Discussion: Long Beach Principles of Risk Management & Patient Safety

Discussion: Long Beach Principles of Risk Management & Patient Safety ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Long Beach Principles of Risk Management & Patient Safety I’m trying to study for my Management course and I need some help to understand this question. CSU HCA 468 Long Beach Principles of Risk Management & Patient Safety PPT I provided the article that I need to make a powerpoint on. This class is about Principles of Risk Management and Patient Safety. Discussion: Long Beach Principles of Risk Management & Patient Safety Please look at the material before hand before bidding. ?? article__10__1_.pdf hca_468_article_presentati Discussion: Long Beach Principles of Risk Management & Patient Safety. Available online at www.sciencedirect.com ScienceDirect Cognitive and Behavioral Practice 22 (2015) 258-268 www.elsevier.com/locate/cabp Legal, Regulatory, and Risk Management Issues in the Use of Technology to Deliver Mental Health Care Greg M. Kramer, Julie T. Kinn, and Matt C. Mishkind, National Center for Telehealth and Technology Improved telecommunications networks and technologies have resulted in increased availability of technology-delivered mental health services to patients anywhere at any time, in particular to those patients in rural and isolated communities. This increased use of technology to deliver mental health care over a distance raises a number of regulatory issues relevant for safe and effective practice. In this article we cover some of the key legal, regulatory, and risk management issues in today’s telemental health (TMH) environment, with specific emphasis on licensure, malpractice, credentialing and privileging, security and privacy, and emergency management. The article further discusses some risk management considerations related to mobile health applications and the use of social networking to deliver TMH services. The information presented is expected to alleviate some risk concerns and provide a framework to effectively manage risk associated with telemental health care. This information should give any new or seasoned telemental health provider the foundation necessary to effectively manage risk associated with telemental health care. T HE information age is an exciting time to deliver mental health care as advances in telecommunications technologies have made it increasingly possible to deliver a range of safe and effective services that reach beyond the confines of traditional clinical settings. This substantial expansion of technologies over the past two decades has further prompted a reconceptualization of human-technology interactions within the health care industry. The use of technologies presents the health care industry with opportunities to economize and streamline a greater proportion of care to the patients who need it most (Steinhubl, Muse, & Topol, 2013). Private practitioners, hospitals, and public service stakeholders have recognized that as all generations continue to increase their use of and comfort with technology, the environments where mental health care can occur will continue to expand. The U.S. Department of Veteran Affairs, for example, has an established telehealth program and is planning to continue to increase its use as a way to meet the growing demand for patient-centric health care delivery services (see, e.g., Darkins, Foster, Anderson, Goldschmidt, & Selvin, 2013; Petzel, 2013). The Department of Defense, likewise, has telehealth programs in all branches of services, and even uses telehealth in operational and other deployed settings (Poropatich, Lai, McVeigh, & Bashshur, 2013).CSU HCA 468 Long Beach Principles of Risk Management & Patient Safety PPT Discussion: Long Beach Principles of Risk Management & Patient Safety. The commonly used terms telehealth (TH) and telemedicine have many definitions, but they broadly refer to Keywords: Telemental health; Mobile health; Safety; Policy; Regulations 1077-7229/14/© 2014 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved. methods of delivering health care via technology over a distance. Telemental health (TMH; sometimes referred to as telebehavioral health) refers to a subset of TH that uses telecommunications technologies and related communication networks to provide psychological, psychiatric, traumatic brain injury, and other mental health and substance use care services from a distance. Similar to the more broadly defined telehealth, TMH “is not a clinical service itself, but rather a mode of service used to connect patients or providers located in one location with providers in a distant location” (Kramer, Ayers, Mishkind, & Norem, 2011). A growing body of literature has demonstrated the benefits and effectiveness of delivering mental health care using technology such as video-teleconferencing (Backhaus et al., 2012; Grady et al., 2011; Hilty et al., 2013; Richardson, Frueh, Grubaugh, Egede, & Elhai, 2009). Given the established benefits of TMH, it is important that those engaged in its practice remain aware of current rules, guidelines, and regulations governing the provision of services from a distance. While these legal and regulatory issues may be seen as barriers by some, the increasing use of TMH throughout the United States and other