Puerto Rico and the Electronic Health Record (Part I)
The focus of this research is on Congressman Pedro Pierluisi who serves in the as the representative of Puerto Rico. He is from the Democratic Party. He can be contacted at 2410 Rayburn House Office Building. His phone is 202-225-2615 and his email is http://pierluisi.house.gov.
Currently, the key major stakeholders involved in the bill are the congressmen since the bill is still in the committee stage in the house. The contents of the bill are being deliberated on by the subcommittee on health. As such, the real benefits of the bill have not achieved yet. However, in the event that the bill passes through the subsequent steps, the patients being taken care of in the acute care settings will be the main beneficiaries. The probable benefits that will accrue from this bill are in line with the advantages of utilizing these technologies. EHR are useful in providing real-time clinical information to the physicians and other care providers to satisfactorily address the needs of these patients. Secondly, the access to the clinical information is safe due to the security checks put in place. Thirdly, the overall health of patients in the acute care unit will be improved since the focus will not only be on the encounter between the doctor and the patient only (King et al., 2014). From a broader perspective, there will be an increase in the multiple avenues through which information can be retrieved to assist in the maintenance the general populace health.
It is, however, worth noting that this bill has got very minimal chances of being passed into law because of various underlying factors affecting it. This bill was first introduced to the congress on the 21st of March 2013 by Representative Pierluisi with the same title but a different bill number which was H.R 1379 – 113th Congress (2013-2014) (Congress.gov, 2013). This bill did not, however, move past by the committee stage considering the fact that the sponsor comes from the Democratic Party which is a minority in the congress. As such, garnering the required numbers to push the bill through the house was a challenge because of the issue of the tyranny of numbers. From the foregoing, therefore, the Bill H.R 1225 has got very minimal chances of being enacted into law mainly due to political differences and ideologies between the Democratic Party and the Republican Party (GovTrack.us, 2015).
Legal and ethical foundations about policy (Part II)
The adoption of this bill will greatly improve operations in healthcare settings. However, there are also legal and ethical implications surrounding its adoption. The ethical issues in line with the approval of this bill are based on the possible benefits from its implementation. As such, the Utilitarianism theory is congruent with the implementation of this bill. The use of EHR in the healthcare provision process is useful since it results in desirable patient outcomes from the advantages that have been linked with its usage (Butts & Rich, 2012). Such a realization is a reflection of the foundations of the theory which supports what is only best for the people. As such, the outcomes of enacting the law will be beneficial to the general population.
The first legal issue surrounding the use of EHR is the risk for claims from medical malpractices. There are probable errors likely to occur during the transition system of the bill from the familiar paperwork. As such, there are bound to be an increase in malpractice liability to the physicians attending to patients a situation that can eventually result in lawsuits (Hospital Review, 2016). Secondly, in the event that proper spell checks are not observed in the system, the possibilities of medical errors occurring are very high. The likelihood for medical faults includes pharmaceutical errors in terms of dosages and the resulting side effects. Another factor in line with medical errors is related to the doctors using a copy-and-paste kind of medical diagnoses that result in a trail of subsequent medical errors (Hospital Review, 2016). Such a situation is the possible genesis of medical lawsuits. Finally, breaches in the conventional operation of the electronic health records may result in theft due to unauthorized access to the system. As such, loss of records and human errors are the possible avenues for medical lawsuits being filed by the patients or their families towards the acute care hospital.
Healthcare policy and different global perspectives (Part III)
The Puerto Rico Hospital HITECH Amendments Act of 2015 114th Congress (2015-2016) which is an amendment of the Social Security Act seeks to apply the Medicare HITECH Act payment to acute care hospitals in Puerto Rico with the intentions of making them qualify for incentives that will enable them to make meaningful use of electronic health record technologies which have been licensed (Congress.Gov, 2015). The end product of this bill is ensuring that the usage of EHR in the care provision process in acute care settings is realized. The benefits that can be associated with the application of EHR in the care provision process cannot be understated. Bearing in mind that the long tedious process that is required in taking the patient’s information on paper every other time they fall sick puts a cap on the efficiency levels of acute care hospitals.
