Health Care Delivery

The entities Comprising the Public Health Infrastructure include: County and city health departments and local boards of health - State, territorial, and island nation health departments - Various U.S. Public Health Service agencies in the Department of Health and Human Services (HHS) - Tribal health agencies coordinated at HHS by the Indian Health Service - Public and private laboratories - Hospitals and other private-sector healthcare providers - Volunteer organizations, such as the American Red Cross, American Diabetes Association, American Cancer Society.

The high cost of healthcare continues to rise and many in the United States are optimistic for health information technology to reduce and improve our current situation. Health IT encompasses a broad array of new technologies designed to manage and share health-related information. When properly implemented, these systems can help coordinate patient care, reduce medical errors, and improve administrative efficiency. Therefore, implementing a Regional Health Information Organization (RHIO) will help the National Health Information Network (NHIN) achieve their goals in improving quality of care for the citizens of the United States. Thus, in order for the health IT to deliver on its promise, several obstacles must be overcome.

Health Information Exchange (HIE) supports both transferring and sharing of health related information that is usually stored in multiple organizations, while maintaining the context and integrity of the information being exchanged (HIE, 2014). The goal of health information exchange is to expedite access to and retrieve clinical data to provide safe efficient, effective, equitable, timelier patient-centered care (HIE, 2014). HIE “provides access and retrieval of patient information to authorized users in order to provide safe, efficient, effective, and timely patient care” (HIE, 2014).

In the past, managed care in the United States took the form of voluntary programs. Such programs date from about 1850, when managed care was provided chiefly by cooperative mutual benefit and fraternal beneficiary associations. Limited coverage by commercial companies was also introduced during that period, and subsequently many plans were established by industries and labor unions.

Since the mid 1990’s, a predominant concept of healthcare is the iron triangle of care, consisting of three competing issues: quality, access, and cost. (Carroll, 2012). William Kissick, who introduced the model, suggested that if you improve one or two of these issues areas, it comes at the expense of the third. If quality of care is increased, it comes at the expense of access or through increased cost. If access to care is improved, it is at the expense of quality or increased cost. If an institution is successful at cost containment while providing care, it is at the expense of quality and/ or access. (Kissick., 1994, p.13). Despite this deeply ingrained concept, the Agency for Healthcare Research and Quality (AHRQ) viewed the use of Health Information Technology (HIT) in the nation’s healthcare delivery as a resource to promote quality and access while potentially decreasing overall cost. (U.S. Department of Health & Human Services, 2003). (Page 175 of Delivering Healthcare in America) In efforts to promote the use of HIT, AHRQ provided five goals of implementation that would best impact the healthcare provided throughout the federal and private healthcare systems. These goals, when applied to the federal

“Go Paperless and Get Paid” is how the Office of the National Coordinator for Health Information Technology (ONC) presents the incentives for electronic health records. The United States Department of Health and Human Services (U.S. Department of HHS) distributed more than $160 billion dollars to “improve and preserve health care, health information technology, community health, and prevention initiatives” (United States Department of Health and Human Services [HHS], 2014e). Likewise, the ONC offers “Health IT Adoption Programs” through the Health Information Technology for Economic and Clinical Health (HITECH) Act, seeking to advance the American health care delivery system and to improve patient care through an unique investment towards health information technology (HHS, 2014d). Additionally, the American Recovery and Reinvestment Act of 2009 allows the Centers for Medicare & Medicaid Services (CMS) to reward eligible hospitals and professionals with monetary incentives as they implement, adopt, or upgrade and demonstrate meaningful use of certified electronic health record (EHR) technology (HHS, 2014b). The Electronic Health Records Improvement Act (H.R. 1331) introduced by the United States House of Representative Diane Black is a bill to further improve the nation’s health care adoption of health information technology.

People living with HIV and AIDS have always had a difficult time obtaining access to health coverage (Sorian, 2010). Medicaid, Medicare, and the Ryan White HIV/AIDS Program have provided a critical safety net (Sorian, 2010). But today, nearly 30% of people living with HIV do not have any health insurance coverage, and many others have limited coverage (Sorian, 2010). In addition, people living with HIV and AIDS have faced hurdles to getting quality care from qualified providers (Sorian, 2010).

Advances in modern technology surrounds us in our day to day lives, allowing conveniences and efficiency at our fingertips. Great strides have been made over the years with technology, and the healthcare industry along with many other industries have adopted this new way of functioning; electronically. The effects of technology have come to the forefront in where our government has acknowledged the benefits and opportunities. “The promise of Health Information Technology for improving quality and safety of health care while reducing costs has caught the eye of policy makers and other leaders in health care” (Hersh, 2006). It deeply affects how we connect, interact, and communicate internally and externally, but also gives us a sense of control on how we engage ourselves to the innovative software and systems.

This article describes The Health Information Technology for Economic and Clinical Health Act’s (HITECH) “meaningful use” objective to create a nationwide system of Electronic Health Records (EHRs) in order to improve patient safety, quality of care, privacy and security. The authors point out that during the first two years of an EHR implementation, clinicians and hospitals must meet certain requirements in order to qualify for federally funded incentive payments totaling up to $107,750 per clinician. This incentive is meant to ease the financial challenges smaller practices might face as the United States works toward a more technically collaborative information care system, EHRs promise to provide.

In our first week of class, we have looked at the first three chapters in, Health Care Delivery in the United States. The first chapter talks about how the health care system has moved from a mindset of restoring a person’s health, into the phase of preventative medicine, which we see now. This has resulted from measurement of how the health care system is working, and with research looking at patients throughout the years. We now know, that any problem, disease, or condition, should be treated early or prevented if possible. The health care system has been working with public education to make citizens aware of what tests and preventative programs will be of assistance to them. (Knickman & Kovner, A., 2015).

The Health Information Technology for Economic and Clinical Health Act (HITECH) was put into place following the passage of the American Recovery and Reinvestment Act in 2009 and was designed to foster the acceptance and purposeful use of health information technology. With the creation and implementation of a national health care infrastructure related to the electronic health care record system among providers, a revision of the current law was necessary and inevitable. “Although HITECH may be viewed narrowly as legislation to stimulate the adoption of health information technology, it is better understood as an essential foundation for our broader efforts to restructure health care

Health Information Exchange is the electronic movement of healthcare information amongst organizations according to the national standards. HIE as it is widely known, serves the purpose of providing a safe, timely, and efficient way of accessing or retrieving patient clinical data. Health Information Exchange allows for doctors, nurses, pharmacists, and other vital healthcare professionals to have appropriate access and securely share vital medical information regarding patient care. Health Information Exchange has been in efforts of developing for over 20 years in the United States. In 1990 the Community Health Management Information Systems (CHMIS) program was formed by the Hartford Foundation to foster a development of a centralized data repository in seven different geographically defined communities. Many of the communities struggled in securing a cost-effective technology with interoperable data sources and gaining political support. In the mid-1990s a similar initiative began known as the Community Health Information Networks (CHINs) with the intention of sharing data between providers in a more cost-effective manner. In 2004, the Agency for Healthcare Quality and Research Health Information Technology Portfolio was funded $166 million in grants and contracts to improve the quality and safety to support more patient-centered care. This was the beginning of the progress we have seen in HIE today. Health Information Exchange devolvement serves the purpose of improving

Health information technology (HIT) involves trading of health information in an electronic format to advance health care, reduce health expenditures, improve work efficiency, decrease medication errors, and make health care more accessible. Maintaining privacy and security of health information is crucial when technology is involved. Health information exchange plays an important role in improving the quality and delivery of health care and cost-effectiveness. “There is very little electronic information sharing among clinicians, hospitals, and other providers, despite considerable investments in health information technology (IT) over the past five years” (Robert Wood Johnson Foundation, 2014, p. 1).

The road to patient-centered care was paved with the passing of the HITECH act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHRs privately and securely to achieve specified improvements in care delivery. If providers do not become meaningful users of EHRs by 2015, penalties will be triggered through reduced Medicare payments. These provisions aim to create a nationwide electronic health system that is efficient and secure to improve health outcomes and lower the cost of healthcare. To accomplish these goals, the federal government allotted $19.2 billion of funding to promote the adoption and meaningful use of interoperable health information technology and electronic health records (EHRs).

Health information exchange and information technology are essential tools that healthcare providers and consumers often utilize to assist in improving health care. An electronic health information exchange promises potential benefits for health care systems through improved clinical care, reduced cost and the needed elements for a national health information network. As with any other industry, the exchange of such information has its many benefit, but it