The federal government primary focus on improving health care quality is through the implementation of electronic medical records and billing. In the past medical records and billing transactions was conducted using a paper filling system. In today's health care environment, the use of electronic systems and billing software has been implemented to control and account for medical documentation. Electronic medical record systems lie at the center of any computerized health information system. Without them other modern technologies such as decision support systems cannot be effectively integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty, multi-discipline computerized medical record, which has been a goal for many health care professional has final become a reality (Openclinical, 2010).
The Department of Veteran Affairs has done an excellent job in implementing a software program called Computerized Patient Record System (CPRS). This software was developed so that the VA can enhance their ability to track and update patient's medical records. When an employee is hired at the VA, they are provided with detailed training on the special software application. There is a wealth of information the provider can review when accessing the patient's medical record through CPRS. An example would be if the provider wanted to review a note from podiatry, they will have the ability to review that note. Providers can also view information from other VA facilities. CPRS is used by health care providers to update a patient's medical history, place a variety of clinical orders and review laboratory results, medical images and current medications. VA clinicians and patients use information in CPRS to make diagnostic and treatment decisions affecting the veteran's health care (Innovations, 2006). This system has been implemented by all VA medical centers and outpatients clinics and has proven to be very successful.
The U.S. health café system has undergone many changes throughout the years. Health care spending and health insurance premiums continue to rise at rates much higher than the rate of inflation. Despite spending over $1.6 trillion on health care as a nation, there are still serious concerns about preventable errors; uneven health care quality; and poor communication among doctors, hospitals and many other health care providers involved in the care of anyone person (Mclaughlin & Kaluzny, 2006). The Federal government has informed health care officials that to improve the quality of care being provided, they must establish and implement electronic systems that will track, analyze and provide access to data throughout the nation. It is critical that managers have the ability to access the same information related to a patient medical record.
How can the concepts and techniques of quality measurement out-lines in the text be adapted to the design, implementation and evaluation of the White House and CHIT strategies as they move ahead?
The concepts and techniques of quality measurement outlined in the text can be used to implement a new design that will allow providers to have access to their patient medical records throughout the nation. It will also allow patients to receive access free care. The main goal of the re-design process will be to personalize care. Personalizing care helps individual's manager their own wellness and assist with their personal health care decisions. The ability to personalize care is a critical component of using health care information in a meaningful manner. There are three different strategies of personalizing care. In setting out the vision, principles and objectives of the Strategy, a wide definition of health information has been adopted to encompass the needs of all those who require such information. The vision is to ensure that all stakeholders, namely the general public, clients/patients, careers, health professionals, service staff, service managers, policy makers, Government, researchers and the media can readily access trustworthy information and can use it appropriately. To improve the quality of care, health care providers must ensure they understand the following principles.
The principles of improving quality health care using information technology.
Safeguard the privacy and confidentiality of personal health information
Ensure that health information systems are efficient and effective
Promote the optimal use of health information
Ensure the high quality of health information.
Health care providers can use four strategies to personalize care. Personalizing care will enable providers to establish a relationship with their patients. Patients will be more comfortable in knowing that their providers are interested in providing them with a rehabilitation plan based on an accurate diagnosis that will improve the patient's quality of life. The first strategy is encouraging the use of electronic medical records. The use of electronic medial records will enable providers to view the patient entire medical history with only a few clicks. Patients will also gain confidence that their medical information is secured and can be updated accurately.
The second strategy is promoting the use of telehealth systems. Telehealth systems allow providers to monitor patients from their home. Telemedicine is being used in the Department of Veteran Affairs (VA). The VA has been researching ways in which they can provide telehealth technology as a way to enhance care that is provided to veterans. In many of the VA medical centers there is a telehealth nurse that is dedicated to training patients and nurses on telemedicine technology. The VA has looked at this initiative for many years and has now realized that to reach out to their entire patient population they will have to implement telemedicine programs, which can improve disease management. For technology to work, it must work for the people it is meant to help. These individuals are patients and the professionals providing care.
Chapter 10 on information technology outlines a life cycle approach to analyzing system development, adoption, and implementation. How consistent with that model are the federal government initiatives outlined in the strategic plan?
The data life cycle approach is consistent with the strategic plan because the strategic plan requires that the organization maintains the integrity of all data that has been collected. The federal government wanted to hire an individual that would oversee that data life cycle process. Executive order 13335 directed the appointment of the National Coordinator for health Information Technology to coordinate programs and policies regarding health information tehnology across the federal government (Mclaughlin & Kaluzny, 2006). The data life cycle includes stages during which data are created, collected, stored, and accessed.
In many cases data can also be manipulated, cleansed, or used in a variety of ways and returned to storage. The strategic plan requires managers to implement data improvement through error checking and validation. An example of an organization that has implemented this process is the Veterans Health Administration (VHA) prosthetic departments. Prosthetic departments within VHA collect patient data through the National Prosthetic Patient Database (Downs, 2007). This software is a national database with potential to enhance quality, reduce costs, and improve efficiency. The goal is to accurately collect patient information for billing and tracking purposes. Prosthetic program managers are required to check this data for errors and validate that all errors have been corrected every month. Below I have displayed a graphical representation of the data life cycle process.
If you were Dr. Brailer or his successor responsible for CHIT, what would you propose for the next iteration of the planning cycle?
The next iteration of the planning cycle would be to ensure that health care organization become certified in their health care technology departments. The Commission for Health Information Technology offers a certification process. The Certification Commission is an independent, 501(c)3 nonprofit organization recognized as a certification body for electronic health records (CCHIT, 2010). Their mission is to accelerate the adoption of robust, interoperable health information technology by creating a credible, efficient certification process. It is critical that health care managers ensure that their organizations are certified in health care technology. The main reason is so that they can improve the quality of their data and their security measures is storing and transmitting that data. This can also be used as leverage when submitting the budget to congress.
On December 3, 2004 the New York Times reported that the $50 million request for funding of Center for Health Information Technology in the budget had been lined out in the FY 2004-05 appropriation bill (Lohr 2004b). What would you do next, if you were responsible for implementing the plan?
Once the request for $50 million was denied I would have requested the funds through some other means. The money was going to be used for an effective cause but this cause was apparently not that important to congress. The budget of the Department of Health and Human Services is more than $500 billion a year. Most of that is pledged to federal obligations like Medicare, but the department does have more than $60 billion in discretionary funds. So it is possible that money could have found its way into Dr. Brailer's office to finance some of its favored projects (Lohr, 2004). I believe the projects would still proceed if they were to use a portion of the $60 billion in the discretionary fund.
In conclusion the health care industry is still transitioning into the electronic medical records phase. This process has been successful for some and challenging for others. The main challenge is having the ability to secure electronic data that is transmitted across lines. It is the responsibility of health care providers to ensure that patients information is protected at all cost. Health care managers will need to provide their employee with electronic medical records so that these records can be maintained and updated anywhere the patient may receive their medical care. One critical goal of Continuous Quality Improvement is for providers to provide access-free, quality and patient centered care to all their customers.
