Subject(s)
American Recovery and Reinvestment Act/trends , Cancer Care Facilities/trends , Communication , Hospitalization/trends , Patient Handoff/trends , Pharmacists/trends , American Recovery and Reinvestment Act/standards , Cancer Care Facilities/standards , Electronic Health Records , Humans , Inpatients , Patient Handoff/standards , Pharmacists/standards , United StatesABSTRACT
EHRs have the potential to support nursing workflow or hinder it.
Subject(s)
Attitude of Health Personnel , Centers for Medicare and Medicaid Services, U.S./standards , Electronic Health Records/standards , Nurses/psychology , Nursing Process/standards , American Recovery and Reinvestment Act/economics , American Recovery and Reinvestment Act/standards , Attitude to Computers , Centers for Medicare and Medicaid Services, U.S./economics , Clinical Coding/standards , Computer Security , Confidentiality/standards , Electronic Health Records/economics , Electronic Health Records/legislation & jurisprudence , Humans , Nursing Process/trends , Organizational Innovation , Terminology as Topic , United StatesSubject(s)
American Recovery and Reinvestment Act/economics , Financing, Government , Medical Informatics/economics , National Health Programs/economics , American Recovery and Reinvestment Act/standards , Health Plan Implementation/economics , Health Plan Implementation/standards , Humans , Medical Informatics/standards , National Health Programs/organization & administration , National Health Programs/standards , Systems Integration , United StatesABSTRACT
Across the USA, health care systems are recognizing the value of integrating behavioral health services and primary care. The Texas Legislature took a unique approach to integration, passing legislation creating a Workgroup to explore key issues, identify best practices, and recommend policy and practice changes. This article situates the Workgroup in a rapidly evolving policy environment, describing the passage of integrated health care legislation in Texas, the Integration of Health and Behavioral Health Services Workgroup that was created by the legislation, and the policy recommendations that emerged from the Workgroup. The article analyzes how the Workgroup process intersected with a changing policy environment in Texas and nationally, opening the door for essential collaboration and partnership. The Workgroup ultimately laid the groundwork for integration's key role in a comprehensive Medicaid transformation waiver designed to expand access, improve population health and satisfaction with treatment, while better managing costs.
Subject(s)
American Recovery and Reinvestment Act/standards , Delivery of Health Care, Integrated/organization & administration , Health Planning/organization & administration , Mental Health Services/organization & administration , Patient Protection and Affordable Care Act/standards , Primary Health Care/organization & administration , American Recovery and Reinvestment Act/economics , Chronic Disease , Comorbidity/trends , Delivery of Health Care, Integrated/economics , Delivery of Health Care, Integrated/legislation & jurisprudence , Health Plan Implementation/legislation & jurisprudence , Health Plan Implementation/organization & administration , Health Planning/legislation & jurisprudence , Health Policy , Humans , Meaningful Use/legislation & jurisprudence , Mental Health Services/economics , Mental Health Services/legislation & jurisprudence , Organizational Case Studies , Patient Protection and Affordable Care Act/economics , Primary Health Care/economics , Primary Health Care/legislation & jurisprudence , Texas , United StatesSubject(s)
American Recovery and Reinvestment Act , Health Care Reform , Patient Protection and Affordable Care Act , Thoracic Surgical Procedures , Access to Information , American Recovery and Reinvestment Act/economics , American Recovery and Reinvestment Act/standards , Delivery of Health Care, Integrated , Diffusion of Innovation , Evidence-Based Medicine , Health Care Reform/economics , Health Care Reform/legislation & jurisprudence , Health Care Reform/standards , Health Services Accessibility , Humans , Patient Protection and Affordable Care Act/economics , Patient Protection and Affordable Care Act/legislation & jurisprudence , Patient Protection and Affordable Care Act/standards , Societies, Medical , Thoracic Surgical Procedures/economics , Thoracic Surgical Procedures/legislation & jurisprudence , Thoracic Surgical Procedures/standards , United StatesSubject(s)
Electronic Health Records/standards , Medical Informatics/standards , Patient Access to Records/standards , Quality Assurance, Health Care/standards , American Recovery and Reinvestment Act/economics , American Recovery and Reinvestment Act/standards , Electronic Health Records/economics , Electronic Health Records/trends , Humans , Medical Informatics/economics , Medical Informatics/trends , Patient Access to Records/trends , Patient Participation/trends , Quality Assurance, Health Care/economics , Quality Assurance, Health Care/methods , Self Care/standards , Self Care/trends , United States , Value-Based PurchasingSubject(s)
Centers for Medicare and Medicaid Services, U.S./standards , Electronic Health Records/standards , Quality of Health Care/standards , American Recovery and Reinvestment Act/standards , Centers for Medicare and Medicaid Services, U.S./economics , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Cost Savings/legislation & jurisprudence , Cost Savings/standards , Electronic Health Records/economics , Electronic Health Records/legislation & jurisprudence , Humans , Information Dissemination/legislation & jurisprudence , Quality of Health Care/economics , Quality of Health Care/legislation & jurisprudence , United StatesABSTRACT
The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals. Specifically, 12 percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals. To advance the creation of a nationwide health information technology infrastructure, federal and state policy makers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals; including such hospitals in state health information exchange programs; and establishing low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers.
