The Impact of Technology in the Delivery of Healthcare - Research Paper Example

The Impact of Technology in the Delivery of Healthcare In the report by the Institute of Medicine or IOM in 2000, it was disclosed that about 44,000 to 98,000 yearly deaths occur in the U.S. due to medical errors committed in hospitals. Medical errors such as the deaths of Boston Globe health reporter Betsy Lehman due to a chemotherapy drug overdose and eight year old Ben Kolb’s drug mix-up while under minor surgery could have been easily prevented had there been truly reliable standards in health care delivery (IOM, 2000). These alarming adverse events made great headlines and paved the way for a much needed change in the U.S. healthcare system. Thus in 1998, The Committee on the Quality of Health Care in America, or CQHCA was established in order to develop plans to create substantial improvement in healthcare quality (IOM, 2001). A report released by the OIM contained the findings and recommendations of the committee, and it was mentioned that the committee gave emphasis on the support of meticulously and well-thought of designs in making the health care delivery system a lot more safer, much more effective, as well as being patient-centered, suitable to the patients’ needs, reasonable and competent (IOM, 2001). Both of the IOM reports showed how medicine and innovation can work together for better results, and it can be accomplished by the use of information technology. Using information technology as the means to implement changes in the health care industry means that the system would be upgraded to give better and more reliable results for both patients and health personnel (IOM, 2001). The main goals that were set by the CQHCA that utilize information technology were developed to address the following aspects of the health industry: Safety – there are evidences showing that automated order entry system can bring down the number of errors in drug prescription and dosage administration. Effectiveness – there are evidences showing automated reminder system improves the compliance rate with clinical protocols and guidelines. Patient-centered – information technology can be used to facilitate access to clinical information through Web sites and online support groups: and tailor fit health education as well as disease management information. Timely – IT can provide clinicians and patients timely information through Internet-based communication such as telemedicine and e-visits. Efficiency – clinical decision support system made possible by IT reduces the need for redundant laboratory tests. Equity – provision of broader range of options for interaction through Internet-based communication with clinicians to all people, regardless of ethnicity, race, geographical location, and socio-economic status. Electronic Health Records through Information Technology Electronic health record (EHR) is a system that is composed of electronic devices, computer programs, active users such as medical personnel and providers, support mechanisms, and other enhancements that not only document care, but also improves its provision (Amatayakul & Lazarus, 2005). It is a collection of health information of individual patients or of groups of people or a population that can be retrieved electronically from a closed system of programs. It may include the patient’s personal data such as age, weight, medical history, laboratory tests, and billing information. Overall, EHR is a clinician’s tool that manages various areas of patient care (Carter 2001). The most common computer systems and their functions in order to make electronic health records as efficient as possible are shown in table 1. Table 1 Type of System Function/s Chart Management/Medical Records System Assist in the management of paper records and required statistical reporting Hospital Information System Core system manages hospital census (admission, discharge, transfer), and billing; most often linked to departmental system such as pharmacy and laboratory Laboratory Information System Ordering of laboratory tests, results, and reporting Master Patient Index Registration and assignment of unique identifier Nursing Information System Storage and collection of nursing documentation, care planning, and administrative information Pharmacy Information System Medication dispensing, inventory, billing, drug information, and interactions. Picture Archiving System Storage and presentation of radiologic images Practice Management System Outpatient system for managing business related information Radiology Information System Scheduling, billing, and results reporting Different Computer Systems Used in EHR with their Corresponding Functions (Carter 2001). The IOM released another report in 2012 that foresees many changes that the healthcare industry would experience upon full implementation of information technology in the systems that deliver patient care. The industry would benefit from the upgrades like: (a) records getting updated immediately and are always available when needed by patients; (b) the care provided is proven reliable and tailored to the patients; (c) the preferences and needs of patients and their families can easily be included in the decision process; (d) the activities of every team member get updated and available in real time; (e) the prices and total costs of all services and products are fully transparent to the participants; (f) incentives for payment of services can be based on the quality of the services provided and not on quantity; (g) errors can identified and corrected promptly; and (h) results can be gathered routinely for use in the improvement of activities and other related studies (IOM, 2012a). Aside from the positive outcomes of implementing healthcare information technology (HIT), the IOM also emphasized that reliable digital health data is necessary for: (a) monitoring and coordinating patient care; (b) analyzing and improving systems of care; (c) conducting research for the development of new approaches and products; (d) assessing the effectiveness of the medical intervention; and advancing the health of the people (IOM, 2012b). U.S. Government Policy on Electronic Health Records The increase in the number of doctors and hospitals adopting the use of electronic health records is driven by the implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH Act) (IOM, 2012c). It was passed into law on February 17, 2009 by President