Transcript ImpactOfTechnologyOnUndwrtngHospPL23-15

2006 Medical
Professional Liability
Symposium
The Impact of Technology on
Underwriting Hospital
Professional Liability
Crystal Brown, CNA HealthPro
Drew Bartkiewicz, DarwinPro
Rob Bartolone, Zurich North America
Louise Bitting, Integro Ltd.
Chicago, Illinois ~ March 14 & 15, 2006
Panel Outline
• Select technological advancements
• Challenges in the underwriting process
for PL underwriters
• Challenges in the underwriting process
for Tech E&O underwriters
• Impact of technology on claims
• Hypothetical loss – panel discussion
• Questions
What is a Digital
Hospital?
“A digital hospital means all digital, with EMR, CPOE, PACS, and labs that
dump into EMR. A digital hospital should be as paperless and wireless
as you can make it.”
-Brad Bjornstad, M.D., CMO, University Community Hospital, Tampa, FL
“A lot of folks are trying to talk about the digital hospital. I think no one
knows what it means. If you ask a hundred different people who haven’t
been exposed to it, you would get a hundred different variations on some
sense of what it means to be a leading-edge technology hospital.”
-Philip Strong, M.D., IT physicians liaison, El Camino Hospital, Mountain
View, CA
“A fully digital hospital would not produce or use paper records. It would
have digital imaging, order transmission, clinical notes and other aspects
of the electronic health record. It would have integrated supply chain
management and integrated revenue-cycle management.”
-David Brailer, M.D., Ph.D., national health information technology
coordinator, U.S. Department of Health and Human Services
SOURCE: PricewaterhouseCoopers
Top 10 I.T. System Priorities
During the Next 24 Months
Percentage of respondents
Move toward an electronic health record
65.1
Improve patient-care capabilities
51.6
Improve decision support for all clinicians
39.9
Improve revenue cycle capabilities
33.4
Improve productivity and reduce costs
33
Improve ambulatory and outpatient capabilities
21.1
Make optimal use of emerging technologies
20.3
Improve use of networks and infrastructure
20
Implement wireless access and personal digital-assistant usage
20
Improve financial management and supply chain
17.1
Source: Modern Healthcare
Web Based Electronic
Informed Consent
Educate
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Inform the patient of the risks, benefits and alternatives
•
Individualized/Private/Secure
•
Multimedia
•
Medically certified content
Respond
•
Interactive
•
Assesses comprehension
•
Automated data capture
•
Patient access 24/7/365
Document
•
Gauge and document patient understanding
•
Document questions & responses
Sign
•
Strong/absolute user authentication
•
HIPAA and FDA compliant
•
Legally valid/non-reputable
Electronic Scheduling
• Email
• Websites
Electronic Medical
Records
Electronic Medical
Records
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Improves documentation quality (legible, organized, complete)
Facilitates better patient communication
Provides built-in protocols and reminders (including health
maintenance)
Improves medication management
Lowers malpractice insurance costs
Reduces pharmacy costs
Improves the completeness of documentation
Increasing the number of services offered
Boosts the number of visits per day---increases efficiency of care
Allows universal access to the chart (by more than one person at a
time)
Improves internal office communication
Improves compliance with chart requests and chart audits
Automated Medication
Distribution
Improved Efficiency and
Enhanced Accuracy in
Dispensing Drugs for Hospital
Patients
• Identification of medication
• Dosage of medication
• Medication match to patient
• Used in conjunction with EMR
CPOE
• Speed & efficiency
Electronic Imaging
Radiology Communication
Network
•Server/web based review of
scans
•Immediate review by
radiology
•Shared analysis with treating
physician
•Multiple radiology reviews
Electronic Imaging
CAD Breast Cancer Screening
•Computer aided detection
•Earlier detection in 23.4% of cases
•Second set of eyes to read
mammogram
•Image analyzer draws radiologist’s
attention to suspicious features
•Image analyzer can detect what
might have been otherwise missed
CAD Image
Centralized Electronic
Patient Monitoring
• Web Cam at bedside
• Real time monitoring of vital signs
• Real time review of chart
Challenges in the
Underwriting Process for
Professional Liability
Underwriters
• The Education Process: Are Underwriters keeping
up to date?
• Identification and Determination of the Impact of the
Exposures: Are you underwriting for these
exposure?
• Impact Evident in the Loss History: Can you tell?
• Impact on Your Decision: Do you Quote or Decline?
• Impact on Your Program: How do you address the
Pricing, Structure and Coverage?
