In 2009 the HITECH Act was enacted with the purpose to improve health for Americans; however satisfying the requirements of the Act potentially reduces the quality of the care given to the patient due to the increased burdens placed on providers. Providers must purchase Electronic Health Record (EHR) Technology and comply with Meaningful Use (1). Initially providers are compensated for participating in Meaningful Use, however, the ultimate end result is providers are penalized if the 15 Core Measures for which they attest to are not met.
Although the stimulus money can provide a gain in the beginning, what happens when the stimulus money is gone? Will the technology be able to support itself? There are costs for maintenance and upgrades of software for technology. For a large institution, such as Washington University, this could cost millions of dollars. Technology costs and reporting of Meaningful Use may outweigh the professed value (1). Health Information Technology (HIT) is used today for a variety of reasons.
It is used by an individual to seek relevant information about themselves, family members, and friends. Additionally, it may be used to access health services, schedule appointments, and refill medications. One may also use HIT to communicate with their provider via a patient portal (PP), seek out information on a chronic condition, or utilize a patient health record (2). Stage 1 of The Meaningful Use rule, or Meaningless Use rule as many named it, is the only stage that is currently enacted and contains three objectives. Only one objective is patient-facing.
This objective requires the patient to be supplied with an electronic copy of their health information, which may include diagnostic test results, problem list, medication list, and allergies (2). The issue with this objective is that if there is a collaborative hospital/provider practice such as Barnes Hospital and Washington University they each have patient portals. If a patient has a radiology test performed and the results are not readily available at the end of the office visit the information may be in the hospital system.
Using the hospital’s portal, the patient can access information that has yet to be reviewed by the provider allowing for confusion and anxiety on the part of the patient. Another objective is “use of EHR technology to identify patient-specific education resources and provide those to the patient as appropriate. ” (2) Elements from the first objective can be used for this measure and can target a patient’s specific problems. This has found to be very challenging in Orthopedic Surgery as this is a specialized practice and this measure is focused on educating patients on disease prevention, such as heart disease and diabetes control.
The last objective for Stage 1 is sending reminders to patients for preventive and follow-up care and providing patients with timely electronic access to their health information. Once again, this has been a challenge to the specialty practices as they are limited on what preventive reminders they can offer. The providers feel as though they are providing reminders to patients solely to fulfill government requirements. One would ask if the government is dictating how providers treat patients. As a professional working in this medical field, I would attest to this being the case.
Another issue faced with technology and the EHR is that they provide access to patient data; however, providers’ face difficulties with using them to support delivery and coordination of care. (3) The HITECH Act envisions that providers will exchange patient data through a common platform and protocols. Some states are currently implementing platforms to exchange such data, but are still in the early phases. (3) A big concern with this is that Health Information Technology alone cannot convert our healthcare system and there needs to be some form of financial incentive for coordinating care for patients.
Secure messaging via a patient portal is another means of communicating with HIT between a patient and provider. Providers, however, are apprehensive of this means of communication as they feel it will overwhelm them. It is time consuming and adds yet another task consuming their time without compensation (2). Does this hold the provider liable if the patient does not relay the correct information or if there was insufficient information relayed to the provider and treatment of the patient was not appropriate or delayed?
In all of the research I read I could not find anything that addresses this issue. One would think this would be a major concern with all providers. Washington University is in the pilot stages of implementing the patient portal and the providers for Orthopedic Surgery have raised concerns of liability issues. Projects are underway for health care plans to compensate providers for secure messaging in hopes to minimize their hesitancy to participate in this form of communications. However, if they do participate will this cause premiums to increase for individuals in those health care plans?
If premiums are increased to pay providers, are we truly benefiting the health of the patient? The answer is no. (2) Providers are currently reimbursed on a fee-for-service scale. In our Orthopedic Surgery practice some providers see on an average of 45-50 patients a day. This can potentially make it difficult for the provider to take the appropriate time to listen to each patient’s concerns with the added burdens placed on the providers with current and future Meaningful Use requirements.
Adding an EHR to each clinical encounter could potentially further distance the provider from the patient. (3). In class, a comment was made by Dr. DeSchryver concerning a visit with her healthcare provider in which the provider was documenting in the EHR during the visit. This caused her to feel like she was not receiving the attention that she deserved. With the added documentation requirements placed on providers and the limited timeframe allowed to document this will become the norm in provider practices.
Providers have 72 hours from the time of the office visit to document Meaningful Use measures. Although HIT can provide tools to help with decision making in regards to diagnosis, management of disease, treatment, and prevention, the current EHR’s do not have a link to support systems to help manage chronic care. Primary care practices must now shift their focus on healthy patients, as well as acute and chronically ill patients. With HIT a provider can effectively report the quality measures, however the current EHR’s cannot identify which patients may need particular services (3).
It appears that we do not have the technology required or currently a sufficient number of trained users for a successful implementation of the HITECH Act. We are potentially setting providers up for failure either on a patient satisfaction level or reimbursement level. There needs to be further investigation on clinical care processes, the execution and use of HIT, and restructuring of reimbursement to the providers. The current EHRs need to be able support both coordination of care and outcomes. EHR Vendors need to ensure they can provide accurate data for reporting.
Another measure of Meaningful Use is E-Prescribe. The requirements are electronic transmission of prescriptions and maintenance of medication list. If this is done correctly and the EHR system is set up correctly it can improve patient safety, alert prescriber’s of drug-to-drug interactions, provide information on patient non-compliance to medications, and drug formulary information for insurance benefits. (4) A study was conducted with 10 physician practices that installed stand-alone e-prescribe systems to replace previously hand writing prescriptions.
This study concluded that e-prescribing will require the provider entering accurate medication history and prescriptions to ensure that their formulary and benefits can be verified. This will also require health plans to ensure that they have a full set of formulary information. Currently pharmacies access this information and it will most likely remain as such. Providers in this study also relied on patients to provide medication history information as the medication history in the e-prescribe system was inaccurate. (4)
In a large institution such as Washington University, a patient may see multiple providers from different specialty groups. One challenge we face with medication history is a provider from one department cannot discharge a medication that a provider from another department prescribed, even if the patient stated that they are no longer taking it. We are required to tell the patient to notify that provider, a lot of times the patient will tell us that they no longer see that provider and want us to discharge the medication, which our University policy does not allow.
The medication will not be removed from the medication history list and the patient’s record therefore becomes inaccurate. The HITECH Act was enacted to allow patients access to their PHI, communicate with their healthcare provider, maintain their health record, schedule patient appointments, and request prescription refills via a patient portal; however, there are many obstacles that providers and patients face through Stage 1 of Meaningful Use. Technology is one obstacle that is faced with both the patient and provider.
There needs to be a sufficient amount of support and resources in the community for patients who do not have the literacy needed to understand how to use patient portals. The government needs to also ensure that providers are trained and have an ample understanding of what is required of them for Meaningful Use. The government also needs to make certain that EHR Vendors are reporting accurate Meaningful Use measures. E-Prescribe and hospital/provider collaboration issues are two other obstacles that need to be addressed as well.
There needs to be a network for all of the systems to be able to “talk to each other” so that patient care is not delayed or potentially at risk. There also needs to be added compensation for coordination of care for providers as this may take away some of the hesitancy that the providers have for the added burden placed on them; however, this should only be done if this does not affect a patient’s healthcare premium. It is in my opinion that the Government was pressured to pass the Healthcare Reform Policy and as a consequence the American people and healthcare providers will suffer as a result either through health or monetary measures
Subject: Health care,
University/College: University of Arkansas System
Type of paper: Thesis/Dissertation Chapter
Date: 30 December 2016
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