The government has an important role to play in improving health care quality, reforming payment processes, and reducing barriers of electronic health record (EHR) implementation. This is especially important since “U.S. health care costs [are] at 17 percent of the gross national product and rising and forty-six million Americans [are] uninsured” (Wager, Lee, & Glaser, 2013, p. 189). Some of these increased health care costs are due to medical errors and medication errors. The landmark study To Err is Human: Building a Safer Health System, reported “that as many as 98,000 people die in any given year from medical errors that occur in hospitals” (Institute of Medicine, 2000). In order to decrease health care costs, the government needs to invest in the public health with early disease prevention, improve health care quality by decreasing medical errors, ensure health care organizations are meaningful users of their EHR systems, and reform the health care payment system.
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One way the government can help improve health care quality is through the investment in public health initiatives. “Public health promotes the welfare of the entire population, ensures its security and protects it from the spread of infectious disease and environmental hazards, and helps to ensure access to safe and quality care to benefit the population” (Minnesota Department of Health, n.d.). Early prevention of health care issues can improve the overall health of the community and help decrease health care spending in the long run. If the public health departments are allocated the funds for adequate health care technology, they will better be able to track the trends of the health care issues faced in their communities and be able to better treat and serve their patients. For example, if the health department had quality health care data that showed a majority of their patient population had complications due to diabetes, they could focus their efforts on education and prevention of diabetes related illnesses and complications.
Another role of the government to help improve health care quality is to help determine ways to prevent and decrease medical errors. To Err is Human: Building a Safer Health System recommends that the government “create sufficient pressure to make errors costly to health care organizations and providers, so they are compelled to take action to improve safety” (Institute of Medicine, 2000). One approach organizations and independent providers can utilize to help decrease medical errors is through the adoption of an electronic health record system. To help encourage the adoption of the EHR the government enacted the Health Information Technology Economic and Clinical Health (HITECH) Act and established the Medicare and Medicaid EHR Incentive Programs. Not only did these programs provide organizations with incentives for the adoption of EHR systems, but they also meant organizations can incur penalties if they fail to meet meaningful use requirements of the EHR system. An organization acquiring an EHR is not enough, they must actually utilize the system in a way that helps improve efficiency, decrease medical errors, and helps to improve patient outcomes and overall quality of care.
The use of an EHR can help improve overall patient safety and help decrease medical cost. Most EHR systems utilize some type of clinical decision support, which can assist the health care provider in providing safer health care for patients. The clinical decision support can help improve overall health care quality because it includes “safety features such as allergy alerts, drug-drug, drug-food, and drug-disease interaction checks, can suggest safe medication dose ranges and intervals, [and] can guide users in implementing clinical practice guidelines and care pathways” (Connelly, 2019). To help improve health care quality, the government should require that all institutions utilize this safety feature. The clinical decision software is not only best for the patient and their safety, but it can help reduce health care spending by alerting physicians of duplicate orders. For example, a provider may order for a patient to be given a pneumonia vaccine not knowing the patient had already been immunized. If the provider isn’t utilizing a clinical decision support system the patient could receive the vaccine again and have to incur that charge again, but the use of the system would notify the provider that this is a duplicate test and is not necessary.
To ensure quality health care is provided to everyone, the government should assist all health care organizations and independent health care providers in implementing an electronic health record. “The cost of EHR implementations can range from $15,000 to $50,000 per provider” (Wager, Lee, & Glaser, 2013, p. 142) and not all health care organizations or private medical offices can incur this cost. The US Federal government attempted to offset some of this burden by funding Regional Extension Centers (RECs) to assist small rural practices that lack IT expertise in the selection and implementation of an EHR. However, the development of the RECs has not been sufficient as many places still lack a functional EHR system. One way to combat the problem many organizations face with EHR implementation would be for the government to develop a comprehensive system that health care organizations could buy at a fraction of the cost, as long as they met predetermined quality care outcomes. This government developed EHR would not only assure all patients were receiving safe quality care since the providers would have timely access to patient information, but it would be easier for the government to obtain health care data and statistics to easily measure population health outcomes.
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The utilization of electronic health records is not enough to combat the rising costs of health care. Reform to the payment process is also needed. Historically, payment has been primarily on a fee-for-service basis. With fee-for-service payment “providers are rewarded for volume and for conducting procedures that are often more complex, when simpler, lower-cost, better methods may be more appropriate” (Wager, Lee, & Glaser, 2013, p. 189). This type of payment does not prioritize patients’ best interest and leads to increased spending with a higher risk for error. Additionally, payment process reform is needed as “most third-party payment systems provide little incentive for a health care organization to improve safety, nor do they recognize and reward safety or quality” (Institute of Medicine, 2000). Patient safety should be first and foremost and the payment process design should prioritize good patient outcomes. One way to ensure that patient safety and quality healthcare is at the forefront is by the utilization of pay for performance (P4P). P4P programs make payments to HCOs and providers based on performance measures such as: “clinical quality and safety, efficiency, patient experience, and health information technology adoption” (Wager, Lee, & Glaser, 2013, p. 193). The P4P model ensures that patients receive quality health care while also helping to cut down the rising health care cost by making providers practice in a more efficient manner.
- Connelly, T. P. (2019, July 29). Computer Provider Order Entry (CPOE). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470273/
- Institute of Medicine (US) Committee on Quality of Health Care in America. (2000). To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK225182/
- Minnesota Department of Health. (n.d.). Government’s Responsibility for Public Health. Retrieved from https://www.health.state.mn.us/communities/practice/resources/chsadmin/mnsystem-responsibility.html
- Wager, K. A., Lee, F. W., & Glaser, J. P. (2013). Health Care Information Systems: A Practical Approach for Health Care Management. San Francisco, CA: John Wiley & Sons.
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