Management
The privacy rules of HIPAA are defined as the right of any persons to have an access to all protected health information that is of him or her and controlled by an entity that operates in a primary paper-based surroundings. Protected health information is been converted from paper records to electronic forms through the help of health information technology. There is a massive adoption of electronic health records in most health institutions to create quality and efficiency in healthcare delivery. The health IT highlights the measures that individuals can request electronically for their protected health information.
The critical role of the privacy rules in HIPAA is to ensure that an individual right to access the protected health information is ensured. The privacy rules explains the exceptions by which people will request for copies of their protected health information and the health care providers will make the information accessible to them. In this process, gives a guideline for individuals to either access, be denied a covered entity right to access, and documentation. The HIT outlines how to solve conflicting interests when it comes to making access to individuals or to a certain entity.
This when brought together shows the importance of the privacy rules as they ensures that : they have a right to request for access of PHI, they have a right make requests in a timely manner, and finally they are in a position in provision of access. The privacy rules of HIPAA have impacts on the staff duties in the health organizations. This is because the staff must ensure that privacy and confidentiality of the health information is guaranteed. This is a challenge, as the workforce must ensure confidentiality and integrity is reached.
Security rules
On the other hand, security rules unlike the privacy rules concentrates on protecting electronic health information only. The security rules outline three measures of security safeguards that are needed for compliance. They include administrative safeguards, technical safeguards and physical safeguards. Each method highlights the way it is specified to guide and help in action and decision taking. The standards are explained below:
Administrative safeguard
These policies indicate how the entities will comply with the set acts. All the entities have the written documents and an officer in charge of the implementing the policies. The policies and procedures outline the workforce with the right to access the protected health information for the sake of confidentiality and avoiding unauthorized access.
Physical safeguards
The security rule works to ensure that all forms of physical access are unauthorized access of the patient data is protected. The protection of the PHI includes both the amputation of hardware and software components from the networks. There individuals allowed to freely access the hardware and software in the institutions is given a user name and password that guarantee confidentiality and privacy of high order.
Technical safeguards
The rules hear plays a role to protect any unauthorized access to the computers and it outline the cover that is given to all the entities. The computer systems are protected from outside intruders that can harm the information that is protected. All data and information stored in these institutions is fully covered and protected. All forms of network configurations are controlled to ensure that hacking of the systems remains a nightmare.
Standardized transaction code sets rules
The transactions in electronic data interchange that takes place in submission, processing and compensating claims are governed with these rules. The standards for electronic transactions covers health claims, enrolment, healthcare payments, health premiums and first injury reports. These standards are in charge of all health plans, all clearinghouses in healthcare, and all health care professionals that convey any health information in all electronic modes when connected to all transactions. The transactions in electronic data interchange (EDI) under the HIPAA rule covers the following: the coordination of benefits, status of heath claims, the eligibility for a health plan, the healthcare payment and remittance advice, referral certification and authorization.
There are many electronic formats under transactions that are used to cover up for medical claims and other businesses. The electronic formats have helped in the improvement and effectiveness of transactions that takes place. The health plans must implement the set standards to match with the regulations. When it comes to commercial use, the health professionals who apply non-electronic transactions are not obliged to take the standards. The electronic transactions in healthcare provisions implement all the set standards to comply with rules and regulations. If they fail to adopt these standards, they must ensure that they encounter the clearinghouse so that the translation services are provided. The standards serve the purpose to reduce errors and avoid duplication of efforts. They help the health insurance industry in billing coverage because of the standardizations that takes place in electronic health care.
Health Information Management Services
Critical issue
The efficiency and effectiveness of the Health information Management system depends heavily on compliance to guidelines of HIPAA. This guideline ensures all data related to patient is securely and appropriately shared between patients, insures and providers. The health records have to be stored, archived, and accessed in a way that fulfils the requirements and standards of HIPAA among other health relate laws. The HAPAA guideline was established to enhance the confidentiality of patient data when viewed by provider, insurers, and other health professional. The strict rules are followed when passing information from one place to another.
Since there are various rules and regulations that are used to facilitate patient data and health care information, it is significant for a patient to understand their right to privacy. This is because this right relates to sharing and managing their health care information. Generally, the health care officials do not have any right to access the patients’ information without medical or business purpose to do so. Unlike other sectors, the information and Technology in the heath care are compliance to strict standard that protects the privacy of the patient.
