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Health IT Topic of the Week and Impact on Practice
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What was the HealthIT Topic you selected related to your specialty (nurse practitioner, FNP) ? Why did you select it? How will this impact your practice?
Lecture
Welcome to Week 6!
This week, we examine key health information technology (HIT) legislation and healthcare technology news on such topics as Computerized Physician Order Entry (CPOE), Electronic Health Records (EHRs), E-prescribing, Health Information Exchange (HIE), Personal Health Record (PHR) and other health IT news and their impact on the healthcare delivery system and the healthcare consumer. We will also review some of the current issues and trends such as Big Data.
Introduction
Every nurse practicing in the United States today has been impacted by health-information technology legislation in one way or another. This week, we will examine key federal legislation, summarizing the intent of each act, its impact upon consumers and healthcare professionals, and related implications for the master’s prepared nurse. The legislation discussed here will include:
- Health Information Portability and Accountability Act (HIPAA)
- American Recovery and Reinvestment Act of 2009 (ARRA)
- Health Information Technology for Economic and Clinical Health Act (HITECH)
- Patient Protection and Affordable Care Act (ACA)
- Electronic Signatures in Global and National Commerce Act (E-sign)
We will also examine the implications of key health information technology (HIT) legislation in relationship to the foundation of knowledge model.
Health Information Portability and Accountability Act (HIPAA)
HIPAA was enacted in 1996. While it is best known among consumers and healthcare professionals for its protection of personal health information (PHI) and the additional forms that each of us are asked to sign when we go to our doctors’ offices, HIPAA also ensures portability of insurance for individuals moving from one job to another, legal protection for PHI, and mandates standards for the electronic data interchange of healthcare data for encounter and claims information, and was intended to simplify the claims submission process by eliminating paper claims. HIPAA established legal sanctions for institutions and individuals who fail to protect PHI. As healthcare professionals, we are cognizant of HIPAA requirements before we share PHI via writing, electronic means, faxes, telephone, or in person. Specific measures to protect PHI include limiting record access to individuals with a “right to know,” signed disclosures to release information, encryption of e-mail and files, fax cover sheets, designated persons who may receive PHI, and the use of passwords to guarantee that PHI is only disclosed with persons designated by the consumer as having a right to “know.” HIPAA has also changed sign-in procedures for patients, disposal of forms containing PHI, and how we use whiteboards to show patient information.
Protection of PHI is the underlying reason that employees are asked to sign a statement that acknowledges that they will access electronic records solely on a “need to know” basis before receiving system access and that inappropriate access can result in termination of employment. An information-system safeguard to ensure that only legitimate access occurred is the electronic audit. Audit reports show all users who access an individual record and specific content viewed, making it possible to quickly establish if the record of a former spouse, another employee, or a celebrity is viewed without legitimate cause.
American Recovery and Reinvestment Act of 2009 (ARRA)
ARRA provided funds to government agencies for improving information-technology systems. It also provided funding for the Office of the National Coordinator for Health Information Technology (ONCHIT), which was established but not funded by HIPAA. Other ARRA provisions include the right for every person to receive an electronic copy of their EHR and to have a copy of their EHR transmitted to a party that they designate, and the Health Information Technology for Economic and Clinical Health Act (HITECH).
Health Information Technology for Economic and Clinical Health Act (HITECH)
HITECH strengthened HIPAA security and privacy rules and provided monies and incentives to increase the adoption of EHRs that meet eligibility requirements for Meaningful Use (Hunter, 2013). The underlying idea was that financial incentives would encourage the adoption of EHR systems, moving the United States closer to a national infrastructure that would support an EHR for every American and provide information via Meaningful Use core criteria that could be used to collect information that could be used to improve population health. Providers that comply with Meaningful Use requirements qualify for additional reimbursement monies over a period of several years. Penalties will be imposed, effective 2015, for providers that do not use approved technology to comply with Meaningful Use requirements. Providers have some latitude on the core criteria that are met from a prescribed set.
Funds allocated by HITECH also support regional centers that guide providers as they adopt EHRs and offer technical support.
Patient Protection and Affordable Care Act (ACA)
Signed into law in 2010 and still very relevant today in 2016, ACA , also known as Obamacare, guarantees healthcare for all Americans, expands Medicaid, provides incentives intended to improve care coordination and quality, restructures healthcare payment, and provides additional information to patients so that they can make value-based decisions. The linkage to HIT occurs because EHRs and health information exchange among providers are required to support the accountable-care organizations (ACOs) and patient-centered medical homes (PCMHs)—both are organizations designed to improve coordination of care.
An ACO is a group of provider organizations that assumes responsibility for the quality and cost of healthcare delivered to a set population of Medicare patients. ACOs consist of a combination of hospitals, primary-care practitioners, and specialists. ACO participation is voluntary. The Centers for Medicare & Medicaid Services (CMMS) provides extensive information on ACOs, including incentives for participation. A PCMH coordinates care and information for a defined group of patients. Each individual within a PCMH has a provider that leads the team responsible for meeting all of his or her healthcare needs.
While the concept of healthcare for all Americans would seem desirable, ACA has generated considerable controversy; primarily, because of (1) its requirement that all Americans purchase health-insurance coverage by 2014 or face financial penalties, and (2) the perceived complexity of reporting requirements for employers and their concerns as to whether they will be able to afford to purchase healthcare benefits for employees.
