Employee Management
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Remember the Basics of Good Documentation
Proper documentation requires adhering to the basic goals of fully and accurately recording the patient encounter. Depending on the circumstances, chart notes should include a brief social narrative of relevant historical data, an explanation of the reason for the encounter, subjective complaints and observations reported by the patient, objective findings on physical examination by the clinicians, a diagnosis, treatment plan, and follow-up instructions for post-discharge care.
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Improve Documentation for Compliance, Med/Mal Defense
Good documentation is the foundation of any solid malpractice defense and proper continuity of care argument, so risk managers constantly urge clinicians to make meticulous notes. But there are many ways in which documentation can fall short. Frequent education and adjustment to technological changes can be key to making good documentation.
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Not a Simple Conversation: Understand Depositions and How to Prepare
It is likely any healthcare litigation will include depositions in which clinicians and administrators are asked questions under oath. The information provided can be critical to the outcome of the case. Depositions can be stressful and difficult for people not accustomed to them. Risk managers can help by preparing participants for this experience.
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Online Collaboration Platforms Create HIPAA Exposures
Business communications are rapidly and dramatically moving from email to various collaboration platforms like Slack, Workplace by Meta, and Microsoft Teams. PHI can easily end up stored as part of collaboration data — a relatively new data set that is uniquely different from other electronic channels because of its fragmented and nuanced nature.
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Proper Disposal of PHI Required, Often Overlooked
The Office for Civil Rights announced a settlement with a Massachusetts dermatology clinic regarding the improper disposal of PHI, which serves as a reminder HIPAA compliance is not only about protecting data from hackers. Covered entities also are responsible for disposing of PHI appropriately.
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Big Penalties for Right to Access Initiative
The Office for Civil Rights HIPAA Right of Access initiative recently led to the resolution of 11 cases at a cost of $626,000, emphasizing the risk of failing to comply with this requirement.
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Gastric Bypass Malpractice Yields $14.1 Million Verdict
There are two principal ramifications arising from this decision. First, in a case involving medical malpractice, a common-law cause of action, the Open Courts Provision does not supersede statutory restrictions on recovery of economic damages via Chapter 33. Second, the decision allows for settlement credits to be applied for settlement of derivative claims, even if the non-settling plaintiff does not have a cause of action for the same derivative claim.
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Provide Frequent HIPAA Training with Real-World Scenarios
Training employees in HIPAA compliance should be frequent and include realistic situations, including scenarios in which they may unknowingly facilitate a breach.
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Staffing Shortages Are Hindering Clinical Trial Completion
Some sites are curtailing new enrollment across all studies, or at least for studies that are not as economically sustainable as others. Sites estimate the average added cost to recruit and train a new patient-facing staff member is approximately six months pay. Due to the limited availability of qualified research staff, sites are replacing research coordinators with individuals without clinical research experience.
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Ethical Approaches to Address Nursing Workloads, Staffing Shortages
Ethicists can perform an invaluable role by working closely with senior management and medical staff leaders to develop collaborative initiatives to acknowledge the problem’s magnitude and engage nursing representatives in developing creative solutions.