Healthcare Ecosystems

Topics: Electronic health record, Health care, Medical informatics Pages: 6 (1770 words) Published: January 11, 2014
Healthcare Ecosystems

There are a number of federal government programs that utilize technologies to accomplish the seamless exchange of health information. The reasoning behind this is to provide consumers with a higher quality of care. I will be discussing three such programs in order to analyze each program’s use of health informatics to include licensure, certification and accreditation, along with how each program impacts clinical quality, reimbursement and patient access to care. Other areas of discussion will involve the Nationwide health Information Network (NHIN) and how each program discussed below relate, along with the evaluation of the roles health informatics professionals play in each mentioned program. The three programs that will be discussed are the following, the National Council for Prescription Drug Programs (NCPDP), Health Level 7 (HL7), the Healthcare Information Technology Standards Panel (HITSP).

The National Council for Prescription Drug Programs (NCPDP) is a non-profit organization with 1600 members strong that represent almost every sector of the pharmacy industry. The NCPDP is accredited by the American National Standards Institute (ANSI), which is the institute that oversees the use of norms and guidelines that impact businesses in almost every sector (ANSI, 2012). With ANSI accreditation, the NCPDP provides leadership and healthcare business solutions through education standards and has been named in federal legislation including, HIPPA and Medicare Part D. Overall, the NCPDP focuses on pharmacy services and has the highest member representation from the pharmacy services sector of healthcare. The main focus of pharmacy services include, the sharing of patient medications, supplies and services within the healthcare systems electronically.

The NCPDP has and will continue to have an impact on clinical quality for several reasons by creating the standards by which a pharmacy operates. Without these standards, for example, physicians would still be handwriting prescriptions that the patient would hand deliver. The patient would be required to pay cash and then hope to be reimbursed by their insurance providers. There would be numerous types of claim forms to work through, and Medicare Part D would be difficult to administer. The NCPDP, however provides harmony across the pharmacy industry through proper use of healthcare technology. One such technology is the way patient prescriptions are exchanged. The NCPDP has created a Script standard that allows proper exchange of prescription information between prescribers, pharmacies, intermediaries, and payers. The overall impact to this type f standard is the reduction manual errors. Another standard is the Structured and Codified Sig Standard that allows better communication between prescribers and pharmacists which improves the efficiency of the prescribing and dispensing activities again reducing any chance of manual error. An additional standard is the Formulary and Benefit standard that provides information to the prescriber to consider the most appropriate drug choice for the patient, such as insurance limitations on coverage, costs to the patient, and any alternative generic medications on the formulary. There are a few more standards that the NCPDP has developed to ultimately improve services for all parties involved in the pharmacy industry, the most important of these services is overall patient care and clinical quality.

Among the standards previously mention there are two more standards provided by the NCPDP that is directly related to reimbursement for services. The first is the Medicaid Subrogation Standard and the second is the Billing Unit Standard, both of which are designed to provide consistent and better defined billing for pharmacy transactions for accurate reimbursement.

Patient access to care becomes a better experience through the standards developed by the NCPDP. By implementing these standards, as...

Cited: American National Standards Institute. (2009). HITSP and Consumers. Retrieved September 30, 2012, from HITSP Enabling Healthcare Interoperability: http://www.hitsp.org/consumer.aspx
American National Standards Institute. (2009). HITSP: Background. Retrieved September 30, 2012, from HITSP Background: http://www.hitsp.org/background.aspx
ANSI. (2012). Overview. Retrieved September 23, 2012, from ANSI.org: http://www.ansi.org/about_ansi/overview/overview.aspx?menuid=1
Ashton, L., Gilbertson, L., & Mullenix, S. (2012, September 20). HIMSSNCPDPStandardsTownHall.pdf. Retrieved September 30, 2012, from The Impact of Standards & Pharmacy Informatics: http://www.himss.org/content/files/HIMSSNCPDPStandardsTownHall.pdf
Health Level Seven International. (2007-2012). About Health Level Seven International. Retrieved September 30, 2012, from Health Level Seven International: http://www.hl7.org/about/index.cfm?ref=common
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