Chapter 3 Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Discuss how accreditation, facility licensure, and certification influence the information needs of health care facilities. Identify and differentiate among major health care accrediting bodies. Understand and manage the impact of the health record as a legal document. Discuss the HIPAA privacy regulations and their relevance to health care organizations and consumers. Describe the laws, regulations, and standards that govern patient confidentiality. Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Licensure, Certification & Accreditation  Facility Licensure  Certification  Joint Commission Accreditation  Other Accrediting Organizations Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Legal Aspects of Health Care Information  Health Record as a Legal Document  Definition  Retention of Health Records  Authentication  Privacy and Confidentiality  Pre-HIPAA  HIPAA  Release of Information Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

States oversee facility licensure Facilities must have a license to operate Emphasis is on standards for physical plant, safety, etc. Minimum standards for patient records Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Gives authority to participate in Medicare and Medicaid Standards were established in 1970’s Hospitals with Joint Commission Accreditation have “deemed” status Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Voluntary external review Well known agencies  Joint Commission—hosptials and other health care facilities  NCQA—managed care plans  CARF—Rehabilitation facilities  AAAHC—Ambulatory care facilities Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Possible Benefits  Deemed status for CMS programs and some state licensure  Required for reimbursement from some payers  Validates quality of care  May influence liability insurance  May enhance managed care contracts  Gives competitive edge over non-accredited Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Founded as non-profit in % of all general hospitals; 95% of those over 200 beds Now includes other types of healthcare organizations Survey every three years to compare practice to standards Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Accreditation decisions  Accreditation  Provisional accreditation  Conditional accreditation  Preliminary denial of accreditation  Denial of accreditation  Preliminary accreditation Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Emphasis on health care information and documentation of care  ~150 JCAHO hospital standards are scored on patient medical record alone Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Goal: “ to support decision making to improve patient outcomes, improve health care documentation, assure patient safety, and improve performance in patient care, treatment, and services, governance, management, and support processes” (JCAHO, 2004) Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

There is a large section of the IM standards devoted to content and maintenance of patient records Other IM standards relate to  IM planning  Confidentiality and security  IM processes  Information-based decision making Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

National Committee for Quality Assurance  Accreditation of health plans and managed care organizations (MCOs)  HEDIS and measuring quality (chapter 1) Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Began accrediting MCOs in 1991 ~3/4 of all enrollees in an HMO are in one accredited by NCQA NCQA surveys organizations Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Published standards grouped into five categories  Access & service  Qualified providers  Staying healthy  Getting better  Living with illness Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Assigns one of five accreditation levels  Excellent  Commendable  Accredited  Provisional  Denied Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Commission of Accreditation of Rehabilitation Facilities (CARF)  Accreditation Association for Ambulatory Health Care (AAAHC)  Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

What is the legal Health Record?  No simple answer in the electronic environment  State and Federal laws are being modified Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

AHIMA define Legal Health Record (LHR) “the documentation of the healthcare services provided to an individual in any aspect of healthcare delivery by a healthcare provider organization.” (Amatayakul, 2001) Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

AHIMA defines four categories of patient data  Legal Health Record  Patient-Identifiable Source Data  Administrative Data  Derived Data Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Most states have retention requirements When no state requirements retain records  At least as long as the statute of limitations  For minors, until the age of majority (defined by the state) Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Joint Commission defines authentication as (JCAHO, 2008) “the validation of correctness for both the information itself and for the person who is the author or the user of the information” Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Forms of Authentication  Handwritten signature  Electronic signature  Most states allow or are silent on electronic signatures  CMS and Joint Commission recognize electronic signatures  Policies and procedures are needed to insure that electronic signature codes, etc are not shared Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Privacy—individual's right to be left alone  In health care—the right to limit access to health care information Confidentiality—the expectation that information will only be used for its intended purpose  Confidentiality relies on trust Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Pre-HIPAA  A few federal and state laws, but no comprehensive federal regulation to protect private health information HIPAA  Multiple Sections, including  Privacy Rule Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Key definitions  Covered Entities  Health plans  Health care clearinghouses  Health care providers Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Key definitions  Protected Health Information (PHI)  Relates to physical or mental health, provision of or payment for health care  Identifies the person  Created or received by a covered entity  Transmitted or maintained in any form Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Five major components  Boundaries  Security  Consumer control  Accountability  Public Responsibility Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Health care organizations need comprehensive policies and procedures for releasing patient information  Routine Use –requires consent  Non-routine Use—requires authorization Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Patient Name Patient Date or Birth Name of entity to whom the information is being released Description of the health information being disclosed Statement of the reason or purpose for the disclosure Date, event or condition on which the authorization will expire Statement that the authorization may be revoked by the patient (or legal representative) Patient (or legal representative) signature Date of signature—must be after the encounter Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Facility Licensure Certification Accreditation Standards and Processes  Joint Commission (  NCQA (  Other Accrediting Bodies Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Health Record as a Legal Document Retention of Health Records Authentication of Health Information Privacy and Confidentiality HIPAA Privacy Rule Release of Information Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser