This course explores legislation and regulation relating to health informatics. The course will examine the major laws and agency regulations governing healthcare technology, data collection, management, and privacy, as well as the security standards required for healthcare and health-related organizations. Students will explore the intent behind, and ethical dimensions of, health informatics regulatory frameworks, using case studies of recent health information uses, security breaches, and challenges to interoperability. This course will also look ahead to the impact of future Health IT regulations.
Please note that all times in the syllabus and in Blackboard refer to Eastern Time. The discussion board and assignment links for each week will open at the start of the week for submissions.
Weekly Discussion Posts – These assignments will assess your ability to clearly and accurately apply concepts from your readings and from your own experiences. Each week you are expected to submit an initial post and comment on at least 2 other students’ posts. You need to follow APA guidelines for citing any sources you may reference in either your initial post or your response to others. Refer to the Discussion Rubric and discussion question for submission guidelines.
Initial post: You should submit your initial post by 11:59 p.m. Sunday. Your initial post should be approximately 500 words; however, your post may occasionally be outside those parameters as long as you are able to accomplish the goals of the assignment. 500 words should allow you to explore the topic with sufficient detail.
Response to others: You should comment on at least 2 other students’ posts by 11:59 p.m. Wednesday. Your comments to others should be thorough, thoughtful, and they should offer some new content. Do not merely respond with “I agree” or “I disagree.” Engage directly with the ideas of your classmates and briefly mention which part of the post you are responding to.
Weekly Case Studies – During weeks 1 through 5, you will be reading case studies and answering questions to help you apply the concepts of this course.
Research Paper – In week 7, you will submit a 5-7 page research paper that includes potential resolutions to current media coverage of the cybersecurity/hacking epidemic.
Your grade in this course will be determined by the following criteria:
Assessment Item | Possible Points | Percent of Total Grade |
---|---|---|
Weekly Case Studies, weeks 1 - 5 | 11 points each | 55% |
Discussion Posts | 3 points per discussion | 24% |
Research Paper | 21 points | 21% |
Total | 100 points | 100% |
Grade | Points Grade | Point Average (GPA) |
A | 94 – 100% | 4.00 |
A- | 90 – 93% | 3.75 |
B+ | 87 – 89% | 3.50 |
B | 84 – 86% | 3.00 |
B- | 80 – 83% | 2.75 |
C+ | 77 – 79% | 2.50 |
C | 74 – 76% | 2.00 |
C- | 70 – 73% | 1.75 |
D | 64 – 69% | 1.00 |
F | 00 – 63% | 0.00 |
Learning Modules | Topics | Assignments and Due Dates |
Week 1 |
Introduction to the Fundamentals of Law for Health Informatics The Legal System in the United States |
Discussion – Initial post by Sunday 3/4, responses by Wednesday 3/7 Case Study – Wednesday 3/7 |
Week 2 |
Consent and Release of Information |
Discussion – Initial post by Sunday 3/11, responses by Wednesday 3/14 Case Study – Wednesday 3/14 |
Week 3 |
Legal Health Record |
Discussion – Initial post by Sunday 3/18, responses by Wednesday 3/21 Case Study – Wednesday 3/21 |
Week 4 |
Corporate Compliance/Medical Staff Compliance |
Discussion – Initial post by Sunday 3/25, responses by Wednesday 3/28 Case Study – Wednesday 3/28 |
Week 5 |
HIPAA Privacy and Security Rules |
Discussion – Initial post by Sunday 4/1, responses by Wednesday 4/4 Case Study – Wednesday 4/4 |
Week 6 |
Information Risk and Management |
Discussion Forum – Initial post by Sunday 4/8, responses by Wednesday 4/11 |
Week 7 |
Information Rights vs. Protection |
Discussion – Initial post by Sunday 4/15, responses by Wednesday 4/18 Research Paper – Wednesday 4/18 |
Week 8 |
Cybersecurity Management |
Discussion – Initial post by Friday 4/20, responses by Sunday 4/22 |
Week 1 — Introduction to the Fundamentals of Law and our Legal System for Health Informatics
Learning Outcomes:
Readings:
Video:
National Partnership for Women & Families. (2016, Feb 26). Get My Health Data. [Video File]. Retrieved from https://www.youtube.com/watch?v=n5bsLCZZsCs
Assignments:
Discussion Prompt: Who owns the patient health record and who controls the use of the information within the record? How does digital and mobile health complicate this? Think about a time when you (or someone you know) requested a copy of your health record. What format was it in — paper or digital? Please provide a short narrative about that experience.
