Discussion on the HITECH Act

Discussion on the HITECH Act ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion on the HITECH Act I’m studying for my Health & Medical class and don’t understand how to answer this. Can you help me study? Discussion on the HITECH Act First, please view this video on the HITECH Act of 2009 Next, please read the attached PDF article titled “Benefits and drawbacks of electronic health record systems”. Finally, address each of following discussion prompts in 2-3 sentences. ( 10-15 sentences total) The HITECH Act was a part of larger act that was passed in 2009. What was the name of that larger act? (Hint: it is also known as the “Stimulus Package”) What did the HITECH Act do? Did it work? Discussion on the HITECH Act What does “Meaningful Use” mean? Is it fair to penalize doctors for not switching over to electronic health records (EHR)? When the HITECH Act was passed in 2009, what were thought to be some of disadvantages associated with EHR adoption? Discussion on the HITECH Act benefits_and_drawbacks_of_electronic_health_record_systems.pdf Risk Management and Healthcare Policy Dovepress open access to scientific and medical research Review Open Access Full Text Article Benefits and drawbacks of electronic health record systems This article was published in the following Dove Press journal: Risk Management and Healthcare Policy 11 May 2011 Number of times this article has been viewed Nir Menachemi 1 Taleah H Collum 2 1 Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA; 2Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 that was signed into law as part of the “stimulus package” represents the largest US initiative to date that is designed to encourage widespread use of electronic health records (EHRs). In light of the changes anticipated from this policy initiative, the purpose of this paper is to review and summarize the literature on the benefits and drawbacks of EHR systems. Much of the literature has focused on key EHR functionalities, including clinical decision support ­systems, computerized order entry systems, and health information exchange. Our paper describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality, reduced medical errors), organizational outcomes (eg, financial and operational benefits), and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs). Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. Overall, experts and policymakers believe that significant benefits to patients and society can be realized when EHRs are widely adopted and used in a “meaningful” way. Discussion on the HITECH Act Keywords: EHR, health information technology, HITECH, computerized order entry, health information exchange Introduction Correspondence: Nir Menachemi UAB School of Public Health, 1530 3rd Ave, S Birmingham, AL 35294, USA Tel +1 205 934 7192 Fax +1 205 934 3347 Email [email protected] submit your manuscript | www.dovepress.com Dovepress DOI: 10.2147/RMHP.S12985 Over the past decade, virtually every major industry invested heavily in ­computerization. Relative to a decade ago, today more Americans buy airline tickets and check in to flights online, purchase goods on the Web, and even earn degrees online in such disciplines as nursing,1 law,2 and business,3 among others. Yet, despite these advances in our society, the majority of patients are given handwritten medication prescriptions, and very few patients are able to email their physician4 or even schedule an ­appointment to see a provider without speaking to a live receptionist.5 Electronic health record (EHR) systems have the potential to transform the health care system from a mostly paper-based industry to one that utilizes clinical and other pieces of information to assist providers in delivering higher quality of care to their patients. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which is part of the American Recovery and Reinvestment Act (ARRA) (aka “stimulus package”), was signed into law with an explicit purpose of incentivizing providers (eg, hospitals and physicians) to adopt EHR systems. Risk Management and Healthcare Policy 2011:4 47–55 47 © 2011 Menachemi and Collum, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Dovepress Menachemi and Collum However, given that a bare-bone EHR system provides only partial benefits to patients and society,6 the HITECH Act requires that providers adopt EHRs and utilize them in a “meaningful” way, which includes using certain EHR functionalities associated with error reduction and cost ­containment. How exactly do EHRs improve care? And what is the current evidence that certain EHR “meaningful use” functionalities will translate into benefits? Answering these questions is the purpose of this paper. Stated explicitly, the purpose of this study is to review the literature on the impacts of EHR.Discussion on the HITECH Act Impacts include both benefits and drawbacks, and, as such, we discuss the advantages and disadvantages that have been identified by researchers and other experts. Overall, we expect that