hismt: healthcare info regulations, laws and standards

Financing

philippine healthcare system:
more equitable financing through major sources like health insurance companies or personal savings

Delivery System

philippine healthcare system:
increases passiveness & client satisfaction
enables all citizens to receive healthcare services when needed
deliver cost-effective healthcare services

Outcomes

philippine healthcare system:
patient-centered care through activation & engagement

Health-financing

involves different layers of financial sources, regulatory bodies, and health service providers

Tax-based budgeting system

___ largely finance the public sector where national & local governments deliver health services

PhilHealth

aims to provide financial risk protection for Filipinos through social health insurance

DOH

funds regional & apex hospitals

Local government units

units fund primary & secondary level care

PhilHealth

reimburses government & private facilities

high household out-of-pocket payment

financial protection is still limited resulting in _______

local
insurance
pocket
donors

4 main sources of financing:
national & ____ government
i______
user fees/out of ______
d_____

basic human right

Health is a _____ - Philippine Constitution 1987

DOH

health facilities:
government corporate hospitals, specialty, and regional hospitals

Department of National Defense

health facilities:
military hospitals

Provincial governments

health facilities:
district & provincial hospitals

Municipal governments

health facilities:
provide primary care including preventive, promotive health services, & other public health programs through rural health units, health centers, and barangay health stations

Highly urbanized & independent cities

health facilities:
hospital services & primary care services

1224

Philippine Health Sector:
_____ hospitals

level 1; 41

Philippine Health Sector:
64% of hospitals are ____, non-departmental
hospitals within an average capacity of ___ beds

level 3; 318

Philippine Health Sector:
10% are ___ medical centers & teaching
hospitals with an average capacity of ____ beds

2587

Philippine Health Sector:
_____ city/rural health centers

20,216

Philippine Health Sector:
___ village health station

Affordability; excellent service

_____ is the main reason for going to a government medical facility, while ____ is the main reason for going to a private medical facility

Health human resource

● The main drivers of the healthcare system and are essential for the efficient management and operation of the public health system
● They are the health educators and providers of health services

fast human reservoir

The Philippine Health system stated that the Philippines has a _____ for health. However, they are unevenly distributed in the country. Most are concentrated in urban areas such as Metro Manila and other cities

nurses, doctors, midwives, medical technologists

the top 4 teams of the institution-based health workers

Health outcomes

- changes in health that resolve from measures or specific healthcare investments or interventions
- process of measuring how will a person respond to treatment whether the process gets better or worse, the cause of care, and how satisfied patients are with the care they receive
- measured based on life expectancies and deaths

Life expectancy

- the average years of life expected by a hypothetical cohort of individuals who would be subject during older lives so that the mortality rate of a given period
- indicates the number of years of a newborn infant would live if patterns of mortality were to stay the same throughout its life

71.59; 72.77

It is projected that the average life expectancy of
filipinos will increase to ____ years from 2015-2020 and that the _____ years from 2020-2025, based on
the national statistics office

deaths and births

measured to determine the status of health and fertility dynamics of an area

crude death rate

indicates the number of life births occurring during the year per 1000 population estimated at mid year

crude death rate

indicates the number of deaths occuring during the year per 1000 population estimated at mid year

rate of the natural increase

- subtracting the crude death rate from the crude birth rate
- equal to the population change in the absence of migration

Health policy

○ refers to decisions, plans, and actions that
are undertaken to achieve specific health
care goals within a society.
○ it outlines priorities and the expected roles of
different groups; and it builds consensus and
informs people.

