ELECTRONIC ARGMT RE PATIENT INFORMATION WITH BANNER HLTH.PDF

ELECTRONIC TRANSMISSION AGREEMENT
This ELECTRONIC TRANSMISSION AGREEMENT (the "Agreement") is made and entered into
this day of , 200_ by and between Banner Health, an Arizona nonprofit
corporation ("BR") and , a group consisting
of at least one physician licensed in who provides treatment to patients who
received or are receiving services at one or more hospitals (the "Physician Group").
RECITALS
A. BR is the custodian of certain confidential patient identifiable information available
electronically ("Patient Information").
B. Physician Group desires to access, and to permit its physicians, healthcare providers, and
employees ("Physician Group Members" or "Members") to access, Patient Information to
provide patient care services. BR is willing to undertake such transmission, subject to the
terms and conditions of this Agreement.
C. Physician Group has the required hardware (PC), software (Internet Browser), and
intemet access method (Internet Service Provider) to access Patient Information.
I. AGREEMENT
I. BR agrees to transmit electronically or permit electronic access to Patient Information in
accordance with this Agreement and to permit Physician Group to request IDs and
passwords as set forth herein.
2. Physician Group agrees to comply with, and ensure that Physician Group Members
comply with, this Agreement.
3. Physician Group has identified a Group Administrator and Sponsoring Physician. The
Physician Group will notify BR whenever there is a change in the Group Administrator or
Sponsoring Physician. The Sponsoring Physician, by his/her signature below, agrees to
accept responsibility for the activities of the Group Administrator and all Physician
Group Members. The Group Administrator, by his/her signature below, agrees to accept
responsibility for the activities of all Physician Group Members. The Sponsoring
Physician and/or Group Administrator will complete all training required by BR prior to
accessing, or permitting Physician Group Members to access, Patient Information.
4. If Physician Group desires any Member to have access to Patient Information, Group
Administrator may request for such Member a user ID and a password, both of which are
necessary to access Patient Information. Group Administrator will assign each Member
his/her own user ID and password. Group Administrator will review the terms of this
Agreement with each Member before permitting such Member to access Patient
Information. Group Administrator will authorize Members access to different
applications based upon such Member's need for Patient Information, and may delete or
limit such Members' access. Group Administrator will delete a Member's access when
such Member no longer requires access to Patient Information, including when such
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Member's affiliation with the Physician Group has terminated. Physician Group shall be
jointly responsible for such Member's compliance.
5. In order to ensure the confidential status of Patient Information, the Physician Group,
Group Administrator, and Sponsoring Physician each agree as follows:
(a) Members will only use the Patient Information when needed, and to the extent
necessary, in order to provide patient services to Physician Group's patients;
(b) Physician Group will protect the Patient Information from distribution, disclosure,
reproduction or dissemination in any manner to any person not authorized or
entitled by law to have access to such information;
(c) Physician Group will be responsible for ensuring that Members will not disclose,
distribute, reproduce or disseminate such information in any manner to any person
not authorized or entitled by law to have access to such information;
(d) Physician Group will limit access to Patient Information by Members to that
information necessary for such Members to perform their responsibilities;
Physician Group will immediately terminate access to those individuals who are
no longer Members or who no longer have a need to access Patient Information;
and
(f) Physician Group Members will not use any other person's user ID or password to
gain access to Patient Information, and Members will not share user ID or
password with any other user for any reason whatsoever.
6. BH may terminate the Physician Group's and/or any member's electronic access to
Patient Information at any time, with or without cause. In the event of any violation of
this Agreement or the Policy, BH may terminate such Member's and/or the Physician
Group's electronic access to Patient Information and may report such Member and/or the
Sponsoring Physician to the Medical Board or other state licensing body.
7. Physician Group agrees to indemnify and hold harmless BH for, from and against any and
all liabilities, damages, claims or losses incurred by BH as the result of any violation by
Physician Group or Physician Group. Members arising out of any violation of the
provisions of this Agreement including but not limited to, Paragraphs 4 and 5 hereof.
8. If Physician Group suspects that an unauthorized individual is obtaining unauthorized
access to Patient Information, Group Administrator will immediately request a change of
any suspected password by reporting the suspected abuse to the BH Information
Technology Help Desk at (602) 495-4444. (BH will log the incident and notify the
appropriate Group Administrator.)
9. This Agreement shall be effective upon signature by all parties and shall remain in effect
until terminated by either party for any reason by written notice to the other party;
provided however, that the provisions of Paragraphs 2, 5, 7 and 10 shall survive
termination of this Agreement. Any revisions of this Agreement shall be effective only
upon signature by all parties, and shall supersede all prior agreements.
10. Physician Group hereby agrees to comply with any BH rules, regulations and policies
implementing the Health Insurance Portability and Accountability Act (HIPAA)
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requirements whether now or hereafter existing. Should BH enact any policies or
determine that modifications to this Agreement are necessary, in order to comply with
HIPAA regulations or either party's obligations thereunder, then Physician Group agrees
to comply, and ensure that Physician Group Members comply, with such new policies or
modifications of which Physician Group is made aware, and agrees to execute any
necessary additional or replacement documents as reasonably requested by I3H in order to
achieve such compliance.
11. Physician Group and its agents shall cooperate with any Corporate Compliance program
now or hereafter instituted by BT-1.