Case Study Assignment (Read the case study and answer the questions that follow. Use APA formatting.):
A patient has filed a $3 million medical malpractice lawsuit against St. Patrick Hospital. In light of the patient’s litigious background and the facts of the case, hospital administration is adamant that the hospital is not liable. The administration has instructed its legal counsel to proceed toward trial where it may be absolved of liability.
1. What source of law is the patient’s lawsuit likely to be based on?
2. Is the hospital’s decision to proceed toward trial a wise one? (Defend your position.)
3. What other options does the hospital have? Explain.
4. Besides the financial resources required to legally defend itself, what non-monetary factors must the hospital take into consideration when deciding to proceed toward trial? Explain.
5. What risks does the hospital assume when it takes a case to trial? Explain.
6. Is it the hospital’s or legal counsel’s decision whether to try the case or settle? What decision-making authority does the hospital’s insurance company have?
Week 2 — Consent and Release of Information
Learning Outcomes:
Reading:
Assignments:
Discussion Question: Describe situations in which state laws may permit a minor to consent to treatment without an adult’s consent. Explain the rationale for such laws. What are the laws in your state? Discuss the pros and cons of such laws.
Case Study (Read the case study and answer the questions that follow. Use APA formatting.):
Employee Unlawful Access to Hospital Records – A former UCLA Health System employee became the first person in the nation to be sentenced to federal prison for violating HIPAA. Huping Zhou, 47, of Los Angeles, was sentenced to four months in prison on April 27 after pleading guilty in January to four misdemeanor counts of accessing and reading the confidential medical records of his supervisors and high-profile celebrities, according to the US Attorney’s Office for the Central District of California. Zhou was also fined $2,000. In 2003, Zhou, who was a licensed cardiothoracic surgeon in China before immigrating to the United States, was employed as a researcher with the UCLA School of Medicine. On October 29, 2003, Zhou received notice that UCLA intended to dismiss him for job performance reasons unrelated to the illegal access to medical records. That night, Zhou accessed and read his immediate supervisor’s medical records as well as those of other co-workers. Over the next three weeks, Zhou abused his access to the organization’s electronic health record system to view the medical records of celebrities and high-profile patients, including Drew Barrymore, Arnold Schwarzenegger, Tom Hanks, and Leonardo DiCaprio. According to court documents, Zhou accessed the UCLA record system 323 times during the three-week period. In the plea agreement, Zhou admitted he obtained and read patient health information on four specific occasions—with no legitimate reason, medical or otherwise—after he was terminated from his job. Zhou did not improperly use or attempt to sell any of the information he illegally accessed, according to the press release. In January Zhou’s attorney Edward Robinson was quoted in the UCLA student newspaper saying Zhou did not know that accessing the records was a federal crime.
1. As a member of the UCLA workforce, would Zhou have a legitimate right to view patient records in his normal course of employment?
2. In managing access and disclosure of PHI how do you think UCLA discovered Zhou’s infractions?
Source: AHIMA. “Californian Sentenced to Prison for HIPAA Violation.” August 29, 2010. http://journal.ahima.org/2010/04/29/californian-sentenced-to-prison-for-hipaa-violation/
Week 3 — Legal Health Record
Learning Outcomes:
Readings:
Assignment:
Discussion Question: Care providers (nurses, doctors, therapists) often print information from the record to assist in the care of healthcare consumers. Please discuss why this is an issue? Consider both pros and cons in your post.