countries demonstrates that there are few absolute barriers to providing safe and effective TMH services, and many other so-called obstacles to using TMH have been reduced (Brooks, Turvey, & Augusterfer, 2013). This article is intended to provide an overview of some regulations and standards in place that make TMH not only an effective mode of health care delivery but also a safe one. The good news is that there are effective risk-management strategies to provide safe, effective, Legal, Regulatory, and Risk Management Issues high-quality services while abiding by legal and regulatory controls. Our goal is to make one thing clear to health services personnel at any stage in their career: Using technology to provide mental health care is achievable and becoming easier all the time. To meet this goal, the content of this article is divided into three main sections. Section 1 focuses on notable regulations governing the safe and effective provision of TMH services via synchronous (live, two-way interactive audio/visual) technologies such as video teleconferencing (VTC). These regulations include health care licensure, malpractice liability, and credentialing and privileging. Section 1 concludes with an overview of some standard risk-management practices to include those for nontraditional settings such as a patient’s home. Section 2 focuses on mobile health (mHealth) applications (apps) and best practices for providing TMH services using mobile devices. Though synchronous communication (live, real-time, two-way interactive) is generally the most common form of TMH care delivery, there is ongoing research into asynchronous (communication happening at different times) forms of TMH care (Odor et al., 2011; Yellowlees, Odor, Parish, Iosif, Haught and Hilty, 2010; Yellowlees, Shore and Roberts, 2010), and mobile health is one way to provide this type of care. CSU HCA 468 Long Beach Principles of Risk Management & Patient Safety PPT Discussion: Long Beach Principles of Risk Management & Patient Safety. Section 3 focuses on the use of social media to provide TMH services. Although social media regulations are in their infancy, TMH stakeholders should be aware of considerations to using this media to provide services. This article does not provide an exhaustive review of all regulations and standards governing the range of TMH services. For example, we do not attempt to address any of the issues or regulatory concerns that may specifically apply to psychotherapy conducted online without using video technology. We have selected to focus on these three sections as we believe they cover the majority of considerations while providing a good foundation for anyone interested in engaging in most forms of TMH services. It should be noted that this article is not intended as a legal review, but rather an overview of the TMH regulatory environment. When in doubt, we encourage all TMH professionals to obtain local legal opinion. Regulatory Issues Governing Synchronous Telemental Health Services Health Care Licensure One of the great promises and selling points of TMH has been its potential to address the unmet health care needs of those living in rural or remote areas and other underserved populations. A 1998 American Psychiatric Association (APA) report spoke of that promise: “[O]riginally conceived to enhance access to health care for the geographically hard-to-reach and the underserved . . . telemedicine is much broader and will become the way we are all served—whether underserved or not—with 259 greater efficiency, continuity, and timeliness” (American Psychiatric Association, 1998). One of the barriers to this vision, however, has been the regulatory environment defining how and when TMH providers can cross over jurisdictional boundaries—for example, state lines—to provide care. Consequently, compliance with appropriate laws regarding health care licensure is one of the most immediate concerns raised prior to engaging in TMH practice. Although additional reform is required, there are recent and continuing developments to reduce licensure concerns across jurisdictional boundaries. Legal Background in the United States In the United States, the individual states, and not the federal government, have historically had control over establishing and enforcing licensure requirements for a wide range of health care professionals, including mental health professionals (U.S. Department of Health and Human Services, 2010). State authority to do this is generally considered a “police power” that comes from the 10th Amendment of the U.S. Constitution. Inherent in this “police power” is a priority to protect the health, safety, and welfare of citizens within their borders (U.S. Department of Health and Human Services, 2010). Since state licensing boards are primarily focused on protecting the public services received within their state, they view the delivery of health care services as occurring where the patient is located. Along with that is the historical expectation that the health care professional providing services is licensed and located in that same state, so if harm occurs the state can intervene to protect its citizens. As a result, one of the most discussed challenges that telehealth may present regarding licensure is how individual states can continue to protect their