Component 1: Introduction to Health Care and Public Health in the US Unit 6- Regulating Health Care Lecture d- Key Processes for the Confidentiality and Safety of the Patient

Health IT Workforce Curriculum Version 1.0/Fall 2010 Objectives Describe the provisions of HIPAA Discuss the issue of patient safety in US medicine Discuss JCAHO evoked requirements for patient safety Define medical malpractice Compare and contrast proposed medical liability system reforms Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Insurance Portability and Accountability Act Widely known as HIPAA The 4 objectives of HIPAA Improve portability of health insurance Combat fraud, abuse, and waste in healthcare Promote the expanded use of medical savings accounts Simply the administration of healthcare insurance Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 HIPAA (Continued) The Department of Health and Human Service was mandated by Congress to developing detailed privacy standards for HIPAA. This took the form of the Privacy Rule which ensures Unique identifying codes for all healthcare providers, healthcare plans, employees, and individuals Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 HIPAA (Continued) Electronic health record security which includes the confidentiality and integrity of individual protected health information, past, present, or future. Standardization of Electronic health records, administrative and financial data, health claim status, enrollment and disenrollment in a healthcare plan, eligibility in a healthcare plan, and healthcare premium payments. Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Patient Safety Patient safety was brought forth as a major deficiency in the US health system when the Institute of Medicine released, “To Err is Human,” in November of 1999. This report noted that between 44,000 and 98,000 die each year from medical mistakes. Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Patient Safety (continued) These mistakes cost between $17 and $29 billion in 1999. This report did not cite individual errors as the problem. The problem is caused by faulty systems and processes, and other conditions that lead people to make mistakes or fail to prevent mistakes Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Patient Safety (continued) This report shook the health care world and the federal government and the Joint Commission for the Accreditation of Health Care Organizations took steps to report and reduce patient errors. The federal government established the Agency for Healthcare Quality Research to help address this problem. Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Patient Safety (continued) JCAHO initiatives to increase patient safety National Patient Safety Goals Patient Safety Solutions Patient Safety-related Standards Patient Safety Advisory Group The Universal Protocol Patient Safety Research Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Patient Safety (continued) JCAHO initiatives continued Speak up ™ initiatives Quality Check ® and Quality Reports Patient Safety Coalitions Sentinel Event policy Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Patient Safety (continued) In the 11 years since the Institute of Medicine report was released, JCAHO has implemented standards addressing patient safety and quality medicine. These include National Patient Safety Goals Purpose- to promote specific improvements in patient safety Highlight problematic areas and describe evidence and expert-based solutions to the problems Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Patient Safety (continued) No adverse event should ever occur anywhere in the world if the knowledge exists to prevent it from happening. Translating knowledge into practice is key. Patient safety solutions are disseminated by JCAHO to support patient safety Patient safety solutions are defined as “any system design or intervention that has demonstrated the ability to prevent or mitigate patient harm stemming from he processes of health care.” (JCAHO) Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Patient Safety (continued) Areas with high patient safety concerns include Medication use, infection control, surgery and anesthesia, transfusions, restraint and seclusion, staffing and staff competence, fire safety, medical equipment, emergency management, and security. Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Agency for Healthcare Research and Quality Purpose To improve quality of health care in the US Conducts and sponsors research to help clinicians, patients, health care institutions, health care plan administrators, others in making decisions. 80% of $610 million budget goes to grants and contracts for research Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Medical Malpractice Medical Malpractice Professional negligence through an action or omission of a health care provider which does not follow the accepted standard of care and causes injury or death to a patient The medical malpractice claim Plaintiff- patient or if a wrongful death, the executor of the patient’s estate Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Medical Malpractice (continued) Defendant- health care provider Plaintiff must establish 4 points of negligence Duty was owed- a legal duty is established by all who take care of the patient Duty was breached- acceptable standard of care not followed Breach caused an injury Damages incurred (loss to patient whether physical or emotional)—without damage, a provider could be negligent, but no case Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Tort Reform Medical liability system reform Malpractice has direct and indirect costs, including defensive medicine where physicians order more tests than normal to cover themselves in case of a lawsuit. Primary criticism of the system is economic Litigation is a bad way of giving compensation for injuries suffered by patients Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Tort Reform (continued) Special malpractice courts Special court where medically-trained judges evaluate cases and render precedent-setting decisions Giving up jury trials and scheduling noneconomic damages would lead to more people being compensated in a more timely manner Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Tort Reform (continued) Limits on noneconomic damages Placing a limit on he amount of noneconomic damages that can be received by a patient Collecting lawsuit claim data from malpractice insurance companies and the courts to determine if there is a connection between the settlements and insurance rates Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Tort Reform (continued) Reduction in statute of limitations action Another philosophy in medical malpractice reform is not to decrease the amount of damages a person can be awarded, but to decrease the amount of time a person has to sue a provider. Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Tort Reform (continued) Economic effects This system has distorting economic impacts: Costs of litigation and compensation raise the cost of insurance The cost of the tort system (medical malpractice in particular) raise the costs of health care Tort liability could stunt innovation Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Tort Reform (continued) Equality in treatment If a person is injured as a result of receiving medical care or a treatment, the tort system allows them to receive full compensation for their suffering. If a person is similarly injured by a natural accident or by environmental factors, they will not be able to receive full compensation. Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Tort Reform (continued) Punitive awards and juries Punitive awards these awards are given to punish or make an example out of the wrongdoer The purpose of punitive awards is to deter wrongful conduct and to serve as a way to express social shock or outrage at the defendant’s actions. Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Tort Reform (continued) Awards for pain and suffering Tort law can easily put a price on property that is damaged. However, it is more difficult to put a price on injuries to a person’ body and mind. It is even more difficult to put a price on the pain and suffering one experiences with an injury Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010

Tort Reform (continued) Class action lawsuits Where the lawyer for one or more claimants brings claims on behalf of all those who may have experienced a similar situation. These can be justified because they ensure equal treatment of all affected, avoid the risk of conflicting judgments, and they allow the efficient resolution of many claims. These lawsuits have been misused to make up for unfavorable laws in particular states as well as unfavorable juries and judges. Component 1/Unit 6d Health IT Workforce Curriculum Version 1.0/Fall 2010