Access Health Care

Health information exchange describes the process of mobilizing health information through electronic means across various concerned organizations within a given hospital system, community or region. This process involves moving clinical information through different health care information systems while ensuring that the integrity and meaning of the information is maintained exactly as it was in its original state. The smooth and seamless exchange of clinical data and information is critical for delivering high quality health care information.

Why it’s Important and How the Government is Promoting It

Health information exchange describes the process of mobilizing health information through electronic means across various concerned organizations within a given hospital system, community or region. This process involves moving clinical information through different information systems while ensuring that the integrity and meaning of the information is maintained exactly as it was in its original state. The smooth and seamless exchange of clinical data and information is critical for delivering high quality care. Thus it also plays a major role in determining the effectiveness of organizations.

Although the advantages of efficient sharing of health care information among concerned parties, including patients and physicians and other authorized members are understood and desired by most people who are involved in health care system, very few organizations have actually gone ahead and taken full advantage of the technological progress made in the area of health informatics and computer science. Health care information exchange involves various technology based systems like interoperability, business information systems, standards utilization, and harmonization. All of these need to be established on local, state and national level to provide a seamless network of information.

According to David Blumenthal, National Coordinator for Health Information Technology, if a standardized system of electronic health records can be put into widespread use it can lead to highly improved levels of efficiency and patient safety, and significantly better quality.

An efficient information system has got several benefits to offer to all parties involved in the field of health care whether they are service providers or consumers. It allows health care professionals to conveniently access and retrieves relevant and complete medical data which helps them in providing patient-centered care that is more efficient, effective and timely. A well established health related information exchange system would also provide public health officials with a ready and in-depth database of public information which they can reliably use in analyzing health of the population effectively.

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A medical power of attorney in Florida is called a “Designation of Health Care Surrogate.” In a Designation of Health Care Surrogate form, the person who is authorizing someone else to be able to make medical decisions in their behalf is called the principal. The person who the principal is authorizing to make medical decisions in their behalf is called the surrogate. Surrogate is defined as “someone who takes the place of another”. A Designation of Health Care Surrogate form may also name a backup surrogate in case the first named surrogate is unable or unwilling to act in behalf of the principal. The surrogate cannot make medical decisions or consent to medical treatments on behalf of the principal until the principal is no longer able to make their own health care decisions and consent to medical treatments. The principal’s inability to provide informed consent is determined by the principal’s attending physician after assessing the principal’s condition. The surrogate’s authority ends when the principal regains the ability to make their own medical decisions and consent to medical treatments.

When a surrogate is notified by the health care facility that they are now authorized to act on behalf of the principal due to the principal’s present condition and the surrogate is not the husband or wife of the principal, the surrogate must notify the principal’s spouse or adult children of the principal’s designation of health care surrogate. The surrogate may also begin to make health care decisions on behalf of the principal now. If the principal had previously informed the surrogate as to what types of treatments he or she would or would not consent to under particular circumstances, the surrogate should make their decisions based on the principal’s wishes. If the surrogate should have to make a decision about something that was not discussed with the principal, the surrogate should make their decision considering the principal’s best interest when deciding. Before the surrogate makes a decision that was not discussed with the principal beforehand, the surrogate may ask for medical information and advice from the principal’s health care providers and have access to the principal’s medical records. The surrogate not only has the authority to consent to medical treatments for the principal, the surrogate may also decline suggested medical treatments or ask that medical treatments being administered to the principal be stopped or removed as well. The surrogate may also request that the principal’s medical records be shared with another medical facility so that the surrogate could get a second opinion from a different physician and even request that the principal be transferred to a different health care facility.

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In June 2009, a 22-year-old Honolulu mother of three young children was sentenced to a year in prison for illegally accessing another woman’s medical records and posting on a MySpace page that she had HIV.

The State of Hawaii brought charges against the woman under a state statute criminalizing the unauthorized access to a computer; and which categorized the conduct of the defendant as a class B felony.

According to accounts of the incidents that led to the woman’s conviction, there was a feud between the victim and the victim’s sister-in-law, a friend of the defendant. The defendant, who worked as a patient service representative at the hospital where the victim was a patient, accessed the computer for the victim’s sister-in-law.