Republic Act No. 11223

- the policy of the State to protect and promote the right to health of all Filipinos and instill health consciousness among them.
- AN ACT INSTITUTING UNIVERSAL HEALTH CARE FOR ALL FILIPINOS, PRESCRIBING REFORMS IN THE HEALTH CARE SYSTEM, AND APPROPRIATING FUNDS THEREFOR
- Former Pres. Rodrigo Duterte signed a universal
healthcare bill in Tulo that automatically enrolls all filipino citizens in the national health insurance program and prescribes complementary reform health system

DOH

provides national policy direction and strategic plans, regulatory services, standards, and guidelines for health and highly specialized and specific tertiary level hospital services

local government unit

responsible for managing and implementing local health programs and services

Phil health Circular no. 2021-008

Only confirmed COVID-19 cases by RT-PCR test who have developed severe illness or are with clinical and diagnostic manifestations of COVID-19 that require hospital admissions starting November 26, 2020 shall be eligible to claim for COVID-19 inpatient packages with package codes C19IP1, C19IP2, C19IP3, and C19IP4. Claims shall be processed and paid based on the applicable guidelines set in PhilHealth CircularNo. 2020-0009

Licensure

the process that gives a facility legal approval to operate.

Certification

gives a health care organization the authority to participate in several programs

Accreditation

an external review process that an organization elects to undergo

hospitals/facilities

licensure:
All ___ must have a license to operate, and it is generally the state department of health or a similar agency that carries out the licensure function.

individuals/professionals

licensure:
usually granted after some form of examination or proof of education and may be renewed periodically through payment of a fee and/or proof of continuing education or professional competence

RA10912 or CPD Act of 2016

requires CPD as the mandatory requirement for the renewal of Professional Identification Card

PRC Resolution No. 2016-990

○ Amendments to the Revised Guidelines on CPD Program for All Registered and Licensed Professionals
○ Initially 45 Credit units required for every 3 years

15; 60

Professionals who renewed their PRC IDs by signing and undertaking shall only comply with the required __ CPD units in pursuant to the resolution that is from initially __ CPD units

Newly licensed professionals

shall be exempted from CPD requirements for their first renewal

organizational licensure

granted following an on-site inspection to determine if minimum health and safety standards have been met.

Maintenance of licensure

an ongoing requirement for the healthcare to continue to operate and care for patients

Accreditation; certification

___ usually applies only to organizations, while ____ may apply to individuals as well as to the organizations

individual certification

individual has received additional education and training, and demonstrated competence in a specialty area beyond the minimum requirements set for licensure

organization certification

additional services, technology, or capacity beyond those found in similar organizations.

accreditation

often a voluntary process in which organizations choose to participate, rather than one required by law and regulation.

accreditation standards

usually regarded as optimal and achievable, and are designed to encourage continuous improvement efforts within accredited organizations

accreditation decision

made following a periodic on-site evaluation by a team of peer reviews, typically conducted every two to three years

philippines tripartite accreditation for health facilities

independent, non-profit organization, dedicated to improve and promote quality and safety in the delivery of healthcare in the Philippines through continuing review of performance, assessment, and accreditation

Association of Nursing Service
Administration of the Philippines

3 Major Organizations of PTAHF:
ANSAP

Association of the Health Administrators of the
Philippines

3 Major Organizations of PTAHF:
AHA

Philippine Association of Government
Hospital Administrative Offices

3 Major Organizations of PTAHF:
PAGHAO

Department of Health
Administrative Order 2013-0002

The hospital accreditation commission which was established through the ____ is the only DOH mandated and first PhilHealth recognized third-party accrediting body in the country

Hospital
Accreditation Commission (HAC)

Department of Health (DOH) introduced the _____

PhilHealth

Before HAC was created, ____ did the accreditation of hospitals through surveys.

PhilHealth’s Benchbook Standards

Only accredited hospitals based on ____ are eligible for the reimbursement of hospital expenses and professional fees.

primary health care practices & management

- is a whole of society approach to help well-being centered on the needs and preferences of individuals and families in the communities.
● it addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical and mental and social health and well-being.
● ensures people receive comprehensive care ranging from promotion and prevention to treatment, rehabilitation, and palliative care

World Health Organization (WHO)

an essential health care made universally acceptable to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country and afford at every stage of development

tertiary

Pyramidal Health Structure:
national health services

secondary

Pyramidal Health Structure:
regional, district, rural (local hospital) health services

primary

Pyramidal Health Structure:
rural health units, barangay health stations

Barangay Health Workers

types of primary healthcare workers in the ph:
- Community volunteers who underwent formal training to provide healthcare to families who reside in their assigned area
- work hand in hand with other members of the health team in promoting the health programs and services in the community
- serve as community organizers to provide instruction and information about health

