Assignment: Health Information Technology and Strategy

Assignment: Health Information Technology and Strategy ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Health Information Technology and Strategy Fully address the following question. Your submission should be well researched and include no less than 2 outside sources and4300 words. Assignment: Health Information Technology and Strategy Select one emerging trend in the healthcare technology. What are three take-a-ways from this course that you could use to implement this trend? Given the strategic alignment models in the healthcare industry today, would this technology be readily accepted and cost justified? If yes, explain. If no, what changes in strategy would have to occur to deem this technology sustainable? chapter_13___15.pdf Chapter 13 Health Information Technology and Strategy Karen A. Wager and Mark L. Diana CHAPTER OUTLINE t Terms and Definitions t Historical Overview and Today’s Health Information Technology Landscape: A National Perspective t Changing Health Environment Relies on Effective Use of Health IT t Health IT Ramifications of Payment Reform and New Models of Care t Strategic Alignment t Assessing Health IT Performance and Value to the Health Care Organization LEARNING OBJECTIVES After completing this chapter, the reader should be able to: Define key terms including health information technology (health IT), electronic health records (EHRs), and interoperability Describe the history, evolution, and current state of health IT adoption and use and current issues Discuss the health IT implications of recent legislation, payment reform, and new models of care (such as accountable care organizations and patient-centered medical homes) and the IT capabilities needed to effectively lead in this new environment Discuss the importance of aligning health IT plans and capabilities with the overall strategic plans of a health care organization Describe the process that health care organizations generally use to manage and enhance value of health IT KEY TERMS $BSF.BOBHFNFOU *OUFSPQFSBCJMJUZ %BUB”OBMZUJDT 1BUJFOU&OHBHFNFOU5PPMT &MFDUSPOJD)FBMUI3FDPSE &)3 1PQVMBUJPOBOE1BUJFOU3FHJTUSJFT )FBMUI*OGPSNBUJPO&YDIBOHF )*& 3FWFOVF$ZDMFBOE$POUSBDUT.BOBHFNFOU )FBMUI*OGPSNBUJPO5FDIOPMPHZ )FBMUI*5 5FMFIFBMUIBOE5FMFNFEJDJOF )*5&$)”DUPG CHAPTER 13 r Health Information Technology and Strategy 333 CHAPTER PURPOSE TERMS AND DEFINITIONS In today’s health care environment, no health care management book would be complete without a chapter on health information technology (health IT) and strategy. The terms “health IT” and “health care information system” are often used interchangeably to describe the technology, data, people, and processes that are needed to provide timely, accurate, and relevant health information where and when it is needed. Advances in technology, consumer engagement, payment reform, and the massive infusion of federal resources have led to widespread adoption and use of health IT including electronic health record (EHR) systems in U.S. hospitals and office-based physician practices. Leadership and management of health care organizations are now grappling with how to optimize the use of such systems in practice, ensure that the systems can “talk to each other,” and share relevant health information securely within and across the continuum of care. They are also investing in the use of data analytics, care management IT capabilities, telehealth, and patient engagement strategies to effectively manage care and resources under value-based payment models. Such investments require substantial resources and should be well aligned and integrated with the strategic plans of the organization. )FBMUI*5 is a general term that describes a broad range of technologies and applications that are used to store, transmit, and manage health information electronically. For our purposes, we focus on technologies and systems (data, people, and processes) that are used to support the strategic and operational needs of health care provider organizations and the patients and/or communities in which they serve. Health IT includes both administrative/financial systems as well as clinical information systems that are commonly used to diagnose, treat, and manage the patient’s care across a continuum. An EHR is a computer-based patient health record that is maintained by the provider over time and may include demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. EHR systems have core capabilities and functions including provider order entry, clinical decision support (CDS), alerts and reminders, and access to evidence-based knowledge aids. EHR systems should be able to share information electronically with others in a secure manner. This chapter provides the reader with a broad historical overview of the health IT landscape including current adoption and use of EHR systems as well as the external factors that are impacting the use of health IT to manage population health under new payment models. Included is a brief description of the EHR incentive programs and major payment reform initiatives. The health IT ramifications