disparities in underserved communities.
This Memorandum sets out to evaluate the importance of implementing and funding health information exchanges and electronic health records systems in underserved communities. By the conclusion of this memorandum, the Department of Health and Human Services will have a clear understanding as to why investing in adopting EHRs is important and how the HIPAA and HITECH Act is important to eliminating the digital divide nationwide and must be properly funded in order to damper the amount of unnecessary breaches, and the proper and secure exchange of information in relation to health disparities. BackgroundThe American Recovery Act was first enacted in February of 2009. HITECH Act (health information technology for economic and clinical health act) was implemented as a provision of title XIII of the American Recovery Reinvestment Act. 22 billion dollars of the money allocated to implementing the ARA was to be used in order to increase the usage of electronic health records in healthcare facilities nationwide. This was initially set up to take place due to the addition of the HITECH provision. Out of this 22 billion dollars, majority of the funds ($18 billion) were to be put towards Medicaid and Medicare reimbursement systems while only 1 billion was set aside to assist in integrating heath information technology systems into facilities. The act was developed in order to increase the adoption of electronic health records and participation in health information exchanges.
It played a major role in establishing grants that could provide funding sources to underserved areas. One of the main goals of the HITECH is to allow patients to have direct access to their medical records in order to decrease the need for excessive appointments. This would allow healthcare providers more time to focus on treatment and improved quality.
Another priority of the HITECH Act is to persuade state organizations to adopt HIE and EHRs as well as providing incentives for funding the adoption by funding education and training opportunities for facility personnel. The HITECH included specific provisions that requires that there would be programs established to provide education and support to providers as they take steps towards making the switch from a paper based system to an electronic based system. This policy included provisions that would ensure that the benefits of increased HER adoption would accrue equally to all types of healthcare providers and patients (Samuel, King, Adetosoye, Sammy, and Furukawa, 2013). It is also a provision of HIPAA in regards to information technology security and privacy in relation to the exchange of hearth records. As a result of the digital divide, underserved areas need to be given a significantly greater amount of funding. While the adoption of health It is growing exponentially, there is significant risk that underserved populations will continue to be left behind (Samuel, King, Adetosoye, Sammy, and Furukawa, 2013). Both the ARA and the HITECH Act include provisions that focus on the improvement of IT among providers that treat underserved populations.
Section 3001 of the HITECH requires that there is an initial assessment of the impact of HIT on communities within health disparities and uninsured, underinsured, and medically underserved areas. HRSA include funding for health care professionals that gives them the resources to train to understand and utilize HIT as well as give the knowledge about how to prevent breaches and securely exchange patient information. Why do EHRs need to be present in Underserved AreasThe incentive programs required by the HITECH Act requires that facilities national coordinators need to strategically develop a proper and adequate information technology infrastructure.
This is directly related to improving healthcare quality, reducing disparities, and reducing the amount of medical error by developing automated systems to keep track of medical history. Most patients in underserved communities lack technological resources and the necessary hardware which is a key element in applying a successful health information infrastructure. Since rural areas lack adequate broadband networks, they require more funding.
The Health Resources and Services Administration is a federal entity that aims to improve the overall outcome of healthcare in relation to groups of people that are geographically isolated and more susceptible to illness and disease. The HRSA takes into consideration the fact that health and technology literacy level is lower in socioeconomically challenged areas. One reason being that the level of educational attainment is low as well.
Since theses literacy and educational attainment levels are lower, people from these areas are fearful in providing their medical information via electronic formats in addition to interacting with technology that they are not familiar with. The HITECH has set out to ease. Both providers as well as patients are fearful in exchanging and storing medical information electronically in fear that it poses a series of threats. The HITECH act places restraints and repercussions if healthcare information is improperly handled. It also sets forth, in hopes of eliminating negligence, facility training resources for personnel to learn about IT and how it can ease their job related duties and improve the quality of the care they are providing. The Health Resource and Services Administration highlights that Section 13101, Subtitle A, Sec. 3001 (c)(6)(C) of the HITECH Act focuses on the assessment of the impact of HIT on communities with higher rates of health disparities in areas where most people are uninsured, underinsured, and medically underserved areas.
