INFORMATION TECHNOLOGY:INTERNATIONAL CONDITION AND

ISSUES

Charisse Hazel G. De Leon, RN

"Computers are incredibly fast, accurate and "Computers are incredibly fast, accurate and stupid. Human beings are incredibly slow, stupid. Human beings are incredibly slow, inaccurate and brilliant. Together they are inaccurate and brilliant. Together they are powerful beyond imagination.“powerful beyond imagination.“

Albert EinsteinAlbert Einstein

Health Expenditure and Influence on IT

Healthcare Expenditure

• U.S. health care industry spends more than $1.7 trillion per year.

• UK healthcare budget ₤110 billion per year

• Philippines national budget 2008 $27 Billion• 2008 Philippines Gov’t spent P28 Billion on healthcare• The DOH budget for Health Facilities Enhancement Program -

P180 million in 2007 • P1.66 billion in 2008 (822% increase)• P2.03 billion in 2009 (22.29% increase)

State of IT in the US

U.S. Making Grants for Healthcare IT, Job Training Friday, 12 February 2010

The Obama administration is announcing Friday that it will award $975 million in grants to bolster the use of information technology in the healthcare industry.

The grants, designed to help states and healthcare providers increase automation and adopt electronic health records (EHR), are part of the $862 billion economic stimulus legislation passed by Congress last year.

State of IT in the US

• Health and Human Services Kathleen Sebelius is awarding $761 million to 40 states, or state-selected healthcare providers, and 32 non-profit organizations to help adopt new information-sharing technology. The funding will make healthcare IT available to over 100,000 hospitals and primary care physicians by 2014, according to the administration.

UK – Connecting for Health

The massive IT program's "scope,

The massive IT program's "scope,

vision and complexity is wider and

vision and complexity is wider and

more extensive than any ongoing or

more extensive than any ongoing or

planned health care IT program in the

planned health care IT program in the

world, and it represents the largest

world, and it represents the largest

single IT investment in the UK to

single IT investment in the UK to

date.”date.”

Not all projects on target

• Warning over fresh NHS IT delays• The introduction of computerised NHS patient records

in England could be hit by more delays, MPs warn. • The Committee on Public Accounts has thrown fresh doubt

on a 2015 deadline for the ambitious £12bn project. • Its chairman said that even in trusts already using parts of

the system, staff were unimpressed and the cost to the NHS was uncertain.

• Project started in 2002 and was due to complete in 2010. Revised completion date is 2014-15.

•

Problem with any long-term project is

Problem with any long-term project is

that it is superseded before it is

that it is superseded before it is

complete, so there must be an ongoing

complete, so there must be an ongoing

budget for upgrade.

budget for upgrade.

Other Issues:

• Cost – not all countries can afford the level of spending of US or UK

• Time – many plans aim at 2015 and beyond• Many hospitals implement alone• Standards:• Many different systems available• Many different organizations – limited discussion• No global standard for data

HEALTH CARE IMPACT ON NURSING HEALTH CARE IMPACT ON NURSING INFORMATICS PRACTICEINFORMATICS PRACTICE

Charisse Hazel G. De Leon, RN

DEFINITION:

• Policy - course of action that guides present and future decisions

• Health care policy – established on local, state and national levels to guide the implementation of solutions for the population’s health needs

What is the impact of Health care Policy on Nursing Informatics?

IMPACTS AND ISSUES:

• Nursing Shortage and Nursing Informatics• Patient Safety• National Initiatives and Nursing

Informatics

ISSUE #1:Nursing Shortage

• In 2002 HRSA’s National Center for Health Workforce Analysis = a shortage projected for 2007 had already occurred by 2000= causes projected: older nursing workforce, increased number of graduates with associate degrees than baccalaureate degrees, availability of more attractive career opportunities for women, decreased interest in nursing as a career, and difficult working environments

Solutions to the Problem:

• Shortened program lengths and accelerated programs for baccalaureate degrees by schools and colleges of nursing

• Advocacy for increasing federal funding for program expansion, student loans, scholarships, and incentives by nursing organizations

• AAN advocacy of IT systems to support care and lighten the workload of nurses; development of a multiphase project to develop IT; IT as a marketing tool for nurses

IT as the Solution: Benefits• decision support technology, streamlined, and

integrated documentation support, measurement capability built into systems for determining intensity of care and outcomes, and workflow management tools

• use of portable and handheld devices, incorporate Internet capability to overcome distance barriers of care and improve access to knowledge acquisition

IT as the Solution: Benefits• Wireless technology and personal digital

assistants (PDA) that support nurses’ workflow • Bar-coding of medications, use of speech

recognition, and fine-tuning the user interface of systems to support nurses

• Integration of clinical data repositories, multidiscipline documentation, and point of care devices help nurses share and access information in their work environments

ISSUE #2:Patient Safety

According to “A Safer Place for Patients” (National Audit Office, HC 456 Session 2005-2006)

• The most common patient safety incidents in hospitals after patient injury (due to falls) relates to medication errors, record documentation error and communication failure.

