Healthcare Informatics Discussion

Healthcare Throughout the Ages – The Patient in Healthand Disease

Medical care dates back thousands of years

Primitive medical records found in Egypt from 2700 BC

Hippocratic Oath originated in Greece in the late 5th century

American Medical Association (AMA) founded in 1847 to develop standards in medical education, improve public health, establish medical ethics, and advance the study of science

American College of Surgeons (ACS) founded in 1913 to improve patient care through better surgical education and practice

Minimum Standard document created 1919

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Learning Outcome 1.1: Describe the history of healthcare delivery and the evolving role of patients, providers, insurers, and regulators in the delivery of healthcare in the United States.

The practice of medicine has been traced back thousands of years, when disease was thought to be the result of offending the forces of nature, of being possessed, or of offending the gods

Science had little to do with medicine until around the mid-1800s

The first four medical schools in the United States were College of Philadelphia (1756), King’s College (1768), Harvard University (1783), and Dartmouth College (1797) (Shi and Singh, 2008).

The first hospital in the United States was founded by Benjamin Franklin and Dr. Thomas Bond in 1751. It was named Pennsylvania Hospital and is still in existence today

For nearly a century, there was no standard in place to ensure the quality of education of physicians, until, the American Medical Association (AMA) was formed in 1847. the purpose of this organization was to establish standards within the healthcare industry.

There were still need to improve the quality of care and in 1913 the American College of Surgeons was founded to provide better services for surgical patients

Discuss a brief history of medicine, medical care, and healthcare in the United States and the development of associations and hospitals created to improve and ensure quality medical care as well as improve medical education. In the lecture, distinguish between accreditation and licensure. Also, discuss the significant acts that were enacted to improve medical care and patient education, such as the Hill-Burton Act , Healthcare Facilities Accreditation Program (HFAP), and Centers for Medicare and Medicaid Services (CMS).

Have the students access a professional association’s website—American Hospital Association , American Medical Association, or American Osteopathic Association—and report their findings to the class. Or, if the class has a writing component, have the students write a brief paper on their findings.

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Healthcare Throughout the Ages – The Patient in Health and Disease

Early 20th century: Medical facilities were looking to achieve licensure as well as accreditation

Mid 20th century: Private health insurance was introduced as an employment benefit

Late 20th century: Issues with high healthcare costs spurred government involvement in healthcare

21st century: Emphasis switched from treating chronic diseases to prevention

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Learning Outcome 1.1: Describe the history of healthcare delivery and the evolving role of patients, providers, insurers, and regulators in the delivery of healthcare in the United States.

The quality of standards began to grow

Beginning in the early 20th century medical facilities seek to attain licensure and accreditation

Licensure Regulations meets the minimum requirements to practice medicine or provide medical services; but this vary from state to state

Accreditation healthcare facility exceeds the minimum requirements set by licensing agencies.

In the Mid-20th century private insurance plans were introduced. Corporations and businesses started offering health insurance as a benefit of employment.

By this time Social Security was already established for the elderly, unemployed, needs for maternal and child welfare and other underserved individuals

In the late-20th century healthcare costs began to grow out of control. Several entities were developed to assist with the cost of health for instance Quality Improvement Organizations, the Centers of Medicare and Medicaid Services, just to name a few

In the 21st century the objectives switched from treating chronic illnesses to trying to prevent them

Explain the difference between accreditation and licensure. Some state governments became involved in improving medical care by requiring the licensure of practitioners and hospitals as a result of the Medical Practice Act. Accreditation is voluntary assessment by an accrediting agency that proves a healthcare facility exceeds the minimum requirements set by licensing agencies.

Discuss the concept of corporations and businesses offering health insurance as a benefit of employment. Healthcare for the poor, sick, elderly, and mentally disabled, however, continues to be scarce, thus leading the federal government to step in and finance healthcare for underserved populations.

