Unit 1

HEALTH CARE INFORMATION

REGULATIONS, LAWS AND STANDARDS

Faculty of Pharmacy
Department of Medical Technology
First Term, A.Y. 2019-2020
Intended Learning Outcomes
At the end of the unit, the student should be able to:
1.Discuss the health care system in the Philippines
2.Explain the importance of human resource in the health
care system.
3.Discuss how accreditation, facility licensure, and
certification influence the information needs of health care
facilities.
4.Interpret the laws, regulations, and standards that govern
patient confidentiality.
Course Content

❑1.1. Philippine Healthcare System

❑1.2. Philippine health policies and initiatives
❑1.3. Licensure, Certification and Accreditation
❑1.4. Patient Safety Organizations
❑1.5. Legal Aspects of Managing Health Information
Inquiry Stimuli
• “The majority of Filipinos only consult a doctor when their illnesses
are already at their worst because of the lack of government
support to the health department. According to our Department of
Health, up to 54% of the country’s healthcare spending in 2016
came from out-of-pocket expenses. That means Filipino families still
account for the lion’s share, they still carry the biggest burden when
their loved ones seek treatment for whatever sickness they have.
That weight should not be theirs to carry alone. In fact, they should
not have to carry that weight at all.” Senator Angara
 Inquiry Questions
• What can you say about the health care system of the Philippines?
• Quantity, Quality, Delivery, Value, Policies
• Since there is a huge human reservoir for health in the Philippines,
what is your observation in terms of Quantity, Quality, and
Distribution?
• Is it necessary for the hospital to have a license to operate & secure
international certification? Why?
• Is it necessary for the health professionals to undergo certification
with CPD units for the renewal of their professional license?
• What is your opinion on the data privacy act? Advantages &
disadvantages
• Can Electronic Medical Record Systems Transform Health Care? In
THE PHILIPPINE HEALTHCARE SYSTEM

A. HEALTH FINANCING
B. HEALTH CARE DELIVERY SYSTEM
C. HEALTH OUTCOMES
A. HEALTH FINANCING

Four main sources of financing:

1)National and local government
2)Insurance (government and private)
3)User fees/out of pocket
4)Donors.
B. HEALTH CARE DELIVERY SYSTEM
B.1. Health Facilities
B.2. Health Human Resource
 B.1. Health Facilities
• Government hospitals
• Private hospitals
• Primary health care facilities

721 public hospitals

70 DOH
Others LGU

(Department of Health, 2009).

 PROPORTION OF POPULATION WHO SOUGHT
B.1. Health Facilities INPATIENT CARE BY FACILITY AND SELECTED
VARIABLES, PHILIPPINES, 2008
B.2. Health Human Resource
• The main drivers of the health care system and are essential for the
efficient management and operation of the public health system.
• They are the health educators and providers of health services.
C. HEALTH OUTCOMES
C.1. Life Expectancy
C.2. Deaths and Births

Source: Michael E. Porter

C.1. Life Expectancy PROJECTED LIFE EXPECTANCY AT BIRTH BY SEX
AT FIVE CALENDAR-YEAR INTERVALS,
PHILIPPINES, 2000 TO 2040 (MEDIUM
ASSUMPTION)
C.2. Deaths and Birth CRUDE DEATH RATE,
PHILIPPINES, 2000 AND 2010
C.2. Deaths and Birth CRUDE BIRTH RATE BY GENDER,
PHILIPPINES, 2000, 2006 AND 2009
 Philippine Health Policies and Initiatives
Health Policy
-refers to decisions, plans, and
actions that are undertaken to achieve
specific health care goals within a
society.
-it outlines priorities and the
expected roles of different groups; and
it builds consensus and informs people.
 Universal Health Care (UHC) Bill
into law (Republic Act No.
11223)
“We believe Filipino families must be afforded a safety net
in times of dire need and this is why I am proud to
cosponsor the Universal Health Care Bill. One of the main
provisions in the bill is every Filipino’s automatic inclusion
into the National Heath Insurance Program. Through this
provision, we seek to protect people from the financial
burden of paying out of their own pockets. It reduces the
risk of people being pushed into poverty because it will
help cushion the impact of having to use the family’s
savings or of borrowing money to pay for health care
services.” Senator Binay (co-author)
 Universal Health Care (UHC) Bill
into law (Republic Act No.
11223)
“Senate Bill No 1896 will pave the way for all Filipinos’
inclusion in our National Health Insurance Program, either
as direct or indirect contributory members. This means that
all Filipinos can use the promotive, preventive, curative,
rehabilitative and palliative health services they need, of
sufficient quality to be effective, while also ensuring that
the use of these services does not expose them to financial
hardship. Our goal is to achieve full 100 percent coverage in
the most expedient way possible, expand our health benefit
package, and bring more doctors to remote communities.”
Senator Villanueva (co-author)
 Universal Health Care (UHC) Bill into law
(Republic Act No. 11223)