Over the course of approximately ten months, the defendant accessed the patient’s medical records three times through a computer. After she learned of the victim’s medical condition, the defendant posted on her MySpace page that the victim had HIV. In a second posting, she said the victim was dying of AIDS.

The victim complained to hospital officials of the unauthorized access. After an internal investigation the hospital terminated the defendant’s employment.

The defendant’s conduct, of course, was egregious and inexcusable. The one-year jail term handed down by the Court exceeded the term recommended by the prosecutor. Nevertheless, beyond the issue of holding the defendant accountable for her actions some may question to what extent the hospital should bear responsibility for the breaches of confidentiality that occurred.

Federal law imposes statutory burdens on health care providers to protect against the improper use or disclosure of private health information and to reasonably limit uses and disclosures to the minimum necessary to accomplish their intended purpose.

Specifically, the Health Insurance Portability and Accountability Act of 1996′s (“HIPAA”) privacy regulations became effective on April 14, 2003. HIPAA is intended to protect consumers’ health information, allow consumers greater access and control to such information, enhance health care, and finally to create a national framework for health privacy protection. HIPAA covers health plans, health care clearinghouses, and those health care providers that conduct certain financial and administrative transactions electronically.

In addition to the privacy regulations, HIPAA’s security rules became effective on April 21, 2005. Together the privacy and security regulations are the only national set of regulations that governs the use and disclosure of private, confidential and sensitive information.

Under HIPAA’s Security Rule, the standards for the protection of electronic information covered by HIPAA are divided into three groups: Administrative safeguards, Physical safeguards and Technical safeguards.

A couple of the most significant required safeguards under HIPAA are the Administrative “Sanction Policy” and “Security Awareness Training” safeguards.

The sanction policy standard requires a communication to all employees regarding the disciplinary action that will be taken by the covered entity for violations of HIPAA. The sanction policy should have a notice of civil or criminal penalties for misuses or misappropriation of health information and make employees aware that violations may result in notification to law enforcement officials and regulatory, accreditation, and licensure organizations.

The security awareness training standard requires all employees, agents, and contractors to participate in information security awareness training programs. Based on job responsibilities, the covered entity should require individuals to attend customized education programs that focus on issues regarding use of health information and responsibilities regarding confidentiality and security.

The HIPAA privacy and security regulations require a privacy officer and security officer to be designated by the covered entity. The privacy and security officer should continually analyze and manage risk by thoroughly assessing potential risks and vulnerabilities, and implementing related security measures.

The U.S. Department of Justice (“DOJ”) clarified the penalties that may be assessed and against whom for HIPAA violations. Covered entities and individuals whom “knowingly” obtain or disclose individually identifiable health information in violation of HIPAA may be fined up to ,000, as well as imprisonment up to one year.

Offenses committed under false pretenses allow penalties to be increased–a 0,000 fine, with up to five years in prison. Finally, offenses committed with the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain or malicious harm permit fines of 0,000, and imprisonment for up to ten years.

Given the security breach that led to the tragic events, including the one-year jail term for the defendant, Hawaii employers, health care providers and health plans should review their privacy and HIPAA policies and conduct an audit of their practices in order to protect against the improper use and disclosure of private health information and to reduce the risk of privacy breaches in their own organization.

Roman Amaguin, Esq. is a Hawaii lawyer specializing in employment law, labor law, and civil litigation. His philosophy is to provide practical solutions to both complex and common workplace, employer/employee, and civil disputes. As a Hawaii attorney, Mr. Amaguin regularly appears before all federal and state courts in Hawaii, as well as state and federal administrative agencies such as the U.S. EEOC and Hawaii Civil Rights Commission.

View his websites at http://www.amaguinlaw.com and http://www.virtualhawaiiemploymentlawyer.com

General Information

Green anoles are the most commonly seen of the anole lizards in captivity. They are regularly exported from Florida and surrounding states. They are cheap to buy, but contradictory to popular belief are actually not ideal for a beginner. Green anole lizards are temperamental to their surroundings, and require the correct temperature, humidity and surroundings to remain healthy. They are a short lived lizard, averaging around 4 years of age in captivity, however have been known to live for up to 10 years. Adult males are larger than females, reaching approximately 20cm, females only 15cm. Many people call these ‘Chameleon Lizards’, due to their ability to change colour. However, unlike chameleons they cannot actually change their colour to match their surroundings. They will however, turn a darker green / brown when either stressed or basking. The darker colour will raise their body temperature quicker when basking; once they reach their optimum temperature they will begin to turn green again. Most anole lizards are communal species, living in highly populated areas of perhaps hundreds of individuals. Males are highly aggressive towards each other when confined in a small terrarium with a number of females. However, a larger terrarium with a ratio of 1 male to 5 females is ideal.

