Legal and Ethical Aspects of Health Information Management

Electronic health records are increasingly scrutinized because of the content of sensitive information such as security, confidentiality and privacy concerns with the emergence of electronic health records systems.  As health care changes new laws are becoming prevalent with regards to the ethical and legal rights of employees, patient’s, and facilities abilities to handle this information appropriately.

The Health Insurance Portability and Accountability Act (HIPAA) established on August 21, 1996 provided guidelines how private health information should be protected in paper and electronic format.  Although HIPAA was originally intended for paper records it has adopted the Privacy and Security rules to deal with the protection of electronic records.  The Privacy Rules regulates private health information (PHI) in oral, written, or electronic format for the purpose of “[meeting] the pressing need for national standards to control the flow of sensitive health information and to establish real penalties for the misuse or improper disclosure of this information” (Choi, 2006, Sec. Privacy Rule, para. 1).  The Security Rule however regulates only the protection of the electronic format.  The Security Rule addresses “PHI electronically stored or transmitted, must be kept confidential and protected against unauthorized users and threats to its security or integrity” (Choi, 2006, Sec. Security Rule, para. 1).  This establishes a minimum requirement of security that entities must meet. 

 

HIPAA Privacy Rule

HIPAA Security Rule

  

The development of HIPAA was not just for patient protection but also involved the billing and administrative procedures.  HIPAA was approved by congress in part to battle fraud and abuse; because of this approval it strengthened programs to fight the fraud and abuse in aggresive billing practices (McWay, 2010).

          Ethical issues related to health information arise from the pressures of releasing information, accidental system and employee HIPAA violations, and reimbursement issues.  It is the health information manager’s responsibility to understand and implement the appropriate security measures.  Federal and state laws determine the rules for the security and policy protocols but health information managers are bound by the American Health Information Management Association (AHIMA) code of ethics concerning electronic health records.  According to AHIMA health information managers are to advocate and uphold patients’ rights to privacy, uphold the security of the contents and information taking into account the applicable statutes and regulations, and most importantly ‘not to participate in or conceal unethical practices or procedures’. (McWay, 2010).  A popular trend today is risk management to assess the vulnerability of the organization.

Risk management trends are using information from databases to ‘predict’ and ‘avoid’ unforeseen circumstances; however today’s risk management includes not only direct patient care and safety but also reporting trends, database storage, and daily operations of facilities to ensure proper safety and guidance of associated risks while decreasing loss and liability (McWay, 2010). 

Improving patient care is one of the main focuses of confidentiality, privacy, security, and informed consent measures.  Federal, and state regulations as well as statutes guide the practice of these measures use in facilities.  The need for laws regarding their use has become a priority because of the increased use of electronic health records.  Confidentiality policies and improved security measures will provide patients the necessary information to access private care and treatment.

Thanks Chelley

 

References

Choi, Y. B., Capitan, K. E., Krause, J. S., & Streeper, M. M. (2006). Challenges associated with privacy in health care industry: Implementation of HIPAA and the security rules. Journal of Medical Systems, 30(1), 57-64. doi:http://dx.doi.org/10.1007/s10916-006-7405-0

U.S. Department of Health and Human Services (n.d.). HIPAA privacy rule. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.htm

U.S. Department of Health and Human Services (n.d.). HIPAA security rule. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html

McWay, D.C., JD, RHIA. (2010). Legal and ethical aspects of health information management (3rd ed.). Clifton Park, NY: Delmar-Cengage Learning. ISBN: 9781435483309.

Telecommunications and Networking in Health Care

         

          Computer science and telecommunications make it possible to achieve integrated health care.  Computers and networking offer health organizations an opportunity to provide excellent service to patients while decreasing costs due to streamlining operations.  Integrated health care will consist of merging these technologies to improve the delivery of health care.

            In the past patients needed to call the doctor’s office and make an appointment and then get to the doctor’s office for the appointments and check-ups.  Today telecommunications have played a vital role in changing this environment.  Telecommunication transmissions mean that a patient will have access to medical treatment or care no matter their location.  These services offer the capability of preventative medicine and monitoring of biomedical telemetry devices such as electronic stethoscope, digitized X-rays, microscopy, blood pressure monitoring and EKG strips.  Interactive video equipment can also provide patients with access to specialists and services not available in rural areas (Kennedy, 1995).  Telecommunications is not only for the use of medical care; videoconferencing and webinars have become the norm.  These are used to educate providers and staff without having to travel reducing time out of the office and travel expenses.  Physicians will have access to the most current health care information available through these interactive sessions according to Kennedy (1995) states “physicians also report that they have learned how to treat more cases through their collaboration with the specialists at the Medical College” (Sec. Hospital and Physicians, para 2).  Telecommunications have improved the face of health care by the ability to share information.

