Executive Summary
The U.S. government introduced great transformations in the health care sector during the last decade. This health policy position paper highlights one of the innovative aspects of the health delivery system, examining the issue of extensive introduction of medical health records to the current practice. Determining the relevant problem, the proposal explores two different types of medical data systems dealing with public and private information. The paper gives the background of the challenge, focusing on aims, sources, and forms of collecting and keeping personal medical information. Analyzing the problem of enhancing information technologies in the U.S. medical practice, the position paper suggests several options and discusses their potential benefits and drawbacks. The extensive introduction of electronic medical records needs thorough consideration. Therefore, social propaganda and privacy policies have been chosen as the most effective steps to be implemented by the U.S. government. Each political decision requires evaluating financial factors stimulating the policy reforms. This proposal will highlight the macroeconomic aspect of the health delivery issue under consideration. Realizing the urgent necessity of the problem, the U.S. authorities have developed the basic legislation supporting the creation of digital storage for personal health information in the United States. Examining the issue, the health policy position paper explores the Health Information Technology for Economic and Clinical Health Act (HIPAA) passed in 2009. The paper studies its key guarantees, such as the right to obtain the data about the use of patients’ personal health data, and the obligation to inform clients about the potential or real leakage of these health details. Moreover, major stakeholders of the electronic medical records policy have been distinguished in the paper. These are patients, doctors, clinics, and providers of IT medical databases. The paper mentions key advantages obtained by these parties. Finally, the essay evaluates the outcome of the suggested policy and dream about the future perspectives of implementing IT technologies in health care delivery.
The Problem
The chief concern deals with the current state of affairs in the health care delivery system. This policy proposal addresses the issue of extensive introduction of electronic medical records that would contribute to the improvement in the healthcare field. The statement is that the government should pay more attention to the legislation and regulation of the process of implementing information technologies in the health care sector instead of leaving this issue for business and private clinics to solve.
Background Information
For several decades, the U.S. healthcare system has been experiencing great transformations, touching its numerous aspects. The issue of collecting and keeping patients’ confidential information is one of the burning challenges nowadays. Launching digital databases is the subject for brisk debates among politics, experts, journalists, and ordinary American citizens. David Cutler notes, “Over the long term, the growth rate of medical costs is driven predominantly by changes in the technological capacity of medicine”. The extensive implementation of digital records would save approximately $78 billion annually. Taking into account the aforementioned benefit of introducing innovative technologies into practice, there is a strong necessity to apply them in the field of the U.S. healthcare system.
Different Types of Medical Data Systems
Medical data systems can be used for public and private purposes, determining the sources of collecting information and goals of its implementation.
There are several sources of acquiring public health information, such as “federally funded national surveys, vital statistics, public and private administrative and claim data, regulatory data, and medical records data”. Healthcare institutions provide the official information obtained from the surveys and official reports on the subject. Private information may be obtained from ordinary citizens personally for their individual needs. The data of this kind urgently demand absolute guarantees of their privacy.
Public health programs involve information received from two types of data systems. The data systems of the first type deal with public medical data, implementing typical approaches. The data systems of the second type are supposed to be used for different aims. Nevertheless, experts may apply those systems in any way. As an illustration of this, the primary goal of vital statistic information is the awareness of the national rates of diseases among the American population. However, the obtained information about the birth and death levels in the USA may be employed for surveillance. The Medicare and Social Security Disability information are used to explore the alterations in the U.S. healthcare field. The information of this kind is freely shared in the digital form, being easily found on the Internet.
Private information about patients requires a more careful attitude of the government, demanding the effective legislation on its keeping absolute protection. Such details concerning patients’ health are to be saved in special databases. Being kept in the written form earlier, clients’ health care data have been transformed into electronic medical records within the last decade.
Electronic Medical Records
Nowadays, launching electronic medical records (EMRs) is becoming the most popular initiative in the health care field all over the world. Nevertheless, in the sector of implementing information technologies in health care, the United States is far behind the world’s developed countries. Nursing personnel has to request entry systems and personal health records for practical use. According to Herrick, Gorman, and Goodman, “only about 17 percent of doctors and 8 percent to 10 percent of U.S. hospitals use EMRs” (2010). These figures demonstrate an extremely narrow utilization spectrum of innovative world experience in the medical practice.
Electronic medical records fulfill numerous functions. Digital records are replacing old-fashioned and inefficient paper notes, informing doctors about their patients’ health. Therefore, the primary and sole goal of EMRs is to retain patients’ health information for their diagnosis and curing. Electronic medical records keep personal information about individuals save, such as the number of their mobile phones and home addresses, their anatomic characteristics like height, weight, and a body mass index. Thereafter follows the medical data. They comprise the information about the preceding medical treatment and cures prescribed for the following period. Information about surgery operations, complications, and improvements are noted in the digital form as well. Being extremely useful, electronic medical records keep medical financial information, such as insurance plans, discharge summaries, and treatment coverage. Patients’ information may be stored in various forms, such as video and electronic files.
