Health Quality Care Administration - Assignment Example

Health Quality Care Administration Unit 5 Lesson 5 1. Discuss the barriers that have been identified regarding the technological approach to computerized order entry and the electronic health records. Among the barriers to technological approaches to computerized order entry and electronic health records are (McLaughlin & Kibbe, P243-245): Fragmented organisation of the health care industry. Which makes implementation of centralised approaches to data collection and storage very challenging Historical lack of monetary investment in IT hardware and software. HIPAA (Health Insurance Portability and Accountability Act) of 1996 enforces stringent patient privacy requirements that may present difficulties with IT approaches to patient record storage and access issues. The prevalence of small practice units of service has been an important barrier to technology implementation Resistance of physicians to adopt newer technological approaches to healthcare delivery due to a generalised perception that this practice depersonalises medical care and doctor/patient interactions. These historic barriers have left the healthcare industry significantly behind other national industries in the utilisation of IT technological tools. According to recent statistics, only about 2% of healthcare revenues are directed to implementation of IT tools and approaches. This investment is significantly greater in the case of other national industries that devote approximately 8.5% revenues into this organisational approach. The result of this historic lack of interest on the part of the healthcare industry to adopt IT approaches to the delivery of medical care has been a lack of organised record keeping and lack of database information that would facilitate optimal healthcare delivery approaches. 2. Explain the reasons as to why it will be difficult to implement computerized order entry and health records into practice based on the barriers previously discussed. Some of the current difficulties to implementing computerised order entry and health records using IT approaches include (McLaughlin & Kibbe, P245-247) AAFP (American Association of Family Practice) estimates that 70% of family physicians continue to practice in small groups of four or fewer physicians. This decentralised framework makes it more difficult to implement standardised approaches to healthcare data management. Ongoing concerns over HIPAA regulations and the potential conflicts that may ensue when IT record keeping approaches are used. Likewise, concerns about insurance and potential lawsuits have made some physicians wary of this approach. Current computerised equipment and software used in medical practice is largely restricted to billing and accounting. Much of this equipment is outdated and would need replacement in order to implement state-of –the –art data recording suitable for patient record maintenance. EDI (electronic data interchange) regulations by HIPAA require modern IT software. Costs for implementing required IT components may be prohibitive in some cases. It has been estimated that $10-15,000 per physician may be required to set up efficient electronic health records (EHR) systems for family practice physicians. Lack of agreement on a suitable EHR software tool that could be used as the dominant IT tool in medical practice. Currently, there are hundred of models available with differing degrees of suitability for healthcare delivery application. These areas represent ongoing challenges that reflect the nature of the healthcare industry rather than transient barriers to IT implementation. In order to transform the healthcare industry into an organised system in regard to IT approaches to EHR and computerised order entry, the substantive differences between the healthcare system and other major industries should be taken into account and a unified approach to IT implementation should be addressed system-wide. It is essential that these areas be addressed by the healthcare industry as the lack of cohesive data reporting has generated many issues regarding the safety and welfare of patients. Studies documenting successful approaches of to IT implementation at several large institutions have generated a call for change from the ad hoc approach to patient record keeping to a more streamlined, accessible format provided by IT tools (McLaughlin & Kibbe, P247). 3. Define the meaning of “health care disintermediation” and who the actors are and what role they play in the disintermediation activities. Health care disintermediation refers to the removal of intermediates from a process. As applied to the healthcare industry, disintermediation has the potential to produce a negative impact on doctor-patient relationships. (McLaughlin & Kibbe, P432). Disintermediation threatens to undermine the physician as the primary source of healthcare delivery as individuals seek out medical information from databases sponsored by medical organisations and even those sponsored by pharmaceutical companies attempting to sell their wares. Among the actors are pharmaceutical and other drug manufacturers are (McLaughlin & Kibbe, P435-449): healthcare product merchants and those who are interested in selling the patient information to third parties. The dramatic