Technology in healthcare is evolving daily, and with the advancements made in going ‘paperless’ and converting to electronic medical records (EMRs) has been a daunting task. The ability to implement technology to accommodate EMRs is rather challenging in lower socioeconomic areas due to a lack of private funding. The use of EMRs makes the gathering and transmission of data quicker and more reliable. The failure for some hospitals and local health agencies to adopt the latest technology standards puts them at a disadvantage when it comes to effective communication. The cost to implement these systems has created thousands of jobs in IT, and has cost the government a considerable amount of resources to allocate. With the implementation of higher technology with sending and receiving patient data, HIPAA compliances have become stricter and fines for violation has increased substantially.
The Health Information Technology for Economic and Clinical Health (HITECH) Act was developed in 2009 under the American Recovery and Investment Act as an attempt to encourage the “meaningful use” of EMRs to improve patient safety and patient care standards. The structurization of the HITECH Act consisted of the first phase which focused on patient medical history and relative individual patient data. The subsequent phase included increasing physician compliance in the use of EMRs, implementing violations after the year 2016 for those who don’t comply. The third phase increased the cohesiveness of communication between multiple different types of medical facilities. The Centers for Medicaid & Medicare (CMS) incentivize the appropriate use of CMRs and average will reimburse a varied amount per certain number of years depending on which of the CMS approved programs you choose to participate in. Participation in a Medicaid program will provide the greatest incentive. Furthermore the government is responsible for allocating up to 90% of the costs associated with implementing new technology to meet the current standards to be in compliance.
HIPAA and the HITECH Act are closely interrelated because during the adoption of the HITECH Act HIPAA laws were strengthened to protect patient privacy and rights. This includes a medical facilities responsibilities in protecting patient data with proper IT safeguards and software. In the event of a breach of data you are required to report the incident to the Health and Human Services Department with a certain period of time while following a specific set of guidelines appropriate for the type of breach which occurred. Penalties increased from an initial $25,000 cap to a current $1.5 million/year cap for HIPAA violations, a significant increase.
Public Health 3.0 is an initiative to serve as a ‘roadmap’ to integrate public health measures with IT interface. Additional information such as social determinants of health and other demographical data can be included to previous general information shared through EMRs. Public Health 3.0 aims to increase data-driven decision making and enhanced community engagement. The use of higher technology allows for better data collection, sharing of data, surveillance of populations, and advanced methods in determining social determinants of health creating health disparities. Public Health 3.0 seeks to improve population health outcomes with IT advancements, while empowering the public to make informed health decisions by participating in their health decisions.
The Joint Commission (TJC) is a independent, non-profit organization which accredits and certifies healthcare organizations in the United States. TJC standards now include of the HITECH Act standards and objectives in mandating robust data protection, breach notification, and the enforcement of the appropriate use of EMRs. Furthermore, TJC aims to improve the overall quality of care patients receive while protecting their private health and personal information. The deliverance of public health related education and the development of federally funded prevention based programs are a key component under TJC. These programs include ‘speak-up campaigns’, patient safety initiatives, community health needs assessment (CHNA), health equity programs, emergency preparedness and response, and behavioral health initiatives.
As a healthcare professional I would say the thing which has been a topic of concern is the providers heightened responsibilities in the EMR documentation process. Many, including myself would agree the task of adequate documentation often takes time from ‘hands on’ patient care while adding hours a week to an already strenuous schedule. While reading research on this topic of modernizing IT in healthcare, physicians are frustrated from the increased time it takes to document patient concerns. The increase if EMRs also increases administrative burdens due to the complexity of EHR systems. The issue I see is the need to have quality over quantity in the collection of data is what makes it a daunting task. We use a funny phrase, “if it is not in the chart, it is not worth a fart” to add humor to the need to provide adequate documentation. Paper charting was quick and allowed more time for patient care, but often lacked the details needed to substantiate the details of the care received. A growing concern is evident with a society where we constantly have computer screens between us and a patient, taking away from the interpersonal aspect much needed in healthcare. I hope we find a way to make advancements in IT to lessen the time it takes to comply with adequate documentation while preserving the physician-patient relationship.