Financing Health IT and strategies for sustaining innovation for Health IT

Financing Health IT

Developing a mechanism to finance investment in health IT can be a challenging process as decisions are heavily influenced, positively or negatively, by the policies of the Congressional Budget Office (CBO) (Longest, 2010). The CBO is a federal agency within the legislative branch of the US government that provides budget and economic information to Congress. It was created as a nonpartisan agency by the Congressional Budget and Impoundment Act of 1974.  In 2008, the Congressional Budget Office reported that about half of all growth in healthcare spending over the past several decades has been associated with changes in medical care due to technological advances.  Healthcare spending will account for more than 30 percent of the GDP by 2035 (Longest, 2010). 

 

As healthcare innovations evolve, the CBO implements policies to support and sustain the change.   According to Longest (2010), the policy modification phase follows the implementation of the policy, and occurs due to potential concerns or consequences of the policy experienced by those that were directly impacted. Two phases make up the policy modification process: (1) the formulation modification phase and (2) implementation modification phase (Longest, 2010).   While financing policy can be driven by the CBO, policies can be modified through interaction with the agency if they have adverse impacts on operations.

 Strategies for Sustaining Innovation in Health IT

Many policymakers believe that health information technology (IT) is necessary to improve the efficiency and quality of health care in the United States. Wider adoption of health IT has the potential to generate both internal and external savings.  Internal savings are those that can be realized by healthcare organizations and providers, which would be seen in the form of improved efficiency on how care is being delivered. External savings would be those that the provider or healthcare organizations accrue to another provider or healthcare system such as the relevant health insurance plan or even the patient (i.e. ability for patient in the health care sector to exchange pertinent information).

Two studies, one by the RAND Corporation and one by the Center for Information Technology Leadership (CITL), provide estimates of the potential net benefits that could result from nationwide adoption by all providers and healthcare systems. Unfortunately, these studies measured different sources of such savings. The RAND research focused primarily on savings that the use of health IT could generate by reducing costs to providers and healthcare organizations, whereas the CITL study limited its scope to savings from achieving full interoperability of health IT, which excluded any potential improvements in efficiency with providers or healthcare organizations. It is telling, however, that both studies, while measuring different variables, arrived at similar conclusions.

The involvement of the federal government in sustaining adoption of health IT is a significant issue for consideration as the initiative continues to grow. The federal government is a major purchaser of health care services through programs such as Medicare and Medicaid. As the manager of those programs, the government is responsible for running them efficiently and maintaining a level of quality in their services that reflects the views of the electorate as expressed by policymakers. The federal government, as a payer, assesses the benefits and costs of health IT, determines which elements of the technology should be required to run federal health care financing programs efficiently and at the desired level of quality, and takes appropriate steps to achieve the level of use of health IT that meets those criteria. I have posted in my earlier blogs the incentives the federal government and other agencies have put in place to encourage the utilization of health IT.

The government is already making some modifications to its EHR incentive program. In January of 2016, the Centers for Medicare and Medicaid Services (CMS) made an announcement indicating that the Medicare Electronic Health Record Incentive Program will be replaced in 2017 by the new Merit-Based Incentive Payment System (MIPS) for physicians, not hospitals. CMS has worked with physician organizations to develop key themes that will guide the changes.  CMS is proposing to transition from rewarding providers for the use of technology to patient outcomes.  Additionally, there has been commitment to enhance the security of health IT as mentioned in my earlier posts.

From a state perspective, Arizona has been awarded funds to participate in the Health Information Exchange (HIE). The HIE Program funds states’ to rapidly build capacity for exchanging health information across the health care system both within and across states. States who receive the funds are responsible for increasing connectivity and enabling patient-centric information flow to improve the quality and efficiency of care as well as advancing governance, policies, technical services, business operations and financing mechanisms. The program is intended to build on existing efforts to advance regional and state-level HIE while moving toward nationwide interoperability.  This program falls under The Office of the National Coordinator for Health Information Technology (ONC).  Hence, there is state support for sustaining this innovation.

From the local level perspective, providers and healthcare organization are positioned to actively influence supporting and sustaining the health IT innovation for the populations they serve. By participating in the state HIE, meeting the federal government requirements for meaningful use are all efforts to support and sustain this innovation.  As individual healthcare consumers we can keep our patient portals updated and use the information to communicate more effectively with our healthcare providers to make better decisions on addressing our healthcare needs.

