Patient Advocacy

Posted: December 07, 2018

Patient Advocacy

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Patient Advocacy

Introduction

The delivery of quality health care has been the main goal and objective from the onset of health care establishment. Thorough research in the medical health field by different scholars led to a new meaning of the term health quality as “the degree to which health services for individuals and populations increases the likelihood of desired health outcomes coupled with the consistency of current professional knowledge” (Earp, French, & Gilkey, 2007). The institute of Medicine later enhanced the definition through the addition of ideas in that health care should be of  “high quality and patient-centered, effectiveness, efficiency, timeliness interwoven with safety as well as equitability”. Coordination, compassion and innovation are also elements in pursuit of patient advocacy, in conjunction with Health Insurance Portability and Accountability Act (HIPAA) (Annas, 2004). 

            HIPAA has provisions for health data privacy with the aim of safeguarding medical information. In order to improve the health care quality, patient advocacy and HIPAA have to be scrutinized and analyzed. To improve the health care being offered through the provision and utilization of state of the art equipment and resources, the people in charge must be forward thinking, in that as time passes by individuals would still be in the position to advocate for better science to be used in the field. Patient advocacy in itself is the central nerve that connects all the aspects that appertain quality improvement in healthcare. It takes shape through the efforts of a person advocating on behalf of a patient as well as a wider scope that involves organizational representation and effort (Earp, French, & Gilkey, 2007).

Patient Rights to Privacy and Confidentiality

HIPAA and Patient Confidentiality

The core value in patient advocacy is the element of encouragement and partnership that enables patients to play a role through participation in the healthcare system thus affecting their outcome from it. Patient confidentiality in relation to HIPAA refers to the obligation of health professionals with access to patients’ records to keep the information in confidence (Annas, 2004). This is a relationship that is developed between the patient and their provider. According to Brodnik, Rinehart Thompson and Reynolds (2012), by law confidentiality is recognized and defined as communication between two or more people in a professional relationship, in this sense the health care sector, such as a patient with a nurse, physician or any other clinical professional. The development and application of the patient confidentiality issue in health care is a sensitive issue that needed to be handled for efficiency purposes, this was achieved through the passing of the Act on Health Insurance Portability and Accountability (Berlin, & Bravender, 2009).

Patient confidentiality limits the nurses, doctors and other clinical professions on what information to divulge when it comes to health care of a patient (Richards, 2009). For instance, discussion of patients with people not related to them is prohibited, as well as discussing the patient’s progress with others, not the patient, neither discuss a patient’s case with colleagues in a public space nor share information with one’s friends or family in that they can identify the patient. There is also the limitation of nurses from reading chart information about a patient one is not caring for, in this instance these are nurses.

HIPAA Privacy Rule Application

With the ever-advancing technology, there was a need to curb the spread of information especially confidential, to preserve the privacy of patients in the health care system. HIPAA came in in time to ease the transmission of confidential information in the wellness program between people especially clinical professionals as well as facilities (Annas, 2004).

The HIPAA applies to all individuals working in health plans these include insurance companies, healthcare providers with consideration of whoever handles any type of medical or health service, not forgetting health care clearing houses that are to mean those with the mandate to clear bills. Under the privacy rule, the protected information in health care must not be shared with any other person not directly working with a patient without prior express permission from the patient or legal guardian (Rutherford, 2016). This is inclusive of health information both past and present be it physical or mental, it also applies to the prognosis that is future mental and physical health information about a patient.

Consequences of Violating the HIPAA Privacy Rules

Upon the establishment of the HIPAA with core reasons to protect the privacy and secure individual patient information, there is consequences that apply due to failure to comply with the set rules. Both civil and criminal penalties coupled with progressive disciplinary actions follow suit the people who do not adhere to the confidentiality and privacy pellets (Annas, 2004). Nurses and other clinical professional have lost their jobs and practicing licenses due to negligence and violation of privacy rules of their patients.

Civil monetary penalties are applied in four categories, first, is to an individual or covered entity who did not know the action taken was HIPAA violation would pay between one hundred thousand dollars to one million, five hundred thousand dollars. Second, if the violation was due to a reasonable cause, then the penalty is between one thousand to one million, five hundred thousand dollars annually (Vedder, Cuijpers, Vantsiouri, & Ferrari, 2014). Third, if the violation was because of willfully neglecting but it was corrected in time, one is given a penalty of $10,000 to $50,000 for each violation. Fourth, if it was because of willful neglect, a penalty of a minimum of fifty thousand dollars to a maximum of one million, five hundred thousand dollars would be levied.

On the other hand, criminal penalties do apply as well for the cases of HIPAA violation. For instance, in the case of unknowingly violating or with reasonable cause, a person can serve up to a one-year jail term. Second, HIPAA violation under false pretense has the potential of up to five years’ jail term (Ness, 2007). Last, violations for personal gain coupled with malicious reasons one’s potential jail term is up to ten years.

