Module 1

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

email

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