Week 9 - Medical technology and policy

application of scientific knowledge to improve health and efficiencies
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Terms in this set (43)
application of scientific knowledge to improve health and efficiencies
medical technology
transformation of data into useful info
info technology
a longitudinal electronic health record storing patient info for the purpose of delivery of care
electronic health records (EHRs)
what are the four components of a fully developed EHR system
collection and storage of health info on individual patients over time

immediate electronic access to person- and population-level info by authorized users

availability of knowledge and decision support that enhances the quality, safety, and efficiency of patient care

support of efficient processes for health care delivery
what are the benefits of EHRs
cost saving

reduce medical errors

reduce the risk of adverse drug effects

improved quality of care
-promote time efficiencies
-support adherence to clinical practice guideline

improved better access to retrievability and/or portability of the data

interoperability
what are the drawbacks of EHRs
stick to institutional interests

need more time and efforts to adopt EHRs

implementation costs
what are the three health outcomes of EHRs
improved patient safety

improved influenza and pneumococcus vaccination rates

provided more preventative care services and prevent adverse outcomes
what are the organizational outcomes of EHRs
increased revenue

improved charge capture

decrease billing errors

increase a providers cash flow

enhance revenue

physician satisfaction

less waiting time

less delays associated with access to care
what are the social outcomes of EHRs
improved ability to conduct research with aggregated data
HIPAA - 1996
Health Insurance Portability and Accountability Act mandate strict controls on access to personal health info (PHI) what are they `
the transfer of personally identifiable health data

provisions for disclosure of protected info

penalties for violation
what are the exceptions for HIPAAfor health care delivery, operations, and reimbursementin 2013, there was an update to HIPAA in conjunction with the HITECH ACT what was it `include vendors and subcontractors as business associates who must comply with HIPAA requirementsHITECH 2009 Health Information Technology for Economic and Clinical Health Act does whatsupport direct grants and financial incentives to promote the adoption of EHR by hospitals and physicians medicare and medicaid incentives to providers for meaningful use of health info technology -the EHR incentive programs (aka the meaningful use programs) ---> the promoting interoperability (PI) programs -up to $27 billion over 10 yearswhat are the four kinds of medical technology in the healthcare systeme-health: telemedicine, EHR m-health: monitoring for risk factors on mobile application, CVD risk calculator e-therapy: mental health counseling virtual physician visits: online clinical encountersE-Health/Telemedicineemploy telecommunications technology for medical diagnosis and patient carewhat are the benefits of telemedicine `efficient and effective healthcare service delivery reduce healthcare costs for patients not for providers improved access to services and information improved professional educationwhat are the disadvantages to telemedicineconcerns of quality of health info need robust established relationship between patient and providersTelehealthbroader scope of practices - technically not the same concept as telemedicine telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical serviceswhat are the characterisrics of telemedicinesynchronous technology: telecommunication occurs in real time asynchronous technology: time difference of telecommunication and review the info laterissues of telemedicineunidentified need for certain types of telemedicine services uncertain reimbursement policies absence of interstate licensure reciprocity lack of universal access to necessary technology concerns about patient confidentiality quality of telehealth is unknowntelehealth and health policy amid COVID-19become primary delivery format of primary care services during COVID-19 -section 1135 Waiver of the Social Security ActUnder the 1135 Waiversome services are added for medicare reimbursement the video requirement for certain services was temporarily removed new payment for virtual check-ins since 2019 medicare part b pays for clinicians for e-visitsin primary care about ______% of practice has been delivered via telehealth `80what five factors drive innovation and diffusionanthro-cultural beliefs and values medical specialization financing and payment expenditures on research and development technology-driven competitionAnthro-Cultural Beliefs and Values - factors drive innovation and diffusionhigh expectations of what technology can do to cure be able to get the most advanced tests, drugs, medical procedures, and equipmentmedical specialization - factors drive innovation and diffusionearly exposure to technology in training may affect clinical preferences, behavior and practice patternsfinancing and payment - factors drive innovation and diffusionpayment incentives like EHR adoption programs generous insurance coverage example: CMS removes knee replacements from inpatient only list for medicare enrolleesexpenditures on research and development - factors drive innovation and diffusionGlobal Biomedical R&D Expenditurestechnology-driven competition - factors drive innovation and diffusionhospitals and specialists have added new services with new technologies self-referral and stark laws: section 1877 of the social security act -self-referral means sending patients to facilities in which the referencing physician or a family member has an ownership interest or some kind of compensation arrangement -self-referral is prohibited to prevent overutilization and high healthcare costs -stark laws covers medicare and medicaid referrals (lab services, rehab services, radiology services, radiation therapy services and supplies, durable medical equipment and supplies, etc. -half the states have own self-referral prohibitions that apply to privately insured patientsassessment on medical technology -high technology assessment (HTA)any process of examining and reporting properties of a medical technology used in healthcare such as safety, effectiveness, feasibility, and indications for use, cost and cos-effectiveness, as well as social, economic, and ethical consequences, whether intended or unintended less widely used in the US because the FDA plays a primary role in efficacy and safety assessmentwhat are the properties of High Technology Assessment (HTA)efficacy - the heath benefit derived from the use of technology safety - to protect patients against unnecessary harm from technology cost-effectiveness - to evaluate the additional benefits derived in relation to the additional costs incurred cost benefit - to evaluate the additional benefits derived in relation to costs in monetary terms cost utility - to evaluate the health benefits with Quality-Adjusted Life Years QALY measure in relation to coststhe government's role in technology diffusionregulation -FDA -Certificate of Need -HiPAA and telehealth Incentivizing -the orphan drug act of 1983 -the FDA Modernization act of 1997The FDA key componentssafety and effectivenessCertificate of Needregulate the diffusion of technology require hospitals to seek state approval before acquiring major equipment or embarking on new construction or modernization projectsHIPAA and telehealthregulate the good faith provision of telehealth services -types of technology -telehealth service coverage -HIPAA compliant providersThe Orphan Drug Act of 1983to provide incentives for pharmaceutical firms to develop new drugs for rare diseases and conditions more than 450 orphan drug products have been approved by the FDAthe FDA Modernization Act of 1997access to experimental drugs and medical devices fast track approvals are permitted when the potential benefits of new drugs for serious or life-threatening conditions are considered significantly greater than the benefits of current therapies ex: the FDA offers a fast track for nine tech companies developing wearable devices (fitbit, apple watch, samsung, etc.)Impact of Medical Technology -Impact on Quality of Care and Lifeprovide precise medical practice provide new treatment more effective, less invasive and safer technology -improve preventive care services as well as advanced care services -improve health outcomes be able to live normal lives better quality of life with less pain give patients more independence and controlImpact of Medical Technology -Impact on Healthcare Costs `arguable the long-term benefits of cost reduction -cost drivers: the adoption of medical technology, enough utilization to reach at least break even point, purchase price cost savings -when eliminating complex medical procedures to simple way -when save resources such as time, labors, etcImpact of Medical Technology -Impact on Accessfor patients -better access to care with remote connection for providers -benefits to emergency medical services with improved accuracy of time estimation and geographic location -benefits to advanced technology education and application to providers in rural areaImpact of Medical Technology -impact on structure and processes on healthcare deliveryshift toward acute care setting reduce the need for institutionalization effective delivery system through IT systemthe future of medical technologycontinue to grow up will become one of main drivers in changing healthcare systemissues with the future of medical technologyethical issues need for standardization balance between clinical efficacy and economic worth = cost effectiveness quality of care issues