Module V - Policy WITH Ethics

Policy and Ethics
What is AHRQ??? AHRQ is the Agency for Healthcare Research and Quality, a research arm of the US Department of Health and Human Services.
What, if any relationship do you see between the information available on this webpage and regulatory, accreditation, and reimbursement issues and healthcare information system use and design?
The AHRQ site is quite visually “busy” (there are so many subsites and linkouts that one can literally get lost on the Hansel and Gretel trail and forget what they were looking for in the first place) but is a virtual clearing-house of information that drives regulatory clinical practice based on current research best outcomes. The Agency for Healthcare Research and Quality's (AHRQ) mission is to “improve the quality, safety, efficiency, and effectiveness of health care for all Americans” (ahrq.gov, 2009) while simultaneously encouraging research by offering grants and funding. Based on the mission and the focus of this government funded agency, it is fairly obvious that research compilation is used to set national standards of care and is the primary link between what is reimbursable to Medicare and Medicaid by appropriate standards of care. For anyone who has been involved in billing services for any healthcare division, reimbursement issues are directly related to documentation (and we are talking about minutely detailed pieces of information) to care standards. This is a paradigm shift for those of us who have documented by exception for the past 15 years.
The A-Z menu offers a tab that links directly to Health IT which specifically highlights health informatics applications and the usability of electronic health records for the spectrum of health care -metropolitan to rural. There are certainly ethical considerations related to reimbursement, electronic charting systems, access to healthcare records and registries, and health information exchange legislation. One of the most debated issues with reimbursement right now is walking the line between reimbursements for services and maintaining integrity in the documentation circus. Electronic record systems (EMRs) can be a clinician’s best time-saving tool in practice by providing instant and real-time access to records and diagnostics, but force providers to take shortcuts in “templating” their documentation that may not accurately reflect their exam. Electronic prescribing has not entirely caught on with all physicians, but tracking patient prescription trends has become easier than ever if the patient “shops” within EMR access (the state of Utah has an electronic warehouse for narcotic tracking). While this is clearly a safety mechanism, electronic security to anything can be bypassed…it simply takes a provider’s password innocently given to an assistant. HIPPA, ever hovering, is not foolproof. Ethics must be based on a value system. Unfortunately, many folks naively, errantly, or blatantly believe that specifics don’t apply to them. And why should they? We have fostered a culture of rule-breakers…even encouraged that culture in some instances while we allow people to be irresponsible for themselves and even for their own health.
These examples are obviously not exhaustive, but are a sampling of some of the current issues that I see in our health care system in general and that are spilling over into the convenience of electronic health care systems. Believe, I am the first to support a global EMR based on collaboration and convenience, but we must always consider our personal values and how we will apply technology into each of our own practices. The government can legislate, guideline, research, and provide benchmarking data for us, but making the system safe becomes an issue of integrity. I am not exactly sure where all the holes are, but the vision looks fantastic on the front end.