References:

Retrieved from: http://www.azhec.org/?page=hie_arizona

Retrieved from: http://www.citl.org/

Retrieved from: https://www.cbo.gov/

Retrieved from: https://data.oecd.org/healthres/health-spending.htm

Retrieved from:  https://www.healthit.gov/newsroom/about-onc

Retrieved from: http://www.rand.org/topics/health-information-technology.html

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.).  Chicago, IL:  Health Administration Press.

 

 

Standardized Context: Patient Portals

Technology Innovations and its impact on patient portals

 There is very little doubt that the pace at which new innovative technology is impacting our daily lives is increasing. Technologists often observe that today we have more computing power in our pockets than NASA had on the moon missions. Many people indicate that their iPhone is the first thing and the last thing they look at everyday—which is telling of how connected we have become with technology.

These technologies are beginning to allow healthcare practitioners and organizations to offer lower cost, faster and more efficient patient care than ever. Traditionally, the healthcare industry has been overburdened by slow moving innovation due to the complexity of the medical ecosystem.  Technology has begun to infiltrate the healthcare profession, and we are seeing significant changes as a result.

2016 may be one of the biggest years for healthcare technology, with innovations in medical devices, software, and changes in how healthcare is administered, both from a care and financial perspective.   A majority of this growth is due to the growing adoption of various healthcare IT solutions. The need to reduce cost of care, meet regulatory requirements for patient care and safety, improve outcomes, and maintain operational efficiency are also often cited as drivers for IT adoption.

An interoperability solution for exchanging patient information across care settings is one particular technological development that will shape the future of healthcare organizations.  Value-based care and health information exchanges are an important part of the overall healthcare landscape.  The ability for all providers to have access to a complete health record; from general practitioners, specialists, and acute care organizations, to post-acute care organizations, etc. – will only grow as a critical component of care delivery in the future.  The timing to standardize the context of patient portals seems to be in alignment with the future of interoperability.

By standardizing the context of patient portals into the interoperability strategies, healthcare organizations and providers can ensure that critical patient information across all care settings will be connected, providing a more detailed patient picture for more specific treatment plans and improved patient care.

Health Informatics. More than half of US hospitals use some type of electronic records system. Electronic records streamline the medical care process, lower malpractice claims, and increase coordination between providers.  Improvements still need to be made in communication of patients between facilities and providers. These communication gaps can increase costs, and lower patient outcomes. Standardization of patient portals can help close those communication gaps. If patients have access to their portal and are required to input certain data, they will have a better understanding of their situation and specific needs to enable more effective dialog with providers to get the care they need.

I recently had the pleasure to interview Sally Schlak, Chief Nursing Informatics Officer from Cerner Corporation. She indicated that technology vendors are committing substantial research and development funding to data analysis. This investment will enable practitioners and medical researchers to apply data analysis to develop new insights into finding cures for difficult diseases. She also stated that healthcare Chief Information Officers and other IT leaders can expect to be called upon to manage all the new data and devices that will be transforming healthcare as we know it today.

Implications for data and privacy: The security and privacy of personal health information is the most significant unintended outcomes of EHRs. In February 2016, a California Hospital was challenged with this issue. IT hackers intercepted Presbyterian Medical Center’s IT system and followed with a payment of $17,000 to reopen their IT network. Beyond the financial implications of this event it was very disruptive to the operations of the organization. Additionally, in March 2016, Methodist Hospital in Henderson, Kentucky was also intercepted by IT hackers.  Their response, however, to similar ransomware demands was to shut down their IT networks, and pay nothing.

Building a culture of Health IT Privacy and Security is what is necessary to achieve cybersecurity in which everybody has a role is creating such a culture. The federal government has put several safeguards in place to decrease the risk of security and privacy breaches. The American Recovery and Reinvestment Act (ARRA) offer financial incentives for healthcare businesses to meet its privacy guidelines, and punishment for people and businesses that fail. It also requires health care providers to safeguard the security and confidentiality of medical records.

Education and training to consumers, providers and healthcare organizations, as well as improvements to security standards in H-IT products are necessary in order to mitigate the risk of future security breaches. As is always the case with technological innovation, there will be bumps in the road.  You had to carry around a marginally functional brick as a cell phone for a few years to get to that shiny iPhone in your pocket today.

