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

The Impact of Technology in The Delivery of Healthcare The Impact of Technology in the Delivery of Healthcare The report To Erris Human: Building a Safer Health System (Institute of Medicine [IOM] 2000) disclosed that there are about 44,000 to 98,000 yearly deaths in the U.S. due to medical errors committed in hospitals. These medical errors which could have been prevented resulted to the deaths of Boston Globe health reporter Betsy Lehman due to an overdose while undergoing chemotherapy and eight year old Ben Kolb due to drug mix-up when he underwent a minor surgery (IOM 2000). These alarming adverse events made great headlines and paved the way for fundamental change in the U.S. healthcare delivery system. The Committee on the Quality of Health Care in America was established in 1998 to develop a plan of strategy that would lead to substantial improvement in the healthcare quality (Institute of Medicine 2001). The report Crossing the Quality Chasm: A New Health System for the 21st Century (IOM 2001) contained the findings and recommendations of the committee. In the report (IOM 2001) “the committee has emphasized that health care should be supported by systems that are carefully and consciously designed to produce care that is safe, effective, patient-centered, timely, efficient, and equitable” (p. 164). The two (2) IOM reports have clearly shown that medicine and innovation go together – innovation that will make use of information technology. Information technology (IT) as suggested in the IOM report (2001) shows great potential in improving the health care aligned to the six goals set by the committee: 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) as defined by Amatayakul and Lazarus (2005) “is a system of devices, programs, users, support mechanisms, and improvements that help not only to document care, but, properly implemented, to improve the provision of care.” To get a simpler concept, EHR is a collection of health information of individual patients or the whole population through a systematic electronic process, and it may include a wide range of data such as personal statistics (age, weight and height), medical history, laboratory tests/results, medication, immunizations, vital signs, radiology images, demographics, and billing information. Further, EHR is a clinician tool that manages the different areas of patient care (Carter 2001). Carter (2001) lists the most common computer systems and their function in attaining electronic health records: 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 The IOM report Best Care at Lower Cost (2012) foresees that the healthcare industry by going digital through information technology will deliver patient care in which: (a) records were updated immediately and always available when needed by patients; (b) care provided is a care that is proven reliable at the core and tailored at the margins; (c) the needs together with preferences of patient and their family were included in the decision process; (d) the activities of every team members are updated and available in real time; (e) prices and total costs are fully transparent to all participants; (f) incentives for payment were based on quality (outcomes and value) and not on volume; (g) errors were identified as well as corrected promptly; and (h) results were gathered routinely for use in improvement activities and studies. On top of the positive outcomes of a healthcare information technology (HIT), the IOM report Digital Data Improvement Priorities for Continuous Learning in Health and Health Care (2012) 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. 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) as cited by the IOM report Digital Data Improvement Priorities for Continuous Learning in Health and Health Care (2012). HITECH Act is passed into law on February 17, 2009 by President Barack Obama as part of an economic stimulus bill known as American Recovery and Reinvestment Act of 2009 (ARRA) (Rouse 2009). The HITECH Act stipulates that financial incentives will be given to healthcare providers, beginning in the year 2011, for demonstrating meaningful use of electronic health records; grants will also be provided in the maintenance of training centers for personnel who will support the infrastructure of the health information technology (Rouse 2009). Meaningful use is defined in two government regulations: 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 (“Meaning Use,” n.d.) Benefits of Electronic Health Records Bates and Gawande (2003) cited three ways by which information technology can reduce errors: (1) “by preventing errors and adverse events” (p. 2526) – a good example is the primary benefit of using computers for drug prescription wherein it is legible and complete as opposed to a handwritten prescription that is prone to error in reading and interpretation; (2) “by facilitating a more rapid response after an adverse event has occurred” (p. 2526) – computerized monitoring with applications that can detect warnings such in the case of a patient monitor that can highlight a signal that suggests the occurrence of decompensation in patient which normally will be hard to detect by human observer; and (3) “by tracking and providing feedback about adverse events” (p. 2526) – the capture of early data through technology-enabled remote monitoring of intensive care is a very good example wherein a study showed that mortality rate in an intensive care unit went down. Amatayakul and Lazarus (2005) characterized the benefits of electronic health records in the following manner: Quantifiable benefits – measurable by numeric values such as cost savings, percent change, revenue