Resident Healthcare IT Expert Heather La Porta examines the IT elements of the new Affordable Healthcare Act
The Affordable Healthcare Act is transforming the way physicians care for patients. As an outsider looking in (albeit with an eye on the tech-end of things), it’s been interesting to watch the healthcare communities’ response to this act and its predecessor, HITECH Act. Uncovering what these acts are designed to do and how they will change the way doctors provide healthcare is a research task in and of itself, but after sifting through more acronyms than you might find at a government agency convention, it became apparent: big changes are coming for medical technology.
The Health Information Technology for Economic and Clinical Health (HITECH) Act is what jump started this whole process. It amends Title XXX of the Public Health Service Act, adding funding opportunities to advance health information technology—much of this is tied into reimbursement for IT expenditure and demonstration of Meaningful Use of the technology (we’ll get into that more in a minute) and/or Medicare and Medicaid reimbursement. This is a ground breaking act that requires physicians to effectively use Electronic Health Records (EHR) instead of paper records to maintain patients’ health information. As physician’s practices have been paper-based in the past, a significant investment of time, technology know-how and money is required to bring records keeping up-to-date. The Office of the National Coordinator for Health IT (ONC) is in charge of regulating and certifying EHRs to make sure they meet baseline criteria and all EHRs must be certified in order to qualify for reimbursements. The ultimate goal of this is to make health care more efficient, more affordable and more available to all Americans.
Meaningful Use is the new mantra for practicing physicians, and it’s also what the EHR companies are living and dying by. So, what exactly is Meaningful Use, and how does it impact practices?
Essentially, Meaningful Use is the process physicians and hospitals must go through to demonstrate effective use of EHR that will qualify them for the financial incentives. Meaningful Use currently has three proposed stages, with Stage One going on now. This stage began in 2011 and goes through the end of the year. Stage One consists of 15 core objectives that must be achieved during this initial phase, and the basic premise is that it sets the baseline for electronic data capture and information sharing. The first eleven objectives relate to transmitting prescriptions electronically and recording key patient and demographic info in the EHR. Basically, doctors have to pick their system, get it up and running and get patient data in it.
The last four objectives give Meaningful Use legs to stand on, technologically speaking. Object Twelve, the first objective, requires physicians to provide patients with an electronic copy of their health information, including lab results and medication lists, upon request.
The second objective, Objective Thirteen, requires a clinical summary for patients for each office visit. This means that each patient will have a printed record of instructions to follow upon visiting their physician.
Core Objective Fourteen, the third objective, requires practices to be capable of exchanging key clinical information electronically. This is essentially where the Health Information Exchanges (HIEs) come into play, and it brings up some security concerns for the practice from the technology perspective. These HIEs are state or area associations that allow participating providers to share patient information in a protected environment. The goal is to have all the HIE’s networked together. If a physician joins one, all of their patients’ information is available to all other doctors in the network. This will allow doctors a more complete overview of a patient’s care by all providers, past and present, but it also puts a stressor on smaller practices who must be able to transmit records securely into the HIE, as is seen in Core Objective Fifteen.
Core Objective Fifteen requires that providers be able to demonstrate they are able to protect EHR info with a security risk audit in keeping with the requirements of the OCR and HITECH Act. This piece will require physicians to add additional layers of security to their IT infrastructure, and increase the complexity of their IT Networks. This part of Meaningful Use will be especially taxing for smaller physician practices. Gone are the days of having your neighbor’s son handle your practice’s IT needs. This move is asking doctors to take off their white coats and put on their business suit jacket. They will have to think operationally and make decisions accordingly with their current technology solutions. Network infrastructure by necessity will be more complex for practices using EHR and will require more skilled management and knowledge of technology security practices. Patient data must be kept securely—not just to meet regulation, but, equally as importantly, to keep practices functioning.
Overall, The HITECH Act and the Core Objectives of Meaningful Use that have developed out of it are drastically changing the way doctors practice medicine. In my next blog, I’ll go into how this is impacting physicians and how medicine is practiced.