Chapter 13 Health Information Technology: An Applied Approach

appeal
a request for reconsideration fo a negative claim decision
appellate court
in a state court system, the court that hears appeals of final judgments from state trial courts
arbitration
a proceeding inwhich disputes are submitted ot a third party or a panel of experts outside the judicial trial system
authenticate
confirm by signing
authorization
the granting of permission to disclose confidential information, as defined in terms of the HIPAA Privacy Rule, an individual’ formal written permission to use or disclose his or her personally identifiable health information for purposes other than treatment, payment, or healthcare operations
bench trial
a trial in which a judge reviews the evidence and makes a determination, without a sitting jury
breach
a violagtion of the law
breach notification
HITECH Act Rule that requires both HIPAA covered entities and business assoicates to identify unsecured PHI breaches and notify the involved parties of the breach
business associate (BA)
according to the HIPA Privacy Rule, an individual (or group) who is not a memnber of a covered entity’s workforce but who helps the covered entity in the performance of various functions involving the use or disclosure of patient-identifiable health information
business associate agreement
a written and signed contract that allows covered entities to lawfully disclose protected health information to business associates such as consultatns, billing companies, accounting firms, or others that may perform services for the provider, provided that the business associate agrees to abide by the provider’s requirements to protect the information’s security and confidentiality
causation
in law, a arelationship between teh defendant’s conduct and teh harm that was suffered
cilnical privileges
the authorization granted by a healthcare organization’s governing board to a member of the medical staff that enables the physicina to provide patient services in the organization within specific practice limits
collective bargaining
the negotiating process between an employer and a labor union, unusally regarding working conditions, wages, and so on
complaint
a written legal statement from a plaintiff that initiates a civil lawsuit
consent
a means for residents to convey to healthcare providers their implied or expressed permission to administer care or treatment or to perform surgery, or other medical procedures
constitutional law
the body of law that deals with the amount and types of power and authority that governments are given
counterclaim
ina court of law, a countersuit
court order
an official direction issue by a court judge and requiring or forbidding specific parties to peform specific actions
courts of appeal
a branch of the federal court system that has the power to hear appeals on the final judments of district courts
covered entity
according to the HIPAA Privacy Rule, any health plan, healthcare clearinghouse, or health care provider that transmits specific healthcare transactions in electronic form
credentialing
the process of reviewing and validating the qualifications (degrees, licenses, and other credentials) of physicians and other licensed indepedent practitioners, for granting medical staff membership to provide patient care services
cross claim
in law, a complaint filed agianst a codefendant
defendant
in civil cases, an individual or entity against whom a civil complaint has been filed in criminal cases, an individual who has been accused of a crime
deidentified information
health information from which all names an dother identifying descriptors have been removed to protect the privacy of the patients, family members, and healthcare providers who were involved in the case
department of Health and Human Services (HHS)
agency within the Department of Health and Human Services responsible for civil rights and health privacy rights law enforcement
deposition
a method of gathering information to be used ina litigation process
designated record set (DRS)
a group of records maintained by or for a covered entity that may include patient medical and billing records; the enrollment, payment, claims adjudication, and cases or medical management record systems maintained by or for a health plan; or information used, in whole or in part, to make patient care related decisions
discovery
the pretrial stage in the litigation process during which both parties to a suit use various strategies to identify information about the case, the primary focus of which is to determine the strength of the opposing party’s case
district court
the lowest tier in the federal court system, which hears cases involving felonies an dmisdemeanors that fall under federal statues and suits in which a citizen of one state sues a citizen of another state
diversity jurisdiction
refers to district court cases tha involve suits where a citizen of one state sues a citizen of another state and the amount in dispute excees $75,000
duty
obligation
equal employment Opportunity Act
the 1972 amndemnt to the Civil Rights Act of 1964 prohibiting discrimination in employmnet on the basis of age, race, color, religion, sex, or national origin
equal pay act
the federal legislation that requires equal pay for men and women who perform substantially the same work
express contract
agreement between physician and patient that is specifically articulated
fair and accurate credit transactions act (FACTA)
law passed in 2003 that contains provisions and requirements to reduce identity theft
fair labor standards act
the federal legislation that sets the minimum wage and overtime payment regulations
false claims act
federal legislation stipulating that an individual may file claim (for example, against a hospital) for up to 10 years after an incident has occurred
federal trade commission (FTC)
an independent federal agency tasked with dealing with two areas of economics in the United States; consumer protection and issues having to do with competition in business
health information technology for economic and clinical health act (HITECH)
part of the american recovery and reinvestment act of 2009, the HITECH Act includes requirements for standards development and for investment in health information technology infrastructure and strengthens federal privacy and security law; meant to increase the momentum of developing and implementing the EHR by 2014
implied contract
type of agreement between physician and patient that is created by actions
