You are on page 1of 34



Charisse Hazel G. De Leon, RN

"Computers are incredibly fast,
accurate and stupid. Human beings
are incredibly slow, inaccurate and
brilliant. Together they are powerful
beyond imagination.“

Albert Einstein
Health Expenditure and
Influence on IT
Healthcare Expenditure

• U.S. health care industry spends more than $1.7 trillion per
• UK healthcare budget ₤110 billion per year

• Philippines national budget 2008 $27 Billion

• 2008 Philippines Gov’t spent P28 Billion on healthcare
• The DOH budget for Health Facilities Enhancement Program
- P180 million in 2007
• P1.66 billion in 2008 (822% increase)
• P2.03 billion in 2009 (22.29% increase)
State of IT in the US
U.S. Making Grants for Healthcare IT, Job
Training Friday, 12 February 2010
The Obama administration is announcing
Friday that it will award $975 million in grants
to bolster the use of information technology in
the healthcare industry.
The grants, designed to help states and
healthcare providers increase automation and
adopt electronic health records (EHR), are
part of the $862 billion economic stimulus
legislation passed by Congress last year.
State of IT in the US
• Health and Human Services Kathleen Sebelius
is awarding $761 million to 40 states, or state-
selected healthcare providers, and 32 non-
profit organizations to help adopt new
information-sharing technology. The funding
will make healthcare IT available to over
100,000 hospitals and primary care physicians
by 2014, according to the administration.
UK – Connecting for Health
o p e ,
" s c
a m 's a n d
r o g r id e r r
I T p is w i n g o
s i v e e x it y o n g o t h e
m a s m p l n y in
The d c o a n a g r a m
n a n v e t h p r o g e s t
is io n s i e I T l a r
v e x te h c a r s t h e o
o r e e a l t s e n t U K t
m e d h e p r e t h e
n n i t r i n
pla , a n d t m e n t
l d e s
wor I T i n v
i n g l e
s ”
t e .
Not all projects on target
• Warning over fresh NHS IT delays
• The introduction of computerised NHS patient records in
England could be hit by more delays, MPs warn.
that with an
• The Committee on Public Accounts has thrown fresh doubt on
com it is y lo
a 2015 deadline for the ambitious £12bn project.
plet s u p ng-t
e, s e rs e e
• Its chairman said that even in trusts already using parts of the
r m
o th d e proj
system, staff were unimpressed and the cost to the NHS was
uncertain. e re m befo ect
get us t re it is
fo r u be a
• Project started in 2002 and was due to complete in 2010.
Revised completion date is 2014-15. n on
• de. goin
Other Issues:
• Cost – not all countries can afford the level of
spending of US or UK
• Time – many plans aim at 2015 and beyond
• Many hospitals implement alone
• Standards:
• Many different systems available
• Many different organizations – limited
• No global standard for data

Charisse Hazel G. De Leon,

• Policy - course of action that guides
present and future decisions
• Health care policy – established on
local, state and national levels to guide
the implementation of solutions for the
population’s health needs
What is the impact of Health
care Policy on Nursing
• Nursing Shortage and Nursing
• Patient Safety
• National Initiatives and
Nursing Informatics
Nursing Shortage
• In 2002 HRSA’s National Center for Health
Workforce Analysis
= a shortage projected for 2007 had
already occurred by 2000
= causes projected: older nursing workforce,
increased number of graduates with associate
degrees than baccalaureate degrees, availability
of more attractive career opportunities for
women, decreased interest in nursing as a
career, and difficult working environments
Solutions to the Problem:
• Shortened program lengths and accelerated
programs for baccalaureate degrees by schools
and colleges of nursing
• Advocacy for increasing federal funding for
program expansion, student loans, scholarships,
and incentives by nursing organizations
• AAN advocacy of IT systems to support care and
lighten the workload of nurses; development of
a multiphase project to develop IT; IT as a
marketing tool for nurses
IT as the Solution: Benefits
• decision support technology, streamlined,
and integrated documentation support,
measurement capability built into systems
for determining intensity of care and
outcomes, and workflow management tools
• use of portable and handheld devices,
incorporate Internet capability to overcome
distance barriers of care and improve access
to knowledge acquisition
IT as the Solution: Benefits
• Wireless technology and personal digital assistants (PDA)
that support nurses’ workflow
• Bar-coding of medications, use of speech recognition, and
fine-tuning the user interface of systems to support nurses
• Integration of clinical data repositories, multidiscipline
documentation, and point of care devices help nurses
share and access information in their work environments
Patient Safety
According to “A Safer Place for Patients”
(National Audit Office, HC 456 Session
• The most common patient safety incidents
in hospitals after patient injury (due to
falls) relates to medication errors, record
documentation error and communication
Patient Safety
• IOM report (1999)
Between 44,000 and 98,000 patients die each
year from medical errors.
• Surveys confirm that concern for patient safety is
the biggest factor driving IT (Anderson, 2004).
• Over 600 participants in Health Data
Management’s annual CIO survey (2004), list
prevention of errors as the main reason for
increasing IT budgets.
IT as the Solution: Benefits
• Computerized physician order entry (CPOE)
systems reduce medication and
communication errors
• Reduction of medical errors and
improvement of quality and efficient care as
advocated by Leapfrog Group, National
Alliance for Health Information Technology
(NAHIT), and Markle Foundation
• Clinical automation/information system
National Initiatives for
• Executive Order for National Interoperable
Information System
• National Health Information Infrastructure
• Health Insurance Portability and
Accountability Act (HIPAA)
• National Agenda for Nursing Informatics
• Telehealth implementation
Executive Order for National
Interoperable Information
• ‘Incentives for the Use of Health Information
Technology and Establishing the Position
Coordinator’ (2004) by Pres. George W. Bush states:
a.1 establishing a national health information
technology coordinator position
a.2 developing a nationwide interoperable health IT
infrastructure that will reduce medical errors,
improve quality, and communication of information
and reduce healthcare costs
Executive Order for National
Interoperable Information
a.3 developing, maintaining, and
implementing a strategic plan for
implementation of interoperable health IT
in both public and private sectors

