English Subtitles for HSA4191 Chapter 2 & 3 Ton Narrated



Subtitles / Closed Captions - English

hello everyone and welcome back to fundamentals of health information

technology this is HS a 4191 my name is Steven Tom and i'm your instructor for this course today we're going to start lecture number to this covers two chapters in your textbook information systems for healthcare management and chapter two is entitled external environment in chapter three is entitled government policy healthcare reform so you see that those two are very tightly deeply related so we'll cover them both in one chapter 41 lecture so let's go

ahead and get started so again chapter two is entitled the external environment and we're looking at the external forces external to the healthcare organization that really shapes and dictates how the organization operates in our first section titled overview get a relatively concise review of chapter one that summarizes the current healthcare challenges that's really driving healthcare reform today again those being the generalized broad

organizational changes the pursuit of evidence-based medicine are challenges with access to health disparities of the poor quality of healthcare and medical errors that we experience in healthcare today and the number one driver of course and healthcare reform being the unacceptable high cost of health care when presented with perhaps a new term your healthcare triangle i have that in italicized and in red and healthcare triangle describes the three

cornerstones of healthcare these being the cost the quality and the access corner stones of healthcare and the reason this forms a triangle is because quality access and costs are inter-related meaning that if you were to modify any one of those criteria you would certainly have an effect on the other two for example one of the solutions and one of the goals is to reduce costs in health care but if we keep for example access constant if you

reduce cost you almost definitely run the it's got producing quality as well how else would you be able to do is cost the same holds true for access if you want to reduce costs and hold quality constant more than likely you're going to see a reduction access to healthcare so the idea again we have these three cornerstones of healthcare its cost quality and access this forms the healthcare triangle and achieving goals

in one of those any of those child cornerstones would have an effect on the other two typically of the goal in one leads to the reduction in the other two so again this is you overview section and my lectures go in sequence with the book we have a review of the current healthcare challenges and the introduction to the term health care triangle and you hear that term used quite a bit in discussions regarding the

health care system moving into the next section this is healthcare triangle and are reminded that the healthcare travel is comprised of three cornerstones of cost access and quality and that's achieving goals in one of those corner stones may not achieve goals in the other two facts do their deep dependency on one another typically improving of one means the compromises requiring one or both of the

main two that really is the challenge of the healthcare triangle is to find a balance in which we can minimize costs but maximize access and quality the next important . i have on here is the commonwealth fund this is an independent private foundation really aimed at improving healthcare and they performed a number of studies and provided number reports are appropriately entitled why not the best where details why the United States is not the best country in

terms of its healthcare system in 2013 i believe is the year 2013 commonwealth fund did a study with 11 nations including Australia Canada France Germany the Netherlands New Zealand Norway Sweden Switzerland the United Kingdom and United States and 49 states i came in last place number 11 out of 11 and this isn't the first time it also came in last place and Justin and 10,000 726 until a new four editions of the previous reports i doing a graph graphic

from the Commonwealth on the next slide and take a look at that in just a second but you know this clearly demonstrates that the u.s. it's not the best trip of healthcare despite the fact that we spend the largest percentage of any other country in the world on of our gross domestic product on on healthcare and looking at all the domains that was assessed in this report the average US score and although mates across all the debates was about 66 out of

so we're looking at my straight scale an academic terms of 66 of the D so the US healthcare system is raining addy sprayed a relative to the healthcare performance is going to want to the next line where we have a graphic we can talk about some of the specific performance measures on that slide so courtesy of the Commonwealth report which is very appropriately entitled why not the best we have this graphic here and as mentioned before the United States falls

in last place number 11 of 11 but we get some more details specifics as to which metrics were falling which which metrics were failing and in last place for you get your attention to the upper left-hand graphic their country rankings and we see the color scheme the dark blue color that represents the top two in that category and then the middle blue-gray represents the middle of performance rankings and that likes a blue light gray color being a little the

bottom two for those performance ranking so again United States number 11 of 11 in terms of the overall rankings we see that there is the last place but if you look at the you know that the left-hand column we also see access efficiency equity and healthy life so in all of those we see number 11 and that represents our position last place in terms of timing and costs related of problem of issues related to access number 11 josé of efficacy number 11

last place in terms of equity number 11 last place in terms of healthy lives the the livelihood of the population number 11 last place so we're not doing very well okay but aside from that i do want to point out that you know as it pertains to health information technology this type of ranking would not be possible if not for performance data and performance data and the only way to really capture performance data is with the aid of health information

technology so no producing this level of transparency and again transparency being a key driver for health care change transparency will lead to the adoption of HIV systems we know that it was quite embarrassing to be the most powerful country in the world and to bring last terms of our healthcare system and not just by the Commonwealth report other independent organizations have ranks of our healthcare system the World Health