Class discussion: The concept of corporations and businesses offering health insurance as a benefit of employment.

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Healthcare Throughout the Ages – The Patient in Health and Disease

Medical Practice Act required licensure of practices and hospitals

Voluntary accreditation demonstrates that facilities meet or exceed standards

The Joint Commission

Healthcare Facilities Accreditation Program (HFAP)

Licensure is required for a healthcare organization to operate, while accreditation shows commitment to quality

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Learning Outcome 1.1: Describe the history of healthcare delivery and the evolving role of patients, providers, insurers, and regulators in the delivery of healthcare in the United States.

To continue with improving quality of services the Medical Practice Act requires for practices and hospitals to be licensed. This required facilities to become accredited through organizations like The Joint Commission (TJC), formerly known as The Joint Commission on Accreditation of Hospitals, is a voluntary accrediting agency holding deemed status by Medicare. Healthcare Facilities Accreditation Program (HFAP) is a voluntary accreditation program used by the American Osteopathic Association, which, like The Joint Commission, holds deemed status for Medicare.

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Healthcare Throughout the Ages – The Patient in Health and Disease

Social Security Act of 1935

Title XVIII: Medicare’s purpose is to provide coverage for persons 65 or older

Title XIX: Medicaid provides assistance for indigent and/or poor individuals

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Learning Outcome 1.1: Describe the history of healthcare delivery and the evolving role of patients, providers, insurers, and regulators in the delivery of healthcare in the United States.

The most influential and long-lasting change to the US healthcare system came in 1965 with the establishment of Medicare (Title XVIII of the Social Security Act of 1935) and Medicaid (Title XIX of the Social Security Act of 1935). The roots of the legislation stretch back to President Roosevelt’s efforts to rebuild America following the Great Depression.

Medicare’s purpose was to provide financial assistance for persons 65 years of age and over (regardless of financial need), and Medicaid was created to provide financial assistance to poor and indigent populations.

At the end of the section: Have the students answer the Thinking It Through questions and then discuss the answers.

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New Policies Transforming Healthcare

Recently, the US Government has developed healthcare initiatives to increase the quality of care, positive outcomes, and access to healthcare

Affordable Care Act (ACA) designed to provide quality and affordable healthcare

Health Information Technology for Economic and Clinical Health Act (HITECH) passed to increase the use of electronic health records (EHRs), health information exchanges (HIEs), and data analysis

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Learning Outcome 1.2: Outline how new laws and regulations are reshaping healthcare in the United States.

The Affordable Care Act (ACA) is healthcare reform with the goal of improving quality of care and providing affordable healthcare coverage through health insurance exchanges. ACA offers healthcare consumers stable and flexible healthcare coverage. According to the Census Bureau, 15.4% of Americans were uninsured in 2012, and the percentage of privately insured Americans fell from 73% to 63.9% as more people became eligible for the government-run programs Medicare and Medicaid.

The Health Information Technology for Economic and Clinical Health Act (HITECH) is part of the American Recovery and Reinvestment Act of 2009 (ARRA), which was signed into law by President Obama on February 17, 2009. HITECH provisions allocated approximately $32 billion to revolutionize healthcare. This consisted of $30 billion in Medicare and Medicaid incentive payments to physicians and hospitals to adopt and use health information technology and EHRs in ways defined as “meaningful,” as well as $2 billion for programs administered by the Office of the National Coordinator for Health Information Technology (ONC) that supported the standards, infrastructure, and pilot projects for EHR use.

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New Policies Transforming Healthcare

Promoting Interoperability “Meaningful Use”

Stage 1 – Data capture and sharing (2011 through 2012)

Stage 2 – Advanced clinical procedures (2014 through 2015)

Stage 3 – Improved outcomes (2016 through 2018)

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Learning Outcome 1.2: Outline how new laws and regulations are reshaping healthcare in the United States.

