ABSTRACT
Truly transforming the healthcare delivery and payment system turns on the ability to engage in the interoperable electronic exchange of patient health information across and beyond the care continuum. Achieving transformation requires a legal framework that supports information sharing with appropriate privacy and security protections and a trusted governance structure.
Subject(s)
Computer Security , Information Dissemination , Confidentiality , Humans , PrivacyABSTRACT
Big data holds big potential for comparative effectiveness research. The ability to quickly synthesize and use vast amounts of health data to compare medical interventions across settings of care, patient populations, payers and time will greatly inform efforts to improve quality, reduce costs and deliver more patient-centered care. However, the use of big data raises significant legal and ethical issues that may present barriers or limitations to the full potential of big data. This paper addresses the scope of some of these legal and ethical issues and how they may be managed effectively to fully realize the potential of big data.
Subject(s)
Comparative Effectiveness Research/ethics , Comparative Effectiveness Research/legislation & jurisprudence , Data Mining , Ethics, Research , Research Design , Humans , Patient Participation , Quality ImprovementABSTRACT
Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an overview of the legal framework governing health information, dispels misconceptions about privacy regulations, and highlights how ambulatory care providers in particular can maximize the utility of big data to improve care.
Subject(s)
Ambulatory Care , Data Mining , Datasets as Topic , Ambulatory Care/legislation & jurisprudence , Electronic Health Records , Humans , Privacy/legislation & jurisprudenceABSTRACT
Long-term and post-acute care providers (LTPAC) need to understand the multiple aspects of health information technology (HIT) in the context of health systems transformation in order to be a viable participant. The issues with moving to HIT are not just technical and funding, but include legal and policy, technical and business operations, and very significantly, governance. There are many unanswered questions. However, changes in payment methodologies, service delivery models, consumer expectations, and regulatory requirements necessitate that LTPAC providers begin their journey.
Subject(s)
Long-Term Care , Medical Informatics , Health Insurance Portability and Accountability Act , Health Services Needs and Demand , Humans , Meaningful Use , Medical Informatics/economics , Medical Informatics/legislation & jurisprudence , Reimbursement Mechanisms , Terminology as Topic , United StatesABSTRACT
This paper reviews barriers to clinical and financial integration in services for dual eligibles prior to passage of the ACA, identifies models used by states to integrate care through contract and waiver authorities available to CMS prior to passage of the ACA, describes two new demonstrations proposed by CMS through the Medicare-Medicaid Coordination Office and Innovation Center, and discusses several new models available for consideration by federal and state policymakers. These options draw on experience from existing programs and waivers to provide suggested changes to existing programs, as well as a permanent state plan option for a fully integrated, capitated care model. This model could be made available to states prior to the completion of the demonstration process begun by the Medicare-Medicaid Coordination Office and Innovation Center.