individual
according to the HIPAA Privacy Rule, a personwho is the subject of protected health information
individually identifiable health information
according to HIPAA privacy provisions, that information that specifically identifies the patient to whom the information relates
injury (harm)
in a negligence lawsuit, one of four elements, which may be economic (hospital expenses and loss of wages) and noneconomic (pain and suffering), that must be proved to be successful
intentional tort
a circumstance where a healthcare provider purposesly commits a wrongful act that results in injury
joinder
in a countersuit, a third party against whom the defendant files a complaint
judicial law
the body of law created as a result of court (judicial) decisions
jurisdiction
the power and authority of a court to hear and decide specific types of cases
legal health record
documents and data elements that a healthcare provider may include in a response to a legally permissible request for patient information
litigation
a civil lawsuit or contest in court
malfeasance
a wrong or improper act
mediation
in law, when a dispute is submitted to a third parry, to facilitate agreement between the disputing parties
medical identity theft
occurs when an individual’s health infomration is misrepresented and used by an unauthorized individual to obtain healthcare goods, services, or money to which they are neither eligible nor entitled
medical malpractice
the professional liability of heatlhcare providers in teh delivery of patient care
minimum necessary standard
a stipulation of the HIPAA Privacy Rule that requires healthcar efacilities and other covered entities to make reasonable efforts to limit the patient identifiable information they disclose to the least amount required to accomplish the intended purpose for which the information was requested
misfeasance
relating to negligence, improper performance during an otherwise correct act
national labor relations act (NLRA)
federal legislation that provides, among other things, procedures for union representation and prohibits unfair labor practices by unions, such as coercing nonstriking employees, and by employers such as interferene wtih the union selection process and discrimination against employees who support a union
negligence
a legal term that refers to the result of an action by an individual who does not act the way a reasonably prudent person whould act under the same circumstances
nonfeasance
a type of negligence meaning failure to act
notice of privacy practices
a statement (mandated by the HIPAA Privacy Rule) issued by a healthcare organization that informs individuals of the uses and disclosures of patient identifiable health information that may be made by the organization, as well as the individual’s rights and the organziation’s legal duties with respect to that information
occupational safety and health act
the federal legislation that established comprehensive safety and health guidelines for employers
personal health record (PHR)
an electronic record of health related information on an individual that conforms to nationally recognized interoperability stndards and that can be drawn from multiple sources while being manaegd and controlled by the individual
personal representative
person wtih legal authority to act on a patient’s behalf
petition for writ of certiorari
a document filed with the U.S Supreme Court, asking for review of a lower court’s findings
plaintiff
the group or person who initiates a civil lawsuit
preemption
in law, the principle that a statute at one level supersedes or is applied over the same or similar statute at a lwer level, for example, the federal HIPAA Privacy provisions trump the same or similar state law with certain exceptions
privacy officer
the individual responsible for the development and implemenmtation of an organization’s privacy policies and procedures
private law
the collective rules and principles that define the rights and duties of people and private businesses
protected health information
under HIPAA, all individually identifiabel inforamtion, whether oral or recorded in any form
public law
…a type of legislation that involves the government and its relations with individuals and business organizations
red flags rule
…a set of FTC regulations that require certain entities to develop and implement identity theft prevention programs
rehabilitation act
…federal legislation passed in 1973 to protect handicapped employees against discrimination
right to work laws
…federal legislation dealing with labor rights (examples include workers’ compensation, child labor, and minimum wage laws
rules and regulations
…operating documents that describe the rules and regulations under which a healthcare organization operates
standard of care
…an established set of clinical decisions and actions taken by clinicians and other representatives of healthcare organizations in accordance with state and federal laws, regulations, and guidelines;
statutory law
…written law established by federal and state legislatures
subject matter jurisdictoni
…pertaining to district courts, jurisdiction to hear cases involving felonies and misdemeanors that fall under federal statutes
subpoena ad testificandum
…a command to appear at a certain time and place to give testimony on a certain matter
subpoena duces tecum
…a written document directing individuals or organzations to furnish relevant documents and records
summons
…an instrument used to begin a civil action or special proceeding and is a means of acquiring jurisdiction over a party
supreme court
…the highest court in the US legal system
tort
…an action brought when one party believes that another party caused harm through wrongful conduct and seeks ocmprensation for that harm
treatment, payment and operations (TPO)
…term used in the HIPAA Privacy Rule pertaining to broad activities under normal treatment, payment, and oeprations activities, important because of the rules many exceptions to the release anddisclosure of personal health information
trial court
…the lowest tier of stte court, ususally divided into two courts
use, disclosures, and requests
…three types of situations in which personal health informaitno is handled
voir dire
…the process of jury selection
workforce members
…employees, volunteers, trainees, and other persons who work under the direct control of a HIPAA covered entity, regardless whether they ar paid by the covered entity