Subject(s)
Electronic Health Records/statistics & numerical data , Hospitals/classification , Medicare/economics , American Hospital Association , American Recovery and Reinvestment Act/economics , American Recovery and Reinvestment Act/standards , Data Collection , Economics, Hospital/legislation & jurisprudence , Economics, Hospital/standards , Electronic Health Records/economics , Electronic Health Records/legislation & jurisprudence , Financing, Government/legislation & jurisprudence , Financing, Government/standards , Health Plan Implementation/statistics & numerical data , Hospitals/statistics & numerical data , Humans , Information Dissemination , Legislation, Hospital/economics , Legislation, Hospital/standards , Medicare/legislation & jurisprudence , Medicare/trends , Patient Discharge/trends , Rehabilitation Centers/economics , Rehabilitation Centers/trends , Reimbursement, Incentive/economics , Reimbursement, Incentive/legislation & jurisprudence , United StatesABSTRACT
In enacting the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act, Congress set ambitious goals for the nation to integrate information technology into health care delivery. The provisions called for the electronic exchange of health information and the adoption and meaningful use of health information technology in health care practices and hospitals. We examined the marketplace and regulatory forces that influence HITECH's success and identify outstanding challenges, some beyond the provisions' control. To reach HITECH's goals, providers and patients must be persuaded of the value of health information exchange and support its implementation. Privacy concerns and remaining technical challenges must also be overcome. Achieving HITECH's goals will require well-aligned incentives, both visionary and practical pursuit of exchange infrastructure, and realistic assumptions about how quickly such wholesale change can be accomplished. The use of metrics to show adoption proceeding at a reasonable pace, increased flow of data across parties, and evidence that care is improving, at least in areas with robust systems, will be essential to persuade stakeholders that the initiative is progressing well and warrants continued investment.
Subject(s)
American Recovery and Reinvestment Act/standards , Attitude of Health Personnel , Confidentiality/standards , Electronic Health Records/standards , American Recovery and Reinvestment Act/economics , Computer Security/legislation & jurisprudence , Computer Security/standards , Confidentiality/legislation & jurisprudence , Electronic Health Records/economics , Electronic Health Records/legislation & jurisprudence , Health Plan Implementation/methods , Health Plan Implementation/standards , Humans , Information Dissemination/legislation & jurisprudence , Information Dissemination/methods , Medicaid/economics , Medicaid/legislation & jurisprudence , Medicare/economics , Medicare/legislation & jurisprudence , Reimbursement, Incentive/legislation & jurisprudence , United StatesSubject(s)
Centers for Medicare and Medicaid Services, U.S./economics , Electronic Health Records/economics , Reimbursement, Incentive/economics , American Recovery and Reinvestment Act/economics , American Recovery and Reinvestment Act/standards , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Electronic Health Records/legislation & jurisprudence , Financing, Government/economics , Financing, Government/legislation & jurisprudence , Humans , Medical Informatics/economics , Medical Informatics/legislation & jurisprudence , Reimbursement, Incentive/legislation & jurisprudence , United StatesSubject(s)
Electronic Health Records/standards , Hospital Information Systems/standards , Quality Assurance, Health Care/standards , Technology Assessment, Biomedical/methods , Aged , Aged, 80 and over , American Recovery and Reinvestment Act/economics , American Recovery and Reinvestment Act/standards , Attitude to Computers , Confidentiality/standards , Electronic Health Records/economics , Electronic Health Records/trends , Electronic Mail/standards , Equipment Failure , Geriatrics/methods , Geriatrics/standards , Hospital Information Systems/organization & administration , Humans , Information Dissemination/methods , Male , Physicians/ethics , Physicians/psychology , Physicians/standards , Quality Assurance, Health Care/methods , Quality Assurance, Health Care/trends , Technology Assessment, Biomedical/standards , United StatesABSTRACT