Private Interests of the Patient

Patients are people who have their individual minds and thus have the ability to dictate what they want when under health care this especially applies to the type of information divulged and to whom. This is when the patient advocate comes in. The patient has the ability to dictate who should be given information appertaining their health (Krishna, Kelleher, & Stahlberg, 2007). In as much as the patient has the right to privacy, it is upon his or her advocate to determine the case at hand. HIPAA has in an array of ways helped in the strengthening individual’s privacy rights, by the fact that it has created awareness about health information privacy with regard to issues that surround the protection of the rule and also the role of the individual patient in the process of receiving health care (Gordon, et al. 2015). With the compliance to HIPAA the health care professionals, patient’s private interests are protected.

Medical Records

The confidentiality of every patient’s medical record is governed by medical ethics, state laws as well as the federal law stated under HIPAA. In as much as there is a provision for medical records being kept confidential, the rules guarding the HIPAA electronic records allow the medical providers these are inclusive of doctors, nurses and other clinical professionals in the medical care sector, to disclose a patient’s health information (Gordon, et al. 2015). These includes information on laboratory tests, diagnostic images and any other healthcare information to be used during treatment prior authorization from a patient.

Information on a Patients Record

Under health care patients are bound to undergo several tests to determine what they are ailing from in order to find a solution through treatment. The information mostly found on a patient’s record include but not limited to diagnostic images, laboratory tests, diagnoses, and billing (Moskop, 2005). The doctor treating the patient as well as nurses have the mandate to input any patient information onto the record.

Owner of a Patient’s Medical Record

The physical medical record is it electronic or paper belongs to the doctor or physician who created it, as well as the facility referring to the hospital in which it was created. Despite the aforementioned fact, information gathered within the original medical record is owned by the patient, in reference to this that is why patients are legally allowed to have a copy of their medical record but not mandated to take the original copy (Newman & Kjervik, 2016). The health care facility keeping patient records is required by law to keep and maintain the original medical record for every patient treated, by safeguarding it from loss, alteration, unauthorized use or even eventual loss. Under the federal law, the original medical record is a legal document that without any court order must not leave or be removed from the health care premises.

Patients Access to Medical Records

Despite the original medical records ownership leaning towards the doctor who created it, the patient has the right to review it, through inspection and even go ahead to be given their billing and medical records in the hands of the medical providers as well as plan and this is covered in the HIPAA privacy rule (Cao, Huang, & Zhou, 2003). The denial of a patient’s medical records is not allowed under the federal law even if the patient has not cleared his or her bills in reference to the services rendered by the health care facility. Despite this, a health care provider has the provision of whether to charge or not to charge the patient a fee for mailing their medical records.

Employers and Health Information in the Workplace (Hipaa)

Under HIPAA, the privacy rule has power thus controls how a patient’s protected medical and health information is shared with one’s employer by a health maintenance provider meaning the hospital or medical insurance provider.

Employment Records

HIPAA privacy rules do not protect a patient’s occupational records, this goes despite the fact that the data therein is related to health. The privacy rule in most cases does not apply to any actions taken by the employer (Annas, 2004). Supposing that one works a health plan or even a covered health care provider that is nurses, physicians, and doctors as well as other clinical professionals, their employment records are exempted from the privacy rule. The rule sure protects one’s health records considering one is a patient at the hospital and a comrade of a certain managed care plan.

Requests from Employer

The company is allowed to and can request you to give them a note from the doctor stating your health condition when in need for of the report with the aim of using it to fill a sick leave, health insurance or even compensation for the worker or employee. However, the employer is not allowed to directly ask one’s healthcare provider for information about you (Hader & Brown, 2010). Under the privacy rule, the doctor cannot divulge medical and health information to one’s employer without the patient’s authorization not unless the law requires and mandated the provider to do so in the instance of a court order.

Personal Representatives

Under the law and the HIPAA, there is a provision that health care providers or plan must allow a patient’s personal representative to review, inspect and go ahead to receive a copy of the protected health and medical information about a patient for keeps’ sake as well as maintenance.

Naming a Personal Representative (Health Care Proxy)

One’s personal representative can be named in different ways, although the state law may somehow affect the naming process. A personal representative is a person who can decide for a patient using medical care authority from an attorney (Annas, 2004).

Children

Minor children always have their parents or legal guardians as their personal representatives, although the state law may affect the guardianship. In the case of custody decree, a child’s personal representative is the parent under the custody decree who can make health care decisions for the child.

Exceptions

A provider or plan may refuse to treat a patient’s personal representative as one, on the basis of belief without reasonable doubt that the person may do harm to the patient by endangering the patient in the instance of neglect or abuse through domestic violence.

Notice of Privacy Practices (Hipaa)

What It Means

The notice of privacy practice is a notification one receives from a health care plan and provider giving one an overview of how the patient’s (you), medical information may be used or shared. There is the inclusion of health privacy rights.

Information Included in the Form

The notice gives a description of how the privacy rule works, by allowing the doctor to adapt and reveal guarded medical and well-being information. It also explains that one must give permission in order for his or her health records to be shared for any other reason other than for treatment purposes (Chiu 2016). The organization’s duties to protect health information privacy is also included. The patients’ privacy rights are also included, along with the legitimacy to make a formal complaint to the company if one believes their confidential rights to privacy have been violated. Further information is provided on how to contact the organization for further clarification as well as making a complaint.