12. MUTUTAL BENEFIT OF BOTH PARTIES. The parties acknowledge that there is no
monetary compensation duty created by this agreement, and further acknowledge that the
mutual, non-monetary benefits created by this agreement are actual and adequate
consideration for the purposes of this agreement.
13. HEALTHCARE FINANCING ADMINISTRATION. The parties hereto acknowledge
that the Omnibus Budget Reconciliation Act of 1989 (Stark I) and the Omnibus Budget
Reconciliation Act of 1993 (Stark II) restrict direct and indirect compensation
arrangements for physicians providing designated health services. If this agreement, or
any of the provisions contained in it are found to be in violation of Stark I or Stark II, or if
either party has reasonable belief that this contract might be in violation of Stark I or Stark
II, then that party may terminate this contract and such termination shall become effective
immediately.
PHYSICIAN GROUP
PHYSICIAN GROUP SPONSORING PHYSICIAN:
[Print Name:
Date:
PHYSICIAN GROUP ADMINISTRATOR:
[Print Name:
Date:
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BANNER HEALTH
By:
Title:
Date:
RETURN CONTRACT TO:
Andrew Balk
Information Technology
Banner Health
1441 N. 12th Street
Edwards Bldg
Phoenix, Arizona 85006
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Policy Title: Electronic Transmission
I. Purpose:
To enhance patient care by permitting medical staff members to access electronically such
members' Patient Information.
II. Policy:
1. BR may transmit electronically or permit electronic access to Patient Information upon
request of a medical staff member.
2. BR will utilize a secure encrypted internet connection, and will post the Patient
Information on a secure server or website maintained by BR Medical staff members are
responsible for acquiring required hardware (PC), software (Internet Browser), and
internet access method (Internet Service Provider).
3. Medical staff member will treat, and ensure. that his/her Agents treat, Patient Information
as confidential medical information to the extent required by applicable law and by the
Medical Staff Bylaws and Rules and Regulations. In order to ensure the confidential
status of Patient Information, the medical staff member agrees to and ensures that his/her
Agents will:
(a) Only access and use the Patient Information for Professional Use only;
(b) Refrain from accessing or using any patient information for any other purpose
other than Professional Use; and
(c) Not disclose or permit the disclosure of the Patient Information to anyone who is
not authorized or entitled, by BH policy or applicable law, to have access to
Patient Information.
4. Medical staff member will treat, and ensure that his/her Agents treat, user IDs and
passwords as the equivalent of legal signatures and will use such IDs and passwords for
Professional Use only. Medical staff member agrees:
(a) Not to use any other person's user ID or password to gain access to Patient
Information;
(b) Not to share his/her user ID or password for any reason whatsoever;
(c) To request a user ID and password for each of his/her Agents;
(d). To assume responsibility for the activities of each Agent relating to the access and
use of Patient Information;
(e) To notify the BH Help Desk immediately of the termination of any Agent or if any
Agent no longer is authorized by such medical staff member to access Patient
Information;
(1) To notify the BR Help Desk immediately of any suspected unauthorized or
inappropriate access or potential access.
5. In the event of any violation of this Policy by any medical staff member or such
member's Agent, BR may immediately terminate such member's and his/her Agents'
electronic access to Patient Information and may terminate all electronic transmissions of
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Patient Information. Such action is not in lieu of, and does not limit, appropriate
corrective action under Medical Staff Bylaws.
6. BR will contract with the medical staff member's billing and/or coding provider prior to
granting electronic access to Patient Information to employees of such provider. The
contract will require the billing and/or coding provider to comply, and ensure that its
employees comply, with this Policy and that any violation of this Policy may result in the
immediate termination of such provider's electronic access.
HI. Procedure / intervention(s):
1 BR will issue to each requesting medical staff member a user ID and a password, both of
which are necessary for such member to access the Patient Information. Medical staff
members may initiate assignment of a new user ID and password by contacting the BR
Help Desk or, in Colorado, by contacting Medical. Records,
2. If medical staff member desires that any Agent have access to Patient Information,
medical staff member shall contact BH Medical Staff Services to request a user ID and
password for such Agent. Medical .staff member shall be responsible for such Agent's
compliance with the terms of this Policy.
IV. Documentation (Documents & Forms):
V. Additional Information:
A. Definitions/Descriptions:
1, Agent is an employee of a medical staff member or such member's employer or
Professional Corporation or an employee of such medical staff member's billing
or coding service authorized by such medical staff member to access Patient
Information for Professional Use.
2. BR Help Desk is the BR Information Technology Help Desk, available at (907)
458-5460 (Alaska), (800) 424-8930 or (970) 350-6669 (Colorado) or (602) 495-
4444 (Arizona).
3. Medical staff member is defined as a member of any BR medical staff, including
allied health professionals.
4. Patient Information is defined as the medical staff member's patient identifiable
information stored electronically by BR.
5. Professional Use is defined as use of Patient Information when needed, and to the
extent necessary, to provide patient services to medical staff member's patients or
to bill for such services.
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C-86-14 ATTACHED TO AND A PART OF
Electronic Transmission Agreement
Banner Health, an Arizona non-profit
Corporation
IN WITNESS WHEREOF, the parties agree to enter into this Contract:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date