Report being one and of the hundred ninety total countries we fall somewhere in 30 so with a low thirties in fact I think it's 36 or 37 on well below some third-world countries so we have a lot of improvements to make begin regarding health information technology as these systems get adopted we will be able to capture and analyze report on performance metrics more

appropriately and it's so doing we may be able to find out where exactly following short so that we no longer are in the last place rankings hopefully very soon we can be more in the middle and hopefully in the top two sometimes very near future but we have a lot more to do it's going to be health information technology that's going to allow us to have a transparency to see what we need to improve on clearly we see we have

issues with access efficiency equity just healthiness of our population so more about health care class we know that's a cost continue to grow that's been growing every year since healthcare started I 2010 we reached a high of two point six trillion dollars for national health expenditure which is approximately eighty percent of our gdp and this is eighty percent of the world's largest economy we have the highest percentage of our gross domestic

product spent on healthcare again the largest percentage of the world's largest economy spent on healthcare now the rate of growth of our national expenditure actually exceeds the rate of growth of the GP this is very problematic I really can't continue although this is a historical trend it has a continue this way throughout history regarding the economic times regards to the

administration brown Susan president the president seat pounds of its republican or democratic on health care expenses continue to go out and rate of growth exceeds the rate of growth of e gross domestic product gives us are relatively a small interesting breakdown of why the national health expenditure has grown so much into four categories we have a population growth clearly we're spending more because we have more people 44-percent due to

population growth than inflation 37.3 percent staggering $PERCENT increase and as to why health grants as cost so much and then higher prices so this is not because of inflation population but just higher prices alone medical services costing more this is 25.6 percent of the group and then are really income increases this means that we're spending more on health care because we have more money to spend on health care of this accounts for 22.4 percent of the growth

all in all were spending way too much on healthcare some text actually have this as high as twenty percent of gdp in our book as it to us ten eighty percent of GDP and this percentage in some cases is double sub triple other industrialized countries on healthcare and again the disparities that we're spending so much on healthcare but we're not getting the value of our expense if the quality was the same quality was we're spending the most in the best healthcare no disparity

spending the most unhealthy beginning subpar quality that's the discrepancy that's the problem going into the next section quality of care i want to connect this back to the previous line healthcare costs we have this on discrepancy between healthcare cost and quality of care again we spend the largest percentage of our gross domestic product on healthcare more than any other country our world and we do not have the highest quality . as we've seen

before in fact the worst quality care by many forms metrics so this action quality of care of we are reminded of the Institute of Medicine 1999 report to err is human we're details that medical errors are leading cause of adverse health events in our country ninety thousand deaths preventable deaths occur each year in hospitals and these medical errors are cause of a broader burden to society as

a whole trip costs but well before 1999 quality concerns actually started with an individual named non-abelian who polish number of articles and books on the subject of healthcare quality an article in 1966 as early as $MONTH 1966 entitled be evaluating the quality medical care a book in 1980 called the definition of quality and approaches to its assessment and then look into other two very recently

introduction to quality assurance in healthcare and always have been quite a foundational in assessing the quality of assessing and improving the quality of healthcare and daughter Betty and had presented a number of observations really pertaining to the decision challenge and record-keeping and this is a little before electronic medical records for mainstream one of the points that don't know Betty and made was that the completeness of Records is critical

to quality of care and really was hitting that we need it means to accurately store retrieve and present comprehensive medical information to be able to provide high-quality care in other words is hinting that we need health information technology last piece of this action is the introduction to the domains of quality and usually 60 minutes of quality from the patient perspective or patients

centered remains of quality of these being a patient safety that healthcare should be focused on patient safety should be patient centered i should be timely to be efficient effective should be fair equity it should be fair continuing the quality of care section we see we had a political push by senator max baucus to help improve the healthcare system through to propose reforms first senator propose we change the way we paint providers change from a

fee-for-service model to a performance based model we pay providers based on the value of efficient effective patient-centered care we provide insanely to do more investments in health information technology senator Baucus took a very firm stance that both these reforms again changing the payment model and investing in chianti are needed to establish a transparent and I based healthcare system very wonderful to see that we have that political push

the last important point of the section that we have some actual evidence that HIV approves compliance which results in better outcomes a study of hospital systems that adopt health information technology revealed that those hospitals that had health information technology had higher levels of patient compliance to the medications and of course patients who are compliant have better outcomes so we see that improve investing in a chatty actually does

result in better outcomes here's a study that's provided and supporting evidence of that fact moving into the next section this is access to care again we're talking about the challenges the healthcare system we want to talk about cost before we talk about quality and naturally ready to access we're going to talk about the various challenges that post barriers to accessing healthcare my first point here

is a distance not the only problem certainly distance of geography and logistics of getting to a care facility is a problem in a large problem to access perhaps the bigger problem is that healthcare is cost-prohibitive this so let's say this is somewhat a different take and just high cost of healthcare cost prohibitive from a bit this perspective means that one chooses not to spent on a service or product not

because it's too expensive but it that but the cost outweighs the benefit that's what cost prohibitive really needs so we have a healthcare system now we're in many cases a consumer chooses not to spend not to consume healthcare because it's cost-prohibitive because the costs actually outweighs the benefit perhaps you want to think of it this way if you have aches and pains and it's going to cost you you know a thousand dollars to see a doctor you're we might

not simply because you rather just bear the pain the cost prohibitive being actually a unique and distinctive definition for our healthcare our access to healthcare challenge another thing i want to bring about is that when we have a large very large population of uninsured underinsured people and when we have a population people who view on healthcare cost prohibitive we're going to see a lot more utilization of ER because what is going to reserve health

care until the absolute absolute and and that leads to chronic needs too much more severe illness so we see more your utilization which of course means higher health care costs of the previous the delay treatments of course can lead to premature death but ultimately we gotta pay for healthcare know if they were having fewer screenings if your preventive care measures take it then in the end we have a short of longevity poor health and also we pay more for

health care so that's certainly not the way that our healthcare system should be set up another consequence of access to care is going to be density now that there are areas where healthcare is provided but perhaps not enough resources to provide for the bottom city is there so density can lead to overcrowding of limited resources and another consideration i want to mention is that if we can actually success

