The pace of Internet technology adoption in healthcare has been accelerating over the last three years, helped along by the dramatic democratization of access to technology and the passage of the healthcare law.
Paper patient records are giving way to electronic health records (EHR). Paper prescriptions are giving way to e-prescriptions, whereby the doctor directly sends the prescription order electronically to be filled or refilled by the patient’s choice of pharmacy. The patient then simply shows up at the pharmacy to pick it up. Video, e-mail, and social media technology are allowing improved access to doctors, with patients able to rate their experiences.
Doctors and nurses are increasingly using tablets and other handheld devices to manage patient visits. Patients are able to view their health information and make and change appointments online using their own computers, tablets, or other handheld devices. Technology is being used to monitor patient status and provide patients with discharge instructions and reminders about how and when to take their medications.
Major EHR vendors are building Health Information Exchanges (HIE) to allow care providers to exchange patient information and access a complete picture of a patient’s health in order to provide better care. Major hospitals are signing up with vendors to participate in these exchanges.
To make it easy for doctors to adopt technology into their practices, several options are available. Many doctors simply sign up with a free EHR provider, which eliminates the need to hire and manage technology staff or maintain servers. The major disadvantage is that the doctor has to plan for a possible service outage, which is frequently mitigated by requiring the provider to maintain a local copy of the data. The other disadvantage is that the service provider may sell de-identified patient data for research purposes (something that HIPAA allows).
Other options include hiring a managed services organization (MSO) to provide hosting and management services or to facilitate a transition for the doctor’s practice into a third-party managed service. Eligible doctors, hospitals, and care providers can recoup expenses of migrating to an EHR by filing for Meaningful Use incentive payments.
Maryland recently became the first state to connect all of its hospitals to a health information exchange (HIE). Maryland's HIE is a mechanism for transport, connection, and exchange of medical information. This system does not store patient data. Patients are opted in by default but can opt out of the system if they wish.
In 2009, Maryland also adopted rules to allow doctors to practice telemedicine, and legislative bills that would allow doctors to be reimbursed by insurers for telemedicine visits are underway. Maryland has also received a grant to build a health insurance exchange.
The big question now: What happens if the federal healthcare law is overturned by the Supreme Court? Chances are high that efforts in some states will continue unabated -- though funding could become challenging.
In other states, such as Maryland, where the state law refers to the federal law instead of incorporating its provisions into the state law as some states did, overturning the federal law will most likely overturn the state law as well. Thus a period of confusion and uncertainty may persist. However, the genie is out of the bottle!
Mansur Hasib has served in CIO/CISO and other leadership roles in the public, private, and education sectors.