            Telecommunications and networking make it possible to share information.  Networking has provided the platform to integrate normally segregated areas into one unified sharing of information.  This is an example of how networking links all the different aspects of health care together for unified collaboration. 

Telecommunications and Networking (n.d.)

What objectives should be considered when selecting which networking solution to use?  Several factors should be considered:

·         evaluate and prioritize users’ networking goals

·         find networking solutions that support a variety of standards and the existing networking

·         Find a solution that compliments existing systems without having to replace them 

·         Networking that supports enterprise wide access so it is usable for future growth

·         Flexibility to third party users for the development of ‘special’ applications

·         Networks that allow access to all systems from a desktop device

(Hax, 1990).

These are some of the key features that must be considered for an organization to remain cost efficient and have room for future infrastructure growth.

            The delivery of health care is changing because of computer technology.  Telecommunication and networking infrastructures provide increased efficiencies and protocols for patient safety.  The objectives of merging these technologies with health care are to create continuity of care, uniformity, and patient safety, while this is being accomplished facilities are experiencing overall decreased costs for improved care.

Thanks Chelley      

References

Hax, M. A. (1990). Toward enterprise-wide networking. Computers in Healthcare, 11(11), 53. Retrieved from http://search.proquest.com/docview/195652421?accountid=32521     

Kennedy, M. (1995). The role of networking in the health care environment. Telecommunications, 29(9), 55. Retrieved from http://search.proquest.com/docview/210536518?accountid=32521   

Telecommunications and Networking Concepts (n.d.). Retrieved from http://hilp.blog.com/telecommunications-and-networking-concepts-for-health-care/

 

 

 

 

         

 

The Impact from Electronic Medical Records Integration

As the process of storing and retrieving patient information is changing from paper based records to electronic medical records, facilities are noticing very specific improvements in business operations and processes.  This impacts health organizations and patient treatment especially in rural communities where health care access may be limited.

The challenges that facilities face in implementing these systems is enormous and routinely underestimated.  Since the ‘top-down’ perspective assumes the improved benefits from an EMR the reality is there has not been much talk on ‘how’ to implement these integrations (Oneill, 2007).  The implementation of an EMR consists of a total business reprocess engineering effort.  This affects every aspect of a health care facility from top managers, employees, staffing, physicians, and billing.  Challenges that paper-based facilities encounter are that the paper record needs to be in two places at once.  Sharing of the information between departments is tedious and time consuming not to mention trying to track the paper chart throughout the facility.  At any given time employees from lab, diagnostic imaging, pharmacy or billing may need to access a patient’s chart simultaneously to get information for treatment.  This is one reason for electronic medical records integration.  The first step in the process is vendor selection.

Vendor selection is a critical part in starting the process for EMR implementation.  Vendor selection for a rural health care facility is a bigger challenge due to the lack of IT funding and ability to hire consultants.  An example of this is Dryden Family Medicine located in a rural community with only four staffed physicians.  They realized the need for an EMR but as with all health care facilities lacked funding.  Because of this they comprised a team of leader employees (with limited IT knowledge) to help select a vendor.  They came up with a list of priorities such as service, support, reliability, stability, and cost.  Using the resources they had available and researching trade journals and product reviews they selected a vendor they felt met their list of criteria (Oneill, 2007).  EMR implementation is usually done in stages to maximize benefits.

Benefits of an EMR video

            The first step in EMR implementation is to work on integrating current operational systems.  Acquiring billing information, patient records, internal communications, and generating prescriptions are the usual day to day first level of operations.  This can impact a practice by making information easier to retrieve/ share saving the staff time.  According to Oneill (2007) the first phase of implementation made a huge difference on office, clinical, and physician staff by “faxing of prescriptions greatly reduced the potential for medication errors due to illegible handwriting or incorrect dosages….[staff time] reduction in phone calls to and from pharmacies….internal e-mail and messaging allowed for more efficient internal communications” (p. 28).  The second phase consists of establishing links with other parties and integrating with specialists, hospitals, labs and pathology departments and the third phase is the quality and disease management and preventative maintenance portion of the EMR.  With all of these working properly it can impact a practice financially decreasing costs, increasing profits and most importantly increasing the care and safety of all patients.    