actually provides care 250 million uninsured currently are not utilizing the healthcare this would add a tremendous straight all the existing resources in other words if you add 50 billion more users to the healthcare system that utilization would strain the system we don't we have a finite resources in terms of health care facilities so adding 50 million more users would require additional facilities and as we understand our

triangle if we increase access were either going to increase costs or lower quality ok so increasing access may result in lower quality care moving into the next section this is entitled impact of the healthcare triangle and again the healthcare triangle is comprised of the three cornerstones of healthcare cost quality and access cornerstones this is a good section like this section quite a

bit as it provides us with a lot of supporting evidence as to why help IT matters and that's the question posed to the very beginning of this course but let's look at y HC matters in terms of cost quality and access terms of cost we now come to understand that reducing cost is going to require transparency much like the transparent that elucidated the fact that our healthcare system is the one of the worst in the modern world we need transparency to be

able to reduce costs we can see what it is that we're doing clearly see what we're doing this transparency can only be achieved through the actor importance of use data and again reporting use data is going to require health information technology same cornerstone is quality improvements and we now understand that and quality is going to require accuracy reliability and timeliness of clinical information at the individual level and again we're going to have have

information systems to provide a comprehensive information to the clinician to be able to produce a better clinical decision this requires health information technology and the last quarter stone access as we improve access to the general population this will increase health care utilization which is going to add a straight to the healthcare system to collect analyze and for more

data again we need HIIT remind you that in the first lecture we talked about how to penn state of Texas utilized HIIT to overcome some access barriers and provided telemedicine to their prisoners so not only does HIIT provide access or color access issues but it's going to be what is going to be necessary to be able to analyze a report on the added use of healthcare once we expand access we'll be right along moving into the next section this is entitled evidence space

management and want to make a distinction between evidence-based management evidence-based medicine evidence-based medicine for what can be abbreviated bbm7 space management typically is written out with their similarity is this that evidence-based management meets the process of decision making based upon the available best information this information that's timely comprehensive reliable it's relevant information you can imagine how

much information is necessary to be able to make informed business decisions management decisions and so this against scratches and need for having health information technology this is quite important that we see medicine moving towards evidence-based nursing management move towards evidence-based and that's quite profound because we see management become a science many of the managers in the industry and many industries pro professor a gut feeling

about how advantage that's really not the case there is a science be like just about everything management should not be an exception so we're seeing that management is becoming science and as it becomes a scientist really reduces the variability in management meeting that whether you have any leader put into the position you're going to minimize the variability as to how they're going to manage the organization and ensure this reduces the variation healthcare

delivery this is very important we want consistency and healthcare delivery because once we find out what works you want to stick to that want to find out what doesn't work we want to eliminate that that's what the best avail information comes in we have our managers utilizing that utilizing the best available information will have reduced variability and improve consistency which is expected to improve healthcare delivery we have some studies

that show that management without information clearly results in increased healthcare costs decrease quality because how would you manage with that information why would you trust any man that makes decisions that's not informed so we certainly have to have information the timely comprehensive reliable and relevant information available to managers to be able to make business

decision and again the need for healthy Commission technology alright final section of chapter to this is entitled organizational change and I've put it two brackets broad there to remind us that were talking about the broad organizational changes are the results from the evolving environment and we say that we're talking taking into consideration the environment being the local environment the competition the various technology changes that have

happened the various changes in cost for technology and operational expenses but as we say evolving environment the environment itself is evolving again it used to be the local environment in which the organization operates but now the farm is quite global and as we see in today's lecture our healthcare system has been compared to other healthcare systems around the world and we have the

worst of all of them again in terms of the overall score but also in terms of access efficiency and expenditures so we have to ask the question why is that why why is our healthcare system before we so poorly versus the other healthcare systems around the world and I what gives us three very compelling very strong reasons as to why that is all not help IT someone well the first reason is that we are at least 10 years a decade later making

health information technology and national initiative 10 years late for us the world superpower for 10 years late to making hnt a national initiative we really haven't had a centralized government role of motivating HIV adoption that'll very decent just started to have algorithmic intervene in having a centralized rule in motivating adoption VIP throughout our country this last one is very very very significant you mind

that we spent the largest percentage of our gross domestic product on healthcare the largest percentage of any other country in the world on healthcare and yet we invest less per capita on a chai tea and how much less you say well I want you to visit page 47 for this details of how much less we spent that you may think maybe we spent half as much maybe spent a third as much as the other countries on a chai tea but it's not even that and I'll read you some of

the details here so the United States invest significantly less per capita me check T data suggested 2005 United States invested about 43 cents per person on each item per capita ok norway invested and you might think it might be a dollar to college but it's actually $11 31 cents per person in HIPAA versus our 41 cents ok Germany has invested $21 in three cents per person in canada has invested

