Analysis of a Pertinent Healthcare Issue Essay

Introduction

Several national healthcare issues impact the healthcare system and healthcare organizations in the US. These issues should be addressed to improve the standards of healthcare; however, some issues are more urgent than others. Healthcare leaders should stay abreast with the ever-evolving healthcare system in order to address emerging healthcare issues. The selected healthcare issue is the Cures Act, also known as the 21st Century Act. Cures Act is a regulation that aims to accelerate the access of medication and medical devices and ensure patients have complete transparency and information regarding their healthcare costs and their healthcare outcomes (Martin, 2020).

National Healthcare Issue

The 21st Century Cures Act was ratified in December 2016, and it is a regulation that aims to accelerate the time taken to get pharmaceutical medications and medical devices into the market, addressing mental health and funds allocation to fight the opioid epidemic (addressing price transparency) (Martin, 2020). The Cures Act also addresses the complex area of health information technology, especially electronic health records (EHRs), as well as the critical issue of interoperability. The Act also prohibits information-blocking practices and thus increases information transparency for patients. Through the Department of Health and Human Services (HHS), the health information is made more computable and this gives patients more control of their health records, and thus increases patient engagement in their care. The Cures Act ensures improved interoperability of the EHRs. Basically, the regulation consists of three elements price transparency, information blocking, transfer (ADT) sharing, and admission, discharge (DesRoches et al., 2020).

The Impact of the Cures Act on the Healthcare Organization

My organization has been making changes to comply with the Cures Act and hence as a healthcare practitioner and nurse informaticist, I have been proactive in supporting and implementing changes to adhere to the regulation. The organization is required to ensure the immediate release of patients’ results and ensure that notes from healthcare providers are shared with patients as per the Massachusetts State Law.

In order to eliminate information blocking, interprofessional members from the information technology department, legal, compliance, and clinical informatics worked together to ensure that the patient information is documented in the patient portal, where patients can easily access the information. Therefore, the Cures Act has improved access to patient information and eliminated information blocking in my organization.

Moreover, to adhere to the price transparency as per the Act, a payment estimator application was added to the organizational electronic system. The estimator includes procedural costs and the charges of various medications and medical supplies. Adhering with price transparency aims to reduce healthcare costs and allows patients to seek out health care of the best value. Moreover, the Cures Act also addresses admission, discharge, and information transfer. As a result, healthcare organizations are required to notify post-acute care services providers or pre-identified primary care providers or group after a patient registers in the emergency department, admitted, discharged, or transferred from the hospital (Barlas, 2018). My organization has adopted an interprofessional team approach to leverage the electronic health record system to create notifications to the appropriate professionals and facilitate information sharing (ADT).

Summary of the Articles

According to Humphries et al (2018), the 21st Century Cures Act requires the Federal Food, Drug, and Cosmetic Act to be amended to ensure a more efficient process for updating susceptibility test interpretive measures to acknowledge antimicrobial resistance. This is to ensure information transparency and accelerate the access to drugs’ information by the consumers. This article supports the importance of updating accurate information about medications, and in this case antibiotics, including antimicrobial resistance. Therefore, with such information, both the clinicians and the patients can access information about the susceptibility to microorganisms against antimicrobials and hence know the probability of efficacy of antimicrobial treatment, based on the most and best available current information about pharmacodynamic/pharmacokinetic, resistance, and clinical outcome of various medications (Humphries et al., 2018).

In the article by Mangino & Danis (2020) patients have a right to access their information through the electronic health records system, and this includes the uses of patient online portals to promote information access and ensure information transparency as per the Cures Act. Mangino & Danis (2020) thus explain that health systems have implemented online patient portals to ensure that patients can easily access and view their health records. However, the article notes that there are various ethical issues involved with availing patient information in online patient portals such as confidentiality and privacy, and hence healthcare organizations should implement security measures to protect the privacy and confidentiality of patient information.

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Strategies Used to Address the Organizational Impact of the 21st Century Cure

According to Humphries et al (2018), one of the strategies healthcare organizations can use is to ensure constant access to information about medications and medical devices so that patients can easily access this information and make informed medical choices. The organization shares patient information and thus it should ensure that the privacy of such information is protected, for example implementing the appropriate security measures to ensure only authorized parties can access the information.

Secondly, the organization needs to ensure that all patient information is documented in the online patient portals to ensure that patients can access their health information easily. Mangino & Danis (2020) explain that sharing patient information in the online patient portals ensures information transparency as per the Cures Act.

Conclusion

The 21st Century Act (Cures Act) facilitates complete transparency regarding the costs of medications, care, and the outcomes of care for the patients. Adhering to this regulation ensures that patients have more control of their health information, and empowers them to be more engaged in their care. Moreover, through this Act, patients are provided with up-to-date information about medications and thus enables patients to make informed treatment decisions. In line with the Cures Act, my organization ensures immediate release and sharing of patient’s findings and notes with the patients. The patient information is also documented in the patient portal, where patients can easily access the information. Finally, the payment estimator application was added to the EHR system to ensure patients are aware of the costs and value of the care services.

References

Barlas S. (2018). Health Care Price Transparency Initiatives Are All the Rage: But Burgeoning Efforts Suffer from Myriad Shortcomings. P & T: a peer-reviewed journal for formulary management, 43(12), 744–768.

DesRoches, C. M., Leveille, S., Bell, S. K., Dong, Z. J., Elmore, J. G., Fernandez, L., … & Delbanco, T. (2020). The Views and Experiences of Clinicians Sharing Medical Record Notes with Patients. JAMA Network Open, 3(3), e201753-e201753.

