1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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