any reader interested in understanding the current state of the knowledge base with regard to EHR benefits will find this paper useful. Why we need EHRs EHRs are defined as “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports”.7 Some of the basic benefits associated with EHRs include being able to easily access computerized records and the elimination of poor penmanship, which has historically plagued the medical chart.8,9 EHR systems can include many potential capabilities, but three particular functionalities hold great promise in improving the quality of care and reducing costs at the health care system level: clinical decision support (CDS) tools, computerized physician order entry (CPOE) systems, and health information exchange (HIE). These and other EHR capabilities are requirements of the “meaningful use” criteria set forth in the HITECH Act of 2009.10 A CDS system is one that assists the provider in making decisions with regard to patient care. Some functionalities of a CDS system include providing the latest information about a drug, cross-referencing a patient allergy to a medication, and alerts for drug interactions and other potential patient issues that are flagged by the computer. With the continuous growth of medical knowledge, each of these functionalities provides a means for care to be delivered in a much safer and more efficient manner. As more and more CDS systems are used, one can expect certain medical errors to be averted and that, overall, the patient will receive more efficient and safe care.11 CPOE systems allow providers to enter orders (eg, for drugs, laboratory tests, radiology, physical therapy) into 48 submit your manuscript | www.dovepress.com Dovepress a computer rather than doing so on paper. Computerization of this process eliminates potentially dangerous medical errors caused by poor penmanship of physicians.Discussion on the HITECH Act It also makes the ordering process more efficient because nursing and pharmacy staffs do not need to seek clarification or to solicit missing information from illegible or incomplete orders. Previous studies suggest that serious medication errors can be reduced by as much as 55% when a CPOE system is used alone,12 and by 83% when coupled with a CDS system that creates alerts based on what the physician orders.13 Using a CPOE system, especially when it is linked to a CDS, can result in improved efficiency and effectiveness of care. Once health data are available electronically to providers, EHRs facilitate the sharing of patient information through HIE. HIE is the process of sharing patient-level electronic health information between different organizations14 and can create many efficiencies in the delivery of health care.15 By allowing for the secure and potentially real-time sharing of patient information, HIE can reduce costly redundant tests that are ordered because one provider does not have access to the clinical information stored at another provider’s location. Patients typically have data stored in a variety of locations where they receive care. This can include their primary care physician’s office, as well as other physician specialists, one or more pharmacies, and other locations, such as hospitals and emergency departments. Over a lifetime, much data accumulates at a variety of different places, all of which are stored in silos. Historically, providers rely on faxing or mailing each other pertinent information, which makes it difficult to access in “real time” when and where it is needed. HIE facilitates the exchange of this information via EHRs, which can result in much more cost-effective and higher-quality care. In the following section, we describe the literature that has examined the effect of EHRs on various clinical and organizational outcomes. A large proportion of the literature has focused on one or more computerized capabilities of EHRs, including CDS, CPOE, and HIE. Many of these studies have been discussed in previously published literature reviews,16–20 so we further summarize them here. Advantages of EHRs Researchers have examined the benefits of EHRs by considering clinical, organizational, and societal outcomes. Clinical outcomes include improvements in the quality of care, a reduction in medical errors, and other improvements in patient-level measures that describe the appropriateness of care. Discussion on the HITECH Act Organizational outcomes, on the other hand, have Risk Management and Healthcare Policy 2011:4 Dovepress included such items as financial and operational performance, as well as satisfaction among patients and clinicians who use EHRs. Lastly, societal outcomes include being better able to conduct research and achieving improved ­population health. EHRs and clinical outcomes Many clinical outcomes that have been a focus of EHR studies relate to quality of care and patient safety. Quality of care has been defined as “doing the right thing at the right time in the right way to the right person and having the best possible results”,21 and patient