of payment reform and new models of care are discussed. The chapter emphasizes the importance of aligning health IT investments and plans with the overall strategic plans of the organization. It concludes with a discussion of how to assess the value of health IT investments and a real-world case study of an organization struggling to share health information effectively across a care delivery network. EHRs have eight main functions as defined by the Institute of Medicine (IOM) (see Table 13.1). The first four core functions enable the EHR to electronically collect and store data about patients, supply that information to providers on request, permit providers to directly enter orders into the computer, and provide health care professionals with advice in making decision about a patient’s care (e.g., alerts, reminders, CDS) (Blumenthal and Glaser, 2007). The other four functions of an EHR are designed to enable health information exchange (HIE) across organizational boundaries and more fully engage the patient in his or her own care through home monitoring, telehealth, and other means. To achieve HIE, the systems must be interoperable. *OUFSPQFSBCJMJUZ is the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user (ONC, 2015). It is often referred to as systems being able to “talk to each other.” Table 13.1 Functions of an EHR System as Defined by the Institute of Medicine Core Functionalities Other Functionalities Health information and data: Includes medical and nursing diagnoses, a medication list, allergies, demographics, clinical narratives, and laboratory test results Electronic communication and connectivity: Enables those involved in patient care to communicate effectively with each other and with the patient; technologies to facilitate communication and connectivity may include e-mail, Web messaging, and telemedicine Results management: Manages all types of results (e.g., laboratory test results, radiology procedure results) electronically Patient support: Includes everything from patient education materials to home monitoring to telehealth 334 PART 3 r MACRO PERSPECTIVE Table 13.1 Functions of an EHR System as Defined by the Institute of Medicine (Continued) Core Functionalities Other Functionalities Order entry and support: Incorporates use of computerized provider order entry, particularly in ordering medications Administrative processes: Facilitates and simplifies such processes as scheduling, prior authorizations,Assignment: Health Information Technology and Strategy insurance verification; may also employ decisionsupport tools to identify eligible patients for clinical trials or chronic disease management programs Decision support: Employs computerized clinical decision-support capabilities such as reminders, alerts, and computer-assisted diagnosing Reporting and population health management: Establishes standardized terminology and data formats for public and private sector reporting requirements SOURCE: IOM Committee on Data Standards for Patient Safety (2003). HISTORICAL OVERVIEW AND TODAY’S HEALTH INFORMATION TECHNOLOGY LANDSCAPE: A NATIONAL PERSPECTIVE More than 25 years ago, the IOM published a landmark report that outlined numerous problems inherent with paper-based record systems and called for the widespread adoption of EHRs (Institute of Medicine, 1991). Studies had shown that paper-based medical record systems can lead to medical errors and duplication of services; in addition, they are often incomplete, illegible, and frequently unavailable when and where the information is needed (Burnum, 1989; Hershey, McAloon, and Bertram, 1989). Computer-based record systems could provide an electronic record of the patient’s care and therefore make an abundance of information instantly available to multiple care providers, providing them with alerts and reminders and giving them access to knowledge aids and the latest research findings. The computer-based record could essentially “follow” a patient throughout his or her lifetime and instantly track all relevant health, mental, and social well-being information electronically (Institute of Medicine, 1991). However, EHR adoption rates remained limited in the two decades following the 1991 IOM report, despite the many potential benefits to be gained from using them. In the intervening years, the IOM issued other seminal reports that detailed critical quality problems in the U.S. health care systems and recommended the increased use of health IT as a significant opportunity to address those quality issues (Institute of Medicine, 1999, 2001). There were significant technological advances in the broader society during this time, including Web-based technologies, smartphones, and other personal digital devices, such as the Fitbit and Apple Watch. Consumers are far more active in the management of their own care, with the Internet and their personal devices serving as their personal library of health information. The ubiquity of personal digital devices that track and collect individual’s health information has led to a new category of data, often referred to as patient-generated data (as opposed to the