The HRSA also notes that this provision states that “The National Coordinator shall assess and publish the impact of health information technology in communities with health disparities and in areas with a high proportion of individuals who are uninsured, underinsured, and medically underserved individuals (including urban and rural areas) and identify practices to increase the adoption of such technology by health care providers in such communities, and the use of health information technology to reduce and better manage chronic diseases.”FundingUnder the current Presidential administration, there is a significant reduction in the amount of funding for IT in healthcare facilities in underserved communities. This lack of funding can be attributed to causing health disparities. One major barrier exists in the form of substantial capital necessary for the initial investment in healthcare IT and has historically been true in the case of free clinics and other safety net organizations that disproportionately serve underserved populations (University of Chicago NORC, 2010). Many of these underserved facilities do not want to accrue debt and are constantly in competition with each other for funds in the form of grants.
The HTECH act provides incentives and programs to persuade these facilities to adopt EHRs and participate in health information exchanges. One such program is the formation of Regional Extension Centers. The HITECH Act includes a statement that suggests that regional extension centers prioritize any direct assistance to providers that may otherwise lack the resources to adopt EHRs and these REC have been working diligently towards promoting equitable patterns of EHR adoptions across the U.S. since 2010 (Samuel, King, Adetosoye, Sammy, and Furukawa, 2013). According to a study conducted by University of Chicago, there has been a significant amount of documentation regarding the general barriers to adoption and implementation of health IT. Some of these barriers have been linked to cost, lack of educated and trained staff, challenges in planning and workflow redesign and lack of perceived demand and utility. Safeguards and securityAs for security and privacy, the HITECH act as stated before, expands on certain provisions of the HIPAA.
The HITECH act mandates that entities such as the Department of Health and Human Services must also be notified when a breach occurs that involves 500 or more patients in which the DHHS can then can decide to reduce funding for resources and Medicaid and Medicaid incentives in addition to a fine ranging from $250,000 to $1.5 million. The HITECH Act takes responsibility for ensuring that healthcare providers are compliant and provide both positive incentives in the form of monetary funding and negative incentives such as legal fines and penalties. Recommendations:Finding ways to adopt a completely interoperable system will decreases the need for funding, provide more security and safeguards, make the information that is exchanged more meaningful (which can be used for quality tracking and improvement), and decrease the amount of medical error and lost paper data. There must be programs put into place that create ways to decrease the digital divide and lack of and fear of using IT. The digital divide is the primary cause that pushes people of lower socioeconomical areas to be skeptical in providing their information in fear that their information will be able to be seen by anyone. Properly educating people in rural areas on the benefits of applying information technology to certain aspects of improve healthcare, there would be less error and more willingness to participate, thus a greater opportunity to collect health data This data can then be used to pinpoint flaws and create solutions to improve quality. After looking at the 2017-2019 FY budgets for the HRSA, many areas of funding are seeing significantly decreases.
The rural health budget in particular shows that the 2019 national budget only provides $75 million for HRSA’s Federal Office of Rural Health Policy. This amount is almost $80 million less than the proposed budget for 2018 and ultimately suggests that there is and will be less funding to properly implement successful HIT systems in rural area hospitals and less funding to provide adequate education and resources.ConclusionThe implementation of HIT plays a crucial role in identifying and addressing healthcare disparities in socioeconomically challenged regions. In order to keep addressing these issues, there needs to be an increase and not a decline in the amount of funding that is allocated towards organizations such as the Health Resources and Services Administration. Eliminating underlying barriers such as the digital divide and educating and training healthcare providers and personnel on how to implement and properly utilize HIT successfully. The proper education plays a great role in increasing awareness and importance of healthcare security, which then allows healthcare facilities to implement the necessary safeguards in regards to exchanging health information technology electronically.