Humphries, R. M., Ferraro, M. J., & Hindler, J. A. (2018). Impact of 21st Century Cures Act on breakpoints and commercial antimicrobial susceptibility test systems: progress and pitfalls. Journal of Clinical Microbiology, 56(5).

Mangino, D. R., & Danis, M. (2020). Sharing Ethics Consultation Notes with Patients Through Online Portals. AMA Journal of Ethics, 22(9), 784-791.

Martin, M. (2020). The Ethics of Emergent Health Technologies: Implications of the 21st Century Cures Act for Nursing. Policy, Politics, & Nursing Practice, 21(4), 195-201.

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Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing the 21st Century Cures Act and how it is impacting your work setting. Be sure to address the following:

Describe the Cures Act and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
Summarize the strategies used to address the organizational impact of the 21st Century Cures Act presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

National healthcare issue

Healthcare is rapidly evolving. Healthcare leaders are responsible for staying abreast of the rapid changes to clinical practice and the awareness of healthcare reform, regulatory changes, trends, and healthcare successes (Laureate Education, 2015). Healthcare leaders are faced with developing solutions for the regulatory changes that strategically align with the Quadruple Aim (Laureate Education, 2018). The 21st Century Act, also known as the Cures Act, is a new regulation passed to allow patients to have complete transparency into the cost and outcomes of their care (Health IT.gov, 2020). The Department of Health and Human Services (HHS) is making health data more computable and giving patients more control of their medical records, thus empowering the patient with the tools to become engaged in their care. The regulation guarantees an increase of interoperability of the electronic health record. It requires three parts to the act, information blocking, price transparency, and the admission, discharge, and transfer (ADT) sharing.

The impact and the changes to the healthcare organization due to the issue

Effective October 1, 2020, in preparation for compliance with the Office of the National Coordinator (ONC), Cures Act Final Rule, as a healthcare professional and nurse informaticist, I worked with my healthcare organization to implement changes to comply with the new regulation. These changes included the immediate release of results to patients and the sharing of provider notes with patients as allowed by Massachusetts State Law.

Information Blocking is listed as a practice that is likely to interfere with access, exchange, or use of electronic health information. An interprofessional approach of members from the information systems, Chief Medical Information Officer (CMIO), legal, compliance, health information management (HIM) and clinical informatics collaborated to identify the program’s documentation for patients in the patient portal, My Chart. Additionally, the members have been working on documentation for providers and reviewing policies on what can and can’t be shared.

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A significant impact as a result of the Cures Act is the sharing and codifying of healthcare costs. The HHS’s objective for price transparency is to lower healthcare costs allowing the consumer to seek out medical care of best value (McElvain, 2019). However, there are concerns that this could result in negative consequences. Furthermore, the price transparency has resulted in a more extensive system implementation as this ties directly to the health system’s finance. This allows for transparency to the patient, but it can be used with competing healthcare organizations. To comply with the price transparency component, a payment estimator application has been added to our electronic system. The estimator is composed of procedural costs and a list of charges that include drugs and supplies.

The admission, discharge, and transfer information sharing is also known as ADT sharing, will require an organized interoperable approach with other healthcare organizations. Organizations will be required to send notifications to a pre-identified primary care provider or group or post-acute care services provider upon the patient’s registration in the emergency department or admission to, or discharge or transfer from the hospital. In collaboration with patient access, the interprofessional team is developing ways to strategically leverage our electronic health record to create notifications. May 2021 is our set date to implement the ADT sharing.

The challenges the organization has faced regarding the issue

On October 29, 2020, the ONC approved a final rule to delay the ONC Cures Act’s enforcement until April 5, 2021. We are still waiting on information from the ONC as to precisely what aspects of the 21st Century Cures Act have been delayed and our organization’s impact. Although this delay is a barrier, it will give us more time to mitigate sensitive issues that may arise during our patients’ care and how to handle best sharing that information in a safe way for our patients and compliant with the regulation.

Since we went live with notes sharing, there have been questions about when to “un” share a note versus when to mark a note as sensitive. Additionally, there is also a small list of labs that we do not share with patients through My Chart. The latest challenge to date is the sharing of the newborn record. Both biological parents have a legal right to access their newborn’s medical record. The challenge is the maternal information that is composed in the newborn’s record from the delivery summary. Additional workgroups composed of clinicians have been brought together to provide insight into clinical workflows. The key stakeholders must be engaged with the project.

Conclusion

There is excellent work being done towards the new regulation, with much more to come. As a transformational leader, it is critical to engage key stakeholders, clinical representation when working on project development for clinical areas, and patient outcomes. By engaging clinicians in the project, they can help identify problems and provide insight into the resolution. Through the engagement of clinicians there is a greater clinician satisfaction which correlates with project and programs successes. The collaborative approach solidifies the Quadruple Aim in healthcare and will ultimately achieve high quality, cost-effective care for patients with improved patient outcomes.

References

Health IT.gov. (2020, May 19). Health IT Legislation. November 30, 2020, https://www.healthit.gov/topic/laws-regulation-and-policy/health-it-legislation

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). The Healthcare Environment [Video]. Baltimore, MD: Author.

McElvain, J. (2019). HHS Seeks Comment on Proposal Requiring Providers to Disclose Price Information: Price transparency goal laced with complexity. Dennis Barry’s Reimbursement Advisor34(7), 3–6.

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