Full version Healthcare Information Technology: Effects On Cost Access And Quality

Healthcare Information Technology: Effects On Cost Access And Quality

This print version free essay Healthcare Information Technology: Effects On Cost Access And Quality.

Category: Technology

Autor: reviewessays 09 January 2011

Words: 1986 | Pages: 8

It is not unreasonable for a patient to expect particular services from their healthcare providers. What services should be considered reasonable and which fall under the context of unreasonable? Should the specialist, your family physician referred you to, have access to your past medical history? What happens when you are traveling and have to make a trip to the emergency room, will your physician at home get all the information from that visit or will the ER physician have access to your medical history? Medical information recorded in paper format makes these tasks very difficult, if not impossible. “Fortunately, there is a growing movement to change that, using electronic information technology[3].” The use of this type of technology allows for “high-quality, safe, well-coordinated, and efficient care[4].” Society today is ever changing, we change jobs, location of residence, and doctors frequently. Many of our doctors and hospitals remain stuck in the medical stone age. While people speak of a medical “system,” American medicine is in fact very unsystematic: it lacks standards, measures, and the ability to exchange information that constitute a true system. The medical industry has taken to every kind of clinical technology; from digital thermometers to CT scanners. However, the adoption of information technology in the medical industry lags behind the rest of our economy.

Health informatics is best described as the point where information science, medicine, and healthcare all meet. It encompasses the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and the use of information in health and biomedicine. Health informatics incorporates tools such as: computers (hardware and software), clinical guidelines, formal medical terminologies, and information/communication systems. Healthcare informatics is comprised of several areas: clinical, nursing, imaging, consumer health, public health, dental, clinical research, and pharmacy. Health informatics consists of many components, the main components focused on are electronic medical records, clinical decision support systems, and telemedicine. The electronic medical record (EMR) is a medical record in digital format. EMR’s facilitate access of patient data by clinical staff at any given location, accurate and complete claims processing by insurance companies, building automated checks for drug and allergy interactions, clinical notes, prescriptions, scheduling, and sending /viewing of labs. Research has shown that electronic health records provide greater accessibility, accuracy, and completeness of clinical information: therefore reducing uncertainty[2]. Clinical decisions support systems are computerized systems designed to assist physicians and other health professionals in decision making. Telemedicine is the use of information technology and communication to deliver care. Telemedicine uses electronic information and communications technologies to provide medical diagnosis and/or patient health care when distance separates the participants.

When looking at the use of healthcare information technology from an administration standpoint, the question becomes; in what way will the use of such practices produce a worthwhile benefit? The foundation of healthcare delivery consists of three major elements: cost, access, and quality (The Triad)[5]. Therefore, this paper will focus on the relationship between these three elements and the effects healthcare information technology will/can have on them.

Healthcare cost is defined in three ways: system-wide healthcare spending (national healthcare expenditure), price of healthcare services, and cost of producing healthcare. Healthcare cosst have grown to an estimated $1.9 trillion annually, which is 16% of the Gross Domestic Product. The high-cost of healthcare is often blamed for the increasing number of uninsured in America, 46 million people[8]. Therefore, finding a practice or a system which will positively effect the cost of healthcare is constantly sought after. So, how is the implementation of healthcare information technology going to effect the cost of healthcare? Electronic medical records have been shown to have a positive effect on decreasing healthcare costs. These savings are seen in all areas: administrative[7], patient, healthcare organization, and government/private insurance.

Administrative costs have been seen through time not spent finding, filing, and retrieving patient charts. Time equals money, and a decrease in employee time equals less money spent by the employer. Cost savings are also seen through elimination of transcription, transferring, and transporting of patient charts. Billing components within EMR packages can provide cost savings through generation of direct billing and reimbursement, this process shows great potential for reduction in billing errors[7]. Errors made during the billing/reimbursement process result in dollars lost or not recovered for the organization, which in turn drives up the cost of healthcare. The Centers for Medicare and Medicaid Services reported (in 2003) that a 10% error rate, regarding payments, resulted in 18.4 billion dollars in overpayment in fee-for-services payments[11].

Emergency room visits generate the most costly healthcare provided, EMR access during an emergency room visit could provide cost reduction. This cost reduction is seen through lab and other diagnostic testing not being unnecessarily repeated, immediate access of previous results allow treating physicians to make a quicker more informed decision[7][15]. Also, time spent not performing these tests or procedures frees up provider time for other patients and procedures; allowing more patients to be seen (equals more profits). These savings directly effect the provider, patient, and payer. Not only are savings seen in the emergency room from unnecessarily repeating labs, radiographs, and other diagnostic tests, but the availability of results from all of these within an EMR provides savings across the board.

Some healthcare technologies are seen as unnecessary or it is felt they are used inappropriately; it is felt that they add to the rising healthcare costs. Many practitioners feel there are alternative cost-effective procedures that are currently underused. The use of evidence-based decision-making, a decision support system, to collect information and analyze data leads to informed decisions regarding medical technology acquisitions, technology adoption and dissemination, coverage and reimbursement policies, usage levels of health technologies and associated costs, potential impact on revenue, best practices and clinical outcomes[13]. This is a tool that aids in the decision of whether or not a new technology is a necessary or needed addition, is the cost going to be rationalized by its function.

Medical errors reported by the Institute of Medicine in 1999 were said to cost the United States $17-$29 billion[10]. These type of reports drive the cost of malpractice insurance higher year after year, these increasing costs sometimes force physicians to stop practicing all together. This phenomenon is seen in the OB/GYN field especially[17]. “EMR’s and clinical information systems have the potential to reduce medical malpractice costs[15].”