safety has been defined as “avoiding injuries to patients from the care that is intended to help them”.11 Quality of care includes six dimensions,11 but most EHR research has focused on the following three: patient safety, effectiveness, and efficiency. In the following paragraphs we summarize some of the studies that examine how EHRs or various related components impact these three quality dimensions. More research is needed on the other three components: patient centeredness, timeliness, and equitable access. EHRs, especially those with CDS tools, have been empirically linked to an increased adherence to evidencebased clinical guidelines and effective care. Despite the best intention of providers, various factors may result in patient encounters that do not adhere to best practice guidelines. Some reasons for this nonadherence include i) clinicians not knowing the guidelines, ii) clinicians not realizing that a guideline applies to a given patient, and iii) lack of time during the patient visit. EHR systems try to overcome these issues, and researchers have focused on preventive services, including vaccine administration, to examine how EHRs can improve adherence rates. For example, researchers found that computerized physician reminders increased the use of influenza and pneumococcal vaccinations from practically 0% to 35% and 50%, respectively, for hospitalized patients.22 A similar study, but in the outpatient setting, found that computerized reminders were associated with improved influenza and pneumococcal vaccination rates among rheumatology patients taking immunosuppressant medications.23 ­Specifically, influenza vaccinations increased from 47% to 65% of patients, and pneumococcal vaccinations increased from 19% to 41% of patients. Other studies on vaccination rates found comparable results that computerized reminders can improve adherence to immunization guidelines.24,25 From the societal public health perspective, adhering to these guidelines keeps individuals healthy and lowers the risk of disease outbreaks in communities. Researchers have Risk Management and Healthcare Policy 2011:4 Benefits and drawbacks of EHRs also focused on other preventive services and on how EHRs can improve various outcomes and make care more ­effective. Discussion on the HITECH Act Kucher et al26 hypothesized that computerized alerts, as part of a CPOE system with CDS, directed at physicians may increase the use of prophylactic care for hospitalized patients at high risk for deep vein thrombosis. They found a 19% increase in the use of anticoagulation prophylaxis when using computer alerts, and this translated into a 41% reduced risk of deep vein thrombosis or pulmonary embolism at 90 days after discharge. Willson et al27 found a significant association between computerized reminders and pressure ulcer prevention in hospitalized patients. They found a 5% decrease in the development of pressure ulcers 6 months after the implementation of computerized reminders that targeted hospital nurses. Other similar studies found comparable results. Rossi and Every,28 for example, found that computerized reminders as part of a CDS have been linked to an 11.3% increase in appropriate hypertension treatment in a primary care setting. Other studies in the outpatient setting have also found that an EHR and its components significantly increase adherence to protocol-based or recommended care.29,30 Although researchers have found CDS tools to be beneficial in most situations, many medical conditions do not have scientifically based guidelines for providers to follow, thus reducing the usefulness and effectiveness of these tools in many clinical situations. More scientific-based guidelines need to be developed in order to maximize the benefits associated with CDS. Similar to a focus on adherence to guidelines, researchers have also found an association between EHRs and efficiency in health care delivery. Efficiency refers to the avoidance of wasting resources, including supplies, equipment, ideas, and energy.11 One such form of waste involves redundant diagnostic testing. Performing redundant tests is costly and may lead to more false-positive results, which will then lead to even more costs.31 Evidence indicates that there is a significant negative (eg, desirable) association between redundant diagnostic testing and the use of an EHR and/or its components. For example, Nies et al32 examined the affects of a CDS on the redundancy of blood tests in a cardiovascular surgery department. They found that point-of-care computerized reminders of previous blood tests significantly reduced the proportion of unnecessarily repeated tests. In the outpatient setting, Tierney et al33 found a 14.3% decrease in the number of diagnostic tests ordered per visit and a 12.9% decrease in diagnostic test costs per visit when using an EHR with CDS and CPOE components.Discussion on the HITECH Act Other, unrelated studies found an 18% decrease in tests ordered for medical visits in the emergency department,34 a 27% decrease