According to the World Health Organization, the obstacles likely to challenge the adoption of these technologies in many developing countries include; the required expertise to ensure that they are rolled out is not available in addition to minimal healthcare funding towards this undertaking (World Health Organization, 2006). Therefore, there is the need for these countries to enact legislations that will oversee the adoption of EHR in acute care settings. Additionally, the policy changes that the WHO has focused on is developing standardized clinical terms that can be applied in the EHR development process to eliminate possible gaps in information (Rajecki, 2010). The WHO posits therefore that, the objectives of ensuring that acute care hospitals qualify for EHR usage will be directed towards; improving the quality and accuracy of data in the healthcare system, enhancing the way patient health information is shared amongst doctors for the ease of providing care both at the present and in the future, improving efficiency in the healthcare delivery process, and finally to have a cap on healthcare costs.
There are a number of stakeholders who will be directly affected by the implementation of this bill. Considering the fact that it will be executed in the acute care settings, it translates to the patients in this unit and the care providers being directly impacted by the bill. The benefits associated with the usage of EHR will directly influence the operations in the healthcare settings where they are used. This will prove important to both nurses and patients since there will be a reduced workload on the side of the nurses while to care provision tom patients will be faster due to minimal bureaucracies involved. Healthcare providers in acute care settings will be the individuals that will be tasked with the putting the certified electronic records technology into use. This implementation will be corresponding to their daily work schedules. Since this bill is an amendment of the Medicare coverage system under the Social Security Act, it means that the funding required for the implementation of this project will be deductions from the beneficiaries’ Medicare scope of coverage.
There are multiple implications that are related to the adoption of the EHR in the care provision process from a global perspective. From the social realm, the adoption of the EHR in healthcare provision process has been faced with myriad of challenges in the sense that, in as much as some acute care patients may be accommodative of these technologies, there is the comprehension that there are some physicians who may want to work independently (Boonstra & Broekhuis, 2010). Apparently, it is these social realms that ultimately influence the culture within respective organizations. As such, in the event that the patient’s health information and the outcomes of their care are shared, such a situation will not be comfortable to the physicians tasked with providing care to these patients. Considering the cultural perspective, particular ethnic groups for instance The Amish insists on avoiding interactions with the rest of the world as it may be a possible leeway for them to sin. These persons still hold to the medieval ways of life (Purnell, 2012).
As such, this legislation may interfere with their ethical and cultural beliefs since sharing of patient information is considered as one way of exposing them to the outside world. Therefore, there is the possibility of this bill not achieving its purpose in the acute care hospitals and once more impacting on the social aspects which define the cultural preferences within the facility. The probable economic implications which will come about from the adoption of this bill are in line with the realization that the upfront costs of acquiring and installing the required software and hardware may be high (Bassi & Lau, 2013). Additionally, it the costs of maintaining such systems because of the state of the art technology used in developing them is significantly high which on average would consume up to 15% of the total budget (Bassi & Lau, 2013). As such, the return on investments of the acute care hospitals that utilize them will not be in line with the business expectations of the management. Consequently, the business motive of adopting the use of EHR will not be achieved (Bassi & Lau, 2013).
Letter to a policy maker (Part IV)
[Insert Date]
The Honorable Senator Robert P. Casey,
United States Senate
393 Russell Senate Office Building
Washington, D.C. 20510-3805
Dear Representative Senator Casey,
It is my honor to be writing to you for the third time again. As you know, on the last two occasions that we have communicated, the focus has been on the Puerto Rico Hospital HITECH Amendments Act of 2015 114th Congress (2015-2016) which has failed to go through the legislative process to achieve the status of becoming a law. I am humbled by your gesture of allowing me your valuable time to regularly discuss the issue.
As you are aware, the bill seeks to amend the Social Security Bill so that the Medicare HITECH payments are applicable within the acute care hostiles in the region of Puerto Rico. The focus of the healthcare system as set up today has been on facilitating the adoption of healthcare technologies so that they can impact on the lifestyles of the people especially in the remote areas that have previously remained underserved (Miller, 2012). The proposed amendments will seek to increase funding for hospitals under Medicare so that they can fully adopt the certified healthcare technologies within Puerto Rico.