Access to healthcare is the ability to obtain healthcare when it is needed. The shortage of medical specialists and access to medical information has necessitated a growing interest for cost effective and efficient telemedicine tools for healthcare delivery. Communications technology is being used increasingly for telemedicine applications to improve access to medical care in rural areas. It has been shown that using telemedicine technology through areas such as radiology, psychiatry, and home health care is cost-effective and enhances access for patients and physicians alike[20]. The use of healthcare information technology will have the biggest impact on access to healthcare through cost-reduction. A decrease in the national healthcare care expenditure will bring about decreased healthcare cost, which will in turn positively increase access. With approximately 46 million persons uninsured in the United States, cost reduction will offer a substantial solution to the access problem in the United States.

The quality of healthcare in the United States has warranted concern; problems such as underuse, overuse, and misuse of healthcare services and uncertainty in clinical decision making about individual patients[2]. Lack of immediate access to a patient’s medical information can lead to a dangerous situation or unnecessary treatments[7]. “Patient safety and prevention of medical errors are a top priority for patients, payers, and providers[7].” Many definitions of quality exist, the Institute of Medicine defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge[6].” Research has shown that EMR’s provide greater accessibility, accuracy, and completeness of clinical information; therefore reducing uncertainty[2].

It is reported that approximately 7,000 people die annually due to prescriptions getting filled incorrectly, due to unclear handwriting[9]. Barcoding systems can safeguard against administering the wrong pharmaceuticals in a controlled setting, and physician entered/computer generated prescriptions provide a safeguard against errors in the reading of a handwritten prescription. Also, the Institute of Medicine released a study indicating 44,000 to 98,000 deaths occur in the United States annually due to medical errors[10]. The availability of clinical information to the physician treating the patient is the key to knowing what has been done, when[10]. It has been reported that the use of healthcare information technology could aid in the prevention of errors though the monitoring of events that are not complying with best practices[14]. A study published in JAMA, conducted in 2003, concluded that clinical information systems improve practitioner performance and have the potential to enhance patient outcomes[15]. Also, a 2004 study resulted in a 22.4% increase in quality improvement indicators due to the implementation of an EMR system[16].

Not only does the implementation of healthcare information systems aid in reducing errors within the medical arena, but it will allow providers to have more hands on time with their patients. This additional time is created due to less time spent on paperwork and processes occurring more efficiently. "Patients constantly judge the motives and competence of caregivers through their interaction with them. This judgment is a very personal one, based on perceptions of care being responsive to patient’s ‘individual needs,’ rather than to any universal code of standards[18].” Improved communication and interaction between caregiver and patient improves actual outcome. “The interpersonal process is the vehicle by which technical care is implemented and on which its success depends[19].”

Paper charts or records bring about questions regarding accuracy, completeness, availability, and legibility; this often leads to a failure in the communication process, this failure places the patients and their lives at risk[14]. Although the adoption of technology has occurred in other industries, healthcare remains one of the few in which technology integration has not occurred. “Coordination of care across the continuum of health services eliminates costly duplication of services, improves efficiency, and enhances the quality of patient care[14].” “As a result, plans can deliver relevant and actionable health content that reduces unnecessary utilization of health services, promotes better self care, drives member acceptance of consumer-directed health plan products, and ultimately reduces healthcare costs[12].”

References:

[1]Miller J. (2006) Transformation IN action. Managed Healthcare Executive. 16(4): 20-26.

[2]Garrido T, Jamieson L, Zhou Y, Wiesenthal A, Liang L. (2005) Effects of electronic health records in ambulatory care: retrospective, serial, cross-sectional study. British Medical Journal. 330(7491): 581(5).

[3]Bates DW & Komanoff AL. (2006) Paperless medicine. Newsweek. 148(16):63.

[4]Romano M. (2006) Ripe for change: study. Modern Healthcare. 36(31): 10.

[5]Shi L & Singh DA. 2004 . Cost, Access, and Quality. In Textbook Delivering Health Care in America. Sudbury, Massachusetts: Jones and Bartlett Publishers.

[6]http://www.iom.edu/CMS/8089.aspx

[7]Novak K. (2005) Reducing costs through electronic health records and services. Benefits & Compensation Digest. 42(10): 40-44.

[8]http://www.nchc.org/facts/cost.shtml

[9]Frist B. (2006) Let’s move medicine into the informational age. The American Enterprise. 17(6): 38-40.

[10]Rogoski RR. (2005) The enterprise take on patient safety. Health Management Technology. 26(8): 12-17.

[11]America’s hidden health care crisis: $100 billion in payment errors...Annually. Ingenix. 2006. www.hssweb.com. Printed on November 3, 2006.

[12]Noland K. (2006) Cultivating an extensive health content strategy begins with the ideal partner. Managed Healthcare Executive. 16:50-52.

[13]Hayes D, Schneider WL. (2006) Using an evidence-based process for integrating new healthcare technologies. Health Management Technology. September: 16-20.

[14]Harrison JP & Palacio C. (2006) The role of clinical information systems in health care quality improvement. The Health Care Manager. 25(3): 206-212.

[15]Garg AX, Adhikari NK, Mcdonald H, (2005) Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 293(10): 1223-1238.

[16]Ornstein S, Jenkins RG, Nietert PJ, (2004) A multi-method quality improvement intervention to improve preventive cardiovascular care: a cluster randomized trial. Annual Internal Medicine. 141(7): 523-532.

[18]http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=397&string=

[19]Press I. 2005. Patient Satisfaction: Understanding and Managing the Experience of Care, 2nd Edition. Chicago, IL: Health Administration Press.

[20]Charles BL. (2000) Telemedicine can lower costs and improve access. Healthcare Financial Management. 54(4): 66.