data generated by health care providers). Social networks have created new ways for patients with similar conditions to connect and share information with one another. Health care organizations and providers have invested in a host of clinical applications designed to ensure patient safety, improve quality, and increase efficiency. Such systems included laboratory, radiology, and pharmacy information systems; medication administration systems with bar-coding technology; computerized provider order entry (CPOE); and other ancillary clinical systems. Despite the advances and the implementation of these applications, however, U.S. health care organizations continued to lag in the adoption and use of EHR systems (Wager, Lee, and Glaser, 2017). Three U.S. presidents have called for the widespread adoption of EHR systems since the IOM report was first published. Most recently, President Obama included in the American Recovery and Reinvestment Act of 2009 (also known as ARRA or the stimulus act) a section known as the Health Information Technology for Economic and Clinical Health Act, otherwise known as the HITECH Act. The HITECH Act set forth a plan for advancing the adoption and appropriate use of health IT to improve quality of care and establish a foundation for the electronic exchange and use of information (Blumenthal, 2009).Assignment: Health Information Technology and Strategy The main method of stimulating EHR adoption and use was through incentives payments from Medicare and Medicaid to eligible hospitals and providers that implemented certified EHRs in a way that fully integrated these tools into the care delivery process and led to “meaningful use.” The term “meaningful use” had a specific meaning that provided detail on how eligible CHAPTER 13 r Health Information Technology and Strategy providers had to use these systems to receive incentive payments (Blumenthal and Tavenner, 2010). In general, eligible providers included nonfederal acute care hospitals and office-based physician practices. The Office of the National Coordinator for Health Information Technology (ONC) was established by George W. Bush in 2004 but substantial funding for HIT adoption and use did not appear before the HITECH Act. The HITECH Act allocated more than $30 billion in stimulus funding to achieve the widespread adoption and meaningful use of health IT (Blumenthal and Tavenner, 2010). This was the largest investment in federal funds ever made to help spearhead the widespread adoption and meaningful use of health IT in the United States, including funding for workforce development and health IT training. Whether this was enough funding to achieve an interoperable and secure nationwide health information system is as yet an unanswered question. Since 2009, EHR adoption and meaningful use among eligible providers has increased dramatically. Initially, eligible hospitals that had already adopted some level of EHRs were the main beneficiaries of incentive payments, but eventually eligible hospitals that did not have EHRs at the start of the program also adopted them. 335 Currently, according to the ONC, nearly 84 percent of eligible nonfederal hospitals have adopted at least a basic EHR system by 2015 (EHR systems can be classified in several ways, most commonly by the degree of functionality. See Table 13.2 for a classification of basic and fully functional EHRs), a ninefold increase from 2008, before the HITECH Act was passed (The Office of the National Coordinator for Health Information Technology, 2015) (see Figure 13.1). While there was some concern when the HITECH Act was first passed that the amount of money allocated was not sufficient to spur significant advances in health IT adoption, the ensuing increase was unprecedented in the United States compared to the incredibly slow progress during the two preceding decades following the first IOM report. Even with this significant increase, evidence suggests that small and rural hospitals continue to lag in EHR adoption and meaningful use, and that up-front and ongoing costs, physician cooperation, and the complexity of meeting meaningful use requirements continue to be barriers (Adler-Milstein et al., 2015). Further, noneligible hospitals, including psychiatric, long-term care, and rehabilitation hospitals continue to have low EHR adoption rates of approximately 10 percent compared to 96% 85.2%* 94%* Certified EHR 96.9%* 75.5%* 71.9%* Basic EHR 83.8%* 59.4%* 44.4%* 27.6%* 9.4% 2008 12.2% 2009 15.6% 2010 2011 2012 2013 2014 2015 Figure 13.1 Percentage of Nonfederal Acute Care Hospitals with Adoption of at Least a Basic EHR with Notes System and Possession of a Certified EHR, 2008–2015. NOTE: Basic EHR adoption requires the EHR system to have a set of EHR functions defined in Table 13.1. A certified EHR is EHR technology that meets the technology capability, functionality, and security requirements adopted by the Department of Health and Human Services. Possession means that the hospital has a legal agreement with the EHR vendor but is not equivalent to adoption. *Significantly different from previous year (p < .05). SOURCE: ONC (2015). 