31 dollars and eighty-five cents per person on a chai tea so how is that there's they're spending well over ten times what we spent on on a chai tea and yet they have a lower percentage of their gdp invested in healthcare maybe that's the relationship maybe we're seeing a trend here but all the countries that perform better than the United States actually invest

significantly more rhit so something to think of off again read the chapter visit page 47 look at some of those detail statistics and see if you see a pattern conclusion for chapter 2 so we understand that the environment really does affect how healthcare organizations can operate and therefore information about the external environment is necessary comprehensive timely relevant after information of the external environment is necessary for good

management good decision-making we also learned unfortunately the United States is you this performer terms of healthcare ranking of global level we also understand that there may be some relationship between how much we best per capita on HIIT versus the other countries the other country spent considerably more capital HIV and lastly the changes occurring Elliot's right

slowly change is occurring we are moving towards evidence-based management which is similar to evidence-based medicine where management processes are now being in fluid by the best available information we started see our government taking more central role in agency adoption mandating HIIT dolphin in some cases and establishing standards for HD adoption and so change is occurring it is occurring slowly but we are in a very exciting time for change

is taking place and we have an opportunity to influence and make this change successful continuing our second lecture together moving into chapter three chapter three is entitled government policy and healthcare reform and it's quite appropriate that's a government policy healthcare reform follows subject matter of chapter 2 which is external environment because we understood that external environment was heavily focused on government

intervention and so now in chapter 3 will expand on your intervention the specifics of government intervention i had some health care reform movements so we're in the first section of this chapter this is a chapter section called all review is an overview we get sound a little bit of the purpose of chapter three and this is to provide help I t leadership with an awareness of the potential effects of health care

legislation the various tools to identify and respond to legislation and a strategic vision to plan future challenges of government intervention now chapter three is divided into three sections will talk about specifically the government's rule and health information technology very specific legislation such as HIPAA and hitech and then health information technology leadership role to wrap this up to close both chapter 3 and the lecture number

two so let's go ahead and start the lecture so our first made section in our lecture for chapter three is a title government's rule in health information technology and the author gives us three very powerful questions to help guide us through this chapter the first one is the why question is their justification for government intervention or why is the government intervening in healthcare and we ask

this question because for the most part of our government is hands-off on most industries and markets it does not get water that's the free market optimized itself so why should our go to get involved in our healthcare system that's the first question the why question the second question is that how question how much it what types of interventions and go through to see exactly what the government's already done and how much it's done and the lastest is what

question what triggered those interventions what actually happened that it forced or pause the US government to intervene in the healthcare system so your first understand that the government is a package repeating it is very doing this it's not really an academic question this is happening so we're going to go through exactly why how the what together and answer those questions as we pursue this chapter but as you see

here I have a simple answer for you the same answer that the off of our textbook gave us is that the answer is yes how what we ask is our justification answer is yes and because the US healthcare system is broken and the government has an obligation to intervene ok and we had a very specifics later but partly because the purpose of any

government our government is really to protect the welfare of its people and we have a healthcare system that is broken it really has a broad obligation to it should be to ensure high levels of quality health care for its citizens but we'll get into all that about again the simple answer to is a justification yes why is that while the system is broken and the cover has an obligation to intervene so we'll get into the specifics and let's go ahead and done we

want to the next line so we'll start with the justifications for government intervention going to talk about why our government needs to intervene in healthcare system this is quite a typical for our government as we know we have a free market system and so our government typically his hands off most markets and industries and allow the markets to determine the cost and quality of its products and services in

and of itself without government intervention other than the laws and regulations that the government opposes but for the most part most markets optimized themselves accordingly but the book does give us some reasons as to why nervous intervie and those reasons are given here first one is problems with public goods and public goods are typically defined as good that are really it should be available to everyone and the consumption of that

goodbye one individual does not exclude or eliminate the opportunity for the consumption affected by someone else we be talking publicly talked about things such as no offense just being a resident of this country we all benefit from the national defense by our servicemen and women and my benefit from that defense doesn't exclude anyone else will benefit for the kids we all sit together or perhaps you could think of sunshine as a public good but again problems with

other goods being one reason for the government to intervene another's externalities and externalities from economical really really from ok from healthcare perspective will be looking at consequences experience by a party that was not responsible for the decision-making that led to that consequence in other words a neutral party that is experiencing either positive or negative consequence that wasn't responsible for for causing a

consequence so an example of an externality would be someone who experiences second chance smoke because someone else chose to slow right so you know you didn't choose to smoke and had no no choice in the matter what someone else you did choose to smoke is now it negatively impacting your quality of air quality of health because of secondhand smoke that's it sample of negative externalities there are certainly positive externality such

as with government-funded research because we're government-funded research we see improvements in various areas in its healthcare with the improvement in healthcare and healthcare consumers we received better healthcare consumer information is another reason what governments do intervene in terms of healthcare i can tell you that some few years ago we had a situation where parents were quite concerned that providing vaccinations for their

children would cause autism or some type of learning disability there wasn't enough information there to justify this but many parents from the cheer fear of that consequence did not provide immunizations that led to any number of illnesses and diseases for their children it took years and years and years of science and evidence to produce these vaccinations and show that they were safe but one very small study which has

since been discredited cause this concern within the consumer history of super super is that vaccinations cause autism and then causes a ripple effect where parents were not vaccinating their children as an example of imperfect consumer information the government has had a hand in correct that certainly funding research to show that sound you know it does not cause autism but also by through its various

government programs such as the centers for disease control after an educated for consumers and consumers providing the correct information there by correcting that imbalance of the perfect super information again we're talking about reasons why the government could intervene in the market the last reason here is monopoly I think we understand what monopoly is monopoly is when any one entity has exclusive control over on industry where they

perhaps own everything and that's not a good not a good situation for consumers are because when anyone cut a organization has exclusive control over an industry which movie see that quality with I on classical love because without competition Washington organization maintain its its quality it doesn't have to because there's no competitors for the consumers to go to and it can certainly drive positive again because

there aren't any other competitors for the consumers to go to we don't have much of a problem monopoly in healthcare but something is certainly a reason for why Kermit's intervene and our government has interpreted number of industries outside of healthcare regarding conservative monopolies but not necessarily in healthcare itself so all these all these four problems the first thing we want to note is that healthcare perhaps there's even a public