Barack Obama as part of an economic stimulus bill, which is known as American Recovery and Reinvestment Act of 2009 (ARRA) (Rouse, 2009). It is stipulated in the HITECH Act that financial incentives will be given to healthcare providers, starting from the year 2011. By being able to out EHR to good use, provisions are given in maintaining training centers for personnel that will support the health information technology’s constitution through meaningful use of data (Rouse, 2009). Meaningful use is the overall usage of electronic data in capturing data, advancing clinical processes, and ultimately having improved outcomes for its users (Health IT, n.d.). The set of rules included in what defines meaningful use was determined by the Incentive Program for Electronic Health Records issued by the Centers for Medicare and Medicaid Services (CMS) and the Standards and Certification Criteria for Electronic Health Records issued by the Office of the National Coordinator (OC) for Health Information Technology (Health IT, n.d.). Benefits of Electronic Health Records In order to understand and appreciate the benefits of electronic health records, one has to recognize the traditional method by which information process is done – tons and tons of papers. Endless paperwork is done by so many people: medical aides logging patients’ vital signs, medically associates posting laboratory test results manually, nurses are writing patient progress on charts, doctors scribbling instructions and prescriptions, then nurses trying to understand the doctors’ handwriting. Medical records and X-rays are physically filed in several filing rooms and retrieval often translates to a horrendous experience (Robinson, 2006). Because of the number of people that are handling the loads of data at any one time, any record can be compromised, causing errors in the process. However, by utilizing information technology, not only can the work get faster, it would also be less prone to erroneous data input (Amatayakul and Lazarus, 2005). There are three reported ways by which information technology can reduce errors: first is the prevention of errors and adverse events; second is the facilitation of a more rapid response after the occurrence of an adverse event; and third is tracking and sending feedback regarding adverse events (Bates and Gawande, 2003). A good example of gaining benefit from the use computers is during drug prescription, where the prescription would be a lot easier to read compared to handwritten prescription, thus reducing errors in reading and interpretation. Applications that are designed to detect warnings in patient monitors are able to gain greater advantages when combined with computerized monitoring, for example in a case of a patient monitor that shows warning signals and sends them directly to the personnel on duty, actions can be done at a faster rate, as compared to just relying on human observations alone. Lastly, in relation to the previous example, because data was captured as early as it occurred, technology-enabled remote monitoring such as patients in intensive care can help greatly reduce mortality rates in hospitals (Bates and Gawande, 2003). Additional benefits of electronic health records are also characterized by several other results. Among these are: Quantifiable benefits – can be measured by numeric values like cost savings, percent change, revenue increase/decrease, and time differences. For example: an electronic chart can reduce cost by eliminating the need for transcriptionists, and missed appointments by staff can be reduced, which could result to an increased satisfactory rating by patients (Amatayakul and Lazarus, 2005). Anecdotal benefits –not quantifiable but can be just as, or even more important. Often described by case studies such as: the identification of the most appropriate drug for Patient X, which was done with the clinician’s recall of an allergy warning plus an access to a reliable online drug database (Amatayakul and Lazarus, 2005). Financial benefits –measured in relation to monetary value. Most medical practitioners would measure this based on their return on investment (ROI) since electronic health record systems require huge financial input (Amatayakul and Lazarus, 2005). Qualitative benefits – may not have direct attribute to monetary value, but are equally important. The quality of care and patient safety are examples included in qualitative benefits of HER (Amatayakul and Lazarus, 2005). Benefits of the meaningful use of electronic health records also include: Complete and accurate information – by using EHRs, providers can get hold of the information they need to give the best possible patient care. Complete patient record including health history will be available for the provider prior to meeting the patient for examination (Health IT, n.d.). Better access to information – EHRs facilitate easier and greater access to information such that providers will have the chance to diagnose their patients’ health problems earlier and at the same time give providers the opportunity to improve the health conditions and outcomes of patients. EHRs can also be shared among doctors, hospitals, and across the health systems which leads to better coordination that translate to better patient care (Health IT, n.d.). Patient empowerment – EHRs will give the patients and their families’ access to their health information and thereby empowering them to take active role in the care of their health. Medical records of patients are given to them through electronic copies for easy access and sharing through the Internet (Health IT, n.d.). Barriers to Adopting Electronic Health Records Numerous studies by different groups concluded that the use of electronic health record in hospitals and other medical facilities is a major factor in the improvement of patient care and reducing errors. The government also offered incentives to practitioners who will adopt the meaningful use of electronic health records. These are enough reasons for practitioners to join their colleagues who have been reaping the benefits of EHRs. However, many are still hesitant and enumerate several issues before they can be converted to electronic health record practitioners. Among the most common barriers that impede the adoption of EHRs by all providers are enumerated: Money –conversion of paper files into digital files requires a lot of capital. While the stimulus bill being offered by the federal