Regulation of Electronic Health Records

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Electronic Health Records (EHR)

Description: The legislation

Over the past fifty years, Electronic Health Records or EHRs have quickly transformed just like all other technologies in computing. The pace of these transformations has seen more acceleration since the promulgation of the Health Information Technology for Economic and Health Act, or HITECH, in January 2009. This was a $30 billion attempt to transform the delivery of healthcare in the United States through greater application of EHR technology. EHR incentive program stipulations, and insistence on meaningful use, have largely assisted in creating more homogeneity in the primary functions of EHR. This uniformity of design has been spreading across systems much more rapidly than could otherwise have been envisaged. However, technological advancements do not solely determine the direction of innovations in EHR. The pace and type of change is impacted by other factors such as "Accountable Care" programs and organizations, business drivers and legal requirements. While the EHR system design and industry as a whole have been changed fundamentally by meaningful application, the main drivers for changes in the future will be these other factors (Tripathi, 2012).

Work on health information technology by the Office of the National Coordinator (ONC) is authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act. The ONC was established in law by the HITECH Act. This gives the Department of Health and Human Services in the United States (U.S.) the power to initiate programs for the improvement of health care safety, efficiency, and quality. One approach to this goal is by promoting health IT, including secure information exchange on electronic health records (HealthIT.gov, 2014).

Definition of the problem intended to be solved by legislation/policy

The whole idea of reform on health care as contained in the Affordable Care Act (ACA) rests on the collection, generation, and information sharing enabled by the focused healthcare technology advancements, particularly with respect to computerized technology of health care information or HIT. The success of several goals of ACA such as effective treatment protocols, curbing hospital readmission, encouraging the development of Accountable Care Organizations and comparative research to produce effectiveness in cost-efficiency are dependent on the widespread adoption of digitized information across the entire system. Several stipulations of ACA contained in the implementation of HIT to aid savings on cost were initially envisaged when the likelihood of transactions through computerized records were seen at the beginning of the 1990s. Even so, expectations in the implementations of HIT over the last two decades have been met by obstacles from other quarters. This may be an indication that any future outcomes in reducing the cost of health care will not be smooth or automatic (Friedman, Parrish & Ross, 2013).

The contributions that EHRs potentially have on the public and population health on the one hand and clinical care on the other were earmarked to improve population health in the U.S. The need to obtain important information from EHRs and a plan to address these needs came with the realization that this potential would entail an understanding of what EHRs would realistically provide in the improvement of population health. The potential contributions EHRs have on the improvement of population health take on board clear understanding of the distribution and degree of function and disease within populations. These requirements embrace standardized EHR reporting methods and content, enough legal permission for applying EHRs especially for population health and improved population coverage. A national effort that is collaborative is needed to address the most immediate barriers and prerequisites for the application of EHRs for the improvement of population health so that the full potential of EHRs can be realized (Friedman, Parrish & Ross, 2013).

National legal health stipulations allowing, though not compelling, entities that are covered to transmit health information that are individually identifiable from health care transactions and EHRs to public health authorities was established by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Standards for Privacy of Individually Identifiable Health Information (Privacy Rule). The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 established funding for sharing specified EHR data with public health authorities while the Privacy Rule established national legal authority for sharing EHR data for particular purposes of public health. Medicaid and Medicare penalties and incentive payments for specified meaningful applications of EHRs are provided for by the EHR Incentive Program mandated under HITECH (Friedman, Parrish & Ross, 2013).

Furthermore, the HITECH meaningful use provisions and the HIPAA Privacy Rule regulations requiring transmission of health care provider data for specified surveillance and civil registration purposes require longstanding state statutes.

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Again, cases such as vital records, cancer registries and reportable diseases and conditions must also be taken into account. Collection of data is also typically enabled by state legal authority in case of dangers to public health (Friedman, Parrish & Ross, 2013).

Discuss the pros and cons of the legislation/policy

Pros

Patient savings

The report of 2001 by the Institute of Medicine entitled Crossing the Quality Chasm talks elaborately how essentially a learned patient is less expensive. There is a theory that a patient who is conscious of the costs equipped with the research resources relating to their infection that is readily accessible on the internet and is armed with immediately accessible and accurate copy of their personal electronic health records would prefer prevention over intervention. The treatment choices would be similarly limited effectively and precisely by any medical intervention needed. The perspective of this utopian view is that HIT or the paperless system of health care technically enables the transformation of the said patient to a cheaper but healthier citizen. This occurs through provision of clinical measurements based on the functional status, well-being and the distributions and levels of disease; and by provision of data for the development and maintenance of health records for populations (Freymann Fontenot, 2013).

Physician savings

Physicians carrying out treatments are allowed by EHRs to access the entire past record of their patients: concerns, problem lists, notes, and diagnostic or laboratory outcomes in the electronic records. This method is practical and obviously much more efficient than turning over a sheaf of pages in a paper or manual file (Freymann Fontenot, 2013).

Population savings

With all the efficiency induced by HIT, it is possible to predictably realize a healthier America by achieving the ultimate vision. This will be possible and the country will have certainty of being healthier if there is standardization of utilization, an educated patient population, and elimination of duplication and ineffective treatment (Freymann Fontenot, 2013).

By providing the burden of disease estimates and its spread in the population and population sub-groups, EHRs can make a contribution to government financing and public health policies. The estimates could assist in program targeting, planning, monitoring or implementation. The government's financing and public health policies in relation to the prerequisites for the EHRs to generate needed information are similar those public health programs based on populations.

Potential disadvantages of EHR regulation

Some researchers have identified possible shortcomings related to this technology, despite the accumulating literature on the advantages of several functionalities of EHRs. Included in these shortcomings are issues such as temporary loss of productivity associated with EHR adoption, privacy and security concerns, changes in workflow and many other inadvertent consequences. Financial matters embrace revenue loss associated with temporary loss of productivity, declines in revenue, ongoing maintenance costs, and adoption and implementation costs. These are certain disadvantages that discourage physicians and hospitals from implementing and adopting an EHR.

The implementation costs in adoption of EHR include converting paper charts to electronic forms, training end-users (office and hospital staff, including clinicians, etc.,) purchasing and installing software and necessary hardware. The costs of maintaining these systems can also be prohibitively high because for instance, software must be regularly upgraded and hardware replaced. Furthermore, the end-users must get support and on-going training from the vendors of EHR. These shortcomings are made worse by the fact that generally, several financial advantages of an EHR do not benefit the vendor who is compelled to make the initial investment. Rather, benefits go to the third party payers in terms of improved efficiencies and errors that are avoided, which ultimately means reduced payment claims. High initial investment costs alongside misalignment of incentives for organizations providing health care presents obstacles to the implementation and adoption of EHR particularly for small practitioners. Disruption of work-flows for medical staff and the vendors is another disadvantage of an EHR whose consequence is temporary losses in the level of productivity. The reduction in productivity emanates from the knowledge end-users acquire about the system thereby posing the danger of revenue loss. Furthermore, an EHR may lead to many inadvertent consequences like changes in power structure, overreliance on technology, negative emotions and increased medical errors (Menachemi & Collum, 2011).

Personal views about the problem and legislation/policy

I want to believe that the initial problems of instituting EHR, from altered/slowed work-flows to third party profits rather than profit return to investing health institution, are all initial drawbacks….....

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