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...
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