The US healthcare system is experiencing a major transformation, driven in large part by a combination of federal incentives and demands, which, in turn, are spurring adoption of secure mobile computing in healthcare.
Regulatory requirements trickle down to specific technical requirements indirectly. For example, the law promotes the adoption of computerized physician order entry (CPOE) for prescriptions and lab orders. One way of getting more physicians to participate is to make electronic orders at least as easy as the traditional paper prescription pad by supporting CPOE on smartphones and tablets. Similarly, regulations require data security and patient privacy, but do not say how to achieve it. Citrix technologies can make healthcare applications accessible across operating systems and device types, while keeping the underlying data centralized and secure.
Even those who work in Healthcare IT can be forgiven for having a hard time keeping track of the requirements and the overlapping laws with which they are associated. The Affordable Care Act (“Obamacare”) and the Health Insurance Portability and Accountability Act (HIPAA) include provisions related to healthcare quality data gathering and the protection of patient privacy. But the program that did the most to accelerate the adoption of health IT is Meaningful Use.
The Meaningful Use program is part of the HITECH Act, which was part of the American Recovery and Reinvestment Act of 2009 – the federal stimulus meant to boost the country out of recession. Lawmakers, at the time of its implementation, decided to stimulate the adoption of electronic medical records, too.
Divided into 3 stages, Meaningful Use creates incentives for physicians and hospitals to adopt Electronic Medical Records (EMRs).
Physicians and physician groups can earn up to $70,000 per year, per physician. Hospitals have similar incentives. Meaningful Use Stage 1 required physicians and hospitals to adopt a certified EMR. Meaningful Use Stage 2, which is currently underway, sets out eight specific core objectives (see Figure 1). The Stage 3 requirements, which will further ratchet up expectations starting in 2017, are in the process of being finalized.
|Meaningful Use Core Objectives||Description|
|Computerized Physician Order Entry (CPOE)||Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology.|
|E-Prescribing (E-Rx)||– Use E-Rx for more than 50% of medication orders, in the process checking them against the formulary of drugs approved under the patient’s insurance|
|Interventions||– Implement 5 clinical decision support interventions|
|Patient Electronic Access||– Provide online access to health information within 4 business days|
|Security Analysis||– Conduct or review security analysis and risk management process|
|Education Resources||– Use EHR to identify and provide education resources more than 10%|
|Rx Reconciliation||– Medication reconciliation at more than 50% of transitions of care|
|Health Information Exchange||-Create summary of care & exchange electronically|
|Secure Messages||– Functionality is fully enabled such that patients can send secure messages to their MD|
The overall vision is of a system in which patient data is captured at the point of care and where physicians have ready access to patient health history, minimizing errors due to inaccurate or missing information. One of the keys to making heath IT pervasive is mobility, whether that means a laptop on a cart that gets wheeled into the room or a mobile device in the physician’s hands. If, instead, a doctor is taking notes on paper to be entered into the computer later, the opportunities for data entry errors increase and the opportunity for interactive data access vanishes.
Or the exam room might be equipped with a desktop computer that forces the physician to sit with his back to the patient while recording or retrieving data. Again, a laptop cart or a tablet gives the doctor the EMR access he needs, along with the ability to maintain better eye contact. Regulators are beginning to look at patient satisfaction as a metric of healthcare quality, so preserving the doctor-patient relationship is important.
Mobile access to ePrescribing makes it easier for doctors to take advantage of clinical decision support while their patients are in front of them. In particular, the software can alert doctors up front to drug interactions and drug allergies so they can avoid medication errors.
Meanwhile, the ability to access a patient record at home while on call gives the physician the ability to respond to patient requests quickly and effectively 24 hours a day and 7 days a week. With Citrix technology, hospitals can allow that remote access to the full EMR without allowing sensitive patient data to be downloaded to a home computer or mobile device.
The regulatory push is intended to promote quality healthcare and improve the patient experience, while protecting the integrity of patient data. The challenge for healthcare IT is to put the necessary ingredients in place to make that possible. Boosting mobility, while ensuring security, will play a big role.
Ben Wilson, MBA, MPH
Sr. Director, Healthcare Strategy
Healthcare Solutions Marketing