I am seeking your audience persistently based on one fact; you played a key role in the making and ultimate passing of the Patient Access and Medicare Protection Act (S.2425). As a member of the House Committee on Health you have played a key role in various issues in health and your background on the importance of healthcare technologies cannot be understated. Your experience and influence within the Congress is also a valuable asset that I think will play a major role to help this bill pass through the various stages and particularly the committee stage where it has stagnated for some time now.
The passing of this bill has many benefits which we have previously explored together with you in our communication. It will actualize the adoption of EHR in Puerto Rico which will imply real-time information and data for the staff including nurses and physicians as well as eliminate redundant issues that emanate from the paper-based systems of data recording. Further, I have explored the security benefits that will be accrued from the adoption of the EHR and noted that it will put in place security checks that will ensure appropriate utilization of resources in the sector and thus eliminate wastage and fraud dealings that may exist in the sector (King, Patel, Jamoom & Furukawa, 2014).
Further, we are in an era where evidence-based medicine is the new in-thing. Evidence-based medicine is possible in an environment where there is abundance of data that can facilitate research and subsequently the development of tailored approaches to specific health issues in the population. With the EHR, researchers and clinicians will have a database that will consistently be used to draw up patterns and trends in relation to the health issues in the community (World Health Organization, 2006).
Amidst these benefits, I would want to point out one issue that may bring about legal and ethical challenges for this bill. In the event of the passing of this bill, there is a possibility that most care facilities will rush to start the implementation and adoption based on the available incentives. This could bring in cases of errors and misses at various points mainly associated with the inexperience of using the EHRs by the staff within the facilities. (World Health Organization, 2006)
I would like to hear your view on the possible measures that can be adopted to avert such issues. My proposal is that the bill be reviewed to accommodate a section that will call on all healthcare facilities to conduct in-house training for their staff through simulation-based methods two months before the adoption. This is, however, my personal view and with your experience in matters of transition, I hope you will even find a better strategy to do this.
I know that the political ideologies based on parties are massive and could hinder the process. However, I believe that with your experience and influence you will be more than capable of achieving the best with this bill. Thank you once more for your time. I hope to hear from you soon.
Sincerely,
References
Bassi, J., & Lau, F. (2013). Measuring value for money: a scoping review on economic evaluation of health information systems. Journal of the American Medical Informatics Association, 20(4), 792-801.
Boonstra, A., & Broekhuis, M. (2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC health services research, 10(1), 1.
Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.
Congress.Gov. (2015). All Info - H.R.1225 - 114th Congress (2015-2016): Puerto Rico Hospital HITECH Amendments Act of 2015 | Congress.gov | Library of Congress. Retrieved from https://www.congress.gov/bill/114th-congress/house-bill/1225/all-info#
GovTrack.us. (2015). Puerto Rico Hospital HITECH Amendments Act of 2015 (H.R. 1225) - GovTrack.us. Retrieved from https://www.govtrack.us/congress/bills/114/hr1225#
Hospital Review. (2016). 5 Legal Issues Surrounding Electronic Medical Records. Retrieved from http://www.beckershospitalreview.com/legal-regulatory-issues/5-legal-issues-surrounding-electronic-medical-records.html
King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2014). Clinical benefits of electronic health record use: national findings. Health services research,49(1pt2), 392-404.
Miller E. A. (2012). The Affordable Care Act and long-term care: Comprehensive reform or just tinkering around the edges? Journal of Aging and Social Policy, 24(2), 101–117. Retrieved from the Walden Library databases.
Purnell, L. D. (2012). Transcultural health care: A culturally competent approach. FA Davis.
Rajecki, R. (2010). World Health Organization launches global EHR standards program | Medical Economics. Retrieved from http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-news/world-health-organization-launches-global
World Health Organization. (2006). Electronic health records: manual for developing countries. Manila: WHO Regional Office for the Western Pacific.
