Exam 2 - HIPAA, IC, and Tx of Minors

What does this refer to

• Prior to 1996 there wasn’t a standard for proper transmission of medical information from one entity to another safely

• With the creation of electronic medical records came the need for readily accessible health information

• _______, created in 1996, gave directions on safeguarding sensitive patient materials while effectively allowing the sharing of health information

HIPAAHealth Information Portability and Accountability Act of 1996

What does this refer to

• _______ protects patients in the event of loss of insurance coverage with change of job.

  • Limits the restrictions on preexisting conditions.

  • Health plans may not cover certain conditions for 12-18 months after enrollment

  • Allows any prior coverage to lessen the restricted period.

  • Exception is health plan premium extra cost for certain conditions

    • Tobacco use

    • BMI

Title I of HIPAA

What does this refer to

• ______ is made up of sections, or rules ensuring national standards for EHR

Title II of HIPAA

What does this refer to

_________

• Purpose-to define and limit the circumstances in which and individual’s health information may be used or disclosed by covered entities.

• Created national standards for the protection of certain health information.

• Addresses the use and disclosure of individuals’ health information, or “protected health information”

Privacy Rule

What does this refer to

• _________ generally requires HIPAA covered entities to provide individuals, upon request, with access to the PHI about them in one or more “designated record sets” maintained by or for the covered entity.

  • May inspect or obtain a copy or both

  • May direct the covered entity to transmit a copy to a designated person or entity of the individual’s choice

  • Have a right to access this PHI for as long as it is maintained by the entity despite the format of the information (paper, electronic, onsite or remote)

The privacy rule (access to health records)

What does this refer to

_______-demographic data that relates to:

• individual’s past, present, of future physical, or mental health condition

• the provision of health care to the individual

• or the past, present, or future payment for the provision of health care to the individual

• Identifiers such as name, DOB, SSN, address

Protected Health Information (PMI)

What does this refer to

• Requires covered entities to maintain reasonable and appropriate administrative, technical, and physical safeguards for protecting e-PHI.

Security Rule

What does this refer to

• Enforces compliance of proper use of HIPAA and conducts investigations and imposes monetary penalties

Enforcement Rule

What does this refer to

• Implements a number of provisions related to an Act covering Health Information Technology

Final Omnibus Rule

What does this refer to

• Notification of any information leaks

Breach Notification Rule

What does this refer to

• Privacy

• Freedom of choice

• Self-determination

• Practical application for PAs

  • “…Each patient should be viewed and treated as an autonomous, or self-governing person who is allowed to act in accordance with freely chosen informed goals, as long as those actions do not obstruct or violate the autonomous actions of others”.

Autonomy

What does this refer to

• You must tell them what’s going on!!!

  • ALL OF IT!!!!!!

    • THE GOOD AND THE BAD!!!

      • THE RISKS AND THE BENEFITS!!!

      • !!!

• Then the patient can decide for treatment based on full knowledge regarding medical situation

Informed consent

What does this refer to

• Benefits

• Risks

• Alternatives, to them

• Insight into what these mean

• Nothing

  • what would be the consequence of doing nothing?

Used with informed consent

What does this refer to

• What is the chance it will prolong my life?

• By how much?

• What are the side effects?

• What are the alternatives?

  • If you know these answers when the patient asks, their confidence and trust in you increases

Questions to know the answer for before going into the encounter

What does this refer to

• Inmates, as well as other patients, can decide to not give consent for treatment

  • When would a provider have to intervene for a refusal of treatment?

  • How can we deal with this?

Informed Consent During Incarceration (incarceration does not take away the right for informed consent)

What does this refer to

• The autonomous patient still makes decisions regarding their health unless otherwise stated in the medical history.

• The patient’s wishes should be honored, and their wishes should still dictate decisions.

  • This is not always the case.

Informed Consent in End of Life

What does this refer to

• Similar and follows same concepts as informed consent.

• Must be specific to the risks

• May include photo consent

• May include observer consent

• Usually requires witness signatures

• Requires interpreters when necessary

• Usually MD signature for surgical consent

Surgical Consent

What does this refer to

• Every attempt must be made to get firsthand consent from the patient.

• If that is not available go to spouse or first degree relative

  • Mother, Father, Brother, Sister, Children

• If no one available, do what’s best for the patient.

  • DOCUMENT

  • DOCUMENT

  • DOCUMENT

Emergency Consent

What does this refer to

• Usually from a third party

  • Parent

  • Guardian

  • Self if old enough

  • Document who you got the history from

• Use open ended questions and inquire for more information

• Once provider feels patient has reached appropriate maturity level may have one on one portion of visit with the child

  • Usually, a group meeting with the adult at the end of the visit to recap all non confidential info

Pediatric history

What does this refer to

• Common-law rule that allows an adolescent who is mature to give consent for medical care.

  • Usually, 14 is considered determining age but not concrete

• This should be distinguished from any other legal requirements

Mature Minor Doctrine

What does this refer to

• Emergency care, sexually transmitted diseases, drug treatment, mental health care, pregnancy, contraception, and emancipation

Exceptions to Mature Minor Doctrine

What does this refer to

• The age of legal competence to consent in sexual acts

• Age varies within jurisdiction but usually ranges between 14-18

• Laws vary by type of sexual act, gender of participants and abuse of a person of trust

Age of Consent

What does this refer to

• Occurs naturally in the US at the age of 18

  • Some disability restrictions hinder emancipation

• If emancipation requested before age 18, the minor must be financially self-sufficient

Emancipation

What does this refer to

• Preparing the Parent/Guardian for upcoming milestone.

• Great segue into potentially avoiding uncomfortable territory.

  • Risky behavior

• Allows the PA to “team up” and build trust bond with the parent and/or child.

Anticipatory Guidance

What does this refer to

Professionalism

• Respect for patients

  • Culturally competent

  • Humanistic

• Compassionate about patient care

• Always maintain integrity

  • Be forthcoming with information and not withholding

  • Admit to errors

What makes a PA a great PA

What does this refer to

Leading cause of deaths in USA

What does this refer to

Ages and leading cause of death in USA