Housing

It has been published and said many a time that green anoles can live in a small terrarium with minimal requirements. I must stress that this is far from the truth, and will lead to a short lived, unhappy and unhealthy pet lizard. Although this is a small species of lizard, they are incredibly active and curious creatures. They need to regulate their temperature and have access to UVA and UVB rays normally omitted by the sun. Humidity is another important factor, this will help in the sloughing of their skin and generally aid in the health of the lizard.

It is recommended that one male is kept to a minimum of three females. Alternatively, if you only want two or three animals, then just buy females. Green anoles are a communal species and should be kept in groups. Keeping a single specimen will deprive it of the much needed stimulation offered by the surrounding lizards. An ideal group consists of one male to five females. This size group should be housed in a terrarium L90cm x H90cm x W45cm. The larger the terrarium, the further you will enrich your lizards life. A larger group of two males to 10 females should be kept in a terrarium L120cm x H90cm x W45cm.

Many keepers choose to house their green anoles with other species, such as brown anoles (Anolis sagrei) and numerous day gecko species (Phelsuma sp.). This is not recommended for a number of reasons. Brown anoles for example are more robust than green anoles and will dominate the terrarium. It may not be so obvious, but the brown anoles will predominate the higher grounds of the terrarium, have first place under the basking site and may even push the green anoles aside when feeding. Day geckos can be rather aggressive and may nip the green anoles. A number of geckos are also nocturnal, meaning that at night time these geckos may literally walk all over the sleeping green anoles. This will add much stress to the green anole and should be avoided at all costs. There is one animal however which I feel will add use to a green anole tank; that is an American Green Tree Frog (Hyla cinerea). These are nocturnal frogs which will help clear up any uneaten insects during the night, they cohabitate with green anoles in the wild and require the same temperature and humidity fluctuations.

Green anoles, when kept in an optimum environment will breed readily; and therefore will need a deep substrate which is easy to dig in. Potting soil is ideal and is completely natural. With this substrate, it is also possible to place live plants directly in the substrate rather than placing them in pots within the terrarium. It is important to balance your planting and décor with space. Green anoles will often like to get out into open space along sticks and branches and onto open leaves to bask and get a good look at their surroundings. However, being able to crawl away into a bush to get cover is also a necessity. Be sure if using live plants not to use anything which is either toxic to eat, or releases toxic fumes. For a list of safe plants, see our plant list.

Heating & Lighting

As already mentioned; green anoles are a diurnal species and will bask in the sun. Therefore they need a basking site to reach their optimum temperature, and a light which emits UVA and UVB rays. Ideally, 2 or 3 basking sites should be set up in your enclosure. These should be simply 60W spot bulbs placed approximately 8″ away from where the lizard/s will bask. By placing more than one basking site in the enclosure you will allow lizards to choose their favourite spot, and allow several lizards to bask in at the same time, as they would do in the wild. These basking sites should reach approximately 86-94˚F, allowing for a more overall air temperature of 80-84˚F and lower down in the enclosure, a cool area of approximately 74-78˚F.

It is possible to replace the spot bulbs with UV spot bulbs. However, providing several of these is a very expensive on-going cost which is not necessary. Instead, place a UV strip light across the top of the enclosure. This should be as long as your enclosure allows, with a reflector behind it so that UV rays are not aimed in the wrong direction. UV bulbs should be replaced every 6-8 months, regardless of whether or not they are still emitting light.

Do not use heat mats or heat rocks with green anoles. They are completely un-natural and serve no purpose. If extra heat is needed during the night time hours, an infra-red bulb will act perfectly.

Humidity & Water

Coming from Florida and surrounding states, a high humidity range is a must. An ideal range is 60-70%, although fluctuations either way will rarely harm your lizard. This can be achieved in a number of ways.