government amounts from $44,000 to $65,000 for providers who will adopt EHRs, it is not given in a single payment. Therefore, a large investment to implement an electronic health record system can be a nightmare to small healthcare providers (Gambon, 2010). Workflow – conversion to EHRs does not only create a paperless workplace, it also requires a total revision of the work process in treating patients. Many doctors and staff are not used to using computers and are resistant to change. Thus the conditioning of people to leave their comfort zone of pens and papers will take some time (Gambon, 2010). Ease of Use – many electronic health record systems are not user friendly. It is highly suggested that systems get redesigned so that these would be easy to use, and consequently, will not be met with resistance and will not hamper the productivity of healthcare providers (Gambon, 2010). Performance Measurement – the new healthcare legislation requires providers to report the quality of patient care as well as compliance to protocols, guidelines, and regulations. They will face a big dilemma if the system they use will not be able to give the necessary outputs for the required government reporting information (Gambon, 2010). Support – transition to electronic health records is a continuous process. While setting up the system is just the beginning, maintenance and upgrades require specialized people. Many providers are also facing the problem of training their people on the new technology as well as training some to maintain their system in a good and reliable running condition (Gambon, 2010). Protecting Electronic Health Records The benefits of electronic health records are numerous, with the greatest achievement of reducing and preventing errors that can lead to death of patients. The benefit is two-folded: improvement of the quality of patient care while at the same time lowering the cost of healthcare (IOM, 1997). However, the issue on privacy of patients’ information must also be taken into consideration. The prospect of storing information in electronic form raises valid concerns regarding data security and patient privacy (IOM, 1997). Gaining public support and trust in adopting electronic health records will stem from careful and strict attention to privacy as well as security issues (IOM 2011). People may take risks regarding their private information in bank transactions but they are more personal when it comes to their medical records. The report of the IOM in 1997 has recommended the use of security tools to protect the privacy and security of electronic health records. These security tools will serve five key functions in the healthcare information systems: Availability – ensures that accurate and timely information is available when it is needed and at appropriate places. Accountability – ensures that healthcare providers are responsible in accessing medical records and the use of information, they know the legitimate need to access to health records. Perimeter Identification – ensures that boundaries for trusted access into the information system in terms of logical and physical access. Controlling Access – ensures that healthcare providers are only given access to information essential in the performance of their duty and limiting and disallowing access to information beyond legitimate needs. Comprehensibility and Control – ensures that owners of record, stewards of data, and the patients have thorough knowledge and effective control over limitation of access to private information. The government should ensure that the population is assured that all measures are being taken to ensure that privacy of information will be taken with utmost seriousness. It was recommended that health care providers must implement a wide range of technical and organizational practices in order to protect patient health care information, while the health care industry must work with the government to create a legal framework as well as a proper set of incentives to increase the interest in privacy and security for ensuring an industry-wide protection of health information (IOM, 1997). References Amatayakul, M. & Lazarus, S.S. (2005). Electronic health records: transforming your medical practice. Medical Group Management Association. Bates, D.W. & Gawande, A.A. (2003). Patient safety: improving safety with information technology. The New England Journal of Medicine, 348, 2526-2534. Carter, J. (2001). Electronic medical records: a guide for clinicians and administrators. American College of Physicians-American Society of Internal Medicine. Gambon, J. (2010, April 28). 5 key barriers to adopting medical records today. Retrieved from http://www.masshightech.com/stories/2010/04/26/weekly12-5-key-barriers-to-adopting-electronic-medical-ecords-today.html Institute of Medicine. (1997). For the record: protecting electronic health information. Washington D.C.: National Academy Press. Institute of Medicine. (2000). to err is human: building a safer health system. Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (Eds.). Washington, D.C: National Academy Press. Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press Institute of Medicine. (2011). Patients charting the course: citizen engagement in the learning health system: workshop summary. Olsen, L.A., Saunders, R.S., & McGinnis, J.M. (Eds.). Washington, D.C.: The National Academies Press. Institute of Medicine. (2012a). Best care at lower cost: the path to continuously learning health care in America. Smith, M., Saunders, R., Stuckhardt, L., & McGinnis J.M. (Eds.). Washington, D.C.: The National Academies Press. Institute of Medicine. (2012b). Health IT and patient safety: building safer systems for better care. Washington, D.C.: The National Academies Press. Institute of Medicine. (2012c). Digital data improvement priorities for continuous learning in health and health care: workshop summary. Washington, D.C.: The National Academies Press. Health IT. (n.d.). Meaningful use. Retrieved from http://www.healthit.gov/policy-researchers-implementers/meaningful-use. Robinson, M. (2006, March 12). Digital technology changing face of modern health care delivery. Retrieved from http://www.bizjournals.com/houston/stories/2006/03/13/focus4.html?page=all Rouse, M. (2009 December). HITECH Act (Health Information Technology for Economic and Clinical Health Act). Retrieved from http://searchhealthit.techtarget.com/definition/HITECH-Act. Read More