Week 3: January 25-January 31
Impact of Healthcare Policy on Health
From the government’s perspective, the central purpose of health policy is to enhance health or facilitate its pursuit (Longest, 2010). Healthcare policy contains several aspects. The aspect of healthcare policy that impacts patients and providers are the actions that the government takes, both federally and state-wide, to influence healthcare service provisions, public health, and the well being of consumers (Kraft & Furlong, 2013). When the American Recovery and Reinvestment Act of 2009 (ARRA) executed on February 17, 2009, the initial impact was on providers, healthcare organizations and medicare advantage organizations to improve adoption and interoperability of technology. The incentive payments associated with this are part of a broader effort under the HITECH Act (HITECH) to accelerate the adoption of HITECH and utilization of qualified EHRs. As this has evolved, there has been an impact to patients as well.
The Office of the National Coordinator for Health Information Technology’s (ONC) work on health IT is authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act . The HITECH Act established ONC in law and provides the U.S. Department of Health and Human Services with the authority to establish programs to improve quality, safety, and efficiency through the promotion of health IT, including electronic health records (EHRs) and private and secure electronic health information exchange.
ONC establishes regulations and sets the standards and certification criteria that EHRs must meet. These regulations and standards are put in place to ascertain that the systems .providers and healthcare organizations implement are capable of performing certain functions, hence the evolution of Meaningful Use.
This presented healthcare organizations and providers with dilemmas on the financial impact of this new policy. Some healthcare providers elected not to implement EHRs into their practice due to cost. Others phased it in over time, while some took the “big bang” approach to EHR implementation. As Meaningful Use continues to evolve, the program will transition from an incentive program to a penalty program for not meeting the stated requirements.
Patient Portals and Health Policy
When the final rule on Meaningful Use Stage 2 was announced by CMS, some healthcare organizations and physicians expressed concern about the requirement that they ensure at least 5% of patients view, download or transmit their electronic health records (Centers for Medicaid and Medicare Services, 2016). However, the experience has been that both healthcare organizations and providers have been able to meet this requirement. Additionally, the literature has shown that patients will use the portals if they include features that they find valuable.
With the incentive program in place, healthcare organizations and providers will continue to implement patient portals and adopt them into their practices and workflow. The likelihood is that patient portals will increase significantly. This could potentially have a positive impact on health care. As time evolves, it can drive greater patient compliance and engagement, increased patient connection to a health care system, and increased responsibility for patients taking care of themselves by knowing what needs to be done to stay healthy and improve their overall health. These are outcomes we would like to see, with a patient portal as one of the drivers to achieve that. This is in alignment with the HITECH Act to improve quality, safety and efficiency.
Role of Ethics in Decision Making Regarding Standardizing Patient Portal Context
With the integration of technology into healthcare and the mixed reviews on the impact on the quality of care; the discussion of regulating the context of a patient portal could potentially be a difficult one. Providers and healthcare organizations may have some reluctance to opening up their perspective portals due to the ethical issues of privacy and security.
The Health Insurance Portability and Accountability Act (HIPPA) was approved by Congress in 1996 , which provides patients with uniform access to their medical records and more control over how their personal health information is used and disclosed. It also requires health care providers to safeguard the security and confidentiality of medical records.
In order to mitigate the risk of security breaches, health care providers should conduct a risk assessment when implementing EHRs including patient portals. The following components should be assessed:
- The risk of interception during transmission
- The risk of unauthorized access
- The risks of Internetfacing interface
- Determine if the EHR portal vendor’s software been independently tested
Other items that need to be taken into consideration to decrease the risk of a security breach:
- Appropriate level of authentication
- Appropriate level of auditing
- Protection of servers
- Security failures
The security and privacy of personal health information pose the majority of ethical issues with patient portals. However, as technology continues to evolve and integrate into healthcare, other issues may arise.
Patient portals are a mechanism to empower patients and improve quality of care. By providing patients with a standardized template that draws from other patient portals, instructing them on the benefits and value, we could see a positive impact on healthcare.
In our current healthcare environment we are undergoing healthcare reform, the integration of technology and an upcoming presidential election. With enhancements to protect the privacy and security for patient portals and the benefits we could see for patients, and healthcare providers, is this the “window” of opportunity to propose legislation on a standardized context for patient portals?
References:
Kraft, M. E. & Furlong, S. R. (2013). Public policy: Politics, analysis, and alternatives. Los Angeles: Sage Publications Inc.
Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press
Retrieved from: https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html
Retrieved from: https://www.healthit.gov/policy-researchers-implementers/health-it-legislation-and-regulations
Retrieved from: https://www.healthit.gov/providers-professionals/patient-portal-benefits-patient-care-and-provider-workflow
Retrieved from: http://www.hipaa-101.com/hipaa-hitech.htm
Retrieved from: https://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html
Patient portals 