citizens for care provided within their state when the professional providing the care is physically located in another state. CSU HCA 468 Long Beach Principles of Risk Management & Patient Safety PPT Discussion: Long Beach Principles of Risk Management & Patient Safety. The general solution has been to require a provider to maintain a license where the patient is located. Prior to the expansion of available telehealth services, questions related to practicing health care across state lines, and thus maintaining multiple licenses, rarely arose because diagnosis and treatment almost exclusively occurred face-to-face, and within one state (Ameringer, 2011). The expanded use of some telecommunications technologies, however, has expanded the use case scenarios such that providers and patients can connect virtually anywhere in the world. While many health care professionals may want to expand their practice into several geographies, the process of obtaining multiple licenses is often a financial and administrative burden (Miller et al., 2005). With the emergence and increased use of TH, commentary on the limits of a state-based licensure system and debates on potential solutions have increased (Ameringer; Gupta & Soa, 2010; Miller et al.). 260 Kramer et al. Some proposed solutions include allowing states to create interstate licensure compacts with each other whereby states can mutually recognize the licenses of other participating states (in general or for specific purposes), creating a special TH license, and creating a national license (Ameringer; Gupta & Soa). The call for TH licensing reform has prompted various national health regulation authorities to consider alternative strategies to address the issue. The Federation of State Medical Boards, the Association of State and Provincial Psychology Boards, and The National Council of State Boards of Nursing have all undertaken efforts to address licensure portability for health care professionals in different ways (see organizational websites and Kramer, Mishkind, Luxton, & Shore, 2012, for fuller discussion of efforts of each to date). Further, the American Telemedicine Association recently launched a website called www.fixlicensure.org that is dedicated to reforming the state-based medical licensing system in favor of a national license portability system. Unfortunately, there remains no consensus on how to address portability of licensure for health care professionals, at least within the United States, with different professional organizations advocating for different solutions. Sample Success Story Although no single TH licensure solution has gained universal support, expansion of licensure portability and the ability to practice across state lines has occurred at the federal level. For some time, certain federal government agencies (e.g., Department of Defense, Veteran Affairs, and Indian Health Services) have followed policies based on statute and/or case law that allow some categories of their respective health care practitioners licensed in any state to practice their federal duties in all states. Within the Department of Defense (DoD), this preemption over individual state licensure requirements previously allowed “members of the Armed Forces” to perform their authorized health care duties in any state, as long as the individual was licensed to practice in one state (Title 10, United States Code, Section 1094(d)). That statue was recently amended to expand the categories of DoD TH providers granted portability of licensure to include civilian employees of the DoD, personal services contractors, and select others when performing their federal duties (Title 10, United States Code, Section 1094(d), as amended by Section 713 of the National Defense Authorization Act for Fiscal Year 2012).CSU HCA 468 Long Beach Principles of Risk Management & Patient Safety PPT This legislative change was seen by many as a positive step towards establishing a precedent for expanding the use of TH, and several additional legislative proposals have been submitted to expand licensure portability to additional classes of federal employees and to other federal organizations. Ongoing Challenges at the State Level While licensure developments at the federal level are promising, they do not currently impact all federal employees, nor do they impact private sector clinicians. For the nonfederal TMH clinicians, cross-state licensure remains a challenge without a widely accepted solution, and those that do wish to practice across state lines need to understand how to safely provide care under the current state-based licensure system, including the probability of obtaining multiple state licenses to practice clinical TMH services. While it is believed that the vast majority of TMH encounters are conducted safely and within the scope of existing regulations, case examples of unsafe practices do exist. In one case, a psychiatrist licensed to practice medicine in Colorado was sentenced to 9 months in county jail because he had prescribed fluoxetine to a California resident whom he did not examine in person (rather, he administered an on-line questionnaire; Hageseth v. Superior Court, 2007). The physician was convicted of practicing medicine without a license after the patient obtained the prescription and died by suicide. Although