Implementation of an EMR will impact job descriptions and responsibilities within the organization.  Flexibility is an absolute for the successful implementation when going through this process.  Many employees will be asked to do jobs they would not necessarily do so flexibility is a key feature.  EMR’s improve nursing care so they can spend more time on patient care instead of remedial tasks, physicians can spend less time on patient phone calls because information was available to staff to answer higher level questions and billers no longer had to depend on ‘doctor staff’ diagnosis coding to bill procedures.  For Dryden Family Medicine this process increased their bottom line by 11 % the first year and 20% the second year (Oneill, 2007).  Interestingly enough the patient volume over these two years remained stable. 

An EMR can impact all sizes of facilities from large multi-national hospitals to rural community care clinics.  EMR’s organize, maintain, share, and improve efficiencies.  They keep consistency in the medical practice generating increased income and providing clinicians with the necessary information for proper and safe patient treatment.       

Thanks Chelley

 References

(2010, July 07). Benefits of an EMR [Web Video]. Retrieved from http://www.youtube.com/watch?feature=player_detailpage&v=TiQ8c11dkU0

Oneill, L., Klepack, W. (2007). Electronic medical records for a rursl family practice. A case study in systems development. Journal of Medical Systems, 31(1), 25-33. doi http://dx.doi.org/10.1007/s10916-006-9040-1

Statistics and Impact on Healthcare

Statistics play a very important role in health care.  They are able to measure disease outcomes, mortality and morbidity rates, groups of individuals at high risk, insurance costs and coverage’s, and a multitude of other factors.  Statistical evidence provides uniformity to abstract situations.  This impacts all aspects of health care from insurance companies, health care institutions, providers, employees, and patients.  Statistics and its impact are gaining momentum as we forge into the electronic era of mandatory health care reporting.

Federal statistics are used to ‘shed light’ on the topic of health care costs and availability. There are two types of surveys most frequently used to measure this data Bureau of Labor Statistics National Compensation Survey (NCS) and the Medical Expenditure Panel Survey Insurance Component (MEPS-IC) these statistical reviews measure the access, availability, and cost for healthcare to employees and employers.  The NCS collects data such as employee wages and salaries, overtime pay, sick leave, vacation benefits, and health and retirement plans for regulation, investigation and enforcement (Buckley, 2004).  The MEPS-IC survey is more specialized to an in-depth analysis of healthcare benefits such as the cost of individual and family plans, employee contributions, and establishment of level tables.  Statistics impact how the insurance coverage’s are dispersed, who is the source of funding such as Centers for Medicare and Medicaid (CMS) or private insurance, and which establishments are used to provide health care.  These surveys are conducted annually to ensure that affordable health care is available to everyone and agencies can denote any changes in trends and causation in an effort to offset disparities.

Statistics impacts health care by the creation and regulation of jobs.  According to the Bureau of Labor Statistics (2013) “the healthcare sector was responsible for nearly one-third of new healthcare jobs last month” (para, 1) budget cuts in Medicare and funding stand to jeopardize the ability to continue the increase in the employment sector.  The major contributor according to the BLS statistical report is the increased growth in the home health sector.  Since 2012 there have been over 93.000 new jobs created in healthcare (“BLS Report”, 2013).

The following graph represents health care jobs by sectors.  As you can see the home health industry is in second place with a total of 19% of health care jobs. 

U.S. Bureau of Labor Statistics (n.d.)

Statistics can reveal areas in health care that are under serviced or vice versa and ultimately provide ideas of where we need more training and employment efforts.

            Statistical evidence is of no use if we do not understand how it works and develops into scientifically based evidence or what we now call evidence based practice.  Statistical research by nature is ethical, rigorous, and systematic and when these "processes [are] applied rigorously [they] can improve patient care” (Sec. What are the Goals of Health Care Research, para, 4).  The code of conduct for health care professionals is to ‘do no harm’ and provide safe effective health care (“Statistics for Health”, 2004).  Statistics help develop the most current safe and effective treatments.

            The point to statistical health care methods is to improve patient care and ultimately safety.  These methods provide scientific evidence of proven situations good or bad and from there we are able to make suggestions on how to improve quality.  Statistics provides evidence of inequality in health care insurances, coverage’s, or job disparities.  These measures also show changes that have improved health care and how far we have come in patient care and safety.  Statistics will always have its place in health care for consistent monitoring and improvements.