good and maybe maybe desire to be a public good to be available to every person that the consumption of one is not exclude another we understand that by those of those terms of definition healthcare today in our country is not a public good is not a public service terms of government reason for another intervention externalities is is a major reason for intervening we've had a number of situation whatever has to interview to correct for externalities

perhaps there's been will really why by proposing legislation so we think what externalities are we should think about things such as HIPAA the government's coming in and corrected for negative consequence to make it more clear think of healthcare organizations and their control over your protected health information if they're not careful of that accountable if they're not what kind of set secure with her health information consumers are at risk of

having their ph I protected health information compromised and so we asked consumers would experiencing negative externality with Health Organization tonight adopt proper measures to handle rph I and enforcing the market has has demonstrated that without government intervention without government producing hip legislation and the penalties are lost behind it that organizations just won't do it

so that's an example of an externality i think i just give you an analogy of imperfect super information with that the autism example mom and again last monopoly we don't have a whole lot of examples of that in healthcare moving into government intervention in the healthcare field want to point out again that our government is in fact intervening and it's intervening because it knows that

has a broad obligation to protect the health and welfare of the population and so to expand on that just a little bit more i will say that governments in general on purpose of government in general it really is to protect the welfare of the population so our government is no different and terms of healthcare wants to as abroad obligation to protect the health and welfare its population it's discouraging to hear that according to the world health

report that working for 36 or 37 out of a hundred 90 countries put on the flip side of that we think there's a hundred fifty other countries that are worse off than we are and i can tell you that those other countries have governments and their governments also have a broad obligation to protect the welfare of the population and many of these are even aware of the challenges in terms of health and well-being and health care for their populations the difference

because they don't act only not acting accordingly and so it's important to note that regardless of your political affiliation that at least in our country our government has an obligation to protect our best interest acknowledges the challenges that we face in terms of cost quality access to healthcare and is really doing something about it intervening so we will talk about those interventions you know throughout this

chapter the next the next no point i want to make is that on the welfare of the population is really compromised again government has an obligation to protect the world from the population it's been compromised this is why intervening remember instead of medicines next day and I report to err is human a hundred thousand preventable deaths occur annually in hospitals

I mean completely unacceptable we have 50 million people uninsured again unacceptable and that uncontrolled cost to the free market has it really created a healthcare system and it is as optimized it's not optimized so cost quality access has not been optimized free market government has 28 edit have government business practice no boy we think about growing involvement in healthcare business practice we have to really think about

HIPAA everything first we bought HIPAA privacy security pho that's really the probables profound invention that the government has a place upon healthcare on and rightfully so we really need to have our protected health information private and secure but also we can think about the various efforts put forth by our government to standardize and nomenclature basically the terminology that we use and the various protocols that we use to exchange information and

this leads to achieving the goal interoperability i want to remind you the interoperability is the goal that a problem the problem is that we don't have interoperability and interoperability against the ability to exchange information despite on platform differences and across more physicians right to exchange information across platform differences and across organizational boundaries

that's the argument now is motivating HD adoption it's motivating ejected option via various incentives to adopt one of the things that you're going to find this chapter it may be very confusing that the book states that there's no compelling business case for investments in a chai tea and that is quite contradictory to what I have been saying what the book is a prior I get my first cap first lecture that investment HIIT

produce profound benefits indeed productivity terms of patient care cost containment so why we say that there's no compelling business case for investments HIIT i have paid close attention to this the government has to intervene now and save it has to be because no compelling business case exists for investment ukti because we have a healthcare system that really rewarding efficiencies and doesn't really reward efficiency

ok so the government step in to do something and we already see that the free market has been optimized that things aren't going to change the healthcare system we have today really encourages over utilization of healthcare which results to increased costs and so things the government has done it will talk about on subsequent slides that it's colored with legislation is coming with a funding coming with incentives to

stimulate hid adoption government spending billions to build infrastructure in terms of health information exchange to enable interoperability it's invested billions and nineteen point two billion dollars to incentivize the meaningful use of electronic health records again we'll talk with all those things and some slides but the government has again is to help motivate HD adoption because this is very confusing

no compelling business case exists for investment in a check T and you want to think about that it sets that changing the way the system works today changing the very the methodology the paradigm of how health care is provided today threatens and jeopardizes the livelihood e monetary monetary incentives of video systems and providers in place today so the government is intervening because these changes additions are needed and providers and health care systems would

act on their own and it's gonna become much more clear as we proceed with residents champion so moving into the next section we'll talk about specific healthcare legislations we have to really talk about HIPAA which is probably the most important piece of government legislation and intervention in the healthcare space people was released $MONTH 1986 sign it too long and 26 it

stands for the health insurance portability and accountability act and watching want to make sure that we all spelled correctly its HIPAA HIPAA to aids and have two keys I have had students write it with 2 p's and i want to show that none of my students ever again will write help of two piece remember it stands for health insurance portability and accountability act so portability 1p never to peace and

it started as it means to ensure that employees could retain their health insurance when they switched jobs so that's the portability part of the Act but it's really for what we're discussing the second provision is actually more important this is the administrative simplification provision this is what gave us the privacy security of our health data ok so again a HIPAA terms of legislation healthcare legislation really have had

no equal but it really has shaped healthcare over the last two decades it's going to continue to do so well the future we all need to know what it is and why it's powerful and it's spelled with 2 a's at the end not two peas in the middle ok so keep that in mind you have a writing assignment coming up please don't ever write hit with 2 p's i will be heartbroken if you do