the actual conviction was for practicing medicine without a license, many aspects of this case focused on other relevant issues, such as online prescribing and whether it is an appropriate standard of care to prescribe medication without actually physically examining a patient. A full discussion of online prescribing and the Ryan Haight Act (H.R. 6353, 2008) that regulates Internet prescribing is beyond the scope of this article. Appropriate telemedicine standards of care are evolving, but valid concerns remain regarding acceptable practices, particularly in the area of tele-prescribing. Physicians who wish to practice and prescribe medication via electronic means should become familiar with this act and with state medical practice law (see Natoli, 2011, for a discussion of two key issues related to telemedicine and prescribing: the physical examination requirement and the preexisting physician-patient requirement). It is also recommended that physicians who are seeing potential telemedicine patients for the first time review applicable laws, regulations, and the literature to ensure that their initial examination does not fall below standard medical care and/or violate local law. The good news is that many states are developing, reviewing, and modifying TH licensure requirements and other aspects related to TH practice. These laws and regulations vary in terms of specific licensure and practice issues they address, with some merely defining TH, some providing guidance on informed consent and information management and assurance issues related to TH, and some defining acceptable TH services one can provide in a state without a full license. Unfortunately, there is no uniformity in how state TH laws address licensure requirements and how they define whether and to what extent someone may Legal, Regulatory, and Risk Management Issues practice TH within their state, with some laws general to all health care providers, some specific to certain health professions, and others silent on the full range of professionals they may apply to.CSU HCA 468 Long Beach Principles of Risk Management & Patient Safety PPT For example, according to one article, only 3 of the 22 states that had TH laws at the time of publication applied specifically to psychologists (although interpretation may generalize): “laws in the additional 19 states with telehealth laws do not appear to apply to psychologists at this time” (American Psychological Association Practice Organization, 2010). This could have a different impact for a social worker as opposed to a psychologist. Some state health practice statutes allow mental health professionals to obtain a temporary license to practice within their state for a maximum number of days per year under certain conditions. Provisions such as this may provide some opportunity for a TMH clinician who wishes to simply contact patients on a limited basis, when either the clinician or the patient is out of state due to work, education, or vacation. Some state statutes also speak to the technologies/type of services covered while others do not define the types of services covered with any specificity, and may have different applicability depending on individual circumstances. Resources are available to help identify new initiatives and advances in licensure requirements. There are reviews of the current state TH laws available (American Psychological Association, 2010) and a way to track ongoing state TH legislation (ATA 2013 State Telemedicine Legislation Tracking). The above information is not intended to dissuade someone from practicing across state lines. On the contrary, we hope that by highlighting the noted resources and considerations we have provided the knowledge set to initiate a well-conceived expansion of TMH services. Malpractice Liability While licensure is often the initial concern raised by practitioners new to TMH, malpractice liability is an equal or possibly even greater issue to consider. Similar to the licensure example above, most cases of “tele-malpractice” to date have occurred when a physician has issued a prescription over the telephone or Internet without first examining the individual in person (Natoli, 2009). However, as the range of technologies used to deliver care (e.g., videoteleconferencing, Internet, mobile phone) and the settings where TMH care is delivered (e.g., patient homes) increases, it is likely that malpractice issues related to mental health practice using technology will also increase. This section will address the main malpractice issues that could occur with TMH practice. In the United States, individual states have the authority to regulate malpractice insurance within their borders. And, as is the case with licensure laws, states vary 261 widely in their insurance requirements and regulations (Gupta & Soa, 2010), with the main similarity among state insurance laws being that a health care professional have some form of malpractice insurance if providing care in his/her state. The lack of standard state-based regulations and requirements is compounded by malpractice liability insurance policies that were developed long ago to cover traditional in-person encounters. As a result, ma … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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