Policy Options
Analyzing the issue of extensive implementation of electronic medical records, several policy options, including the predicted outcomes of each alternative, have been developed.
Taking into account all the aforementioned information, several challenges are to be solved in the health care delivery sector. First, people are to be convinced in the safety and effectiveness of medical health records. Therefore, the first policy option is to launch the mass media and corporate propaganda of the EMRs benefits. The wise probation period should be provided to convince people of the effectiveness of digital innovation. On the other hand, such governmental support may be denounced for imposing ideas on independent citizens.
The second policy option is to devise a legislative base to protect the security of personal data. In fact, this task is the prime challenge in the urgent shift from the old-fashioned paper health documentation to the digital variant. The protection of personal data may be provided by suggesting that only authorized persons have access to confidential information. The nursing staff is to be divided into several groups with different level of power. On the other hand, this step would cause several difficulties, such as the shortage of experienced specialists and the increase of expenses concerning the issue.
Poor system design and indexing is the next problem. The third policy option suggests that the authorities initiate grant programs supporting the development and implementation of ‘third platform technologies.’ Currently, computer engineers share ideas about using such innovative tools on individual mobile phones and social websites. Information analysis and the cloud are regarded as a perspective as well. The governmental support of technological advances would increase the U.S. healthcare standards, offering American citizens easy access to medical services. The potential negative side of this alternative may include high costs of the issue.
The greatest challenge of implementing electronic medical records is the poor privacy protection of confidential information about individuals’ health, contacts, and their financial state. People can suffer from mental or fatal diseases. The leak of such data may cause both moral and material adverse consequences for patients, their relatives, friends, and surrounding individuals. The confidential status of personal data requires introducing a wise policy and creating proper legislation to support governmental projects.
The next policy alternative concerns the legal inconsistency in the field of U.S. health care delivery. During the reforms in the medical sector, numerous laws have been adopted. Nevertheless, this legislative base should be systemized and enhanced. The U.S. authorities should provide efficient legislative support to the project, offering all the stakeholders the necessary guarantees.
The next policy option deals with the practical side of the electronic medical records issue. Unfortunately, there are numerous contradictory approaches to the use of terms in electronic medical records. This detail complicates the understanding of the core aspects and makes obstacles for implementing digital information successfully. Therefore, the government is expected to conduct research on a respective level concerning the development of an efficient approach to the issue.
Finally, the system design and indexing leave much to be desired. All these challenges require great costs to be considered. The authorities would be advised to provide support programs for the scientific enhancement of the project.
Analyzing the drawbacks of the last alternatives, the great expenses incurred by the issues happen to present the adverse side of the policy options. In fact, the implementation of electronic medical records needs great expenses to be a success. Nursing personnel and clinics are not expected to get profits from putting their costs into the project. Therefore, the authorities are supposed to tackle such challenges.
Policy Proposals and Recommendations
Addressing the problem of extensive implementation of medical records in practice, it would be recommended to study and implement the propaganda option and introduction of supporting programs for the scientific enhancement of the project.
The launch of electronic medical records meets two key challenges, making numerous health care institutions and clinics reluctant to further enhancement of the digital project. In fact, many pioneering projects cause vigilance, taking many years to overcome it. Scott writes, “Innovation is like traveling in negative. Instead of the familiar entering the foreign system, innovation is the foreign entering the familiar system”. People need a certain time to see that electronic medical records are safe and effective. Therefore, the option of the propaganda policy would be the best remedy under the circumstances. A wise and argumentative propaganda policy will convince an ordinary person that storing their private data in the digital form is convenient and helpful. As a result, patients would believe the nursing personnel and give all the necessary personal information without any doubt.
The second alternative recommended is to further develop the policy of creating suitable conditions for innovations in the field of electronic medical records. EMR systems experienced the introduction of the innovative cloud-based technology that has become extremely popular. According to the statistics, the cloud-based EMT systems market grew at an average annual growth rate of 10.9 % during 2011-2014. The authorities are expected to support this trend, providing national grants for further IT improvement in the field of health care delivery in the United States.