Case Study (Read the case study and answer the question that follows.Use APA formatting.):
The director of health information management, as the custodian of medical records, is having a great deal of difficulty responding to subpoenas for patient records. The facility is in the midst of converting from a paper-based to an electronic patient record. Some information is on paper (such as consents), some information is scanned immediately following discharge (such as nurses’ notes), some information is automatically (COLD) fed into the EHR system (such as transcription reports) and some information resides only within electronic systems (such as lab results and physician orders). The process of finding and identifying the various parts of the patient’s record from the various sources is time-consuming and there is concern about ensuring the same response (that is, that the legal health record is produced) each time a record is requested. An attorney requested a record, followed by an additional request. What he received from the organization the first time was substantially different from what he received the second time. When the attorney deposed the custodian, many questions were raised about how record requests were handled. Questions were also raised about daily operational processes including how the patient’s legal health record was compiled in response to a subpoena, and if the resulting report was the true and complete record for the patient.
1. What steps should the director take to ensure that responses to subpoenas consistently result in the true and complete health record of a patient?
Week 4 — Corporate Compliance/Medical staff Compliance
Learning Outcomes:
Readings:
Reference:
Assignments:
Discussion Question: Why do you think that health care fraud and abuse is such a significant problem? Explain the rationale for your belief.
Case Study (Read the case study and answer the questions that follow.Use APA formatting.):
Dr. Pearson has recently been hired into the Central City Internal Medicine Group as its fifth physician. He has recently completed his residency and is eager to enter private practice. Dr. Pearson is introduced to Meredith and Dawn, two members of the billing staff for the practice. Unbeknownst to Dr. Pearson, Meredith financially assists the practice in several ways. She bills procedures by using individual codes instead of comprehensive codes, she has decided to bill Dr. Pearson’s services under the Medicare number of Dr. Craig (another Central City physician) until Dr. Pearson’s credentialing process has been completed, and habitually submits a claim more than once if she isn’t sure whether or not it has already been submitted.
1. Name the types of fraudulent billing that Meredith is conducting.
2. Could Meredith be held liable for these activities?
3. Is Dr. Pearson subject to liability although he doesn’t know Meredith is conducting these activities?
4. Once Meredith’s activities are discovered, how should her conduct be addressed by her employer, Central City Internal Medicine?
5. What should Central City do to ensure these types of problems don’t occur in the future?
Week 5 — HIPAA Privacy and Security Rules
Learning Outcomes:
Readings:
Videos:
Assignments:
Discussion Question: This week you watched a series of short videos entitled Your Health Information, Your Rights which were designed for healthcare consumers. You have read and thought a lot about healthcare records from the perspective of healthcare providers, but it is important to consider them from the perspective of consumers as well. Please comment on something that jumped out at you from the videos. Was there anything in the videos that surprised you?
Case Study (Read the case study and answer the question that follows.Use APA formatting.):
The following case study (Rinehart-Thompson) at hypothetical St. John Hospital illustrates numerous issues that the HIPAA privacy rule presents and which HIPAA-covered entities must address on a daily basis. As you conclude Chapter 9 and the HIPAA privacy rule requirements, use this case study to identify the issue(s) presented on each date, determining how each situation should be handled in order to comply with the HIPAA privacy rule.
From May 26-30, Mary Jones was hospitalized in St. John Hospital, located in Johnson County, with depression and a drug overdose (documented by the physician as a possible suicide attempt). She also had Type I diabetes and a previous above-knee amputation of the right leg, with a prosthesis. During her hospital stay, she had several sessions with her psychiatrist, Dr. Bridges.
On July 18, Ms. Jones contacted the HIM Department at St. John Hospital to request a copy of her medical records from her May hospital admission. The chart was copied for her by ReadyChart, the record-copying service utilized by St. John Hospital.
On August 7, Ms. Jones returned to the HIM Department at St. John Hospital, extremely upset that her May records indicated a possible suicide attempt. She wanted Dr. Bridges to change the incorrect records to reflect that the overdose was accidental. Dr. Bridges refused, stating that Ms. Jones didn’t know what she was talking about.
On September 14, Ms. Jones was readmitted to St. John Hospital with an infection of the prosthetic site. She was treated with an antibiotic regimen.