Intermediate level Primary Health Care Worker

types of primary healthcare workers in the ph:
- attends to health problems beyond the competence of the BHW
- they represent the first source of professional healthcare

primary health care team

multidisciplinary group of health and social care professionals who work together to deliver accessible local health and social care services to a defined population in the community

community participation

4 pillars of health care:
○ is a social and proven approach in addressing health care needs of the people
○ involvement if the community people concerned in analysis, decision making, planning and program implementation all the activities
○ share their needs living in a specific geographic area and establish mechanisms to meet this need

intersectoral coordination

4 pillars of health care:
○ the collective actions involving more than one specialized agency performing different roles for
a common purpose
○ this includes agriculture, animal husbandry, food, industry, education, housing, public works, communication and other sectors

appropriate technology

4 pillars of health care:
○ important strategy in improving the availability and accessibility of healthcare services

support and mechanism available

4 pillars of health care:
○ targets to make essential healthcare and first level referral facilities are available and accessible
○ vital to health and quality of life

declaration of Alma Ata

elements of primary healthcare:
The ______ was adopted in the international conference of primary healthcare

education

elements of primary healthcare:
_____ concerning prevailing health problems and the methods of identifying, preventing and controlling these problems

prevention of endemic disease

elements of primary healthcare:
local endemic disease prevention and control

immunization

elements of primary healthcare:
Expanded program on immunization against major
infectious disease

maternal and child healthcare

elements of primary healthcare:
family planning

drug availability

elements of primary healthcare:
essential drugs arrangement

nutrition

elements of primary healthcare:
nutritional food supplement
an adequate supply of safe and basic nutrition

treatment

elements of primary healthcare:
____ of communicable and noncommunicable disease and promotion of mental health

water and sanitation

elements of primary healthcare:
safe water and sanitation

patient-specific information

legal aspects of managing health info:
governed by multiple state and federal laws and regulations in addition to those for licensure and certification

Authentication

signature on a document

Destruction of records

involved burning or shredding

issues of retention

address the medical record as a legal document,
including the ______ and authentication of healthcare information, and the privacy and confidentiality of patient information

American Health Information Management
Association (AHIMA)

Health Record as a Legal Document

file folder

The patient medical record is a _____ that is full of paper in the health information management department.

LHR Legal Health Record

documentation of the healthcare services provided to an individual in any aspect of healthcare delivery by a
healthcare provider organization

administrative; derived

_____ data and ______ data are not considered part of legal health records.

advance
anesthesia
care
treatment
consultation
discharge
e - mail

Examples of documentation found in the LHR:
_____ directives
_____ records
____ plan
consent for ____ forms
_______ reports
______ instructions & summary
_____ containing patient - provider or provider -
provider communication

Patient - identifiable source data

data from which interpretations, summaries , notes , etc. are derived

identification purposes
dictation
telephone call
films

Examples of patient - identifiable source data:
analog and digital patient photographs for
_____ only
audio of ___
audio of patient _____
diagnostic ____ and other diagnostic images
from which interpretations are derived

electrocardiogram
fetal monitoring
telemedicine

Examples of patient - identifiable source data:
_____ tracings from which interpretations
are derived
_____ strips from which interpretations are
derived videos of office visits
videos of procedure
videos of _______ consultations

Administrative data

patient-identifiable data used for administrative regulatory, healthcare operations, and payment (financial) purposes

Derived data

consists of information aggregated or summarized from patient records so that there are no means to identify patients

Retention of Health Records

● these state requirements should be the basis for the health care organization’s formal retention policy
● when no specific retention requirement is made by the state, all patient information that is a part of the LHR should be maintained for at least as long as the state’s statute of limitations or other regulation requires.

AHIMA

● recommended retention standards policy