Lecture 1 Intro & HIPAA

PHRD 519: Introduction to Pharmacy Practice

How hazardous is health care?

Dangerous
o
Healthcare due to manual errors
o
Ppl can make mistakes all the time

That can cause someone their life

Most mistakes are in medicine (pharmacy less so)

When you do make mistake, you know how to handle it and not
repeat it

Pharmacy do not see as many errors as Medicine

Malpractice insurance for medicine (thousands)

For pharmacy (hundred)

When the malpractice insurance increases for pharmacy,

then you know that our profession is progressing
o
Mountain climbing
o
Bungee jumping

Regulated
o
Driving
o
Chartered flights
o
Manufacturing

Ultra-safe
o
Scheduled airlines
o
European railroads
o
Nuclear power
Medication Safety Problems in U.S.

1.5 million preventable adverse drug events occur each year

Medication errors cost $3 mil each year

Growth in chronic conditions

Diabetes

Stroke

Heart Disease and hypertension leads to stroke

Rheumatic arthritis

COPD
Causes of Growth

Nutrition

Sedentary lifestyle

And is expected to increase in the next decades

Not enough physicians to take care of these conditions

More pharmacists than physicians and can help with primary care to take
care of these conditions
Impact of Clinical Pharmacy Services

Integrated clinical pharmacy services

o
Clinical pharmacists have full scope

Physicians refer to pharmacist to take pts on diabetes

Educate them on medication/change meds/add
meds/make all these decisions to manage chronic condition and to
reduce hospitalization of the pt & amputation
Reduce complications from diabetes (blindness, kidney
disease, etc)
Kaiser patients
Has a tremendous pharmacy team
Ambulatory care to manage chronic diseases

Congestive heart failure

Diabetes

Which of the following are most critical to the future of the pharmacy profession?
A.
Clinical practice guidelines
B.
Our next presidential election
a.
Critical role in how we move forward in our profession
b.
Does the PPACA stay, modify or go? Overhaul?
C.
Global economics
D.
The increasing # of schools of pharmacy
a.
Too many pharmacists (supply and demand)
b.
California has the most in the union (14)
c.
Years ago, invested so much money in institutions for PharmD
programs due to shortage of pharmacists
d.
Also pharmacists that are creating their own positions
E.
The PPACA (patient portability affordable care act aka Obama care)
a.
Everyone are insured now, but a shortage of physicians/providers to
handle the loan
b.
News: Aetna pulled out of ACA and only exists in 3 states
c.
Pharmacists are now filling in the rules
F.
Drug discovery and translational research
a.
Discovering new drugs to treat certain diseases and educate the
patients
b.
Translational: once u discover the drug, how does it work in pharmacy
All of these things matter --> critical to our profession
Senate Bill 493 (SB 493)

Signed into law and effective January 1, 2014

What does SB 493 mean for me?

How it impacts the future of pharmacy

Healthcare provider status

Integrated healthcare: pharmacists will be included in the collaborative

multidisciplinary review of patient progress, including access to medical records

Chronic Disease Management: pharmacists can provide consultation, training,

and education to patients on drug therapy, disease management, and disease
prevention

Ex) insurance companies pay providers (panels) for services

o
Direct patient care (medication management) --> reimbursed for that
work

SB 493 authorizes pharmacists to:

Furnish emergency contraception and self-administered hormonal

contraceptives
o
Furnish prescription for nicotine replacement products
o
Furnish travel medications as defined by the CDC
o
Order tests related to managing a patient's medication regimen

Importance: increase access for patients

Ex) diabetes

Lab tests: to see what their renal/liver function are like

and see the blood glucose levels
Pharmacists consultation and tell you to fill a questionnaire and then furnish
the oral contraceptives
o

Advanced Practice Pharmacist (APP)

A new category of pharmacists in California that will have the ability to

o
Perform assessments
o
Order and interpret drug therapy-related tests
o
Refer patients to other providers
o
Participate in the evaluation and management of diseases and health
conditions in collaboration with other providers
Self Study

Create the profiles/accounts

Complete pre-test (15 questions)

o
Dont need to study for it (don't worry about the score)

Access self-study material

Carefully study all material

Complete Self-Study Assessment (80 questions)

o
Open book assessment
HIPAA lecture
More about HIPAA on the training that she will send out.
The Health Insurance Portability and Accountability Act (HIPAA): Privary Regulations
HIPAA Background

Health Insurance Portability and Accountability Act of

1996 mandated:
put in place for 2 reasons
- standardized patient records
- make it easier for pt to access own information
o
o