increase/decrease, and time differences. Examples: electronic chart can reduce cost by eliminating the need for transcriptionists and missed appointments can be reduced and satisfactory rating on patient survey may increase. Anecdotal benefits – are not quantifiable but are just as important, or in some instances are more important. They are often described by case studies such as the identification of the most appropriate drug for Patient X was done with the clinician’s recall of an allergy warning plus an access to a reliable online drug knowledge source. Financial benefits – are measured in relation to monetary value. Most medical practitioners will calculate their return on investment (ROI) since electronic health record systems require huge financial capital. Qualitative benefits – may not have direct attribute to monetary value, but they are equally important. The quality of care and patient safety are examples included in qualitative benefits of EHR. Benefits of the meaningful use of electronic health records (“Meaningful Use,” n.d.) include the following: Complete and accurate information – with EHRs, providers get hold of information they need to give the best possible patient care. Complete patient record including health history will be available for the provider before they meet the patient for examination. 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. 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. To fully 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). Barriers to Adopting Electronic Health Records Many studies by different groups including the Institute of Medicine has touted that electronic health record is major factor in the improvement of patient care and reducing errors in the medical field. The government has 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. Gambon (2010) enumerates the most common barriers that impede the adoption of EHRs among all providers: Money – the conversion of paper files into digital files requires a lot of money. It is expensive. It is true that the stimulus bill being offered by the federal government will amount from $44,000 to $65,000 for providers who will adopt EHRs, the amount will not be given in a single payment. The big upfront investment to implement an electronic health record system can be a nightmare to small healthcare providers. Workflow – the conversion to EHRs do not only require turning to paperless workplace, it also requires a total revision of the work process in treating patients. There are doctors and staff who are not used to using computers and are resistant to change. The conditioning of people to leave their comfort zone of pens and papers will take some time. Ease of Use – many electronic health record systems are not user friendly. The key issue is to designing systems that are easy to use so that it will not be met with resistance and will not hamper the productivity of healthcare providers. Performance Measurement – the new healthcare legislation requires providers reporting information regarding the quality of patient care and compliance to protocols, guidelines, and regulations. Providers will face a big dilemma when the system they use will not be able to give the necessary outputs for the required government reporting information. Support – transition to electronic health records is a continuous process. Setting up the system is just the beginning. Infrastructure maintenance requires specialized people and many providers are facing the problem of training their people on the new technology as well as training some personnel to maintain their system in good and reliable running condition. Protecting Electronic Health Records The benefits of electronic health records are numerous and the greatest achievement is the reduction of errors and preventing errors that can lead to death of patients. Its benefits can be summarized in two-folds: improving the quality of patient care and 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 For the Record: Protecting Electronic Health Information (IOM 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. The IOM report (1997) recommends that “health care providers have to adopt a range of technical and organizational practices to protect health care information, and the health care industry will have to work with government to create a legal framework and proper set of incentives for heightening interest in privacy and security and for ensuring industry-wide protection of health information” (p.160). 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, Committee on Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure, Computer Science and Telecommunications Board, Commission on Physical Sciences, Mathematics, and Applications, & National Research Council. (1997). For the Record: Protecting Electronic Health Information. Washington D.C.: National Academy Press. Institute of Medicine & Committee on Quality of Health Care in America. (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 & Committee on Quality of Health Care in America. (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 & Committee on Patient Safety and Health Information Technology. (2012). Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D.C.: The National Academies Press. Institute of Medicine & Roundtable on Value and Science-Driven Health Care. (2012). Digital Data Improvement Priorities for Continuous Learning in Health and Health Care: Workshop Summary. Washington, D.C.: The National Academies Press. Institute of Medicine & Committee on the Learning Health Care System in America. (2012). 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. Meaningful Use. (n.d.) 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