• Other Exposures or Coverages: What am I
missing?
Possible Next Steps for
the Professional Liability
Underwriters
• Establish a task force to keep track of Technological
Advancements in HealthCare
• Look at your own internal tools and prepare to
address the exposures – formulate an underwriting
guide
• Evaluate the impact as it relates to the historical
loss data
• Is there a need for an expert underwriting system
that can aid in the process?
• Evaluate the impact on coverage
• Is there an opportunity for a “new” product (PL /
Tech E&O) or coordination with another area within
your underwriting company?
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Why in the last 5 years hospitals risks
have caught up to other technologydependant industries (banks,
insurance, retail, tech companies
themselves)
Hospitals have their own networks
Hospitals have centralized their data storage and
servers
Hospitals outsource certain IT intensive activities
(storage, coding, hosting)
Hospitals conduct business and processes via the
Internet
Hospitals are under required standards of care for
information technology (HIPAA, state privacy laws,
federal upcoming)
Hospitals have placed IT security as a boardroom
priority
A hospital’s balance sheet, operations, and reputation
can be severely impacted by a technology wrongful act
* The managed care industry has experienced a similar transformation of risk.
Hospitals are now exposed
to technology risks in
significant ways:
• Technology Wrongful Acts – Failure of a technology
service (outsourcing, data processing, online
scheduling) causes bodily harm
• Data Privacy Wrongful Acts – Failure to protect
patient data
• Network Security Wrongful Acts – Failure to prevent
hospital interruption
• Internet / Content Wrongful Acts – Error in a
hospitals online activities (libel, slander, defamation,
advertising, IP infringement, email)
The Landscape of Hospital
Technology Risk is One of
Increasing Interdependence
Hospitals and Care Givers
Risks in data
Providers of Technology
Services
(Offsite and Onsite)
Aggregation
Automation
Business interruption
Lost Data
Access
Theft
Cyber Liability and
Internet Liability
How do they fit next
to Med Mal?
Tech Policies can address
both tech providers and
hospital cyber needs
1 in 4 hospitals will have a network security
incident in 2006 - Computerworld
Contingent BI
Tech E&O and
Cyber Liability
Do hospital
subcontractors and
tech providers have
the adequate
coverage?
Impact on Claims
Positive results expected
• Better chart to defend
• Enhanced ability to diagnosis thoroughly and
quickly
• Fewer radiology errors
• Faster response to change in symptoms
• Better patient communication
• Increased patient knowledge
• Fewer medication errors
• Enhanced ability to treat
Web Based Electronic
Informed Consent
Educate
• Inform the patient of the risks, benefits and alternatives
• Individualized/Private/Secure
• Multimedia
• Medically certified content
Respond
• Interactive
• Assesses comprehension
• Automated data capture
• Patient access 24/7/365
Document
• Gauge and document patient understanding
• Document questions & responses
Sign
• Strong/absolute user authentication
• HIPAA and FDA compliant
• Legally valid/non-reputable
Hypothetical – How will the
PL and E&O Policies
Respond
• Hospital’s system encompasses
electronic medical record component
and back office accounting functions
• Hacker gains access to personal
financial information for 10,000
patients
• Hacker plants virus in EMR with intent
to sabotage
Hypothetical . . .
• As a result of the identity thefts, the
hospital offered each of the 10,000
patients free access to a credit
monitoring service for 2 years @$500.
Total Cost $1,000,000
Hypothetical . . .
• As a result of the virus, the allergy
warning system malfunctioned causing
7 patients to be given inappropriate
medications resulting in death. Each
family brought a wrongful death claim
seeking $1,000,000.
Total Cost $7,000,000
Hypothetical . . .
• As a result of the identity thefts, the hospital offered
each of the 10,000 patients free access to a credit
monitoring service for 2 years @$500.
Total Cost $1,000,000
• As a result of the virus, the allergy warning system
malfunctioned causing 7 patients to be given
inappropriate medications resulting in death. Each
family brought a wrongful death claim seeking
$1,000,000.
Total Cost $7,000,000
Man Indicted in Attack That
Crashed Hospital
Computers
• January 2005 “Botnet” attack crippled 187 bed
hospital in Seattle
• Attack slowed down the hospital’s computer
network, causing the operating room doors not to
open, pagers to shut off, a temporary shutdown of
computers in intensive care units and delays in
processing lab tests
• $150,000 estimate for repairing system
• “Though no patients were harmed . . . any attack
that compromises a hospital’s system endangers
lives.”
Source: komotv.com February 10, 2006