Threats create a need to coordinate with providers
January 1, 2002 6 minutes read
Threats create a need to coordinate with providers
As the nation’s health care system continues to prepare for terrorist attacks, risk managers are finding new tasks that may pose unforeseen challenges. Risk management leaders caution, however, that you should not focus so much on those difficulties that you put up roadblocks when your health care provider is trying to take necessary steps.
Risk managers will find a number of new tasks to tackle in the coming months, most of them related to improving the hospital’s disaster plans. Though you should take those tasks seriously, you shouldn’t be overwhelmed by the risk management implications of the changes, advises Grena Porto, RN, ARM, DFASHRM, senior director of clinical operations at VHA Inc. in Berwyn, PA, and past president of the American Society for Healthcare Risk Management.
She cautions that risk managers could become the naysayers at a time when they should focus on being part of the team.
"The nation is at war, so let’s not throw up roadblocks where none are needed," she says. "We’re trying to get away from the image of risk managers as the people who always point out the negative and get in the way of progress. That’s not what we are and this is a good opportunity to show that."
Don’t cry wolf
But risk managers have a fine line to walk, she admits. There are some legitimate risk management concerns arising from the health care industry’s response to terrorism — confidentiality concerns, for example — and Porto says she has no doubt that risk managers will be on top of those issues. She’s more worried that they will go overboard.
"This should be a team effort among everyone in the organization, and the risk manager should work hard to be a constructive part of the team," she says. "We don’t want to start crying wolf now."
Risk managers likely will be concerned about a recent directive from the Joint Commission on Accreditation of Healthcare Organizations that calls for more explicit, in-depth coordination between health care providers in a local community. That could lead to some dicey confidentiality problems.
The Joint Commission recently added a new requirement to E.C.1.4, the standard requiring each organization to have an emergency management plan. Noting that "the experiences of health care organizations responding to the September 2001 terrorist attacks in New York City and Washington, DC, "showed gaps in the way hospitals cooperate during a community disaster, the Joint Commission added a clause requiring "cooperative planning." The goal of that planning should be to facilitate the timely sharing of information about:
- essential elements of their command structures and control centers for emergency response;
- names, roles, and telephone numbers of individuals in their command structures;
- resources and assets that could potentially be shared or pooled in an emergency response;
- names of patients and deceased individuals brought to the organizations to facilitate identification and location of victims of the emergency.
Robert Wise, MD, vice president in the division of research at the Joint Commission, says the commission realized that in a communitywide disaster, "it’s not going to work to have each organization trying to decide what to do on their own." Wise notes that though the new language has only been added to the intent section of the standard, meaning it is technically not a new part of the standard, surveyors will check for compliance with this new clause.
"We will want to see evidence of this later on," he says. "This is a change in a requirement; it’s not important whether it’s in the intent or the standard."
Porto says the new requirement will force most providers into relationships they’ve never had with competitors across town. Current community disaster coordination usually focuses on triage and making sure there are enough health services for a mass-casualty incident, but the New York attacks revealed a major weakness: there was no central system for listing patients treated at a number of hospitals. Family and friends were forced to wander the streets, visiting every hospital to look for a missing loved one.
"We hope not to see that again," Wise says.
The Joint Commission indicates that the best way for a hospital or other provider to coordinate with others in the community would be through the existing structures such as local hospital councils or state hospital associations. That is where some risk management issues may crop up because the new focus is on information exchange. One expert on health care confidentiality says there are some issues to work out, but that the real risk may not be as bad as it first sounds.
George Schroeder, BSN, Med, JD, is a principal with RiskNet Consulting in Westminster, CA. He says state privacy laws may pose the biggest challenge for risk managers.
"It is easier said than done to share this information," he says. "What is confidential will vary from state to state. The problem with the Joint Commission is that they are a great advisory body but they have no authority to supercede state law. They are basically encouraging you to maximize what is appropriate to share."
Schroeder points out that the Joint Commission requirement applies only to a disaster situation. It does not require a central database that is available all the time so a person can walk into any hospital and find out where a patient is being treated. In that context, risk managers might find little to balk at when the hospitals set up a plan for sharing patient names. But he has one important caution for risk managers.
"Remember that the intent here is really only to share a list of names, not much else," he says. "If you see that the plan is spiraling and you’re getting into sharing more than that, then you could have a problem and you might have to put a stop to that. The people in New York just wanted a name and a hospital so they could find people. That’s all."
Share your privacy concerns
Keeping to that minimum amount of information should make it easy to comply with state laws, Schroeder says. A patient list is not necessarily confidential, but any further information about the patient usually is.
The Chicago-based American Hospital Association (AHA) has released new guidelines for releasing information on the condition of patients, in response to the concern about improved information flow after a terrorist attack or other disaster. The recent advisory updates the AHA’s 1997 Guide for the Release of Information on the Condition of Patients. As part of your disaster plan revamping, the AHA suggests you share the guidelines with public relations and human resources staff, legal counsel, chief privacy officer, and the heads of your compliance and risk management departments, among others. The guidelines also should be incorporated into the overall disaster readiness plans, and the AHA suggests that your public relations staff share the guidelines with local reporters so they will know what to expect when looking for information. It also might be a good idea for the public relations director to hold a joint media briefing with area hospitals during an emergency. (See "AHA guidelines urge protection of privacy," in this issue.)
EMTALA and pathogens
Porto points out that one worry among risk managers has been effectively dealt with by federal regulators. With all the concern about a biological terrorist attack, some risk managers worried that it would be practically impossible not to violate the Emergency Medical Treatment and Active Labor Act (EMTALA) without exposing hospital staff to the pathogen. (EMTALA requires that patients be evaluated and stabilized before transferring to another facility.) But the Health and Human Services’ Office of the Inspector General recently issued a statement clarifying that EMTALA is not violated if the facility is incapable of treating the victim of a biological attack.
The statement says hospitals must meet EMTALA obligations during a terrorist attack "within the hospital’s capability and capacity, and/or within the provisions of a community response plan developed by a state or local government." It goes on to say that there may be situations "where referral of a potentially exposed patient prior to the actual examination is appropriate." When a communitywide program for responding to such an event has been put in place, examination at the first hospital where the patient presents may not be required.
"There may be cases in which state or local governments have developed community response plans that designate specific entities [hospitals, public health facilities, etc.] with responsibility for handling certain categories of patient in bioterrorism situations," the statement says. "The transfer or referral of these patients in accordance with such a community plan would not violate the hospital’s EMTALA obligations."
(Editor’s note: For more information on preparing for terrorism and other disasters, see the Joint Commission’s publication, "Perspectives." The December 2001 issue is a special report on emergency management and contains a wealth of useful information. The issue is available on-line for free at www.jcrinc.com/subscribers/perspectives.asp?durki=187.)
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