 

References:

American Recovery and Reinvestment Act ( 2013). Retrieved from: https://www.fcc.gov/general/american-recovery-and-reinvestment-act-2009

Cerner Corporation (2016). Retrieved from:  http://www.cerner.com/solutions/Hospitals_and_Health_Systems/

Becker’s Hospital Review (2016). Retrieved from:  http://www.beckershospitalreview.com/healthcare-information-technology/hackers-shut-down-hollywood-presbyterian-medical-center-it-systems-demand-3-6-million-ransom.html

Becker’s Hospital Review (2016). Retrieved from:  http://www.beckershospitalreview.com/healthcare-information-technology/to-pay-or-not-to-pay-ransom-a-tale-of-two-hospitals.html

 

 

Patient Portals: Standardized context

Private Sector Innovation and Policy Advancement 

The implementation phase of policy making involves two components, (1) rulemaking and (2) operation of policies (Longest, 2010). According to Longest (2010), the success of any policy’s operational stage depends on two variables:  (1) the design or construction of the policy and (2) characteristics of the organization including the capability of its managers.  A critical element for an organization is to have leaders that are in alignment with the goals and objectives of the policy, if not, this could risk the success of the implementation.  Leader’s main objectives in operationalizing the implementation phase of a policy include, strategizing, designing and leading.

Private Sector Organizations and Patient Portals

I will focus on the implementation of patient portals at the organization I work for- Yavapai Regional Medical Center, located in Prescott Arizona.

Yavapai Regional Medical Center (YRMC) is a full-service, not-for-profit community health system. YRMC is a state-of-the-art healthcare system with two acute care hospitals, a network of primary and specialty care clinics, outpatient health and wellness centers, cardiac diagnostic centers, and outpatient medical imaging centers. Together, YRMC’s network of services provides medical care and wellness resources to a geographic area encompassing 5,500 square miles and covering the communities of Prescott, Prescott Valley, Chino Valley, Dewey, Humboldt, Mayer, Paulden, Bagdad, Yarnell, Kirkland, Skull Valley, and Crown King. Yavapai Regional Medical Center, is locally owned and operated out of Prescott, Arizona. Yavapai Regional Medical Center (YRMC) strives to create an environment where people of YRMC work alongside patients and their families to provide peace of mind and peace of heart, as well as physical cure and comfort. YRMC has two main campuses, YRMC West (located in Prescott, AZ) and YRMC East (located in Prescott Valley, AZ). YRMC West, the original campus, has 134 inpatient beds, and YRMC East, which opened on May 15, 2006, has 72 inpatient beds.

Strategizing:  In June 2012, YRMC went live with our electronic medical record (EMR) which comprised of 55 IT applications across the two acute care hospitals. One of YRMC’s goals for fiscal year 2012 was to attest for Meaningful Use Stage One.  One of the set objectives to meet Meaningful Use Stage One was getting patients to sign up for the portal.  This was part of the YRMC’s strategy in the timing of the implementation of the EHR.

My interviews of the professionals I conducted were: Randy Rahman, prior CIO of YRMC (he was CIO when YRMC went live with the EHR), and Tim Roberts, current CIO for YRMC.  Their perspectives on the strategy for designing, implementing and sustaining the EHR were similar.  Additionally, their concern about security and privacy regarding the patient portal was paramount.  They both concurred that the integration of Health Information Technology and EHRs in healthcare was evolving and  is a journey.

Leading and Designing:  Prior to implementation of the EHR, we began working with our marketing department on the development and communication of the patient portal, which we named CareConnect.  Through workflow analysis, we determined that the most important interface with patients regarding the portal occurs during the registration process.  Therefore, we developed talking points for our  registration staff and developed Care Connect brochures (see brochure below) for patients and their family members to take home for reference.

The Health Information Management (HIM) department conducted internal open house events where YRMC staff could register for a CareConnect account. Additionally, the HIM staff participated in local community events discussing the benefits of the patient portal in order to support the registration process with the public.

YRMC also developed a robust Public Relations (PR) campaign which included media releases, articles in local publications, with a heavy emphasis on EMR/Patient portal in community newsletters, annual reports, etc. A patient portal community was also established, which can be accessed on www.yrmc.org.