the next section is titled the need for information privacy and security and relatively straightforward section if you think about the need for information privacy security first point here very obvious point is that health information systems could contain sensitive information that you know sensitive is in quotes there we understand the sensitive nature of our information contained our personal information are our address our date of birth or social

security number all our personal graphic information that we don't want everyone to know and even more importantly we have our private medical information are procedures are conditions and so forth it's all very private that should be only discuss with our care providers and in many cases we don't want our families down so that's very sensitive information and certainly our financial

information which everyone seems to want to get a piece of these days so again health information systems contain sensitive information private a personal political financial data and we have to have comprehensive privacy and security systems in place to ensure that safety of our information another point I want to make a make is that today's systems contain much more data that before so our health information systems of today contains so much more sensitive data

that before so this poses a much bigger risk in a much larger threatened breach it also provides a much bigger honey pot for those who want to have unauthorized access to our data so you're a hacker years back it might not have been worth your time to try to hack to clinical system because they just wasn't there for you to do anything with it wasn't a big enough challenge or or or prize but today the challenge is much greater there are much more sophisticated

systems in place because the data is of sensitive so that if you can get the data that that that that part is so much larger so much bigger risk in a much larger threat of breach we have some examples of breaches data breaches on pages 60 and 61 of a very briefly California Department of Health Services accidentally revealed the names of aids aids patients by sending letters to the wrong people so can you imagine getting a letter for someone perhaps

someone you know maybe a neighbor and community regarding their participation in aids program that's quite sound that's quite an appropriate another example would be the veterans affairs office in Los a desktop computer this is interesting that a laptop a desktop computer and this computer of course had records of 30,000 patients their information financial condition so for again a very large bridge but no these two are you know happens all the time

and what we call the wall shade is actually a public-facing of public facing a website that posts breaches that are subject to greater than 500 patients would more than 500 patients more than 500 records are breached you know your your organization has been listed there so that consumers know that that breach has occurred so again review those types of regions of pitches 60 61 on and don't think that these things are isolated incidents this happens a lot so

we have to be very careful with our information our privacy and security protocols health information technology for economic and clinical Health Act we saw 2009 the release of the american recovery and reinvestment act arra and within our we have the HITECH Act this is a really major component to ARA on and it was designed to promote the expansion of electronic health records

that's what HR is bc 22 billion dollars being allocated for that that effort and 19.2 building for EHR adoption we saw an additional two billion dollars established to allocate to establish the opposite national coordinator for health information technology and this offices to oversee the promotion of electronic of a promotion of health information exchange to provide guidance and funding for workforce training and to promote interoperability so in the eighth

edition we actually have a section for adoption of eh i think it's quite appropriate again each other stands for electronic health record and you may have heard the term TMR dropped many times by myself and perhaps others in the field on and what is the difference of we want to do a lot too much that even in your book on but I want to understand that there is a difference between EHR and II mr of course is that Center letter the H versus the M

electronic health record vs electronic medical record and this is in fact quite a paradigm shift in and of itself on know an EHR i would say would be a subset of an EMR ok TMR electronic medical record was the idea from the very beginning it has been around since the sixties as you remember co-star was an early attempt at having an EMR this is a medical record basically includes the medical history of the diseases medications whatnot of the patient and

this is how you think of it is the medical record of the patient and not necessarily the health of the patient's not designed to promote the health and well-being of the patients more calculating the illnesses and diseases a patient it also will more specifically the purpose of an EMR is to facilitate productivity for the provider and

practice it's not patient center its provider center electronic medical records were designed to help providers be more efficient therefore save money make more money whereas today it's patient-centric focuses around the patient are the patient's health and well-being and that's what electronic health record is so we're seeing an evolution so long story short of use the terms EHR and mr

almost interchangeably there is a significant difference between the two hrs is more patient centric TMR is more provider century and in order to be patient centric we have to have the inclusion of the patient and the patient has to be included his or her help and so there's a key functional difference between the two as well EHR systems have to have interoperability built in other words

this system HR system needs to be able to communicate with others assistance to be able to facilitate that help the patient with an EMR system is not so provider who's adopting an EMR for his or her sole purpose for his or her practice on isn't necessarily looking to exchange that information just want to digitize their replicating ok and easy way to think of it today everything is patient-centered everything we do is th are specific there's not a mention of

EMR side are so as we move forward the terms can be used interchangeably but as my students as you will understand after you've completed this course it's all about the patient it's all about th are ok and so this section and started going off topic for a little bit but this section adoption HR the purpose of an HR really is to be able to provide complete and accurate information to provide better access to

information this is both as a digital copy of the information but also the interoperability so data that doesn't exist within perhaps the system at the providers office can be pulled from health information exchange for from a another provider for also patient empowerment like we said HR is about health you want to engage the patient is her on health is patient education is patient communication so for so that's

what an EHR is promoting better care better health of the patient and through continuity of care of your communication be a comprehensive records be a patient empowerment so although quite happy to see an extensive section of meaningful use which did not exist in the previous edition because when the previous edition came out really useful it's not defined yet the author now really extensively reviews me use and I don't think it's entirely useful or necessary

for all of your students to go through all the specifics of meaningful use iphone as it was a career choice very much an expert in meeting with a consultant for a few years on reading use still have today but for you when I provide here at slides is really all that I want you to know and understand you can certainly review the textbook for the specifics if you're interested but otherwise it's it's going to be no it's not gonna be on your test