The requirement for all Americans to purchase health insurance was upheld by the Supreme Court (Supreme Court, 2012). The Obama administration announced that required healthcare coverage for workers by employers having 50 or more employees would be deferred until 2015 in response to employer concerns. Rules requiring employers to identify individuals with coverage on a monthly basis had not been released as of July 2013 (Healy, 2013; Majur, 2013). There are also questions whether implementation of other ACA aspects will be deferred as well. Professional organizations, such as the American Nurses Association, provide an excellent resource for nurses seeking further information about ACA and its proposed timelines (ANA, 2010a). The ANA (2010b) provided a favorable analysis of the elements of ACA when compared against its own health-system agenda.
Electronic Signatures in Global and National Commerce Act (E-sign)
E-sign was enacted in 2000 to support commerce. It affords the same legal status to electronic signatures as traditional, witnessed, hand-written signatures. An electronic signature is defined as either a handwritten signature that is electronically captured or a digital signature. The latter is a method of signing an electronic document that provides assurance of the sender’s identity and authority as well as sender authority. E-sign also works well for healthcare.
Summary HIT Legislation: Implications The HIT legislation discussed here was intended to change the healthcare delivery system with the introduction of incentives, new requirements, new technology, new healthcare delivery models, and provider-patient dynamics. Significant in-roads have been made towards creating a national HIT infrastructure. We need an infrastructure that will support a birth-to-death EHR for every American that can be accessed from anywhere in the country to accommodate the needs of a mobile population. We are closer, but have not yet achieved the level of health information exchange required for this to occur.
As noted in Gialanella (2012), legislation established the Office of the National Coordinator for Health Information Technology and provided incentives for the adoption of technology capable of collecting and reporting Meaningful Use criteria and of improving safety and quality of care. All healthcare professionals need to be informed of the potential that technology offers and advocate for applications that can improve the quality of care provided. Healthcare professionals need to stay informed through involvement in professional organizations and professional-education opportunities, not only as to what might be, but also of legislation and compliance issues that directly impact the way that they practice. As patient advocates, it is also important to inform patients of their rights, whether that might be the ability to restrict who has access to their PHI or that they have the right to receive an electronic form of their record. And as advocates, we also need to be aware of proposed legislation and its potential impact, and to let our elected representatives know why they should or should not support pending legislation. As healthcare providers, we have an obligation to apprise healthcare consumers of new developments, such as health information exchanges (HIEs), ACOs, and PCMHs, and what it means for them.
As nurse leaders, the master’s-prepared nurse is often in an administrative position or perceived as a role model. For these reasons, he or she needs to determine if appropriate safeguards to protect PHI are in place, and if HIPAA requirements and other legal mandates are met. Ethically and legally, nurse leaders need to model “need to know” access.
As leaders, we also need to realize the potential that currently lies just beyond our reach as we compile huge data sets that now remain largely untapped within many separate silos. Consider how HIT legislation has positioned us to make good use of the foundation of knowledge model to acquire new knowledge, to improve our knowledge-processing capabilities, and to enable us to generate more knowledge.
Summary
HIT legislation impacts all healthcare professionals through its requirements to safeguard PHI, mandates for universal healthcare and new delivery models, and financial incentives and changes to payment models and reimbursement.
HIPAA
Protects patient privacy, ensures portability of health insurance, and mandates states for electronic data interchange for submission of claim and encounter information
Nurse leaders have an obligation to be informed of legislative mandates, model appropriate behaviors, and inform colleagues, subordinates, and consumers of ways that HIT legislation impacts them.
Nurse leaders need to also consider ways in which the HIT infrastructure that legislation is building supports the acquisition, processing, and generation of knowledge.
Health IT Topic of the Week and Impact on Practice
References
American Nurses Association. (2010a). Selected Patient Protection and Affordable Care Act (PPACA) implementation dates of interest to RNs as caregivers, RNs as patients, and RNs as employees. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform/Health-Care-Reform-Legislation-Timeline.pdf>
American Nurses Association. (2010b). ANA policy & provisions of health reform law. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform/Policy-and-Health-Reform-Law.pdf
Gialanella, K. M. (2015). Legislative aspects of nursing informatics: HITECH and HIPAA. In D. McGonigle & K. G. Mastrian (Eds.). Nursing informatics and the foundation of knowledge (3rd ed.). Sudbury, MA: Jones and Bartlett.
Healy, J. (July 3, 2013). Obamacare’s troubling, stumbling start. Los Angeles Times Opinion. Retrieved from http://www.latimes.com/news/opinion/opinion-la/la-ol-obama-postpones-obamacare-employer-mandate-20130702,0,7632523.story
Hunter, K. (2013). Legislation. In T. Hebda & P. Czar (Eds.). Handbook of informatics for nurses & healthcare professionals (5th ed.). (pp. 379–385), Upper Saddle River, NJ: Prentice Hall.
Majur, M. J. (July 2, 2013). Continuing to implement the ACA in a careful, thoughtful manner. Treasury Notes. Retrieved from http://www.treasury.gov/connect/blog/Pages/Continuing-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx
Sorrell, J. M. (2012). Ethics: The Patient Protection and Affordable Care Act: Ethical perspectives in 21st century health care. OJIN: The Online Journal of Issues in Nursing, 18(1). DOI: 10.3912/OJIN.Vol18No02EthCol01
Supreme Court of the United States. (2012). National Federation of Independent Business et al. versus Sebelius, Secretary of Health and Human Services, et al. Retrieved from http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf
Health IT Topic of the Week and Impact on Practice