In order to support the registration conversation and PR campaign, we used print and radio advertising to extend our message into the community.

As  both Mr. Rahman and Mr. Roberts indicated in their interviews, this is a journey, so we continue to support the patient portal with radio advertising as appropriate to keep the CareConnect brand in the public’s mind.

In June 2015, YRMC Physician Care (YRMC’s employeed physician practices) made the transition from Athena to Cerner EHR. This was also part of the strategy in obtaining “One Chart” for patients seen in the office practices.  Again, we worked with our marketing department to communicate this change internally and externally.   This included an entirely new campaign that was focused on internal communication/talking points, etc. (see brochure below).

Throughout this journey, we have monitored our progress on meeting the indicators for meaningful use.  We have successfully attested for both Meaningful Use Stage 1 and Stage 2.  This has required the organization to develop a council that oversees the process, a dedicated individual that monitors progress and an executive sponsor that  provides leadership and guidance. Throughout this process, YRMC consistently worked together to create the empathetic environment necessary to meet the stated goals and objectives.

Serving as the executive sponsor for this initiative,   I would concur with the comments by Mr. Rahman and Mr. Roberts; implementation of a policy is an evolving journey.  The rules change, incentives change, and penalities are applied for not meeting the requirements.  I would add one other comment, the reward for achieving success is extremely satisfying. Although the monetary reward was beneficial to the organizations bottom line,  seeing the team who worked hard to meet the requirements beam with pride and take ownership, has been well worth the effort.

References

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.).  Chicago, IL:  Health Administration Press

Retrieved from:  www. yrmc.org

 

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: Standardized Context

Week 5: 2/8/2016 – 2/15/2016

Historical and Contemporary role of institutions and actors:  Statutory and regulatory mechanisms related to patient health information

 The Role of Institutions/Actors in policy making

Public policy making in the U.S. health domain is a complex process that is highly political.  It is continual and cyclical and is heavily influenced by internal and external factors (Longest, 2010).  There are several players/actors inside of government involved in the process of policy making.  These include the office of  President, his resources and political appointees; civil servants; and Congress (Kingdon, 2011).  Each of the players/actors can influence one another in decision-making, however; some have more influence than others.  The President and his political appointees are critical to agenda setting, but have less control over the alternatives considered and over implementation (Kingdon, 2011).  Civil servants do not have a significant role in agenda setting; however they have more impact on alternatives and implementation.  Congress is central to both agenda setting and alternative specification, although the members have more impact on the agenda while the staffers concentrate on the alternatives (Kingdon, 2011).

 Statutory and regulatory mechanisms related to patient health information

Current State:  Statutory requirements and regulatory requirements are requirements that are mandated by law, and are non-negotiable. Failure to comply could result in a fine or other penalty for the person(s) and/or organizations  for the non-compliance.

According to Longest, (2010),  political  problems that move forward to legislative development are those that policy makers believe are urgent and have a high public interest.  There are a number of laws and regulations at both the federal and state level that govern the confidentiality of health information, including:    

The privacy rule:

• Preempts state law contrary to the privacy rule (exceptions are made if certain conditions are met)
• Establishes requirements for notice and acknowledgment
• Establishes an individual’s right to opt out of the facility directory, or to request restrictions to other uses of his or her health information
• Establishes requirements for use
• Establishes administrative requirements

 

The Privacy Act of 1974 was designed to give citizens some control over the information collected about them by the federal government and its agencies. It grants people the following rights:

• to find out what information was collected about them
• to see and have a copy of that information
• to correct or amend that information
• to exercise limited control of the disclosure of that information to other parties

Confidentiality of Alcohol and Drug Abuse Patient Records.  This rule establishes additional privacy provisions for records of the identity, diagnosis, prognosis, or treatment of patients maintained in connection with a federally assisted drug or alcohol abuse program.

The Health Insurance Portability and Accountability Act (HIPAA)  – when Personal Health Information (PHI) is connected to the patient’s legal medical record it is protected under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

Future State:  President Obama has requested a thirty five percent increase in the 2017 budget for cybersecurity and has announced plans to implement a Cybersecurity National Action Plan (CNAP).  The CNAP would take short term actions and develop a long-term strategy to enhance cybersecurity awareness and protections, protect privacy, maintain public safety (as well as economic and national security), and empower Americans to take better control of their digital security.

