Task 2

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Feb 20, 2024

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1 WFM1 Task 2: Trends in the Ecosystem Heather Guy Western Governors University Tricia Jones May 22, 2023

2 Part One: Historic Events From the belief that illnesses were caused by bad the wrath of the gods in Ancient Egypt or the belief that illnesses were caused bad air in Ancient Greece, there is a lot throughout history that has helped shape the current world of medicine. Minor health issues such as constipation or the common cold were understood as a normal part of life. More serious health problems were thought to come from supernatural causes. In the 1700s and 1800s, medicine was practiced primarily in the home by middle class and wealthy families. Institutions carried a stigma; they were for the black sheep of society. Unwed mothers, the mentally ill, the poor etc. were housed in what was called pesthouses or almshouses. The first recognized hospital was in New York City and founded in 1736 (History of Public Hospitals in the United States, n.d.). Also, the first ambulance service was a horse-drawn carriage in New York City in 1869, before the days of sterile technique and tobacco was primarily used to prevent infection. (Penn Nursing, 2020) The first medical school was founded in Pennsylvania in 1765, what now is known as the University of Pennsylvania School of Medicine. One of the earliest known physicians was Imhotep who served King Djoser in Egypt in the 27 th century BCE. Schools of medicine began to spring up in the late nineteenth century. Thereafter, standards and criteria were established for an individual that practiced medicine to be considered a physician. “Physicians also began to gain professional sovereignty. They were able to control the demand for the services they provided because the patients generally did not know what services they needed and had to rely on the professional for guidance. This professional sovereignty is often thought to be a factor that contributed to escalating medical costs.” (Wagner, 2020)

3 The idea of integrating computers into healthcare came in the 1960s. Computers then were very large and required a lot of space. It would not have been worth the investment for providers to incorporate computers into their offices based on how expensive they were. In the 1980s computers became more user friendly and simpler to use. They were much smaller, limiting the amount of space needed. However, many facilities did not have the budget for such a change due to the changes in managed care, so they used paper charting. “The implementation of diagnosis-related groups (DRGs) for hospitals and the rise of managed care significantly lowered funding levels for health care providers. Medical practices had little cash for information systems despite growing evidence that they could improve outcomes and reduce costs.” (Ambinder, 2005). The world wide web was developed in the 1990s, making storing information easier. In 2009, the HITECH Act was passed by President Barack Obama, and it paved the way for use of technology in healthcare. The number of organizations in 2009 using an electronic health record was 12 percent, and it grew to 85 percent in 2015. Part Two: Healthcare Delivery Systems Modern healthcare utilizes three components of a healthcare delivery system which are delivery, organization, and funding. This includes hospitals, rehabilitation facilities, long-term care, and clinics. Healthcare providers such as physicians, nurses, occupational and physical therapists, speech-language pathologists, imaging technicians, radiologists, dieticians, and pharmacists among many other specialties are a part of the delivery system. The ability of a health system to provide support departments, specialties, and facilities has a large influence over patient access to healthcare. There must be organization within a healthcare system to prevent delay or quality issues in care. Delivery is important as it provides access to inpatient as well as outpatient services to

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4 patients. For example, if a patient requires physical therapy after being hospitalized for joint replacement surgery such as a hip or knee replacement. Another example is access to speech- language pathologist after a patient has had a stroke and must receive therapy to learn to speak and swallow, etc. Patient care costs can be covered by federal programs such as Medicare or Medicaid, group policies through an employer, private healthcare insurance, and there are also individuals that are uninsured. Most states also require that employers cover employee medical costs due to work-related injuries. There are health savings accounts, or HSAs which is basically a savings account for healthcare costs that comes from pre-taxed income. Health reimbursement accounts work similar to HSAs, however the employer funds the HRA versus the employee and employer funding a HSA. Managed care influence patient care access by obtaining contracts with providers. “Managed care systems control costs primarily by presetting payment amounts and restricting patient access to healthcare services through precertification and utilization review (UR) processes. Managed care delivery systems also attempt to manage cost and quality by doing the following: Implementing various forms of financial incentives for providers, promoting healthy lifestyles, identifying risk factors and illnesses early in the disease process, and providing patient education.” (Oachs and Watters, 2020) Medicare influences patient care costs because it uses is a prospective payment system. A hospital may make a profit, or even lost money based on the costs of care. Medicare influences quality of patient care utilizing the quality reporting programs. There are different quality reporting programs depending on the type of services provided. For example, inpatient and outpatient care, home health, hospice, and long-term care among many others In other words, Medicare allows organizations to keep the full payment amount for

5 services when they participate and submit required information within a specific time frame. The data submitted must meet at least 80 percent reliability. Medicare also utilizes a quality survey called HCAHPS for funding, or the Hospital Consumer Assessment of Healthcare Providers and Systems survey where patients complete the survey based on their healthcare experience. Part Three: Trends In Healthcare One government initiative related to health informatics is the American Recovery and Reinvestment Act that included the HITECH act of 2009. HITECH stands for Health Information and Technology for Economic Clinical Health Act. HITECH was implemented to reward providers and organizations through the utilization of an electronic health record and demonstrating Meaningful Use. Meaningful Use are standards set forth by the federal government when exchanging health information between providers, providers to insurers, and providers to patients. HITECH also could penalize providers for not using an electronic health record system. Telehealth is an emerging technology that is gaining traction and is affecting the practice of medicine by increasing patient access to healthcare and providers. During the COVID-19 pandemic, telehealth became popular because it allowed patients and providers a second alternative to receive medical care. Patients can receive medical care from their provider without having to leave their homes. Telehealth is not simply limited to patients sitting in front of a computer and speaking with a provider. There are kits that get sent out to patient homes so that healthcare providers can monitor a patient’s weight, vital signs, diet, and medication adherence.

6 Resources Ambinder E. P. (2005). A history of the shift toward full computerization of medicine. Journal of oncology practice , 1 (2), 54–56. https://doi.org/10.1200/JOP.2005.1.2.54 History of Public Hospitals in the United States . (n.d.). America’s Essential Hospitals. https://essentialhospitals.org/about/history-of-public-hospitals-in-the-united-states/ Oachs, P. K., & Watters, A. (2020). Health information management: concepts, principles, and practice. (6th ed.). Ahima, American Health Information Management Association. Penn Nusing. (n.d.). History of Hospitals . Nursing, History, and Health Care. Penn Nursing. https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-hospitals/

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