• Every Filipino, including overseas Filipino workers, are eligible for

preventive, promotive, curative, rehabilitative, and palliative care
upon automatic enrollment to the government’s health insurance
program.
• the Philippine Health Insurance Company (PhilHealth) will have
expanded coverage to include free consultation fees, laboratory tests
and other diagnostic services.
• to improve doctor-to-patient ratio, upgrades hospital bed capacities
and equipment and established more hospitals in remote areas.
 Licensure, Certification and Accreditation

• Licensure
❑the process that gives a facility legal approval to operate.
• Certification
❑gives a health care organization the authority to
participate in several programs.
• Accreditation
❑an external review process that an organization elects to
undergo.
A. Licensure
A.1. HOSPITAL/FACILITIES
• All facilities must have a license to operate, and it is
generally the state department of health or a similar agency
that carries out the licensure function.

Licensure regulations
tend to emphasize areas such as physical plant
standards, fire safety, space allocations, and sanitation.
A.2. LICENSURE TO INDIVIDUALS/PROFESSIONALS
usually granted after some form of examination or proof of
education and may be renewed periodically through
payment of a fee and/or proof of continuing education or
professional competence.
RA10912
❖CPD Act of 2016
PRC Resolution No. 2016-990
❖Amendments to the Revised Guidelines on CPD Program for All
Registered and Licensed Professionals
❖Initially 45 Credit units required for every 3 years
IRR of the Republic Act 10912 (March 1, 2019)
Professionals working abroad shall not be covered by the CPD
requirement during the period of their employment abroad.
Newly licensed professionals shall be exempted from CPD
requirements for their first renewal
CPD councils shall reduce the required CPD units to a minimum
which shall not be more than 15 CPD units
All seminars attended by licensed professionals should be
recognized as CPD units and shall be accepted as valid for the
renewal of their licenses
A.3. ORGANIZATIONAL LICENSURE
granted following an on-site inspection to determine if
minimum health and safety standards have been met.
Maintenance of licensure is an ongoing requirement for
the health care organization to continue to operate and
care for patients
B. CERTIFICATION
B.1. Applied to individual practitioners
-certification usually implies that the individual has
received additional education and training, and demonstrated
competence in a specialty area beyond the minimum
requirements set for licensure.

B.2. Applied to an organization

-certification usually implies that the organization has
additional services, technology, or capacity beyond those
C. Accreditation
• Often a voluntary process in which organizations choose to
participate, rather than one required by law and regulation.
• Accreditation standards
• usually regarded as optimal and achievable, and are
designed to encourage continuous improvement efforts
within accredited organizations.
• Accreditation decision
• is made following a periodic on-site evaluation by a team
of peer reviewers, typically conducted every two to three
Philippine Tripartite Accreditation for
Health Facilities, Inc. (PTAHF, Inc.)
• an independent, non-profit organization, dedicated to
improve and promote quality and safety in the delivery of
health care in the Philippines through continuing review of
performance, assessment and accreditation.
• 3 Major organization:
• ANSAP
• AHA
• PAGHAO
Philippine Tripartite Accreditation for Health
Facilities, Inc. (PTAHF, Inc.)
Four Key Sections:
1.Standard Development Department
2.Research and Training
3.Accreditation Department and Assessment and Monitoring
Department.
4. It offers assessment and accreditation, including: research
and development, training and capability building for
assessors and implementers.
Accreditation
• Department of Health (DOH) introduced the Hospital
Accreditation Commission (HAC)
• Before HAC was created, PhilHealth did the accreditation of
hospitals through surveys.

PhilHealth’s Benchbook Standards are

eligible for the reimbursement of hospital
expenses and professional fees.
Patient Safety Organizations
• conduct activities to improve the safety and quality of
patient care.
• create a legally secure environment (conferring privilege and
confidentiality) where clinicians and health care
organizations can voluntarily report, aggregate, and analyze
data, with the goal of reducing the risks and hazards
associated with patient care.
 Patient Safety Organizations
Functions:
• Collect data on the prevalence and individual details of
errors.
• Analyze sources of error by root cause analysis.
• Propose and disseminate methods for error prevention.
• Design and conduct pilot projects to study safety initiatives,
including monitoring of results.
• Raise awareness and inform the public, health professionals,
providers, purchasers and employers.
• Conduct fundraising and provide funding for research and
safety projects
• Advocate for regulatory and legislative changes.
• Healthcare providers may be:
❑ Doctor of Medicine
❑ Med. Tech.
❑ Nurse
❑ Midwife
❑ Dentist
❑ Other allied professionals

Duly licensed to practice in the Philippines

Legal Aspects of Managing Health Information
Health care information (patient-specific information)
-governed by multiple state and federal laws and
regulations in addition to those for licensure and certification.