In order to implement these changes, the federal government is seeking a 2017 budget of greater than $19 billion for cybersecurity.  This will enable agencies to increase their level of cybersecurity, help private sector organizations as well as individuals better protect themselves, deter adversary activity and more effectively respond to incidents.

Another variable to agenda making is the current political circumstance that surrounds the problem.  According to Longest, (2010), the window of opportunity to allow a problem to move forward may depend on what society and existing political bodies currently view as actions of  priority.  With the increase in the number of people using personal health records to manage their health information and become more engaged in their quest for good health, along with the amount of funding being put in place to enhance the security of personal health information, this may be the “window of opportunity” to regulate and standardize the context for patient portals.   

References:

Kingdon, J.W.  (2011).  Agendas, alternatives, and public policies (2^nd ed).  Boston, MA:  Longman.

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL:  Health Administration Press

Retrieved from:  http://www.clinical-innovation.com/topics/privacy-security/obama-announces-cybersecurity-national-action- plan?utm_source=CINW&utm_medium=4141580&utm_content=article&utm_campaign=newsletter_referral

Retrieved from:  https://www.healthit.gov/…/personal–health–record-phr-model-privacy-n…

Retrieved from:  https://www.healthit.gov/…/can-i-keep-my-own-personal–health–records–…

Retrieved from:  https://patientprivacyrights.org/learn-personal–health–records/

Retrieved from:  http://perspectives.ahima.org/patient-access-to-personal-health-information-regulation-vs-reality/#.VruMSZjruJA

Retrieved from: http://www.himss.org/

 

 

Patient Portals and Health Policy: The Ethical impact of Healthcare Policy and the Role of Ethics in Policy decision making regarding standardizing the context of patient portals

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

 

 

 

 

 

Introduction and Background

Week 2: 1/17/16 – 1/23/16

Healthcare Problem

Mixed reviews on the benefits of patient portals

 

Background on patient portal evolution

On February 17, 2009, The American Recovery and Reinvestment Act of 2009 (ARRA) was enacted. With this enactment,  the establishment of  incentive payments to eligible professionals, eligible hospitals, and critical access hospitals, and Medicare Advantage Organizations occurred.  This was done  to promote the adoption and meaningful use of interoperable health information technology (HIT) and qualified electronic health records (EHRs). These incentive payments are part of a broader effort under the HITECH Act to accelerate the adoption of HIT and utilization of qualified EHRs (American Recovery and Reinvestment Act, 2009).  The Stage 1 final rule set the foundation for the Medicare and Medicaid EHR Incentive Programs by establishing requirements for the electronic capture of clinical data, including providing patients with electronic copies of health information. The Stage 2 final rule expanded upon the Stage 1 criteria with a focus on ensuring that the meaningful use of EHRs supported the aims and priorities of the National Quality Strategy.  Stage 2 criteria encouraged the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible. Stage 2 requires that eligible professionals ensure at least 5% of patients view, download or transmit their electronic health records (Centers for Medicaid and Medicare Services, 2016).

Current Status

As a result of ARRA, the use of patient portals has been implemented in physician offices, healthcare organization, and pharmacies. The literature from studies on patient portals has mixed reviews on the benefits.  Some studies have shown positive impacts with regard to perceptions of patient-centeredness and receipt of preventive services (Agency for Healthcare Research and Quality, 2013).  This indicates if the context of a portal is established, and if the portal is being used as intended, you will see the benefits to patients.

Relevancy to Legislation 

My intent is to evaluate the context of what should be included in a patient-centered portal which would be populated by the various patient portals from providers. I would seek guidance on proposal of legislation to standardize the context of patient-centered portals to improve outcomes and efficiency.

I welcome your thoughts and personal experiences on how we can maximize the benefits of patient portals.

 

References:

1. Agency for Healthcare Research and Quality (2013). Web-based patient portal improves perceptions of patient-centeredness and receipt of preventive services. Retrieved online from http://www.ahrq.gov/news/newletters/research-activities/13mar/0313RA36.html
2.  Retrieved from: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms
3. Retrieved from: https://www.fcc.gov/general/american-recovery-and-reinvestment-act-2009
4.  Retrieved from: http://www.hhs.gov/hipaa/for-professionals/special-topics/HITECH-act-enforcement-interim-final-rule/index.html