Macroeconomic Factors
The United States has always paid due attention to the health care sector. In the 2000s, the government spent over $3,000 per individual annually. Considering electronic medical records to be a successful initiative, the U.S. authorities provide $27 billion support for its overall implementation in 2009. As a result, many American health clinics started collecting and storing digital information about their patients. For example, the health insurer Kaiser Permanente initiated the implementation of the digital project for about 9 million individuals. Approximately 14,000 doctors and about 159,000 nursing personnel were involved in the reform project. Since 2011, eligible Medicare physicians could receive up to $44,000 over 5 years. Eligible Medicaid physicians could receive up to $63,000 over a 6-year period that could begin as late as 2016 and run through 2021. As one can see, the starting point of introducing electronic medical records was a success.
Nowadays, there is a strong necessity in the health care digital product. According to the statistics, the EMR systems market is experiencing significant growth rate due to several favorable macroeconomic factors, such as people’s growing fascination towards new healthcare technologies and increasing disposable incomes. The elderly are the category most interested in implementing electronic medical records. In fact, older individuals need additional health facilities because of the deteriorating state of their health. The growth in the number of the aged population would lead to the rapid development of the global EMR systems market.
Reacting to market demands, certain initiatives have been made. In 2014, above 70% of all non-federal acute care hospitals introduced a basic EHR with clinician notes. Moreover, 70% of small clinics with less than 100 beds, country-side hospitals, and critical access hospitals implemented a basic EHR with clinician notes. Therefore, the tendency of increasing the implementation of electronic medical records is taking place.
The U.S. authorities’ attention to the issue of electronic health records has made a certain positive effect. In April 2015, 54 percent of all U.S. office-based physicians (MD/DO) have demonstrated meaningful use of certified health IT in the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs. This fact proves the ability of nursing personnel to follow new trends in their professional sphere.
Political Process
The authorities of the United States pay due attention to the development of the national health care system, transforming failed healthcare projects and introducing innovative programs.
By this time, the U.S. authorities have developed a certain legislative base supporting the electronic medical records project. The U.S. government initiated the launch of electronic medical records to practice, passing the Health Information Technology for Economic and Clinical Health Act (HIPAA) in 2009. This legislation provides the standards and requirements for keeping patients’ confidential data in the digital form. HIPAA guarantees customers the right to control their personal health information and impose limits on their sharing and implementation. For example, any person enjoys the opportunity to obtain full information in the written form about implementing and suggesting their personal information to third parties. HIPAA introduces fines for breaking those legislative norms. All the data are to be given within 30 days since the moment of the appeal. All the providers are obliged to inform their clients about data leakages, hackers attacks, and broken databases. Nevertheless, additional legislation should be developed, facilitating the procedure of sharing confidential information. Currently, many providers also express concern about their ability to share information in any fashion without incurring potential legal liability, unless they receive explicit patient permission. Therefore, the team of legislators is expected to adopt effective legislation, taking into account the needs of all the stakeholders.
Patients, physicians, clinics, and IT providers are the stakeholders of the policy concerning the extensive implementation of electronic medical records. Sharing their personal health dates, patients receive the opportunity to get high-quality medical service. Having quick access to patients’ medical information, doctors get the opportunity to obtain the necessary information in a short time. This information would be complete because it excludes suggesting false information due to problems with patients’ memory or routine causes. Moreover, digital information may save patients’ lives in urgent cases when they have no time or capacity to provide vital information. Being the third stakeholder, clinics would enjoy the opportunity to boost the level of their work process and their reputation as well. Finally, providers of IT medical systems for collection and storage of health care information would enhance their opportunities to run business.
Evaluation
The United States has always paid due attention to health coverage, introducing Medicare, Medicaid, and other initiatives. In the 2000s, the United States provided health insurance of two types, such as public and private ones. The demands of modern life generate new requirements to all the economic and social aspects, and to the healthcare field, in particular. Therefore, the U.S. government undertook fundamental reforms in the healthcare field during the last decade. The introduction of electronic health records is one of its most successful initiatives.
The opponents of innovations argue that extensive implementation of electronic medical records has several disadvantages, such as satisfactory privacy protection, significant costs, the lack of well-developed legal base to support it, various approaches to the terminology, poor system design and indexing. Nevertheless, the benefits of this digital project are considered much more significant. Modern society exists in extraordinary conditions, urgently demanding new approaches to ordinary circumstances. Information technologies have become the best remedy in this case. Electronic medical records facilitate the workflow, boosting the quality of medical service at the same time. Introduction of ‘third platform technologies’ in the future decade would considerably boost the quality of medical services and improve the system of health care delivery. The cloud technology for storing information would be the real breakthrough in the field. In order to support this project, it would be advisable that the authorities create suitable conditions for innovations in the field of electronic medical records and broadcast propaganda about the benefits of the issue.
It is the universal truth that the health of the nation is the greatest treasure of the state. Therefore, the U.S. authorities are expected to control all the issues in this sphere.