336 PART 3 r MACRO PERSPECTIVE the 84 percent among eligible hospitals. There also continue to be low levels of interoperability, including low participation in HIEs, that facilitate sharing information across care settings, and the number of HIEs in general is declining (Adler-Milstein, Lin, and Jha, 2016; Walker et al., 2016). On the other hand, the ability of eligible hospitals to report public health data, including electronically reporting to immunization registries, laboratory results, and syndromic surveillance, has significantly increased (Walker and Diana, 2015). Federal government hospitals were not eligible for incentive payments, but the Veteran’s Administration had already established its own system-wide interoperable EHR system. In addition to acute care hospitals, the growth in the adoption and use of EHRs in office-based physician practice settings has also increased considerably. As of 2014, 79 percent of primary care physicians and 70 percent of medical and surgical specialties had adopted a certified EHR system (Heisey-Grove and Patel, 2015). Considering that the main goal of adopting health IT is to improve the quality, effectiveness, and efficiency of health care delivery, there is some evidence that hospitals adopting EHRs have improved their adherence to process measures and patient satisfaction (AdlerMilstein, Everson, and Lee, 2015; Kazley, Diana, and Menachemi, 2012). The dramatic increase in EHR adoption since the passage of the HITECH Act, at least among eligible providers, has led to a shift in emphasis away from adopting health IT to how the data and information derived from it can be used to improve quality, effectiveness, and efficiency. Adoption alone is not sufficient to achieve these goals. Optimization and integration of the systems is vital to providing key stakeholders (patients, providers, payers, etc.) with the information needed to effectively manage population health. Therefore, we will focus our discussion in this chapter on the external environment that health care providers face and on how health IT capabilities can help support strategic initiatives to respond to the rapidly changing environment. Table 13.2 Functions Defining Use of EHRs Basic System Fully Functional System Patient demographics X X Patient problem lists X X Electronic lists of medications taken by patients X X Clinical notes X X )FBMUI*OGPSNBUJPO%BUB Notes including medical history and follow-up X 0SEFS&OUSZ.Assignment: Health Information Technology and Strategy BOBHFNFOU Orders for prescriptions X X Orders for laboratory tests X Orders for radiology tests X Prescriptions sent electronically X Orders sent electronically X 3FTVMUT.BOBHFNFOU Viewing laboratory results X X Viewing imaging results X X Electronic images returned X $MJOJDBM%FDJTJPO4VQQPSU Warnings of drug interactions or contraindications provided X Out-of-range test levels highlighted X Reminders regarding guidelines-based interventions or screening X SOURCE: DesRoches et al. (2008). CHAPTER 13 r Health Information Technology and Strategy CHANGING HEALTH ENVIRONMENT RELIES ON EFFECTIVE USE OF HEALTH IT The Affordable Care Act President Obama signed the Affordable Care Act (ACA) in 2010. The goals of the ACA are to improve access; reduce the cost of services and bend the overall cost curve; and improve the quality of health care service delivery, health outcomes, and public health. These goals are consistent with the Triple Aim of improving the patient experience, including quality and satisfaction; improving population health; and reducing cost (Whittington et al., 2015). The components of the ACA that address these goals include coverage expansion and insurance market reforms to expand access, payment reforms to reduce costs, and delivery system reforms to improve quality. Many of these reforms have implications for health care providers and health IT. Furthermore, other delivery system models have implications for using health IT including, for example, patient-centered medical homes. One of the key components of the ACA that affects health IT is coverage expansion. The ACA included provisions to expand Medicaid eligibility and to offer a variety of health insurance plans for people who do not qualify for Medicare or Medicaid and who do not have employer-based insurance. Coverage expansion means that health care providers are likely to have more patients, and many of these may be sicker and have more complicated heath care needs, although this is still somewhat uncertain. Among the most important reforms under the ACA that influence health IT are the various payment reforms. Most of these programs represent a shift in emphasis from paying for service delivery to paying for value. Value refers to the level of quality given the level of cost. The major initiatives that focus on paying for value include the EHR Incentive Program, originated in the ARRA legislation and now replaced in the Medicare Access and Chip Reauthorization Act (MACRA) of 2015; the value-based purchasing (V … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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