When and How to Receive a Notice of Privacy Practices

A notice is issued on one’s first appointment to a health care provider. In the cases of a necessity, you should be given the notice immediately after the emergency. In a health care facility, the notice should be posted in a clear and open location with easy access for the patients to see (Annas, 2004). Provision ought to be available for every person who requests and asks for it. It can also be found on an organization’s website. A health plan must provide the notice upon enrolment and a subsequent reminder every three years reminding one that they can ask for it at any time.

Conclusion

Every patient under the HIPAA has the right to privacy and confidentiality. Patient confidentiality in relation to HIPAA refers to the obligation of health professionals with access to patients’ records to keep the information in confidence. Patient advocacy is a relationship that is developed between the patient and their provider. Under the privacy rule, the protected information in health care must not be shared with any other person not directly working with a patient without prior express permission from the patient or legal guardian. In as much as there is a provision for medical records being kept confidential, the HIPAA electronic medical records rules allow health care providers these are inclusive of doctors, nurses and other clinical professionals in the health care sector, to use or disclose a patient’s medical health information. This aspect helps in curtailing any plans of people to use health records for ill motives.

The privacy rule has power thus controls how a patient’s protected medical and health information is shared with one’s employer by a health care provider, although the rule does not protect employment records of a person even if they are health related. A personal representative is a person who can decide for a patient using health power of attorney. Medical care providers or plan must allow a patient’s personal representative to review, inspect and go ahead to receive a copy of the protected health and medical information about a patient for keep’ sake as well as maintenance. The notice of privacy practice is a notification one receives from a health care plan and provider giving one an overview of how the patient’s (you), medical information may be used or shared. There is inclusion of health privacy rights

Patient advocacy is the central nerve that connects all the aspects that appertain quality improvement in healthcare. It takes shape through the efforts of a person advocating on behalf of a patient as well as a wider scope that involves organizational representation and effort. Patients need to be enlightened about their rights and how to go about their medical information on who should view it. HIPAA has expounded and brought in the health care sector the much-needed control over the privacy and confidentiality of medical records.

Patients have rights that need to be upheld by all clinical professionals. Patient advocacy in itself is essential for everyone so that they are not left out in the basic understanding of rights. HIPAA implementation made it possible for easy understanding of the rights for patients and should any person go against the laid down rules, they would be held liable and face charges in court. Confidentiality and privacy in regard to medical records of individuals should be held in high esteem by every person under the health care industry.

 

 

References

Annas, G. J. (2004). The Rights of Patients: The Basic ACLU Guide to Patience Rights. New York: New York University Press, ISBN: 9780814705032

Berlin, E. D. & Bravender, T. (2009). Confidentiality, consent and caring for the adolescent patient. Current opinion in pediatrics, 21(4), 450-456

Cao, F., Huang, H. K., & Zhou, X. Q. (2003). Medical images security in a HIPAA mandated PACS environment. Computerized medical imaging and graphics, 27(2), 185-196

Chiu, W. T. et al. (2016). Quality and patient experience: a six-dimensional approach for the future of health. Journal of Hospital Administration, 5(3), pp. 40

Earp, J.L., French, E.A. & Gilkey, M.B. (Ed) (2007). Patients Advocacy for Health Care Quality: Strategies for achieving patient-Centered Care. Jones and Bartlett ISBN: 13:978-0-7637-4961-3

Gordon, C. R. et al. (2015). Digital mobile technology facilitates HIPAA-sensitive perioperativemessaging, improves physician-patient communication, and streamlines patient    care Patient safety in surgery, 9(1), 21

Hader, A. L. & Brown, E. D. (2010). Legal briefs. Patient privacy and social media. AANA journal, 78(4).

Krishna, R., Kelleher, K., & Stahlberg, E. (2007). Patient confidentiality in the research use ofclinical medical databases. American journal of public health, 97(4), 654-658

Lo, B., Dornbrand, L., & Dubler, N. N. (2005). HIPAA and patient care: the role forprofessional judgement. JAMA, 293(14), 1766-1771

Moskop, J. C. et al. (2005). From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine- part 1: conceptual, moral and legal foundations. Annals of emergency medicine, 45(1), 53-59

Ness, R. B. & Joint Policy Committee. (2007). Influence of the HIPAA privacy rule on health research. Jama, 298(18), 2164-2170

Newman, A. B.,  Kjervik, D. K. (2016). Critical care nurses’ knowledge of confidentiality legislation. American Journal of Critical Care, 25(3), 222-227

Richards, M. M. (2009). Electronic medical records: Confidentiality issues in the time of HIPAA. Professional Psychology: Research and Practice 40(6), 550

Rutherford, A. (2016). Byrne: Closing the gap between HIPAA and patient privacy. San Diego L. Rev., 53, 201

Vedder, A., Cuijpers, C., Vantsiouri, P., & Ferrari, M. Z. (2014). The law as a “catalyst and facilitator” for trust in e-health: challenges and opportunities. Law, innovation and technology, 6(2), 305-325

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