Grand Canyon University
Health care delivery in the United States has changed over the last few decades. Technological advancements in health care delivery has improved access to care, care coordination, patient outcomes, and patient safety. This paper will discuss historical perspectives surrounding the delivery of health care, how technology has impacted health care delivery, and how technology has influenced public opinion. Technological advancements have continued to improve patient safety, quality of care, and patient outcomes.
Historical Perspectives on Health Care Delivery
Historically, physicians communicated with patients as they saw fit. There were no standards outside of ethical treatment regarding how physicians and hospitals treated patients. Patients rarely had a voice and did not play an active role in their health care treatment. In 1985, Notre Dame professors Irwin Press and Rod Ganey started a patient experience survey business called Press Ganey. Press Ganey surveys patients for satisfaction with their hospital experiences, and then comparing data between hospitals in the United States (Siegrist, 2013). These surveys reflected the patient’s perception of care in areas such as physician communication, nurse communication, pain management, and discharge instructions. In 2002, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS) began a collaborative effort to research, develop, and test patient experience surveys. These surveys were called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). In 2013, CMS started publishing hospital CAHPS score on the Hospital Compare website. Hospital performance scores from CAHPS surveys account for 30% of hospital reimbursement rates (AHRQ, 2017). Prior to this, patient opinion on their treatment or provider communication was not solicited on a national level. Now patients have a voice on how they are treated by providers and health systems, and CMS has begun to hold providers and health systems accountable for patient satisfaction.
Electronic Medical Record Systems
In the not so distant past, health care providers used paper charts to record and store personal health information. These were often hand-written notes. Poor legibility and penmanship has been associated with medical errors. Paper charts could easily be misplaced or misfiled. Paper charts were often incomplete, inaccurate, and have “minor qualitative advantages” (Stausberg, Koch, Ingenerf, & Betzler, 2003). Chart audits typically only transpired when requested by insurance payers or court subpoenas. Patients feared their personal health information could be lost or stolen. However, when electronic health records became available, patients also feared electronic technology. Today, electronic medical records systems (EMR) are a combination of personal health information, database management system, educational resources, revenue cycle management, information collection, management, and sharing, conformance to legal and financial requirements, disease management systems, population health management, and electronic prescribing tools. EMRs have improved patient safety, outcomes, and lowered health care costs.
Health Information Exchange
Health information technology (HIT) “involves the exchange of health information in an electronic environment” (HHS, 2017). Health information technology, such as electronic health information exchanges, has reduced medical errors and health care costs, improved patient outcomes, improved the quality of care and patient safety, improved patient privacy, and allows health professionals to exchange health information in real time. Health information technology also included advancements for providers to delivery care. This includes evidence-based clinical decision support, computerized provider order entry, chronic disease registries, electronic prescriptions, and telemedicine. Health information technology provides “accurate and complete information” to improve diagnosis and disease management, the “ability to better coordinate” care between medical providers, “securely share information” in seconds, reduces medical errors, and reduces medical costs (AHRQ, 2015). Historically, it could take days, or even weeks, for health information to be exchanged between providers or hospitals. In many circumstances, providers would have to wait for transcription services to be completed before reviewing and signing off on their patient notes. This could delay patient care and increase health care costs from duplicate testing.
Health Care Delivery Forecast
As technology advances in health care, legislation must continue to create national standards to protect patients. Each year, there is new development in health care technology. This includes using EMRs for telemedicine, population and public health management, and identifying at-risk groups for development of disease or lack of healthcare resources. Some people feel that relying on technology may cause a breach in classified or personal information, or identity theft. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a “set of national standards for the protection of” certain health information (HHS, 2013). HIPAA provides standards for health information exchange and to ensure safe and high-quality health care. Protected health information is considered “individually identifiable health information,” including demographic data, “that relates to the individual’s past, present, or future physical or mental health condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual, and common identifiers such as name, address, date of birth, or Social Security Number” (HHS, 2013). HIPAA allows individuals to have the right to review, obtain a copy of their protected health information, and the right to know who has reviewed one’s medical records (HHS, n.d.). Patients now have the right to confidentiality to safeguard information that is gathered in the context of a physician-patient relationship. Patients also have the right to expect their health information is secure to prevent unauthorized access, modification, use, or dissemination of their protected health information. Patient privacy promotes individuality, respect, dignity, and personal autonomy.
Advancements in health care technology has been beneficial to patients, providers, and health systems. Technology has allowed patients to become more involved in their care, have access to their personal health information, and voice their opinion on how they are treated by physicians and health systems. EMRs have improved accuracy and care management. Health information exchanges allow providers to consult and communicate with hospitals and other care providers. Both EMRs and health information exchange technology has improved patient safety, patient outcomes, disease and population health management, and lowered health care costs. Technological advances continue to evolve, bringing positive change to health care delivery.