National uniform standards for electronic transactions in health care

Creation of "privacy rule" to safeguard personal health information

Concern that increase in electronic transaction could lead to

unauthorized disclosures of personal health information
Final Implementation Date- April 14, 2003
Does not Preempt stricter state laws

HIPPA is a federal law- but if your state has

a stricter law u follow the state laws

HIPAA the basics

Consumers

- signing a notice of privacy act (HIPAA)

- it made it easier for ppl to assess their own medical records/history
-info is only shared with covered entity
o
o
o

Get to know how you will use their info

Can ask for copies of your records
Info shared with your authorizations except

Treatments, payment, other healthcare operations (TPO)

Providers
Need to secure Protected Health Information
PHI
-name, dob, #, ss#
- info that can used to identify that patient
- no need to get pt consent to share for TPO (treatment)
-ex) walgreens pharmacist ask pcp for the last blood records before they can fill the prescription, do not
need pt consent because covered entity

o
o

Secure transmission of data

No need to get patient's consent to share PHI for TPO
Goes in your Notice of Privacy Practice (NOPP)

when ppl hacked into Anthem

- got 80 million peoples health information
- for social security & dob (generated together)
- for fraud
- credit card numbers not stolen anymore

Lecture 1: Intro to Public Health

Introduction to Public Health
Carla Blieden, PharmD, MPH, AAHIVP
Lily Fu, MPH, CHES
What is Public Health?
Example: Population health

Review of the video (class participation)

Definitions of Public Health

Science & art of preventing disease, prolonging life, and promoting health
and efficiency through organized community effort (Winslow, 1920)
o
Comprehensive definition that stood the test of time

Fulfilling society's interest in assuring conditions in which people can be

healthy (IOM,1988)
o
Institute of Medicine
o
First useful modern definition of public health
o
Developed in landmark study of the US
o
Problem with this definition is vague
Good thing about this definition, while vague, very useful that direct our
attention to a bunch of conditions/factors that impact health and wellness

Any condition--> physical, mental, environmental

o
Core value: society's interest; to focus on population instead of just
individual

All organized measures (whether public or private) to prevent disease,

promote health, and prolong life among the population as a whole. Its activities
aim to provide conditions in which people can be health and focus on entire
populations, not on individual patients of diseases (WHO)
o
Brought the first two definitions together.
o
Good idea of what public health is
o
Question: what are the broad implications of public health?

Through organized group efforts to help public health

Brings stakeholders together to work together for a common

goal

Implication: public health is an art and a science

Practice of public health = science

Discrete, concrete data

Public health= art

Requires understanding of people, health policies,

social sciences/social determinants of health, civil rights

3P's (prevent, promote, and prolong) through organized group

efforts to help public health from both (art and science)
Similarities Between Pharmacy & Public Health

Implement public health policies (FDA-- pharmacists work there)

Differences Between Pharmacy & Public Health

Public health
Public health
post treatment
Public health
much
Public health
use it as much

focuses on creating legislature

focuses on diagnosis while pharmacists focus on preventive &
focuses on environmental health while in pharmacy not so
focuses on epidemiology & biostatistics but pharmacists don't

Pubic Health is all around us video

ROI: Return on Investment

Spend a $1 on health care preventive measure --> save $$ down the line

Every $1 invested in adding fluoride to drinking water saves $38 in dental

care. ROI =3700%
o
Controlled addition of fluoride in public water in order to keep
gums/teeth healthy
Stakeholders: dentists, communities, organization

Depends on how much water you are drinking

All water we buy now are fluoridated

Switzerland & Germany fluoridated their salt instead of water

Vaccination Example

Every $1 spent on immunizing children with the MMR vaccine saves $16 in
health care costs. ROI = $1500
Vaccination Policy
Factors

Research (safety & components)

o
Which vaccines is needed
o
Is the vaccines effective
o
Studies & clinical trials
o
funding

Policy
o
Who gets vaccinated
o
Now schools required vaccinations
o
Funding
o
Bills passed
o
Lawsuits
o
Mandates
o
Supreme Court --> personal belief is no longer valid to not vaccinate
children

Stakeholders (lobbyists- trying to get bills passed and policies made)

o
Medical professionals (advocates)
o
Education of the public
o
Pharmaceutical companies
o
Government
o
Organizations

