The movement advocatingfor the widespread implementation of the electronic health records (EHR) began many years before the passage of ARRA and the HITECH Act.
The movement advocatingfor the widespread implementation of the electronic health records (EHR) began many years before the passage of ARRA and the HITECH Act. Various milestones including legislation and publications are representedin Figure 1 as a timeline.
Figure 1
Timeline depicting various milestones including legislation for HIT in the US
Note. Timeline.
The chapter authors an overview of the milestones in Meaningful Use. According CMS meaningful is defined as “using certified EHR technology to
• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• All the while maintaining privacy and security
• Meaningful Use was mandated into law to receive financial incentives” (CMS, 2010)
Meaningful Use Stage 1 was issued in July, 2010. Meaningful Use Stage 2 was issued in 2012. The Final Rule for Stage 3 was released in October, 2015. According to CMS “Stage 3 includes flexibility within certain objectives to allow providers to choose the measures most relevant to their patient population or practice. The Stage 3 objectives with flexible measurement options include:
• Coordination of Care through Patient Engagement – Providers must attest to all three measures and must meet the thresholds for at least two measures to meet the objective.
• Health Information Exchange – Providers must attest to all three measures and must meet the thresholds for at least two measures to meet the objective.
• Public Health Reporting – Eligible professionals must report on two measures and eligible hospitals must report on four measures.
More details regarding Stage 3 can be found at the CMS.gov website.
Of particular interest, Murphy and Johnson (2015) provide a concise summary of the intersection of HIT policy and nursing informatics. The authors note that informatics nurses are needed to help ensure the achievement the goals expressed in ARRA and HITECH.
Alexander and Halley in Chapter 18 continue the discussion of nursing informatics participation and influence in public policy. The authors identify various avenues to influence policy including
• Federal Advisory Committees
o National Committee on Vital and Health Statistics
o Health Information Technology Policy Committee (HITPC)
o Health Information Technology Standards Committee (HITSC)
• Policy Institutes
• Professional Organization
o ANA
o American Academy of Nursing (AAN)
o Alliance for Nursing Informatics (ANI)
o American Telemedicine Association (ATA)
o American Medical Informatics Association (AMIA)
? Nursing Informatics Working Group (NIWG)
o American Nursing Informatics Association (ANIA)
o Health Information Management Systems Society (HIMSS)
• Technical Expert Panels
• NI Policy Advocates
The chapter authors identify and discuss three landmark reports released by the IOM. These include
• Future of Nursing Leading Change, Advancing Health
• Health IT and Patient Safety
• Best Care at Lower Cost … The Path to Continuous Learning Healthcare in America
Alexander and Halley note that “NI leaders must be knowledgeable and current of in public policy and regulatory initiatives” (2015, p. 287). The authors continue “advocating for informatics is a complex responsibility that requires in-depth knowledge of both clinical processes and clinical systems”. The informatics nurse must recognize and be capable to articulate issues of usability, interoperability, standardization, terminology, cost, quality, and safety” (p.288). Furthermore, NIs “must be able to convey their concerns about data, and its availability for reporting and dissemination, in terms that are easily understood within the context of the recipient’s own constitutional paragon. In other words, nursing informaticists must engage key stakeholders at the intersection of the stakeholder’s ability and willingness to influence change” (p. 288). In summary, Alexander and Halley state “NIs must recognize the importance of engaging in the public policy process and advocating for advancement in technology and processes that will promote improved patient care, better health, and lower healthcare costs in the United States” (p. 289). Alexander and Halley conclude the NI “is positioned to collaborate with technology vendors, regulatory bodies, politicians, and other to ensure that healthcare technologies and public policies promote patient care at the extraordinary level we have always ascribed to in nursing” (p. 289).
Since publication of the textbook additional legislation has been enacted including
• The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law on April 16, 2015. According to CMS (2017) MACRA
o “Changes the way that Medicare rewards clinicians for value over volume
o Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS)”
• The 21st Cures Act, signed into law on December 13, 2016. According to HIMSS (2017) the Cures Act
o “Promotes and funds the acceleration of research into preventing and curing serious illnesses
o Accelerates drug and medical device development
o Attempts to address the opioid abuse crisis
o Tries to improve mental health service delivery
o The Act includes a number of provisions that push for greater interoperability, adoption of electronic health records (EHRs) and support for human services programs”
Learning Objectives
• Discuss the significant impact of federal legislation from 2009 and 2010 on the use of health information technology
• Describe the creation of the office of the National Coordinator for Health Information
Technology and summarize the major role it plays in the implementation of health information technology
• Discuss the implications of policy on nursing informatics as a specialty
• Identify the impact that national trends and events focused on information and information technology have on nursing informatics practice
• Outline the role of health IT in key emerging payment and clinical practice change initiatives, both in the government and private sectors
• Examine the course to navigate public policy as related to healthcare and nursing informatics
• Define the public policy process
• Analyze the skills and competencies nursing informaticists must possess in order to effectively communicate with policy-makers and those in positions to sway policy-makers
• Explore how the nursing informaticists are impacting public healthcare policy
• Review how education for nurses continues to increasingly leverage technology for learning and supporting nursing practice
• Encourage the nursing profession to collaborate, educate, and coordinate efforts in policy formulation to support nursing’s role in quality, safety, and patient advocacy
Activities
Read and review
Murphy, J., & Johnson, L. O.(2015). Chapter 16Nursing informatics and healthcare policy. In V. Saba & K. McCormick (Eds.), The essentials of nursing informatics (6th ed., pp. 249-271). McGraw-Hill.
Alexander, D., & Halley, E. C. (2015). Chapter 18 Establishing nursing informatics in public policy. In V. Saba & K. McCormick (Eds.), The essentials of nursing informatics (6th ed., pp. 281-291). McGraw-Hill.
Individual Activity
In order to participate in policy formation, it is necessary to know policy makers such as state and national representatives and senators.
1. In an effort to influence policy, write and submit in Canvas a 500-word letter to Alex M. Azar II, Secretary of Health and Human Services explaining why the Office of the National Coordinator for Health Information (ONC) should be led a nurse informaticist specialist (INS) during the COVID-19 pandemic. Information regarding how to prepare a letter is available from https://www.ncsbn.org/APRN_formletter_Legislator_web.pdf. Your letter must be unique
2. Information regarding the ONC can be obtained from
https://www.federalregister.gov/documents/2014/06/03/2014-12981/statement-of-organization-functions-and-delegations-of-authority-office-of-the-national-coordinator
https://www.healthit.gov/newsroom/about-onc
http://searchhealthit.techtarget.com/definition/ONChttps://www.hhs.gov/about/agencies/orgchart/onc/index.html
https://www.hhs.gov/about/leadership/don-rucker/index.html
3. Organize the submission by
o Using a cover page
o Letter to
o No references required
Contact the course faculty if you have questions.
In an effort to influence policy, write a 500-word letter Alex M. Azar II, Secretary of Health and Human Servicesexplaining why the Office of the National Coordinator for Health Information should be led by a nurse informaticist specialist during the COVID-19 pandemic. Information regarding how to prepare a letter is available from https://www.ncsbn.org/APRN_formletter_Legislator_web.pdfYour letter must be unique
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