in submit your manuscript | www.dovepress.com Dovepress 49 Dovepress Menachemi and Collum redundant laboratory tests of antiepileptic medication levels in ­hospitalized patients,35 and a 24% reduction in redundant laboratory tests in a hospital.36 Studies focusing on patient safety have frequently examined the effect of EHR components on medical or medication errors. In a widely cited study, experts found that a CPOE system was associated with a 55% reduction in serious medication errors in the hospital setting.12 A follow-up study by the same team found that by adding a CDS system to a CPOE ­system, medication errors can be reduced by as much as 86%.13 A similar, more recent study in the outpatient setting found that computerization resulted in an error rate reduction from 18.2% to 8.2%.37 Other studies have concluded that the number of appropriate medication orders involving dosing levels or dosing frequency can be increased with the use of a computerized system.38 ­Specifically, in one study, the use of a CDS yielded a 32% decrease in the number of days that antibiotics were prescribed outside the recommended dosage range and a 59% decrease in the need for pharmacist intervention to correct a drug dose.39 On the other hand, a few studies have found an association between the use of CPOE and increased medical errors. These increases generally occur due to poorly designed system interfaces, lack of end-user training,40 or lack of systems integration.41 Factors such as dense pull-down menus and text entries in inappropriate areas of an EHR can have negative consequences for patients.40 Specifically, one study found that the use of a CPOE was associated with 22 types of medication error risks.41 Many of the studies described have focused on clinical outcomes at the patient level. Such studies have been conducted in a clinical setting, frequently by employing a randomized trial research design. Discussion on the HITECH Act An additional body of literature has examined, observationally, whether hospitals that have adopted EHR or other computerized capabilities perform better than their counterparts that have not. For example, Menachemi et al42 found that Florida hospitals with greater investments in EHR technologies had more desirable rates on a variety of commonly used quality indicators. In a similar study of hospitals, researchers found that computerized records and order entry were associated with lower mortality rates, and CDS was associated with fewer complications.43 Additionally, the same study found that computerized test results, order entry, and CDS were all associated with lower costs. However, despite the results discussed here, other researchers have found only small positive effects from EHR adoption44,45 or mixed results.46 50 submit your manuscript | www.dovepress.com Dovepress EHRs and organizational and societal outcomes Organizational outcomes Studies examining organizational outcomes have focused on EHR use in both the inpatient and outpatient settings. Such outcomes have frequently included increased revenue, averted costs, and other benefits that are less tangible, such as improved legal and regulatory compliance, improved ability to conduct research, and increased job/career satisfaction among physicians. Increased revenue comes from multiple sources, including improved charge capture/decrease in billing errors, improved cash flow, and enhanced revenue. Several authors have asserted that EHRs assist providers in accurately capturing patient charges in a timely manner.47,48 With an EHR system, many billing errors or inaccurate coding may be eliminated, which will potentially increase a provider’s cash flow and enhance revenue.18,49,50 Reductions to outstanding days in accounts receivable and lost or disallowable charges can potentially lead to improved cash flow.50 In addition, EHR reminders to providers and patients about routine health visits can increase patient visits and therefore enhance revenue.49 Many averted costs associated with EHRs are the result of efficiencies created by having patient information electronically available. Some of these include increased utilization of tests, reduced staff resources devoted to patient management, reduced costs relating to supplies needed to maintain paper files, decreased transcription costs, and the costs relating to chart pulls. Discussion on the HITECH Act The use of EHRs can reduce the redundant use of tests or the need to mail hard copies of test results to different providers.35,51 By making patient information more readily available, EHRs reduce costs related to chart pulls52 as well as supplies needed to maintain paper charts.53 Studies have also shown that having an EHR as opposed to a paper file can result in reduced transcription costs through pointof-care documentation and other structured documentation procedures.50 One author found a significant decrease in staff resources dedicate … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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