so review for your for your sake of knowledge but not commissioned critical for you to memorize any of that to understand the value of HIIT so I back to the section meaningful use talk about the office of the National Coordinator for HIIT this is really refer to mostly it's just osc don't put hid behind the osc gallons of the National Coordinator and the office of the National coordinated five appropriate standards for use of a charge so you know if

you're a practice adopting an electronic health record system just buying a piece of software and putting it on a computer is not enough you have to use it accordingly right just like when you know if you have a car going to get the drive accordingly I'm now you use a charge accordingly as well and so only defined also some financial incentives to motivate me to use again the market you know hasn't

hasn't pushed for providers to adopt hrs if you know if it did we'd see all of our providers abandoned paper-based records and optic motor system that has been the case so the government has allocated as we saw nineteen point two billion dollars to help stimulate the adoption of the H arts I for Meaningful Use if a provider of Medicare provider is it full compliance stops electronic healthcare system certified health care system can

actually earn a forty-four thousand dollar insensitive it's a compliance and said to him for adopting a charm and so we have a number of exhibits by your book 3.63 . 73.8 really details meaningful use the core measures that many measures that various thresholds for me for use and a wonderful if you want to learn that absolutely but i think it's a bit too much for the for the scope of this course so only review that only to

memorize anything but a point to make here is this that meaningful use which is a cache term is actually is the appropriate terminology for the use of EHR meaningful use of an HR specifically require health IT right because you're going to have to have a computer system to put the software on and have networking to facilitate the communication of data records you have that interoperability to be able to share that information reporting

security ph I all those things require health information technology so big push you know hitech act as a big push towards a national adoption of HIIT again nineteen point two billion in terms of adoption of electronic health record systems so we are seeing that you know if we ask the question before does HIIT

matter that's where the bottom 20 billion dollars in terms of our government spending so yes it does matter so we get to the next section this is patient protection and affordable care act we really know this as the Affordable Care Act or ACA 2010 until a profound piece of legislation intervention and health care spanks really key purpose most to expand coverage to health care of course

expanding coverage means to improve access to healthcare but there were some other very important on benefits to the Accountable Care Act one was really moving away from the fee-for-service type of model too leadership of accountability and financial responsibility off of the players on to the providers so that now the focus on performance so we see on the creation of many accountable care organizations again these are collective

organization comprised of a primary care office some specialist at least one Hospital where the care of a managed group of medicare patients is handled between those organizations so improve care coordination improved efficiency of care between those linked on care providers would result in cost savings for Medicare and Medicare would share that cost savings with the accountable care organization so again encouraging efficiency and it improved their

performance and being rewarded with a financial incentive of cost savings saying again this direct pay-for-performance initiative so we discussed something means for that perhaps bundle care of payments so you pay one payment for both surgery and the post-surgical care to help encourage providers and care facility suits to really you know do a better job so if you do a better job you're going to make money if you don't do a very good job

you're not going to make money and that that process kind of itself out so shifting accountability and financial responsibility off the payers onto care providers themselves are starting to see a change in the fee-for-service model could want a pay-for-performance type of model and that's really will be 18 to get to improve healthcare system next section we're in is health information technology leadership roles relatively straightforward section but we

understand that healthcare is experiencing rapid changes that will require strategic planning and a bit of technical competency so we have to show we have a need for a chai tea as well as a cheap leadership being expanded need for a chief information officer rules of the healthcare space on the expected role for the new AG leader and the CIO able to understand to anticipate and you to explain

pack of legislation and this is really critical because we need to be able to respond to changes in a timely manner and timely action changes to healthcare organizations take time and tell you that implementation of HIV technology takes time it's not something that you identify today little bit tomorrow and have running no final third day typically takes months if not years to fully implement a system and quite a significant time thereafter to have

productivity of the levels that are necessary to justify the application so we have to anticipate changes often the horizon well in advance to be able to act accordingly it time to have those responses take place what needed to be a very good example the incentives for the Medicare incentive program although it's four thousand dollars for providers who do

fully comply there's also a penalty part of that as well so cut next year 2015 medicare providers who are not in full compliance who have not successfully adopted a thr is not meaningfully using the HR is going to see a financial penalty penalty is going to come in the form of a reduced reimburse so instead of getting your full hundred percent get 99 percent first year next year not apply to get 90

percenter don't keep coming down as you're not compliant so . here is if you didn't plan on adopting an HR you didn't plan on an optimum health information technology were in September of 2014 and by next year you're going to face a penalty it's very difficult for an organization to adopt hid system of that magnitude and become fully compliant that quickly and that's the point of the rules HC

leadership understand it's been explained back and then respond to change the timely manner so the section is somewhat of a continuation of the previous section in terms of a tighty leadership roles this is a title environmental scanning and organizational education but it is much more specific in terms of environmental scanning we're referring

to a serving of the healthcare landscape in order to identify any necessary for additional responses are to be see what's coming in to be prepared for it and we are specifically talking about possible government intervention government changes to the law so that you can act accordingly so that you can remain in compliance so you don't have penalties and someone's response is going to include

resource review your staffing will make your facility performing necessary gap analysis either internally or hire consultants to do that a gap analysis basically means you're looking at what you do today first what you need to do it tomorrow in order to make applied and what that change process looks like that's what the gap analysis and producing various implementation plans and timelines to make sure that you can commit those

