As of 2014, the US spent 17.1% and the UK spent 9.1% of gross domestic product on healthcare-related expenditures. Healthcare in the U.S. is also one of the most heavily regulated segments and the industry represents one of the most numerous parties segments in all of litigation. While, malpractice claims in terms of numbers and for claims over $1mm have been on a modest decrease, there is a greater focus and cost intensity of claims against hospital health service organizations. The numbers of those claims are in the hundreds of thousands per year.
Healthcare companies and providers, therefore, find themselves involved in litigation, regulatory submissions, inquiries and investigations on a frequent and regular basis. From HIPAA compliance to healthcare fraud qui tam actions, healthcare companies and providers can anticipate being on the receiving end of discovery requests and subpoenas at some point.
Develop Internal Healthcare Data Management Resources
Health Care Service Providers include companies that provide health care services to consumers. This may be a hospital, clinic, or primary care organizations. They may also be Health Maintenance Organizations, or HMOs. An (HMO) is an organization that provides health services or health coverage with providers under contract.
An HMO differs from traditional health insurers because they direct covered patients to the HMO’s own provider services. Within each of these entities finding the individuals who are most knowledgeable about the systems and applications used and how they are used is the first challenge for eDiscovery professionals.
Establish Organizational Response Protocol for eDiscovery
One solution that many organizations have implemented has been to identify and define the role of the medical staff in an eDiscovery team and organizational response to an eDiscovery request for information. Many healthcare organizations designate a member of medical staff or an individual with extensive clinical background to function as the chief medical information officer.
Understanding where and how data is maintained within the healthcare service providers system will be important when implementing preservation and collection plans.
This person can be a valuable resource to legal counsel in understanding the applications and functionality of the organization’s information systems and the impact they have in the delivery of patient care. Medical staff rules, regulations, and bylaws specify the practices for documentation in the medical record.
Locate Critical Data Sources Needed for eDiscovery
Understanding where and how data is maintained within the healthcare service providers system will be important when implementing preservation and collection plans. Likewise, a medical coder and medical biller with a deep understanding of medical billing applications and the coding that is used have also proved useful in this regard.
Medical coding is the transformation of healthcare information such as diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. Medical billing translates medical coding into healthcare claims. Both of these individuals are powerful sources of information for eDiscovery efforts. For example, knowledge of the codes for underlying procedures or medical devices will be key in healthcare fraud and class action cases. These codes can be used, for example, as filtering search terms, in applying advanced analytics and for predictive coding purposes.
Proactively Leverage eDiscovery Expertise for Cost-Effectiveness
Prior to collection or developing a discovery plan, the lawyer or eDiscovery professional will want to sit down with the client and identify which person or persons are in the best position to inform this process. Building a relationship with this stakeholder will be key in effectuating a cost-efficient collection and review of the data. This is especially true as the technological landscape within the healthcare industry has exploded and navigating those technologies will require some expertise.