credit reports, educational records, and video rentals, there have been no U.S. federal privacy laws providing individuals the right to know how their medical records are used and disclosed. The Health Insurance Portability and Accountability Act of 1996 (HIP AA) mandated standards for the transmission of electronic health information and protection of that information by practitioners, health plans, clearinghouses, and pharmaceutical drug card sponsors who electronically process medical transactions. An estimated 400,000 small practitioners were required to comply with HIPAA. Small health care providers in rural West Virginia faced additional challenges. West Virginia is the second most rural state in the nation; has the oldest median age; is the only state to experience a natural decrease in population; ranks first in the percentage of residents on Medicare; placed lowest in median household income; and in 1998, SO of West Virginia's 55 counties were designated as Medically Underserved Areas.

The goals of this study were to promote HIP AA awareness, ascertain levels of HIP AA awareness, and identify barriers or issues that may have hindered those who perceive themselves as HIPAA privacy compliant. The descriptive research methodology was utilized to achieve these goals. Surveys were distributed to 408 licensed physicians in rural West Virginia. This study assessed if participants qualified as small, i.e., annual revenues of $5 million or less; if they were HIP AA covered entities; their HIP AA awareness level; and provided access to no-cost HIPAA training. The 78 HIPAA compliant respondents were asked to identify any barriers or issues they experienced while pursuing compliance. Vagueness of the regulations; confusion by physicians, patients, families, and the public; and the cost of compliance were identified as major concerns. This was consistent with findings in the literature. Results of this research were used to assist West Virginia officials address compliance barriers and identify remediation efforts the state could employ to assist in ongoing HIPAA, and other, legislated compliance efforts.

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