changes implemented in time to beat the deadlines in that last piece organizational education certainly training is this necessary education is necessary anytime you implement any new system there's going to be processes and procedures that are you and this affects both leadership and the user and so certainly necessary and key point here it applies to all levels

this affects the chief executive officer chief operating officer chief petty officer Sarah at all levels of executive-level all the way down to the end user moving on to the next section this is information security policies and procedures the first . want to make is that security is really only as good as its weakest lake so you know you may have the most secure operating environment but only takes one moment of weakness for one individual on a one act

of carelessness to really jeopardize your protected health information so i can tell you that I've been consulted and some of the organizations have quite robust policies around privacy security but there's always an individual who is above the law perhaps the CIO perhaps the HSE leader who as a cell phone or a laptop a smart device that has direct access to secure

information and that device may make perhaps this is not utilized appropriately could be lost and so forth so again security is only as strong as its weakest link no one is above Loch I say that their healthcare organizations because of us have to establish enterprise-wide standards for data privacy security that's why i have Enterprise capitalize it red because it needs to be enterprise

y know what is about long next point i want to make is that there really are two types of protections we're looking to protect against failures in the system either due to just normal wear and tear feelings or catastrophic events that we have any number of possible catastrophic events and also the second class of protection against unauthorized access so this would be an offering access both within the organization just by perhaps accident or by the

intentional balance but by hackers and virus's and want to get into the system and extract information with damaged information for any number of malicious reasons so those two types of levels of protection two types of protection that we need failures and catch up events it's those type of events and often authorized access events we're now into a disaster preparedness and recovery planning this this is

something that's not very exciting for foremost practices they don't want to worry about this because it's a very negative type of a perspective and concern but it's absolutely necessary because the disasters do happen unfortunately recovery is necessary so we have to plan for one thing I tell everyone if you have a digital system you have to back up data backup is critical

both were consumer but critically important for Health Organization for that data first of all it's very sensitive it's also critical mission critical the data backup itself bc the comprehensive needs to be everything you can't just pick and choose pieces because you're not going to have all the information that you eat anything is creepy enough so that there isn't any window of opportunity where you're not backing of information you know a

disaster could happen and you lose data insurance between backups maybe quite redundant so sometimes backups have backups of backups ok because you know mediums fail how do you had a bad CD it's gone bad or a bad hard drive so those things fail and needs to be stored off-site other words it's not very effective to have a backup sort of the same location perhaps even the same desk same room as well

where the data is because if a flood would happen or earth big if the primary data source goes bad the back of is C acidity you know they both go back i believe the new requirement is that the back of house has to be a hundred fifty miles away from the data source of the poison will also give us some examples of disasters remember the September 11 attacks of it the twin towers went down any number of records were lost forever

unfortunately because the organizations within that building and they were backing up data onto other floors and so you know that i was on one floor and then you know the source status on one for the back without another which provided significant well backup security and unfortunately the entire building with down in all the floors without like then another example of course hurricane katrina in 2005 vast majority of those reference wrong paper

there was no data backup fortunately it was no real recovery plan in place either and so tens of thousands of medical records lost forever because of Hurricane Katrina it really was an eye-opener to understand that first ball value of digital record keeping but also the value of data backups and contribute to be on redundant and off-site final point of the session but that's a viruses actually post real threat today I used to be a nuisance used to be they

steal your password do some harm but viruses in terms of health information data is it's a real threat we have to ensure that we scan all Internet activity with the scan becoming outgoing mail organizations have to truly limit physical access to equipment because you know playing it USB drop device or other medium to a consistent can also introduce software viruses that so they can do some arm so it's a real threat we as consumers should also do the same

every system that i ever work on as much as I have a good user activity in other words i know what to do what not to do i still can't offer without having multiple levels of firewall viruses to protect myself and the people that I come to contact with so antivirus software very very critical information privacy confidentiality protection too . want to make in this section firstly in order to have a comprehensive security policy once have three elements

first element is physical security means having some physical barrier to protect your information could be locked doors lock computers bars on the windows security guards etc I'm sick will be technical control over axis will be programmatic controls clearly having a password on your system it would be a technical control over access lastly this is probably most important one management policies that

are well known and forced enterprise why ok so we'll be one part force this probably keyboard here that's why it's red and an enterprise-wide why it's capitalized and address again no one is above the law and then my final point of this section is that most organizations unfortunately are not compliant somewhere just you know why do we not complain but summer blade are compliant and that's a big issue but as

we have more health information technology and more things become transparent will be able to more easily identify which organizations are not compliant and get them to be more compliant and again best for the protection of the consumer our protected health information protected health information we have to ensure that the organizations have comprehensive security policies in place and that it's enforced enterprise why

alright we finally come to the conclusion of chapter three and inclusion of somewhat of a very long lecture and cussing both chapters 2 and 3 but three big points in this chapter one the government really need to get involved in healthcare because the free market has not successfully optimized healthcare attributes such as cost quality and access that's the first mate . second point is that soon the government legislation is going to

continue to have effects on health care specifically HIPAA high-tech Accountable Care Act will continue to shape the healthcare landscape towards a more efficient delivery system and health information technology my final point systems contain sensitive data I think that some rather obvious but requires comprehensive strategies to protect against data failures which happened data breach which is happening more often and got a loss but effectively

does happen as well at this effectively clue



Video Description

University of Central Florida, College of Health and Public Affairs.
HSA4191: Fundamentals of Health Information Technology. Instructor: Steven Ton
Lecture #2 - Covering Chapters 2 and 3: External Environment & Government Policy and HC Reform