Authentication
-signature on a document
Destruction of records
-involved burning or shredding.
Legal Aspects of Managing Health Information

address the medical record as a legal document, including

the issues of retention and authentication of health care
information, and the privacy and confidentiality of patient
information.
The Health Record as a Legal Document
The Health Record as a Legal Document
❖American Health Information Management Association
(AHIMA)
• “Guidelines for Defining the Health Record for Legal
Purposes”
• define the legal health record (LHR) as the
documentation of the healthcare services provided
to an individual in any aspect of healthcare delivery
by a healthcare provider organization
LHR
• Legal Health Record
• documentation of the healthcare services provided to an
individual in any aspect of healthcare delivery by a
healthcare provider organization.
• includes records of care in any health-related setting used
by healthcare professionals while providing patient care
services, for reviewing patient data, or documenting
observations, actions, or instructions.
LHR excludes:
health records that are not official business records of a
healthcare provider organization
records such as personal health records (PHRs) that are
patient controlled, managed, and populated.
Examples of documentation found in the LHR:
• advance directives
• anesthesia records
• care plan
• consent for treatment forms
• consultation reports
• discharge instructions
• discharge summary
• e-mail containing patient-provider or provider-provider
Patient-identifiable source data
• data from which interpretations, summaries, notes, etc.,
are derived.
• Examples of patient-identifiable source data:
• analog and digital patient photographs for
identification purposes only • audio of dictation
• audio of patient telephone call
• diagnostic films and other diagnostic images from
which interpretations are derived
• electrocardiogram tracings from which interpretations
are derived
• fetal monitoring strips from which interpretations are
derived
• videos of office visits
• videos of procedure
• videos of telemedicine consultations
Administrative data
-patient-identifiable data used for administrative,
regulatory, healthcare operations, and payment (financial)
purposes.
-Examples:
authorization forms for release of information
• birth and death certificates
• correspondence concerning requests for records
• event history/audit trails
Derived data
• consists of information aggregated or summarized from
patient records so that there are no means to identify
patients.
Examples:
accreditation reports
• anonymous patient data for research purposes
• best practice guidelines created from aggregate patient
data
• MDS report
• public health records
Retention of Health Records
-majority of states have specific retention requirements for
health care information.
-these state requirements should be the basis for the health
care organization’s formal retention policy.
-when no specific retention requirement is made by the state,
all patient information that is a part of the LHR should be
maintained for at least as long as the state’s statute of
limitations or other regulation requires.
• AHIMA
• “recommended retention standards,”
• state that patient health records for adults should be retained for
ten years after the most recent encounter and patient health
records for children should be retained until the time the person
reaches the age of majority plus the time stated in the relevant
statute of limitations.
AHIMA destruction guidelines:
❑Destroy the records so there is no possibility of
reconstruction.
Burn, shred, pulp, or pulverize paper.
Recycle or pulverize microfilm or microfiche.
Pulverize write-once read-many laser disks.
Degauss computerized data stored on internal or
external magnetic media (that is, alter the magnetic
alignment of the storage media, making it impossible to
recover previously recorded data).
AHIMA destruction guidelines:
❑Document the destruction.
Date of destruction.
Method of destruction.
Description of destroyed records.
Inclusive dates of destroyed records.
A statement that the records were destroyed in the
normal course of business.
Signatures of individuals supervising and witnessing the
destruction.
Authentication of Health Record Information
• The Joint Commission Hospital Accreditation Manual
defines authentication as, “The validation of correctness
for both the information itself and for the person who is
the author or the user of the information”
❑Electronic signatures
created when the provider enters a unique code,
biometric, or password that verifies his or her identity.
electronic signatures show up on the computer screen or
printout in this form: “Electronically authenticated
by____________”
accepted by both The Joint Commission and CMS.
Privacy and Confidentiality
❑Privacy
• an individual’s constitutional right to be left alone, to be
free from unwarranted publicity, and to conduct his or
her life without its being made public.
• individual’s right to limit access to his or her health care
information.
❑Confidentiality
• the expectation that information shared with a health
care provider during the course of treatment will be used
only for its intended purpose and not disclosed otherwise.
• relies on TRUST
Privacy and Confidentiality
RA 8504
• Philippine AIDS Prevention and Control Act of 1998
• Approved on Feb. 13, 1998
• All results of HIV/AIDS testing shall be confidential.
RA 8504
It shall be released only the following:
• Person who submitted himself/herself to such test
• Either parent of a minor child who has been tested
• Legal guardian in case of insane persons or orphans
• Person authorized to receive such results in conjunction
with the AIDSWATCH program
• Justice of the Court of Appeals or the Supreme Court
END
• SURVEY FROM FAMILY MEMBERS THE REASONS OF CHOOSING A
PRIVATE OR A GOVERNMENT HOSPITALS
• SURVEY THE EFFECT OF DATA PRIVACY IN THEIR LIFE
• SURVEY THE EFFECT OF WITH OR WITHOUT CPD