Thanks Chelley                

References

BLS report: Home health sector generates nearly one-third of all new healthcare jobs in august. (2013, Sep 09). PR Newswire. Retrieved from http://search.proquest.com/docview/1430885948?accountid=32521

Buckley, J. E., & Van Giezen, R.,W. (2004). Federal statistics on healthcare benefits and cost trends: An overview. Monthly Labor Review, 127(11), 43-56. Retrieved from http://search.proquest.com/docview/235649923?accountid=32521

 U.S. Bureau of Labor Statistics (n.d.). Current employment statistics and the ambulatory health care industry. Retrieved from http://www.bls.gov/ro6/ro6_ces_ambulatory_hc.htm

 Statistics for Health Care Research (2004). Retrieved from www.sagepub.com/upm-data/9572_019596ch01.pdf‎



    

Accreditation and Continuous Quality Monitoring

 Health care facilities are under constant pressure to improve and maintain patient safety.  In order for facilities to accomplish this task they must have resources that are able to measure different levels of care.  Accreditation and continuous quality monitoring (CQI) are two ways health care facilities can make sure they are giving the best care and receive maximum insurance reimbursements for improved methods of patient safety and monitoring.   

Accreditation is an external independent review of the delivery of health care against nationally-accepted standards which includes periodic reviews of performance, processes, and outcomes (“Accreditation Association”, n.d.).  Organizations such as the Joint Commission on Accreditation of Health care Organizations (JCAHO) (which is the most common) are aimed at improving health care through basic safety standards and methods.  Their goals are to increase patient safety and quality control.  JCAHO was established  in 1951 for the primary goal of setting a standard for safety within hospital settings and in 1981 was changed to include other ‘healthcare organizations’ which included home health and hospice agencies  (“What is NCAQ”, n.d.).  Hospitals and health care entities seek for this approval since the Department of Health and Human Resources Center for Medicare and Medicaid (CMS) base reimbursements and preferred providers on this accreditation.

Health care providers want to seek accreditation approval since CMS relies heavily on the JCAHO surveys to ensure that health care facilities have met the health and safety standards they require.  CMS requires facilities to participate in accreditation authorities for maximum reimbursements.  One reason this approval is important is because other insurance companies tend to follow the lead of CMS guidelines for reimbursement procedures.  Accreditation ensures communities the safest care possible.  

As health care continues to change and the requirements to get maximum reimbursements are more difficult it is even more important that health care facilities achieve and maintain accreditation standards.  Every three years facilities are subject to an ‘on-site’ visit and given plenty of warning before the visit is to take place, allowing for plenty of time to get things in order if necessary.  Some of the items to be checked are:

Patient rights, governance  administration, quality of care, management and improvement, clinical records and health information, infection prevention and control, professional improvement, facilities and environment, and anesthesia and surgical services  (“Accreditation Association”, n.d.).  As you can see the inspections will consist of all areas to make sure the facility is doing everything they can to minimize errors and maximize safety.  Another area they use to ensure safety is continuous quality control or CQI policies.

Here is a link to a power point that can help explain in a little more detail the specific areas that accreditation is looking to assess and improve: Understanding Accreditation

Continuous quality improvement methods started to gain momentum in 1991 realizing these strategies could improve health care facility operations.  According to Vanderveen  “CQI is as an approach for examining interactive systems, layer by layer, in achieving improvement at all levels…. a step-by-step flow model that aids institutions in arriving at solutions in an orderly and systematic fashion” (para, 3).  Facilities are required to monitor their performance as part of accreditation which consists of brainstorming activities, structuring issues, problem focus, uncovering issues, and lessons to be learned (Vanderveen, 1991).  In order to implement CQI processes you must have a strong leader and a diverse team to work on it.  The reason for CQI is not to expose things individuals are doing incorrectly but to fix processes that can work more efficiently and safe (Vanderveen, 1991).  CQI is just as it is stated: continuous.  Facilities must continually reassess their work through teams, patient surveys, and outcomes to seek where they can find ways to make improvements.

Bottom line is accreditation and CQI are processes that health care entities must comply with in order to receive maximum benefits and safety for patients according to CMS.  The reasoning for this is to protect the public and give them access to the safest care possible. 