change in the infrastructure of healthcare information and delivery imposed by internet resources threatens to challenge the primary importance of the individual doctor-patient relationship in diagnostic and therapeutic areas of medicine. Increasingly, patients in search of medical advice are accessing databases that may or may not provide accurate and reliable information about critical health issues. This practice may also cause critical delays in patients’ seeking medical attention for serious health conditions. The direct advertising of drugs and medical products to patients by TV paces the patient in the role of “shopping” for healthcare products without physician consultation. Managed care has played an extremely important role in undermining the doctor-patirent relationship as it often overrules medical decisions and ignores the importance of doctor-patient interactions in decision-making processes. For these reasons, healthcare disintermediation poses a threat to the well-being of the community, as the information may not be correct and may even be harmful. Moreover, online ”diagnostic” tools can be extremely misinformative and hazardous to patients in need to primary medical care. (McLaughlin & Kibbe, P435). 4. Discuss the suggested ways to transition primary care practices into a new re-intermediating role with the development of technological opportunities. An important approach to preserving the primary role of the physician is for physicians to utilise the IT approaches favoured by their patients to provide access to healthcare information. The failure of the medical community to keep pace with the internet age has, in some ways, set the stage for these practices which not only erode the dioctor-patient relationship but may also pose a health hazard to unsuspecting patients in search of medical information. (McLaughlin & Kibbe, P436). Improved communication via internet technology between doctors and patients may be the best way to alleviate this problem. Doctors need to be more available to their patients via internet email exchange. The concept of “office hours” may need to be broadened to include online chats at specified times to discuss important healthcare issues. Physicians must be compensated for the time they devote to patients via websites, emails and other internet based approaches to healthcare delivery. The medical community as a whole needs to concern itself with the plethora of unreliable information currently disseminated via mass communication technologies. They need to counteract these sometimes dangerous approaches to healthcare information delivery by developing resources to facilitate communication with patients and their families. 5. Explain how the series of steps shown in the “Illustrative Alternatives for Re-intermediating Delivery” in Table 16- of our text can redefine the physician’s practice to develop stronger, long-term doctor-patient relationships. Each of the steps outlined in Figure 16.2 represents an important component of establishing strong patient-doctor relationships at a time when their importance is undermined by the many factors associated with disintermediation McLaughlin & Kibbe, P438). The first guideline emphasises the importance of instruction and guidance. It is important that the physician take the time to explain relevant medical issues to the patient directly in conversation and also to send additional materials by internet if appropriate. The second stage involves setting expectations by developing a treatment plan with the patient and setting up a mechanism to chart progress with the patient. The third stage involves a determination by the physician that the patient is capable of accessing relevant information or contact via internet or whether telephone follow-up may better suit the capabilities of individual patients. Adherence/compliance is another important component stressed in the illustration that involves follow-up as well as motivational tools to involve the patient in his/her treatment plan. Behaviour modification is related to this concept, as effective care may involve behavioural changes in the patient that require follow-up. Prescriptions should not only be written but carefully explained by the physician to the patient and a mechanism for follow-up questions and prescription renewal should be established. Finally, monitoring of long-term progress should be carried out via arrangements for follow-up visits and internet communication of patient data. Taken together, these steps are designed to strenthen the doctor-patient relationship in order to [preserve its priomacy in healthcare delivery at a time when this relationship has been threatened by disintermedaition. References McLaughlin, C. & Kibbe, D. (2005). Information management and technology for CQI. In Continuous quality improvement in health care: theory, implementations, and applications (Chapter 10, 243-277 ). Curtis P. McLaughlin & Arnold D. Kaluzny (eds.) Boston: Jones & Bartlett Publishers. McLaughlin, C. & Kibbe, D. (2005).Quality: from professional responsibility to public policy and back again. In Continuous quality improvement in health care: theory, implementations, and applications (Chapter 16, 424-443). Curtis P. McLaughlin & Arnold D. Kaluzny (eds.) Boston: Jones & Bartlett Publishers. Read More