Role of Healthcare Law in Regards to Informatics 1

Role of Healthcare Law in Regards to Informatics

Timothy C. Lentz
HCM500, 14TW3 - Southern New Hampshire University















ROLE OF HEALTHCARE LAW IN REGARDS TO INFORMATICS 2
Healthcare Law and Informatics
Most people today associate healthcare law only with the recently adopted Affordable
Care Act, but healthcare law is not a new institution. Healthcare law in the United States dates
back to the early 19
th
century (Palmer, 1999). Along with the growth of healthcare law in the 19
th

century was the growth of information technology. In the 1960s, it seemed that the needs of
healthcare law and the abilities of information technology seemed to comingle for the first time.
It was at this time that Medicare and Medicaid were enacted. Alongside the enactment of these
programs, mainframe computers were commercially available as well as the ability for
centralized processing (Rosenthal, 2010). The first IT in healthcare took the form of
administrative and financial information systems. Medicare and Medicaid in conjunction with
other legislation continue to drive further efficiencies in healthcare IT throughout the next
decades and still today.
Growth in the past 100 years in the healthcare field has been phenomenal. The growth of
IT in the past 100 years has also been phenomenal. However, the growth of IT has not been equal
in healthcare as it has in other sectors. This has been credited partially to the fragmented nature
of the healthcare industry (Kudyba, 2010). Healthcare is made up of many different entities that
bill separately, are funded separately, and look to different policies and procedures for guidance.
This fragmented nature creates the need for all IT to speak together from numerous different
sources. This communication challenge requires standardization of software or vendors, which in
turn could create this lag in the use of information technology in healthcare. In addition to this,
the use of paper for charting, prescriptions, orders, etc., have been very intertwined in the culture
and needs of healthcare. This paper culture along with HIPAA concerns made the paper
method more appealing and could have also created delays in IT in healthcare, with fears of
ROLE OF HEALTHCARE LAW IN REGARDS TO INFORMATICS 3
patient privacy and transfer of patient information still a topic in todays EHR discussion. This
lag of implementation of IT in healthcare is important to note when reviewing the state of
healthcare law in regards to informatics. The correlation between the laws being implemented
and the growth needed for health informatics to catch up with informatics in other industries can
easily be seen through the recent legislation.
One recent legislation that clearly shows this correlation with healthcare informatics
offers incentive payments for those using electronic health records in a meaningful way. This
legislation, passed in 2009 within the American Recovery and Reinvestment Act, is titled the
Health Information Technology for Economic and Clinical Health (HITECH) Act. This act
requires not only that electronic health records be in use to be eligible for the incentive
payments, but that the use is meaningful and the efforts continue to grow (Kudyba, 2010). This
legislation could not be in place without the accompanying healthcare informatics technology. It
cannot be stressed enough that informatics, with respect to this legislation, will either make a
healthcare system pass or fail. To analyze this more, one of the meaningful use objectives set by
the law will be reviewed.
Stage 1 of 3 of the HITECH Act requires that a hospital meet 13 core objectives. All of
these objectives are related to electronic health records, and many provide a lot of opportunity to
provide additional patient data. This patient data will be within the electronic health record
system and will be able to be correlated to demographics, diagnoses, etc. In turn, this valuable
patient data will allow the eligible professional/hospital to be more efficient, possibly improve
patient outcomes, reduce cost, and increase patient satisfaction (create an improved system).
One example of an objective that has the opportunity to provide this valuable information
is Measure 1 of 13, CPOE for Medication Orders. This objective measure states, More than 30
ROLE OF HEALTHCARE LAW IN REGARDS TO INFORMATICS 4
percent of all unique patients with at least one medication in their medication list admitted to the
eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have at least one
medication order entered using CPOE (Centers for Medicaid & Medicare Services, 2013). This
example illustrates the growth of health informatics due healthcare law, and in turn the ability to
mine this data to find efficiencies. First, to fulfill this requirement the information technology
capabilities must be expanded utilizing new equipment (i.e. computers, mobile devices), new
integrated consistent software and/or vendors, and education/management of implementation
processes and use. This up-front growth will result initially in the ability to fulfill the incentive
requirement of 30% of unique patients utilizing the technology for at least one medication. Other
immediate benefits would be the possible decrease in errors due to handwritten orders, and
decreased waiting time for orders to be filled. A secondary benefit, more directly applicable to
informatics, would come after the successful implementation of this technology. The utilization
of this new technology will result in the generation of data that will be able to be analyzed for
many different uses. For instance, a lab being ordered can be correlated to the findings of a
particular diagnosis. This data over time would allow for further analysis and the creation of an
improved system, and possibly aid in the selection of a certain lab when suspecting that
particular diagnosis.
The measure studied is just one example of the meaningful use measures required by
the HITECH Act. The 13 other measures required in Stage 1 are just as important for similar
reasons, and are mutually dependent upon each other. Each of these have the requirement to
grow information technology in some way, and in turn will create computable data that can be
utilized for further analysis. The process of analyzing and reporting the successful fulfillment of
ROLE OF HEALTHCARE LAW IN REGARDS TO INFORMATICS 5
the requirement itself is a separate challenge for informatics, and will be discussed in further
detail later.
Another program that is directly reliant on the growth of health informatics is the