Thanks Chelley

 References

Accreditation Association for Ambulatory Health Care (n.d.).  What does accreditation mean for my care. Retrieved from http://www.aaahc.org/en/my-care/

What is NCQA and JCAHO ( n.d.).  Retrieved from http://www.healthcare-information-guide.com/NCQA.html

Vanderveen, L. (1991). CQI system puts process into improving hospital. Health Care Strategic Management, 9(2), 16-8. Retrieved from http://search.proquest.com/docview/226922337?accountid=32521

Evolution of Health Care Informatcs

The increasing trend in health informatics has led people to believe this field of study is new and just beginning but in actuality it has been developing since the 1960’s.  Let’s take a look at the following time line to see where this all begins.

 

In the mid 1960’s the group The American Society for Testing and Materials (ASTM) recognized a need for set standards with several areas of health care.  Theses areas included laboratory message exchange, data content, health information system security, and properties relating to electronic health record (“Evolution of Health”, n.d.).  This is the beginning of what we now call Health Information Management. 

By 1965 the College of American Pathologists developed a nomenclature (determined number sequence for disease coding) for pathology which is internationally recognized and currently used.  In 1974 a uniform discharge data set called ‘Uniform Hospital Discharge Data Set (UHDDS) was approved by Health and Human Services (HHS) and recommended by the National Center for Vital Health Statics (NCVHS).  This is a set of items that are based on standard definitions to increase consistent data collection across multiple users which decreases disparities in health care by the collection of consistent and reliable information.  Lynn Thomas (2012) states “unified data governance principles will help promote accuracy and consistency and reduce ambiguity…[and] establish the guidelines that will accurately and fairly represent performance and outcomes of care (para. 4).  This standardization will expose disparities in health care so we can address them and make improvements.   

The American College of Radiology and National Electrical Manufacturers Associations collaborated and recognized a need for a standard digital image format which is currently known as a DICOM image.  This was developed in 1985 which makes sharing electronic images possible without facing incompatibility issues.  This is interesting because this development is considered non-proprietary meaning that no one person owns the rights to the digital format and everyone shares it.  This is a concept of open source software which was initiated by Richard Stallman in 1983 by the development of the GNU Project or free software sharing, which has become vital in the success of implementing health information systems.

In 1987 was the first release of what we all know is Health Level7 (HL7).  This particular development included a variety of message format standards for patient orders, registration and observations reporting and by 1991 the Accredited Standards Committee (ASC) started developing interactive communication standards for the transmission of health claims, financial applications, and administrative transactions (“Evolution of Health”, n.d.).   As these developments matured they have brought us into an era of health information exchange.  There are not many hospitals, clinics, or health care facilities that do not have some sort of electronic exchange.  Most of this is due to the ‘meaningful use’ objectives implemented by the Federal Government.

Meaningful use is a termed dubbed by the Centers for Medicare and Medicaid (CMS) for the establishment of specific criteria to help improve the delivery, safety, and cost of health care through the use of electronic information or computers.   The objectives of ‘meaningful use’ are simple “achieving sustainable improvements in healthcare quality… [while maintaining] vision of better patient care at a lower cost” (“How do we get”, 2011, para. 1).  It is mandatory that health care entities participate in meaningful use measures and the government has a strategic timeline when these measures are to be implemented.

The latest health care initiative starting January 2014 is called blue button.  This is an interactive secure application that allows patients to view, download, and manipulate their health care information.  I have attached a podcast  by Lygeia Ricciardi, Director of the Office of Consumer eHealth at the Office of the National Coordinator for Health IT (ONC) in which she discusses the Blue Button initiative.  As we have followed some of the highlights of the progression of health informatics from the 1960’s through 2014 I hope this has given you an idea of where this technology began and where it is headed but ultimately it is for our safety and improvement of the health care system.  

Chelley Plueger R.T. ®
 

References

American health information management association; AHIMA calls for improved health information governance to unify standards for EHR use. (2012). Information Technology Newsweekly, , 443. Retrieved from http://search.proquest.com/docview/1095551688?accountid=32521

Evolution of health informatics. (n.d). Retrieved from http://www.himss.org/ResourceLibrary/GenResourceReg.aspx?ItemNumber=17863

HOW DO WE GET TO MEANINGFUL USE? (2011). Health Management Technology, 32(4), 10-2, 14, 16. Retrieved from http://search.proquest.com/docview/864536463?accountid=32521

Van Leeuwen, D. (Producer) (2013 , June 04). Using onc's patient engagement podcast. Using ONC's Blue Button to Engage and Empower Patients, Caregivers..and You. [Audio podcast]. Retrieved from http://www.himss.org/files/HIMSSorg/Content/podcasts/patientengagement/20130604_patientengagement.mp3