Information use
the information in this department is used to determine the systems efficiency in detecting flaws and defining priorities in the health care. The information is also used in spotting the innovative solutions and resource allocation that enhances the outcomes in the health sector. The goal of this department is to utilize information effectively that is vital to the patient and ensure that the providers are able to access the information as fast as they need it. The information in this department is used to analyze the trend and operation of the health facilities so that managers are able to carry out effective planning.
Clinical Nursing Services
Critical issue
The main role of this department is to watch over the outpatient and inpatient and enhance space utilization and scheduling in the health sector. The department consists of registered nurses that are backed up by the patient care technicians. All nurses inn this department are certified by the administration of biotherapy-chemotherapy in conjunction with Advanced Cardiovascular Life Support (ACLS). On the other hand, all the nurses that handle the outgoing patients are certified by the Pediatric Advanced Life Support (PALS).
Information use
The specialists to integrate conventional nursing duties and responsibilities with their area of expertise use the information retrieved from this department. In addition, the information is applied in the health care to offer direct patient care in prevention, identification, and declaration of illness. This allows the specialist to diagnosis and treats the patient with regard to their field of specialty. Therefore, the information assists the clinical nurses to offer care to individuals, groups, and family with complex medical necessities as per their clinical expertise. The information helps the clinical nurses who are fundamental agents in determining the outcome and direction of the managed care. Without this information, it would be hard for the nurse to identify the patients’ needs.
Credit department
Critical issue
The credit department is a critical component in the health sector’s operations. The department uses innovative methods when required to structure transaction so that services are offered effectively in enhancing patient welfare. The key issue in this department is to determine how and when to accomplish the sales in the health facilities. The department ensures that risk of non-payment and payment, by patients is minimized. Therefore, the department facilitates a favorable relationship between the patients and the health center.
Information use
The data retrieved in this department is used to ensure that the health facility attains maximum sales of services and products such as medicine. Well-organized information in this department will assist the department to communicate with other departments that are within the entity. They communicate about sales, entry, and shipping. Most significantly, the information assists the department to facilitate the credit and collection strategies as well as safeguarding the hospital’s investment in the account receivable.
On the basis of credit and collections holds, customers sometimes overreacts over the decisions that are made by the credit department during placing orders on credit products. Therefore, a good record on the matter is helpful in clarification of such issues. The creditor department should therefore make sure that the patients and debtors understand the collection period that is applied by the creditors and be informed of the risk associated with payment delay.
The credit department also engages in Collections and Credit Risk Management. Various collection problems in the health facilities are as a result of flawed or inadequate information about the credit investigation. Therefore, the information will assist in determining the credit extension when issuing a loan or credit to the applicant. The information provides a detailed thoughtful of the financial worth and creditworthiness of the patients and other stakeholders in the credit department. This is because the creditor will not be in a position to approve open account terms without the adequate documents to indicate the applicant is creditworthy.
TPO
Treatment
Under the HIPAA, treatment is defined as the coordination, management, or provision of health care and other services that are related to health by one or more health care providers. This includes the management or coordination of health services by health-care provider with an intermediary. This involves the medical appointment of health services from one health facility to another or session between the patient and the health care provider. In other terms, treatment encompasses all the health care services that are subjected to patient by the health care provider.
Payment
This represents the variety of activities that engaged by health care provider to acquire payment or be paid back for their services. The payments are also involved in health plan that yields premiums, offer benefits and attain the coverage responsibilities that are outlined in the plan. In addition, the payment activities include risk adjustments, collection and billing activities, review of health care services and, adjudicating claims and determining eligibility under plan. Generally, payment represents all collected data for collections and billings received or in anticipation of collection outcome
Operation
Payment involves financial, administrative, quality and legal improvement activities of a covered unit that are required to operate its business and sustain the central function of the payment and treatment. The activities that are not covered by the definition include quality assessment and improvement, facilitating competence, underwriting, planning and development, and management and administrative functions among others. In simple terms, operations represent anything that is all about business activities such as training and teaching of the professionals in the health care sector.
References
Warren S. and Brandeis L., (1990) "The right to privacy," Harvard Law Review, Vol. 4, 193-220. Graham Greenleaf, Global Data Privacy Laws: 89 Countries, and Accelerating
Cavoukian, Ann (2005) Who Knows: Safeguarding Your Privacy in A Networked World. Random House of Canada: Random House. ISBN 0-394-22472-8
McCormick, Michelle (2003) "New Privacy Legislation." Beyond Numbers 427 (2003): 10-. ProQuest. Web. 27 Oct. 2011