ISSUE #2:Patient Safety

• IOM report (1999)Between 44,000 and 98,000 patients die each year from medical errors.

• Surveys confirm that concern for patient safety is the biggest factor driving IT (Anderson, 2004).

• Over 600 participants in Health Data Management’s annual CIO survey (2004), list prevention of errors as the main reason for increasing IT budgets.

IT as the Solution: Benefits

• Computerized physician order entry (CPOE) systems reduce medication and communication errors

• Reduction of medical errors and improvement of quality and efficient care as advocated by Leapfrog Group, National Alliance for Health Information Technology (NAHIT), and Markle Foundation

• Clinical automation/information system

ISSUE #3:National Initiatives for Informatics

• Executive Order for National Interoperable Information System

• National Health Information Infrastructure• Health Insurance Portability and

Accountability Act (HIPAA)• National Agenda for Nursing Informatics• Telehealth implementation

Executive Order for National Interoperable Information System

• ‘Incentives for the Use of Health Information Technology and Establishing the Position Coordinator’ (2004) by Pres. George W. Bush states:a.1 establishing a national health information technology coordinator positiona.2 developing a nationwide interoperable health IT infrastructure that will reduce medical errors, improve quality, and communication of information and reduce healthcare costs

Executive Order for National Interoperable Information System

a.3 developing, maintaining, and implementing a strategic plan for implementation of interoperable health IT in both public and private sectors

*All informatics professionals will need to help health care workers accept IT and push for implementation of CPOE.

National Health Information Infrastructure (NHII)

• A 3-staged process of national voluntary initiative intended to improve the effectiveness, efficiency, and overall quality of health and health care in the United States

• Vision: development of a comprehensive, knowledge-based networks that integrate clinical, public health, and personal health information to improve decision-making by having information available to providers

Health Insurance Portability and Accountability Act (HIPAA) - 1996

• Aim: Improve public and private health programs by establishing standards to facilitate the efficient transmission of electronic health information

• Designates financial penalties for noncompliance with standards related to specific transactions; it also gives the patients permission to review and amend their medical records

• IT must be designed to comply with Title II of the Act

Health Insurance Portability and Accountability Act (HIPAA) - 1996

• HIPAA requires the DHHS to establish national standards for electronic health care transactions; for national identifiers for providers, health plans, and employers; and for the security and privacy of health data (DHHS, 2003).

• *Privacy rule – published in December 2000 and compliance date of April 14, 2003; it requires health plans, health care clearinghouses, and health care providers to protect and guard against the misuse of identifiable health information

National Agenda for nursing informatics

• The nursing workforce has continued to be deficient in informatics skills

• Solution: DN convened the National Nursing Informatics Work Group (1997) to make recommendations to the National Advisory Council for Nurse Education and Practice (NACNEP) for setting the nation’s nursing informatics agenda (NIA) for nursing education and practice, aiming to identify nursing informatics needs

• Five key directions for informatics in nursing education and practice:

• Educate nursing students and practicing nurses in core informatics content• Prepare nurses with specialized skills in

informatics• Enhance nursing practice and education through

informatics projects• Prepare nursing faculty in informatics• Increase collaborative efforts in NI

Telehealth: Underutilization and Issues

• Telehealth remains to be an underutilized tool for nursing and NI

• Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration

• During the 2003 – 2004, the federal government has spent about $88 million on telehealth projects (Telemedicine and Telehealth Grant, 2004).

Telehealth Issues:

• Disjointed development, research, demand, and investment resulting in a small telehealth market

• Independence of telehealth from a national strategy or effort

• Significant disconnection between telehealth and informatics

Telehealth Issues:

- organizations are not entirely close with each other e.g. American Telemedicine Association (ATA) and American Medical Informatics Association (AMIA)- documentation of telehealth events has frequently been independent from IS

• Reimbursement, licensure, and security issues

- Solutions to reimbursement, licensure and security issues: • HIPAA regulations regarding privacy issues and security

standards• National Council of State Boards of Nursing (NCSBN)

issuance of mutually-recognized state-based license• Implementation of the Balanced Budget Act (1997) which

mandated the first national reimbursement policy of telehealth services for Medicare recipients

• Implementation of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 which increased usage of telehealth services

Telehealth Issues:

• Delivery of telehealth services across state lines- due to federal laws implemented per state- Solutions:

• OAT and CTL assembly to discuss options for eliminating interstate licensure barriers that impact telehealth practice