Despite all the talk about the relationship between PACS and digital imaging to the Health Insurance Portability and Accountability Act (HIPAA), a great deal of x-ray film is still being sold and used throughout the U.S. The recycling of that film can present patient-privacy concerns that need to be addressed as part of a facility’s HIPAA compliance effort.
Even if your clinic or hospital has gone digital, you probably have file film that needs to be recycled sometime in the future. If you are still using film, you also have scrap film that must be dealt with on a recurring basis.
As of April 14, 2003, film recycling must be performed in compliance with HIPAA's privacy rule. However, if your facility had a contract in place before October 15, 2002 with a recycler of x-ray film, you have until April 14, 2004 to have a new contract in place that includes all of the elements necessary to comply with HIPAA. An amendment to the present contract may also be added to put you in compliance with HIPAA.
Is a HIPAA-compliant contract enough?
It's important to understand how x-ray film has been recycled in the past. Typically, broker/silver service providers and x-ray film suppliers have recycled film. Brokers owned a much larger share of the market, as there was a lot of silver in film and on canisters to recycle.
Film suppliers made most of their money selling supplies, so they didn't concentrate on recycling as much. Whoever serviced the account would approach a clinic or hospital and ask to take care of its x-ray film/silver recycling needs. The company would put a contract in place that effectively gave it license to control the silver/x-ray film recycling for a certain number of years.
As it turns out, many of these services controlled the silver and film too well, returning to the institution only 10% to 15% of the total value recycled. The recycler is typically paid about 20%, with the broker or service pocketing the rest.
The situation has been allowed to continue in large part because of poor information available to the hospitals and clinics. Those who were smart enough or lucky enough to choose an x-ray film supplier for recycling received a much better return.
However, because of increasing bottom-line concerns, the market has changed, and more hospitals are switching to the people they already do business with, the x-ray film suppliers.
Shifting market
The industry has begun to evolve as the amount of silver on film and in recovery canisters has fallen. Dry laser films have eliminated the need for silver-recovery canisters, and the amount of money brokers and/or service providers can make has fallen dramatically in the last few years. As a result, many are getting out of the business.
The people that will service these accounts in the future will be the ones already in the hospitals delivering supplies or services, such as x-ray film suppliers. They can pick up the film and/or service the silver-recovering equipment for little or no additional expense. They are also very unlikely to do anything untoward with the x-ray film/silver recovered, as they wouldn’t want to do anything to upset a customer relationship.
Affected by these market dynamics, the recycling industry has consolidated. Very few recyclers are left, and not many can process dry laser film. As a result, you need to ask questions about where and how your film is being recycled:
- How does the service recycle dry laser film? A wet chemical process should be performed, rather than offsite burning.
- How does the recycler's HIPAA contract differ from the one posted on the OCR (Office of Civil Rights in the Department of Health and Human Services) Web site?
- Does the service use cyanide, enzyme, or a chemical process? The first two do not impact dry laser film.
- Is the customer permitted to inspect the facility at any time? A good recycler will say yes.
Older technologies do not destroy dry laser films, leaving behind protected health information (PHI) as defined by HIPAA. The use of cyanide, for example, can also open up possible legal issues. The hospitals and clinics should ask a number of questions before they turn over their film and/or silver to a broker or service, and pull out a HIPAA contract for the company to sign.
If the recycler can handle new films such as dry laser and is HIPAA-compliant, this information will usually be stated right on the provider's Web site. Caution should be exercised with any recycler that is not completely up-to-date on HIPAA requirements.
To find recyclers, try performing a Google search using key words such as "x-ray film," "recycle," and "HIPAA compliant." Call recyclers and ask who services accounts in your city.
A good large recycler should have at least one partner in each city and sometimes more, usually x-ray film suppliers. These recyclers should give you the best price for your film and silver, and will be very knowledgeable about HIPAA issues.
Contract matters
Standard contracts used today by hospitals and clinics to comply with HIPAA typically state that PHI will be stored electronically, and all information can be returned to the covered entity (CE) with five days written notice. This is not possible with old x-ray films, of course.
The provider should warrant that the material is not stored or used in any way other than to recycle the film, and that the PHI is completely destroyed. A good recycler has already submitted contracts to their partners that cover this matter, and a good service should offer you this contract.
If you are not offered a HIPAA-compliant x-ray film recycling contract by your present service, you may want to look for a new one, as anyone up to date on HIPAA knows that the standard contract from the OCR Web site is not appropriate for recycling.
Any reputable film recycler should be able to answer your questions. That's a good place to start.
By Jason BallAuntMinnie.com contributing writer
July 10, 2003
Jason Ball is a vice president at Petag Corporation, a Houston-based firm that provides x-ray film recycling services.
Related Reading
Smoothing the transition to filmless, June 16, 2003
Separating HIPAA facts from fiction, May 12, 2003
Web-based integration of PACS and RIS systems improves workflow, patient care, May 12, 2003
Iotronics to offer silver recycling technology for medical x-rays, February 4, 2003
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