National Patient Safety Goals Plan put together by the Joint Commission. The first set of goals
were published by the Joint Commission in 2002 and was made effective in 2003 (The Joint
Commission, 2011). The Patient Safety Advisory Group is responsible for analyzing the high risk
areas established over the previous year and adding any goal(s) or element(s) of performance that
will aid in the improvement of processes to reduce the risk of the accredited organization in these
specific areas. These National Patient Safety Goals require the help of accurate patient
information at two different times.
First, the Patient Safety Advisory Group relies on patient information from accredited
organizations to establish the high-risk areas that need improvement. These goals are very
specific to an individual procedure and/or diagnoses. In example, in 2012 one additional
National Patient Safety Goal was approved. This goal states, Implement evidence-based
practices to prevent indwelling catheter-associated urinary tract infections. (The Joint
Commission, 2011). In order for the Patient Safety Advisory Group to recommend this goal for
inclusion in the National Safety Patient Goals, there needed to be data to support the claim that
this is a critical risk within the accredited organizations. Locating high-risk areas can be vital to
the improvement of care, and the determination of these goals can only be as accurate as the data
from which these determinations are made. It is for that reason that the data received to make this
determination is very important to the improvement of healthcare.
Next, the Joint Commission relies on patient information from accredited organizations to
analyze whether or not the National Safety Patient Goals are being achieved. The Joint
ROLE OF HEALTHCARE LAW IN REGARDS TO INFORMATICS 6
Commission provide a best practice to fulfill these goals, but does not implicitly explain how to
show achievement of the goal. This analysis of achievement of these goals is similar to the
challenge to show the data needed to illustrate the achievement of the goals in the HITECH Act.
The process of analyzing the patient data to confirm that the goals of the specific
legislation or program are being met is a different challenge in itself. The HITECH Act spells out
clearly how to calculate the data for the core objectives. This process for the purpose of this Act
is referred to as Attestation. Even though the calculation needed for attestation is spelled out, the
data needed to calculate this result is not necessarily the standard data to achieve. Revisiting the
previous example given for the HITECH Act, the Stage 1 Objective, CPOE for Medication
Orders, provides that the requirement is, More than 30 percent of all unique patients with at
least one medication in their medication list admitted to the eligible hospitals or CAHs inpatient
or emergency department (POS 21 or 23) have at least one medication order entered using
CPOE (Centers for Medicaid & Medicare Services, 2013). To calculate this percentage, specific
numerator and denominator definitions are provided. For this specific example, in order to attain
the values needed, the hospital has to document the number of all unique patients admitted to the
hospital within the EHR reporting period with at least 1 medication on their medication list. They
then need to calculate the number of patients from the above that have at least one order input
using CPOE, without counting multiple orders from a single patient. The point of reviewing the
specific example above is to illustrate that each objective has detailed data needs. The
information needed for this verification of compliance may be independent of the information
received from achieving the objective in itself. This is important information for the healthcare
organization to be aware of, as added analysis and data tracking will be necessary, which could
come at additional cost. However, the cost could be even greater if the objectives or goals are
ROLE OF HEALTHCARE LAW IN REGARDS TO INFORMATICS 7
met, but the correct data was not tracked to verify the achievement. The same analysis is needed
for the National Patient Safety Goals. The difference for these goals, is that the data needed is
less specific and the achievement of the goal must simply be illustrated through the data
achieved.
Through the analysis of current healthcare law in regards to informatics, it is apparent
that there are many improvements to be made in order to make the current EHR and health
informatics systems efficient. The current healthcare law has many individual requirements, but
if these requirements are thought of as mutually exclusive, the efficiencies of a comprehensive
electronic health record system will be lost. As each of the objectives and goals are reviewed, it
becomes more apparent that the most efficiency can be gained if the EHR system and data
collection can grow as a whole. Approaching these requirements with a system-wide (or even
perhaps an industry-wide) approach will maximize the patient data received, and will allow for
the greatest amount of data mining for the purposes of creating an improved system. The up-
front effort seems daunting, as it requires a change in processes and possibly the culture of
healthcare altogether. However, the rewards for setting up a comprehensive EHR and health
informatics system is much greater than any incentive. In fact, the data received from all of the
computable patient information will be priceless and the possibilities for continual efficiency and
growth only as limited as the dedication to analyze the information received.





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References
Rosenthal, Paul, History and Evolution of Healthcare Information Systems [PPT document].
Retrieved from Lecture Notes Online Web site:
http://instructional1.calstatela.edu/prosent/CIS%20581/chapter4.pptx

Palmer, Karen, (1999). A Brief History: Universal Healthcare Efforts in the US. Retrieved from
http://www.pnhp.org/facts/a-brief-history-universal-health-care-efforts-in-the-us

Kudyba, S.P. (2010) Healthcare informatics: Improving efficiency and productivity
Boca Raton, FL: CRC Press

The Joint Commission, (June 2011). Facts about the National Patient Safety Goals. Retrieved
from http://www.jointcommission.org/assets/1/18/National_Patient_Safety_Goals_6_3_111.PDF

Centers for Medicaid and Medicare Services, (April 2013). Eligible Hospital and Critical Access
Hospital Meaningful Use Core Measures. Retrieved from http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/downloads/1_CPOE_for_Medication_OrdersEH.p
df