1. School of Health Sciences Unit 4 Legal Aspects of Health Information and Health Care Statistics HI 135 Instructor: Alisa Hayes, MSA, RHIA, CCRC

2. Introduction Instructor Alisa Hayes, MSA, RHIA, CCRC Contact Information AIM:AlisaCHayes Email: ahayes@kaplan.edu Office Hours By appointment School of Health Science

3. Chapter 9 Confidentiality and Informed Consent Protect information and ensure that patient’s needs are met Confidentiality is a developing concept Obligation to maintain patient information and protect it from dissemination or disclosure Responsibility of providers and health information managers Informed consent: providing information to patients needed to decide for or against treatment School of Health Science

4. Chapter 9 Confidentiality and Informed Consent Confidentiality Focus: relationship between the patient and health care provider Patient gives provider information Provider uses data/information to diagnose/treat Dialogue is private information is not disseminated beyond the health care provider(s) Obligation: Hippocratic oath set the foundation School of Health Science

5. Chapter 9 Confidentiality and Informed Consent Legal protections are based on patient’s right to privacy Right to be left alone Right to control personal information Legal sources for foundation for rights Constitutional provisions Statutory provisions Common law provisions School of Health Science

6. Chapter 9 Confidentiality and Informed Consent Privacy and confidentiality Separate but related concepts Important to distinguish between Privacy Right belonging to patient Looking inward: patient protecting her information Confidentiality Duty belonging to health care provider Looking outward: provider does not disseminate information about anothe r (the patient) School of Health Science

7. Chapter 9 Confidentiality and Informed Consent Protected Health Information (PHI) HIPPA privacy rule defines confidential health information as PHI Contains identifiers by which the individual may be recognized, including Name, address, dates (of birth, death, admission) Phone numbers or email addresses Social security, health record, or insurance number Photos or other identifiers (vehicle or device) Without authorization, information must be de-identified prior to release or disclosure School of Health Science

8. Chapter 9 Confidentiality and Informed Consent Ethical obligation Duty to protect patient privacy and confidentiality of information Health care providers and HIM owe this duty Increasingly difficult with increased demands Notice of privacy practices HIPAA requires provider to inform patients Describes duties concerning PHI Disclosure, safeguards, accounting, complaints Notice is to be posted and acknowledged by patient School of Health Science

9. Chapter 9 Confidentiality and Informed Consent Expanding responsibilities of HIM EHR poses challenges to maintaining confidentiality and privacy HIPAA requirements Expansion of electronic exchange of PHI Computer data security programs to address concerns Scope of influence and responsibilities will continue to grow School of Health Science

10. Chapter 9 Confidentiality and Informed Consent HIV Information and Ethical Issues Professional guidelines to guide action Standards of conduct issued May be used to establish standard of care Patient death: obligation to keep HIV information confidential does not end Ethical guidelines from AMA When to include HIV/AIDS information on autopsy report School of Health Science

11. Chapter 9 Confidentiality and Informed Consent Informed Consent Legal analysis shifted from Did patient consent to treatment? Did patient understand the nature and effects of treatment? Focus moved to evaluate the quality of consent Did the patient have sufficient information to make and informed decision? School of Health Science

12. Chapter 9 Confidentiality and Informed Consent School of Health Science

13. Chapter 9 Confidentiality and Informed Consent Who may Consent? Patient who is a competent adult Substituted consent for incompetent patient Minor Emancipated minor is considered competent School of Health Science

14. Chapter 9 Confidentiality and Informed Consent Patient Self Determination Act (PSDA) Cruzan case raised concerns about end of life Led to passage of PSDA Goal: patient’s right to self determination should be communicated and protected Requires that certain providers inform patients Of state laws governing right to make advanced directives Of providers’ policies regarding patient rights School of Health Science

15. Chapter 9 Confidentiality and Informed Consent Advance Directives Patient describes wishes regarding care Written when patient is competent In effect only after patient becomes incompetent Living will Provides direction on medical care wishes Durable power of attorney for health care decisions Identifies health care decision maker School of Health Science

16. Chapter 9 Confidentiality and Informed Consent Emergency Consent What happens if patient needs care but cannot consent due to an emergency condition? Another is not available to give consent Delay would result in death or serious harm State laws protect providers from risk of liability If emergency condition exists and patient cannot give consent, provider may act to save life or limb without informed consent School of Health Science

17. Chapter 9 Confidentiality and Informed Consent Did the patient receive enough information to make an informed decision? Matter of state law Generally, sufficient disclosure includes: Nature of the proposed procedure/treatment Risks Benefits Any available alternatives School of Health Science

18. Current Week 4/11/12-4/17/12 Unit 4: chapter 9 (pp. 172-189) Selection of research topic for paper due in unit 9- see instruction document in docsharing Confidentiality response paper School of Health Science

19. Next Week 4/18/11-4/24/11 Unit 5: chapter 10 (pp. 192-221) Test 2 Case study A OR B at end of ch 10 One time SEMINAR time CHANGE for 4/19, seminar will be at 8pmEST!!! ANY QUESTIONS??? School of Health Science