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What is HIPAA?
the Health Insurance Portability & Accountability Act
Intention & Purpose of HIPAA
to prevent HC fraud & abuse
it enforces standards for health information & guarantees its security & privacy
assures health insurance for employed workers even when they lose their job
what health information is protected (PHI)?
names
geographic info smaller than state
all dates, except year
phone/fax numbers
SSN
medical record #
health insurance #
account #
licence #
VIN & pate #
device ID/serial #
IP address
biometric’s ID’s
photographs
when can pt information be disclosed?
under certain circumstances without the pt’s permission as specified by law
treatment, payment & HC operations as defined by HIPAA
information that can’t be linked to a specific person
examples of information that can be disclosed
medical examiner when a death is under investigation
cancer diagnosis to central cancer registry
abuse/neglect or suspicions
any public danger
outbreaks of reportable communicable diseases
wounds involving crime
impacts of HIPAA on HC consumers
access to medical records
control on who can see their health information
ensure that their private health data is protected from unauthorized disclosure
impacts of HIPAA on HC professionals
establishes clear guidelines for managing & protecting patient health information
ensuring confidentiality
fostering trust with patients
classification of HC agencies
length of stay
type of service
type of ownership
length of stay HC org.
short stay
traditional, acute care; <30 hrs
long term care (nursing home)
type of service HC org.
general vs. specialty
community vs. tertiary
in-home care
ambulatory/outpatient care
type of ownership HC org
government owned (19%)
for profit (28%)
not-for-profit (53%)
primary prevention HC & examples
care before the disease, preventing it from developing
e.g. obesity, smoking cessation, vaccines, prenatal care, scoliosis
respite care
short-term care that gives family caregivers a break
can be provided in-home, at an adult day care center, or at a HC facility
preventative care
helps prevent disease & disability
helps detect health issues early so they can be treated more efficiently
vaccinations, screening, annual checkups, lifestyle changes
restorative care
helps people maintain their independence & functional abilities after injury or illness
hospitals, long-term care facilities
palliative care
focuses on improving the quality of life for people with serious illnesses
reduces pain & discomfort, prevents or treats symptoms & side effects
provides emotional support
how do HC economics affect the quality of care
limiting access to care
reducing investments in new treatments
affecting the availability of trained staff
managed care organization (MCO)
offers services to members through a network of contracted provided to lower costs while providig quality care
independent PCP’s
CMS prospective payment system (DRGs)
method where medicare pays hospitals for each inpatient stay based on the diagnosis & severity
categorized into a specific DRG, rather than based on actual cost
primary prevention example - location
occupational nurse providing an exercise program after work for employees
safety belt laws, smoke free environment laws, flu-clinics
secondary prevention care & examples
the disease is already there, you’re trying to prevent it from becoming worse
monitoring glucose & BP, routine screenings, mammograms, prostate exam, pap smears
secondary prevention examples - location
hospitals
emergency care
intensive care
around-the-clock care
tertiary prevention & examples
the disease is already there, you’re trying to stop it from becoming worse
e.g. mental/economic breakdown, post MVA, post-stroke, PT
tertiary prevention examples - location
PT, rehab, hospice, end-of-life-care
factors affecting HC delivery
patient needs
severity, compliance, culture
financial constraints
technology
advances & breaches
community-based nursing
provided to people who live within a defined geographic area, rather than individuals
improves health of entire communities by addressing social, environmental, & behavioral factors that influence health
types of community health settings
community clinics
local health department
nonprofit organizations
outpatient clinics
schools
competencies required for community-based care
easy access/care
flexibility in responding to needs
promoting care through effective communication
affordable
cultural competence
discharge planning & care coordination in community settings
continuous process in which pt care shifts from being provided in one setting care to another
aims to link pt with community resources, improve information exchange, & reduce fragmentation and duplication of service
florence nightingale
first practicing epidemiologst
first nursing school
lilian wald & mary brewster
Henry Street Settlement
founder of public health nursing
Harriet Tubman
“the moses of her people”
underground railroad
sojourner truth
underground railroad
nurse & counselor for Freedmen’s relief association
dorothea dix
union’s superintendent of female nurses during civil war
clara barton
organized the american red cross
mary mahoney
first AA trained nurse
lilian wald
founded Henry Street Settlement & Visiting Nurse Service
founder of public health nursing
Nurse Practice Acts
overseen by state boards of nursing
regulates the scope of nursing practice
protects public health, safety, & welfare
scope of nursing
patient centered care
Quality & Safety Education for Nurses (QSEN)
professionalism
American Nurses Association
health care advocacy groups
Robert Wood Johnson Foundation (RWJF)
future of nursing: campaign for action
institute of medicine (IOM)
publication on the future of nursing