There are three stages to Promoting Interoperability Meaningful Use. Each of these stages has specific benchmarks and requirements that must be met in order to receive Meaningful Use incentive payments.

At the end of the section: Have the students answer the Thinking It Through questions and then discuss the answers.

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Health Information Empowering the Patient

The push toward preventive medicine is supported by the American Academic of Family Practitioners’ patient-centered medical home (PCMH) model

Healthcare is approached as a team with the patient, family, and providers working together to care for the patient

Accessing patient information through health information technology (HIT) and mHealth is critical to coordinating patient care efficiently

Patients actively participate in their care by keeping an personal health record (PHR)

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Learning Outcome 1.4: Explain how health information is being used to empower patients.

The patient-centered medical home (PCMH) is a model developed by the American Academy of Family Practitioners for caring for patients with chronic conditions. It has evolved to cover preventive services and involves a team approach to care. The goal of PCMH is to involve the patient as well as the patient’s family or caregiver(s) in the care of the patient. Care is rendered in a team approach among the PCP, the patient/family, and other healthcare disciplines. Health IT plays a very important role in the PCMH for both the physician in the form of access to clinical decision support software and for the patient in the form of a patient portal, where the patient has access to pertinent historical data, such as blood pressure measurements.

The health record kept by a healthcare provider or facility is a legal document and is the property of the hospital. The information in it, however, belongs to the patient. Patients are now more active participants in their own healthcare, and part of that participation means keeping records of their own healthcare through the use of a personal health record, or PHR.

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Health Information Empowering the Patient

The health system in the US is divided into two focal areas

Healthcare, focusing on wellness and prevention

Medical care, focusing on treatment of medical conditions and disease management

mHealth improves healthcare by providing caregivers immediate access to information necessary to manage patients’ health

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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Learning Outcome 1.4: Explain how health information is being used to empower patients.

The US health system has two divisions: healthcare, which focuses on wellness and prevention, and medical care, which would signify care and treatment of medical conditions, or a state of disease, rather than wellness. Both necessitate the concept of coordination of care, patient involvement, and the exchange of health information to improve patient outcomes and quality of care efficiently and effectively. Coordination of care is more organized and streamlined when treatment plans are developed with the input of the healthcare team along with the patient and/or family. Disease management programs can be developed by independent associations, such as the Care Continuum Alliance, or by health insurance companies, federal agencies such as the Agency for Healthcare Research and Quality, or The Joint Commission.

mHealth is the sending and receiving of health information using a mobile phone, mobile device, or other wireless device. Through the use of mobile devices, care is improved because care providers have the information necessary to make critical, time-sensitive decisions without having to go back to the office or hospital to retrieve that information or having the information collected remotely at a patient’s house.

At the end of the section: Have the students answer the Thinking It Through questions and then discuss the answers.

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Chapter Summary

Medical care has a rich history dating back thousands of years. Significant improvements in education, standards, quality of care, and technology have been introduced in the last century.

The Affordable Care Act, Health Information Technology for Economic and Clinical Health Act, and Meaningful Use are recent federal initiatives that are reshaping healthcare.

Healthcare professionals are the key to controlling healthcare costs and reshaping healthcare in the US.

Coordinating patient care involves health information technology, empowering patients, and a group approach to treatment.

Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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Chapter 1 Summary

Before reviewing with the students, have them list two major takeaways and two outstanding questions/challenges from chapter one.

Review with the students:

1. Why there has been increased oversight and regulation in the healthcare industry since the early part of the 20th century.

2. What is meant by informed consent.

3. The difference between accreditation and licensure.

4. Why Medicare and Medicaid are so important in shaping healthcare.

5. The definition of the Affordable Care Act and HITECH and the impact they have had on healthcare.

6. The stakeholders in healthcare and how their roles are being changed by healthcare transformation.

7. The approaches to paying for healthcare.

8. The definition of Personal Health Record (PHR).

Assign the Chapter Review questions for homework.