On October 5, St. John Hospital received a call from Mercy Hospital. Ms. Jones was in the emergency department there, with a severe infection of her prosthetic site. The nurse in the Mercy Hospital emergency department asked for faxed copies of medical records from Ms. Jones’ September admission at St. John, as she was being prepared for immediate surgery.
On October 15, Ms. Jones decided to go to another psychiatrist. She called St. John Hospital HIM Department and asked that her medical records from her May hospital admission be mailed to Dr. Lyon, as she has an appointment scheduled with him this coming January. Ms. Jones stated that she had also changed jobs in September, and her new health insurer was Liberty Life and Health.
On October 30, Ms. Jones requested a copy of her medical records from her September admission. The new HIM manager in charge of correspondence, Don Day, stated that he was aware of a state statute that prohibited the release of medical records to patients without the prior written approval of their attending physician. This has not been the practice at St. John Hospital. Mr. Day was concerned about the hospital’s longstanding violation of state law. He suggested that correspondence requests (in which records would be released directly to patients) be suspended until the state law could be researched further.
On November 10, Ms. Jones received a brochure and samples from Comfort Healthcare, a pharmaceutical company that manufactures ointment for patients with prostheses. Ms. Jones called the St. John Hospital registration desk to complain. Jessica Carter, a candy striper, took Ms. Jones’ call.
On November 12, Liberty Life and Health submitted a request to Dr. Lyon’s office for copies of Ms. Jones’ medical records from her May St. John Hospital admission and from Dr. Lyon’s office.
On November 17, A caseworker from the Johnson County Children’s Services called the HIM Department at St. John and requested Ms. Jones’ medical records from her May hospitalization. Children’s Services had received a complaint that Ms. Jones had an “episode” on May 26 and there was concern that her children were being subjected to ongoing abuse. As a result, it was initiating an investigation.
On November 20, the physical therapy department at St. John Hospital is performing a correlational study to determine the effects of two different types of treatment that the physical therapy department has used with its above-knee amputation patients during the past two years. Ms. Jones received treatment from the St. John physical therapy department during her September admission.
On November 21, Dr. King, an orthopedic surgeon, presented a seminar to the state association of orthopedic surgeons on above-knee amputation techniques. He had performed Ms. Jones’ procedure one year ago, and he showed slides that compared her condition before the procedure, immediately after, six months later, and one year later.
1. Based on the HIPAA privacy rule issues discussed in Chapter 9, identify the issue or issues presented on each date in the above case study.
Week 6 — Information Risk and Management
Learning Outcomes:
Readings:
Assignments:
Discussion Question: With ransomware attacks on the rise, each healthcare organization must consider how they will deal with these attacks. Please offer your thoughts both for and against paying for healthcare data that is held ransom.
Preview of week 7, Research Paper: You should begin work on your research paper this week (week 6). You will turn in the paper next week (week 7). The description of the research paper is found under week 7.
Week 7 — Information Rights vs. Protection
Learning Outcomes:
Readings:
Assignments:
Discussion Question: Most states now have Health Information Exchange systems. The systems are either set-up as “opt-in” or “opt-out”. Determine what your state does (or what a neighboring state does). Do you know if your personal data is shared in your state? Discuss your thoughts and opinions about the ethics of this. Pay particular attention to the “tricky” areas of underage consent, mental health services, and HIV status.
Research Paper: Please review the current media coverage of the cybersecurity/hacking epidemic and consider potential resolution options. Your paper should include:
Students are encouraged to dig into any strategy that might work – even if not widely applied today. Consider both technology and policy approaches. Submission Requirements: 5-7 pages with at least 5 references. Please use at least two academic journals references and the other three or more can be any combination of industry articles/website, mainstream media (examples: New York Times, CNN, PBS, NPR) or other resources. Follow APA guidelines.
Week 8 — Cybersecurity Management
Learning Outcomes:
Readings:
Assignment:
Discussion Question: In this week’s reading, you considered how other parts of the world think about the privacy of healthcare data. Please discuss the different ways healthcare information is managed and the pros/cons to the different processes. Along with countries mentioned in your textbook, please research and find one more country (preferably a “third-world” or poverty-stricken location) and consider how that country may see privacy of healthcare information differently.
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