Public Sector Influence on institutions and policies: efforts to embrace/incentivize use of Electronic Health Records (EHRs)
The Affordable Care Act (ACA)
The ACA is the only significant federal law approved in the U.S. that attempts to achieve “comprehensive” health reform, for the purposes of improving access, quality and cost control (McDonough, 2014) . The ACA is divided into 10 titles, 61 sub-titles, and 487 sections to address the integral components of healthcare and to meet the objectives of the law.
To improve access, the ACA is proposing a new structure to ensure that US citizens and legal residents will have access to affordable health insurance coverage (McDonough, 2014). To achieve this, Medicaid is expanding for low-income households, and subsidized private insurance for lower and middle income households who cannot obtain insurance elsewhere. The ACA also contains a mandate on most individuals to purchase health insurance or to pay an annual tax penalty (McDonough, 2014).
Several ACA initiatives will move away from fee-for-service reimbursement that reward medical providers for the volume and quantity of services (McDonough, 2014). Payment models will transition to one that rewards healthcare providers based on improvements in quality, efficiency, and outcomes of care. New innovative systems will be established by the ACA, some examples are accountable care organizations and patient-centered homes. These new systems will increase emphasis on health promotion and disease prevention (McDonough, 2014).
The Incentive to Embrace EHRs
In 1996, Congress began encouraging the healthcare community to embrace Health Information Technology (HIT) when it passed the Health Insurance Portability and Accountability Act (HIPPA). HIPAA created an electronic data interchange that health plans, healthcare clearinghouses, and certain healthcare providers, are required to use for electronic transactions, which included claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, coordination of benefits, and premium payment.
In 2009, the American Recovery and Reinvestment Act (ARRA) was enacted by Congress offering higher Medicare and Medicaid payment to physicians and healthcare organizations who adopt electronic health records (EHRs) and met the criteria for Meaningful Use. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the ARRA of 2009, was signed to promote the adoption and meaningful use of health information technology. Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules. The HITECH included billions of dollars in new Medicare and Medicaid incentive payments and millions of dollars for states to develop health information exchanges. The HITECH Act also established a government led process for certification of electronic health records through a $35 billion appropriation for the Office of the National Coordinator for Health IT, located in Centers for Medicare and Medicaid Services (CMS).
Other federal programs designed to incentivize the use of EHRs
In 2006, a Physician Quality Reporting System (PQRS) was created. This is a voluntary physician electronic reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. PQRS gives participating EPs and group practices the opportunity to assess the quality of care they provide to their patients, to ensure that patients get the right care at the right time. Under the ACA, this has now become a mandate. In 2015, Medicare payments are reduced for nonparticipating physicians.
In 2008, the Electronic Prescribing (eRx) Incentive Program was created under the Medicare Improvements for Patients and Providers Act which provides incentives for eligible physicians who e-prescribe Medicare Part D medications through a qualified system. In 2012, this program transitioned to a penalty program for physicians who don’t use eRx.
Additionally, grants were developed under the HITECH act to fund HIT infrastructure and low interest HIT loans. The Agency for Healthcare Research and Quality (AHRQ) has awarded millions in federal grant money to more than several hundred projects across the United States to promote access to and encourage HIT adoptions.
Under the 2005 Deficit Reduction Act, several millions in Medicaid transformation grants have been awarded to three states and territories for HIT in the Medicaid program.
The ACA which was enacted in 2010 carried these initiatives even further by establishing uniform standards that HIT systems must meet, including automatic reconciliation of electronic fund transfers and HIPAA payment and remittance, improved claims payment process, consistent methods of health plan enrollment and claim edits, simplified and improved routing of healthcare transactions, and electronic claims attachments.
EHRs and the Disabled
In 2010, Health 2.0 and the Office of the National Coordinator for Health Information Technology (ONC) announced the launch of a new Investing in Innovations mobile app challenge, the “EHR Accessibility Module Challenge” aimed at providing people with disabilities with access to their health records.
Individuals with disabilities are more likely to report having poor health compared to those without a disability. This population faces significant difficulties with accessing and receiving healthcare. HIT and EHRs have tremendous potential to improving the health outcomes and coordination of care for people with disabilities. The accessibility and usability of HIT can be of concern to people with disabilities, such as vision, hearing, intellectual, manual dexterity, mental health, developmental and others.
The top 3 videos of the challenge can be viewed by clicking: “EHR Accessibility Module Challenge”. This is a great demonstration on how EHRs can benefit people with disabilities.
Looking to the future
It is evident that significant effort and taxpayer dollars have been dedicated to drive efficient use of HIT and EHRs hoping to streamline our fragmented healthcare system, improve patient safety, increase efficiency, reduce unnecessary tests, and increase coordination of care.
HIT, EHRs and Meaningful Use are not going away. Vendor products are maturing and improving and new technology is emerging. Acceptance by large and small physician practices and healthcare organizations has gained traction. The public at large has shown acceptance and, in some instances, embraced the technology to be more engaged in their care.
Standardizing the context of patient portals would give patients the information needed to communicate with their providers so their health issues can be appropriately addressed. It would also assist the disabled patient in garnering critical access to healthcare information. Patient engagement is in alignment with the overall goals of the ACA in improving access, quality and reducing cost.
References:
McDonough, J. E. (2014). Health system reform in the United States. International Journal of Policy Management, 2, 1-4.
Retrieved from: http://www.ahrq.gov/
Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqri/
Retrieved from: https://www.cms.gov/Regulations-and- Guidance/Legislation/DeficitReductionAct/index.html
Retrieved from: http://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
Retrieved from: https://www.irs.gov/uac/The-American-Recovery-and-Reinvestment-Act-of-2009:-Information-Center
Retrieved from: http://www.hhs.gov/hipaa/for-professionals/special-topics/HITECH-act-enforcement-interim-final-rule/index.html
Retrieved from: http://www.health2con.com/devchallenge/ehr-accessibility-module/#background
Patient portals 