*All informatics professionals will need to help

health care workers accept IT and push for
implementation of CPOE.
National Health Information
Infrastructure (NHII)
• A 3-staged process of national voluntary
initiative intended to improve the
effectiveness, efficiency, and overall quality of
health and health care in the United States
• Vision: development of a comprehensive,
knowledge-based networks that integrate
clinical, public health, and personal health
information to improve decision-making by
having information available to providers
Health Insurance Portability and
Accountability Act (HIPAA) - 1996
• Aim: Improve public and private health programs by
establishing standards to facilitate the efficient
transmission of electronic health information
• Designates financial penalties for noncompliance
with standards related to specific transactions; it
also gives the patients permission to review and
amend their medical records
• IT must be designed to comply with Title II of the Act
Health Insurance Portability and
Accountability Act (HIPAA) - 1996
• HIPAA requires the DHHS to establish national
standards for electronic health care transactions; for
national identifiers for providers, health plans, and
employers; and for the security and privacy of health
data (DHHS, 2003).
• *Privacy rule – published in December 2000 and
compliance date of April 14, 2003; it requires health
plans, health care clearinghouses, and health care
providers to protect and guard against the misuse of
identifiable health information
National Agenda for nursing
• The nursing workforce has continued to be
deficient in informatics skills
• Solution: DN convened the National Nursing
Informatics Work Group (1997) to make
recommendations to the National Advisory
Council for Nurse Education and Practice
(NACNEP) for setting the nation’s nursing
informatics agenda (NIA) for nursing education
and practice, aiming to identify nursing
informatics needs
• Five key directions for informatics in nursing
education and practice:
• Educate nursing students and practicing nurses
in core informatics content
• Prepare nurses with specialized skills in
• Enhance nursing practice and education
through informatics projects
• Prepare nursing faculty in informatics
• Increase collaborative efforts in NI
Telehealth: Underutilization
and Issues
• Telehealth remains to be an underutilized tool for
nursing and NI
• Telehealth is the use of electronic information and
telecommunications technologies to support long-
distance clinical healthcare, patient and professional
health-related education, public health, and health
• During the 2003 – 2004, the federal government has
spent about $88 million on telehealth projects
(Telemedicine and Telehealth Grant, 2004).
Telehealth Issues:
• Disjointed development, research,
demand, and investment resulting in
a small telehealth market
• Independence of telehealth from a
national strategy or effort
• Significant disconnection between
telehealth and informatics
Telehealth Issues:
- organizations are not entirely close with each
other e.g. American Telemedicine Association
(ATA) and American Medical Informatics
Association (AMIA)
- documentation of telehealth events has
frequently been independent from IS
• Reimbursement, licensure, and security issues
- Solutions to reimbursement, licensure and security issues:
• HIPAA regulations regarding privacy issues and security
• National Council of State Boards of Nursing (NCSBN) issuance of
mutually-recognized state-based license
• Implementation of the Balanced Budget Act (1997) which
mandated the first national reimbursement policy of telehealth
services for Medicare recipients
• Implementation of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 which increased usage
of telehealth services
Telehealth Issues:
• Delivery of telehealth services across state
- due to federal laws implemented per state
- Solutions:
• OAT and CTL assembly to discuss options for
eliminating interstate licensure barriers that
impact telehealth practice