Component 1: Introduction to Health Care and Public Health in the U.S. Unit 6: Regulating Health Care Lecture 4 This material was developed by Oregon Health.

Component 1:Introduction to Health Careand Public Health in the U.S.

Unit 6: Regulating Health Care

Lecture 4

This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

Objectives of This Lecture

• Review the privacy and security requirements of HIPAA (the Health Insurance Portability and Accountability Act)

• Discuss the issue of patient safety in U.S. medicine– Explain patient safety initiatives of the Joint

Commission– Describe the Agency for Healthcare

Research and Quality

Component 1/Unit 6-4Health IT Workforce Curriculum

Version 2.0/Spring 20112

Health Insurance Portability and Accountability Act

• Improves “portability” of health insurance– New employer plan may not limit coverage due to pre-existing

condition– If health insurance is lost, improves access to group health plan– Protects from discrimination based on health status

• Combats fraud, abuse, and waste in health care• Promotes use of health savings accounts• Improves access to long-term care• Simplifies the administration of medical insurance



HIPAA Privacy & Security

• Privacy requirements

– What health information must be protected– http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/

index.html• Security requirements

– How to protect the information– http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html



HIPAA Covered Entities

Adapted from http://www.cms.gov/HIPAAGenInfo/Downloads/CoveredEntitycharts.pdf



HIPAA CoveredEntities (cont’d)

• Health plans– Insurance companies– Health maintenance organizations (HMOs)– Company insurance plans– Government agencies that pay for health care

• Health care clearinghouses– Billing services– Repricing companies– Community health management information systems– Value-added networks that perform clearinghouse functions



HIPAA Privacy Rule

• Applies to protected health information• All individually identifiable health information is

protected– Held or transmitted by a covered entity or its

business associates– In any form or media, whether electronic,

paper, or oral



Individually Identifiable Information

• Physical or mental health condition• Provision of health care• Payment

and • Identifies the individual, or there is a

reasonable basis to believe the information can be used to identify the individual



Privacy Rule Requirements

• Notify patients of privacy rights• Allow patients to see their medical records• Implement privacy procedures• Train employees • Designate an individual to be responsible for

seeing that privacy procedures are adopted and followed

• Keep patient records secure



HIPAA Security Rule

• Requires covered entities to use security measures to protect health information

• Does not require use of any specific technology• Establishes minimum standards

– If state laws require more rigorous safeguards, the state law must be followed



HIPAA Security Rule:General Guidelines

• Ensure the confidentiality, integrity, and availability of health information

• Anticipate threats to the security and integrity of the information, and protect against them

• Protect against reasonably anticipated, impermissible uses or disclosures of health information

• Ensure compliance by the workforce



HIPAA Enforcementand Penalties

• Enforced by Office of Civil Rights of the U.S. Department of Health and Human Services Violations can result in civil fines and criminal penalties

• $4.3 million civil penalty in 2010– $1.3 million for failure to give patients access to

medical records– $3 million for failure to cooperate with investigation



Patient Safety• To Err is Human—published in 1999 by the

Institute of Medicine• Reported that:

– 44,000 to 98,000 people die in hospitals each year as a result of preventable medical mistakes

– Mistakes cost hospitals $17 billion to $29 billion yearly

– Individual errors are not the main problem– Faulty systems, processes, and other conditions

lead to preventable errors



Medical Mistakes Today

• Affected 1 in 3 hospital patients in one study• In 2008, harms to patients from medical errors

cost $17.1 billion• Errors can result in medical malpractice lawsuits

– 42% of doctors are sued at some point– Hospital malpractice suits alone could top

$8.6 billion in 2011• Suffering from medical errors: not measurable



The Joint CommissionSafety Initiatives

• Sentinel Event Policy– Unexpected death, unexpected serious

physical or psychological injury, or the risk of such an event

• Patient Safety Advisory Group– Panel of experts who recommend National

Patient Safety Goals– Also address newly developing safety issues



The Joint CommissionSafety Initiatives (cont’d)

• Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery– Pre-surgery verification– Site marking– “Time out” before an incision is made

• The Speak Up Initiative– Encourages patients to participate in their care– Free patient education materials



Agency for HealthcareResearch and Quality (AHRQ)



National Healthcare Quality Report

• Effectiveness • Timeliness• Efficiency• Patient safety • Access to care• Patient centeredness



AHRQ: Health IT

http://healthit.ahrq.gov/portal/server.pt?open=514&objID=5664&parentname=CommunityPage&parentid=50&mode=2



Summary

• Patient privacy and safety are high priorities for all people employed in the health care industry

• HIPAA has rules for the privacy and security of patient health information

• The Joint Commission supports initiatives for reducing medical errors

• The Agency for Healthcare Research and Quality is an important source of information about how to keep patients safe and maintain the privacy of their health information



Component 1: Introduction to Health Care and Public Health in the U.S. Unit 6: Regulating Health Care Lecture 4 This material was developed by Oregon Health.

Documents

department of health

public health

protected health information

health information technology

health insurance portability

health care lecture

group health plan

workforce component