Campaign
o
Health education
o
Side effects

Advertising/marketing
Events
Production & distribution of the vaccines

Examples of Public Health Achievements

1.
Vaccinations
2.
Motor-vehicle safety
3.
Safer work places
4.
Control of infectious diseases
5.
Decline in deaths from coronary heart disease and stroke
6.
Safer and healthier foods
7.
Healthier mothers and babies
8.
Family planning
9.
Fluoridation of drinking water
10.
Recognition of tobacco use as a health hazard
Strand called pharmacists to develop social abilities and innovation to enforce
public health policies

Lecture 2 IPPE
Office of Professional Experience Programs
Agenda

Program overview

IPPE schedule & curriculum

Expectations

Blackboard

Docusign
Experiential Program Structure

IPPEs
o
P1 on Tuesdays
o
P2 on Wednesdays
o
P3 on Fridays
o
Class the other days of the week
o
300 hours

APPEs
o
P4 full time
o
No classes
o
1440 hours
IPPE Curriculum

300 hours of IPPE during first three years of PharmD

150 hours from Hospital (75) and Community (75) pharmacy practice

Remaining 150 hours can be from other fields

You need to keep track of your hours on E value

For school/accreditation purposes

300 P1-3

1440 P4
For the board of pharmacy

1500 total
o
900 from an actual licensed pharmacy (clinic doesn't count)
o
600 can be from school

No longer have to prove it (CA grads are assumed to have it)

Other states don't reciprocate

Required Hours- Summary

Translation if you ever want to be licensed and work in a state other than CA
you will need to keep track of your own intern hours and prove that you meet
their requirements!
o
Pharmacy Intern Hours Affidavit
IPPE Schedule

P1 (Tuesdays, all day)

10 hours community service/outreach (fall & spring)

o
5 hours per semester (health fairs)

Soup kitchens

Walk/run for breast cancer

32 hours community practice

32 hours hospital pharmacy practice

P1 IPPE curriculum

Classroom component Mondays 3-5 pm during IPPE assignment

o
Part of PHRD 511
IPPE guides for preceptors & students

Read IPPE guide before their first day of IPPE

Students should sit down with preceptors on the first day of IPPE to discuss
the contents of the entire guide

Includes
o
IPPE schedule
o
Student background and expectations
o
Learning objections
o
Orientations checklist
o
IPPE assignments to complete while at the site

Due by the end of the rotation

Expectations

Contact preceptor ahead of timer to touch base and ask for any Day 1
instructions (week in advance)

Arrive on time (or early) each day

Attend all assigned days

o
ALWAYS immediately contact the preceptor and Dr. Lieu if there are
any extenuating circumstances

Professional dress, white coat, name tag

o
Well groomed, minimal makeup, no perfume/cologne, minimal jewelry
o
Black slacks & a nice top

Be prepared

If you don't know something, say so

o
But then be willing to find out the answer

Be friendly, open, willing, and eager to learn

o
View this as a chance to grow professionally, every moment is a
chance to learn

Appreciate/respect the time of your preceptor and other colleagues

Be willing to do what is asked

o
BUT you don't have to do everything and anything that is asked of
your

Do NOT do something that you suspect is unethical or illegal

o
If this occurs, notify Dr. Lieu or Dr. Durham
o
If you observe something unethical or illegal at your site, notify

Avoid inappropriate or excessive use of electronic devices

Protect patient privacy

Docusign

Use Docusign for signing

LAC Clearance and Badge Process (ONLY AFTER YOU RECEIVE YOUR INTERN
LICENSE)

1.
a.
b.
c.
2.
a.
b.
c.
3.

LAC Badge Application Link

You can access the link at http://ladhs.lacounty.gov/wps/portal/CEF
Sponsor Facility- LACUSC
Sponsor Division- USC School of Pharmacy
LiveScan & LAC E2 Forms (Docusign)
Don't do livescan anywhere else besides LAC
E2 forms to be filled via Docusign
Please post a picture (front & back) of your LAC Badge in E-value
HR & EHS Clearance & Badge Pick up

***************************************
- docusign all documents
- LAC & USC Badge application completion
- will email us to do County Clearance
- then Jocelyn will email us documents to docusign
- then we wait until we can pick up the badge
- you can't do any of these steps until you get your intern license first

MyFolio/Portfolio

Replacing the 3 ring binders previously carried to the site on the first day of
rotation
Step1: save Docs ( in a myfolio folder)

Everything on myfolio needs to be on one file (PDF)

TB test- IGRA (quantiferon)

364 hours

Get TB screening every year

Intern License, need a pen signature on it and then scan into the e-value
Need to type the license number in the comment/note line
Tb skin test- event date--> go with the one that was read