Firstly, a large water bowl placed as near as possible to a heat source will aid in the overall humidity. One step better is to then add air bubbles, commonly used in aquariums for fish. The bubble effect will continually circulate the water and burst small water vapours into the air. Similarly, a small waterfall will give the same effect.

Offering plants such as bromeliads is another way to increase humidity. These plants hold water within the pockets at the base of the leaves, allowing for more surface area of water to evaporate. They also make a great addition for a display terrarium.

Spraying the terrarium with cool water once a day, preferably in the mid-morning will certainly help the humidity, and at the same time allow the anole lizards to drink the water droplets that gather on any leaves or other surfaces. If you have a larger budget, a timed misting system will be perfect for when you are not around and would like the terrarium sprayed at regular intervals. These are becoming fairly inexpensive and are a perfect addition to a wonderful anole display tank. One word of advise though; direct the spray nozzles away from the front of the terrarium, as the spray will obstruct your view into the terrarium and the glass will need to be cleaned more often.

Food & Feeding

Green anoles are predominantly insectivorous (insect eating). However, I say predominantly because they are also known to eat pollen, nectar and other tasty liquid type fruits. They may not eat a banana for example, but may lick the juices. Try offering your anole some of these tasty fruit options, if it eats it, great.

Offering a variety of insects will stimulate the anoles natural feeding responses and aid in the general health of your animal. As we humans need a balanced and varied diet, so do anole lizards. Do not simply offer the same crickets all the time. Although there is not the best selection of foods available within the UK, there is still enough to satisfy the needs of your anole. Offer a mix between crickets, small locusts, mealworms, wax worms, small earthworms, small cockroaches, flies and even moths, butterflies and spiders you find in your own home. Not only will giving a variety offer a more balanced, nutritious diet, but will also make the anole adapt its hunting methods for each food item. An anole lizard won’t have to chase a waxworm, but will run like mad to chase a fly or daddy long legs spider. This will give your anole a chance to exercise and aid in the overall health and longevity of it.

It is important to supplement the food with calcium and mineral dusting powders. This should not be done at every feeding, but at least once every two or three feeds. An ideal dusting powder is Repton, a specially formulated powder for insectivorous lizards. As long as this is combined with the appropriate foods and UV rays your anole should be perfectly healthy.

By Chris Jones
Director of Pet Club UK Ltd.
http://www.petclubuk.com

By far, across the most well-known U.S. discount dental health care plans are those provided by state-funded Medicaid programs. Residents fitting a particular income requirement and their children can be eligible for routine and emergency dental care at a very low cost. This is good news for families who may even have trouble paying the premiums required by most discount dental health care plans in the U.S.

For low-income and minority families, Medicaid and the State Children’s Health Insurance Program (SCHIP) may be the best source of dental care. According to the Kaiser Family Foundation, tooth decay is the most common chronic disease affecting children in the U.S. Sadly, 20 million children in the country do not have dental health plans, according to Kaiser. In addition, many families may not be aware of discount health care or able to afford their low cost rates. What can families in this situation do to receive preventative services and dental treatment?

Some states, such as Montana, cap the amount of dental care provided to children through Medicaid while others trim benefits during times of budgetary crisis. On the whole, however, low-income families can apply at their local Medicaid office for discount dental health plans. Those families should also keep in mind that children enrolled in Medicaid and SCHIP have better access to dental care than uninsured children. (Source: “Dental Coverage and Care for Low-Income Children,” The Kaiser Commission on Medicaid and the Uninsured)

Some states, such as Illinois, have further improved their offerings of discount dental care through increase of provider payment rates, more efficient billing, and by assigning care managers to families. According to the same study, a Maryland child died from lack of treatment for a tooth abscess. This kind of tragedy is completely unnecessary and its risk can be eliminated for even the most desperate family. Imagine the terrible pain suffered both by this boy and by his family. Help is available in the form of Medicaid and discount dental care plans through local non-profit organizations.

Are Discount Dental Plans Really Your Best Option or is Dental Insurance The Way To Go? Find Out The REAL Truth by Watching This New Video Right Now At http://www.Discount-Dental.net or by clicking on U.S. Discount Dental Health Care Plans. Joe Stewart is a former Life And Health Insurance Agent that now works independently providing solid, expert information to consumers.