Payers are known to influence the adoption of health information technology (HIT) among hospitals. However, previous studies examining the relationship between payer mix and HIT have not focused specifically on electronic health record systems (EHRs). Using data from the Nationwide Inpatient Sample and the American Hospital Association Annual Survey, we examine how Medicare, Medicaid, commercial insurance, and managed care caseloads are associated with EHR adoption in hospitals. Overall, we found a weak relationship between payer mix and EHR adoption. Medicare and, separately, Medicaid volumes were not associated with EHR adoption. Furthermore, commercial insurance volume was not associated with EHR adoption; however, a hospital located in the third quartile of managed care caseloads had a decreased likelihood of EHR adoption. We did not find empirical evidence to support the hypothesis that payer generosity and other indirect mechanisms influence EHR adoption in hospitals. The direct incentives embedded in the Health Information Technology for Economic and Clinical Health Act may have a positive influence on EHR adoption--especially for hospitals with high Medicare and/or Medicaid caseloads. However, it is still uncertain whether the available incentives will offset the barriers many hospitals face in achieving meaningful use of EHRs.
Subject(s)
Diagnosis-Related Groups/economics , Electronic Health Records/economics , Insurance, Health/economics , Reimbursement, Incentive/economics , American Medical Association , American Recovery and Reinvestment Act/economics , American Recovery and Reinvestment Act/standards , Cross-Sectional Studies , Electronic Health Records/statistics & numerical data , Health Care Surveys , Humans , Inpatients/statistics & numerical data , Insurance, Health/standards , Managed Care Programs/economics , Managed Care Programs/standards , Medicaid/economics , Medicaid/standards , Medical Informatics/economics , Medical Informatics/trends , Medicare/economics , Medicare/standards , Reimbursement, Incentive/legislation & jurisprudence , United StatesABSTRACT
BACKGROUND: Health information technology (HIT)-supported quality improvement initiatives have been shown to increase ambulatory care quality for several chronic conditions and preventive services, but it is not known whether these types of initiatives reduce disparities. OBJECTIVES: To examine the effects of a multifaceted, HIT-supported quality improvement initiative on disparities in ambulatory care. DESIGN: Time series models were used to assess changes in racial disparities in performance between white and black patients for 17 measures of chronic disease and preventive care from February 2008 through February 2010, the first 2 years after implementation of a HIT-supported, provider-directed quality improvement initiative. PATIENTS: Black and white adults receiving care in an academic general internal medicine practice in Chicago. INTERVENTIONS: The quality improvement initiative used provider-directed point-of-care clinical decision support tools and quality feedback to target improvement in process of care and intermediate outcome measures for coronary heart disease, heart failure, hypertension, and diabetes as well as receipt of several preventive services. MAIN MEASURES: Modeled rate of change in performance, stratified by race and modeled rate of change in disparities for 17 ambulatory care quality measures KEY RESULTS: Quality of care improved for 14 of 17 measures among white patients and 10 of 17 measures among black patients. Quality improved for both white and black patients for five of eight process of care measures, four of five preventive services, but none of the four intermediate outcome measures. Of the seven measures with racial disparities at baseline, disparities declined for two, remained stable for four, and increased for one measure after implementation of the quality improvement initiative. CONCLUSIONS: Generalized and provider-directed quality improvement initiatives can decrease racial disparities for some chronic disease and preventive care measures, but achieving equity in areas with persistent disparities will require more targeted, patient-directed, and systems-oriented strategies.