C799 #2 Task - Copy

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Healthcare Ecosystems – C799 Task #2

Evolution of Medicine In 1931 Ernst Ruska and May Knoll of the University of Berlin created the electron microscope (Oachs & Watters, 2020). The creation of the electron microscope greatly impacts the field of medicine to this day. It significantly influences the way researchers and medical professionals understand and study biological structures. The optical microscope was the first type of microscope, but it had limitations that would prevent the end-user from observing smaller biological structures. EM uses concentrated beams of electrons and dyes to illuminate their specimens (Flewett, 1972). Science has proven that electrons have a shorter wavelength than photons which enables the end-user to observe detailed images of blood vessels, individual proteins, atoms, as well as cells, microbes, and tissues within the beam of high resolution. Here are several other examples in which the EM has contributed to the evolution of medicine:  EM enables the visualization of subcellular structures because of its high-resolution capabilities. This has been crucial for understanding the intricate details of cells, organelles, cellular processes (Flewett, 1972).  EM provides a broader understanding of pathogens. It enables researchers to understand the morphology, replication mechanisms, and interactions of microorganisms at a depth that was previously unknown. This knowledge is the basis for which medical practitioners develop treatment plans and vaccines (Flewett, 1972).  EM enhanced diagnostic pathology by providing detailed images of tissues and cellular structures. This has advanced diagnostic accuracy in the identification of diseases that may not be easily identified using other methods (Flewett, 1972).  EM has significantly improved drug development and research. Researchers can observe how drugs interact with cellular components, which assist in the design and optimization of pharmaceuticals (Flewett, 1972).

 The evolution of neuroscience has also been impacted by the creation of the EM. It allows medical practitioners and researchers to study intricate structures of neurons, synapses, and other components of the nervous system. It has influenced a broader understanding of brain function which equips neurologists with better methods of approaching neurological disorders effectively (Flewett, 1972).  EM is also utilized in the study of genetic disorders which enhances insights into the structural abnormalities associated with various genetic conditions. This knowledge is critical for understanding the mechanisms underlying specific disorders and constructing potential therapeutic interventions (Flewett, 1972). The electron microscope is a valuable technique in the surveillance of emerging diseases and potential bioterrorism viruses (Flewett, 1972). This method is continuously at the forefront of virus identification to this day and is the apparatus used to detect unknown or unsuspected agents. Although electron microscopy is considered old by some it provides deeper insights into the development of diagnostics, treatments, and our overall knowledge of health and disease. On September 11, 2001, a terrorist attack on the World Trade Center occurred that exposed vulnerabilities in our healthcare system. The event profoundly impacted various aspects of society, including the field of medicine. This unfortunate event prompted federal, state, and local officials to focus on improving emergency response, rescue operations, and disease surveillance (Ringel & Wasserman, 2011). The attacks also highlighted the importance of effective emergency medical response and disaster preparedness. Healthcare professionals had to be trained in new protocols that improve emergency medical care in the aftermath of large-scale disasters. Hence this led to timely advancements in disaster medicine, trauma care, and coordination among various healthcare entities.

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In 2009 our nation faced the H1N1 pandemic and the response and preparedness from healthcare professionals were timely and efficient because of the lessons learned from the 9/11 terrorist attacks. The swift identification and characterization of a novel pandemic virus, and the fast pace with which a new flu vaccine was developed and produced was a great success (Ringel & Wasserman 2011). Moreover, the Centers for Disease Control (CDC) and Prevention Strategic National Stockpile rapidly distributed antiviral drugs; and effectively educated the public on proper methods to prevent transmission of the virus (Ringel & Wasserman 2011). Roles of Healthcare Professionals In 1870 almost all practicing physicians were unlicensed and could easily portray to the public that they were qualified to practice medicine. However, in the 1870s the Medical Practice Acts were passed which required physician licensure to be a state function (Sandvick, 2009). As a result, 15 states passed some form of medical licensing between 1870 and 1880 (Sandvick, 2009). This legislation allowed state officials to regulate the practice of medicine in specific jurisdictions. These acts outline the legal framework for the licensing and oversight of physicians, making sure that they fulfill certain qualifications and standards to practice medicine. For example, physicians must maintain ongoing professional development through continuing medical education (CME), complete licensing examinations, obtain and maintain specialty certifications to ensure certain standards are met for their expertise, and go through background checks to ensure good moral character. These measures significantly improved public health, safety, and welfare because they protect the public from incompetent, unlawful, fraudulent, and deceptive practice of medicine (Sandvick, 2009). The stethoscope was invented by Rene Laennec in 1816 (Reiser, 1979). This medical apparatus improved both the way physicians perceive disease and the rapport with the patient. At the start of the 19 th

century, patients were often diagnosed based on the patient’s verbal history of his/her illness and the physician’s observations of the patient’s breathing patterns, skin color, and tongue condition (Reiser, 1979). Many of the methods used before the creation of the stethoscope were unreliable to ensure an accurate diagnosis. The ground-breaking accuracy of the stethoscope made it the first medical instrument to be generally used by physicians to diagnose ailments (Reiser, 1979). Physicians who regularly used the stethoscope method made physical examination the cornerstone of providing an objective diagnosis. Signs that would normally elude outdated methods of observation were directly communicated to the physician via the patient’s body. As a result, this improved the overall accuracy of clinical assessments in healthcare. The stethoscope played a pivotal role in identifying conditions in the respiratory and cardiovascular systems. It became an essential instrument for diagnosing respiratory conditions like pneumonia, bronchitis, asthma, and heart conditions such as heart murmurs, valve disorders, and arrhythmia (Reiser, 1979). The advancements in cardiology stemming from the creation of this instrument influenced the development of specialized fields within cardiology, such as interventional cardiology and electrophysiology (Reiser, 1979). In addition, a Gastroenterologist utilizes the stethoscope to auscultate and interpret sounds from gastrointestinal functions as well. Its relevance in the 20 th century and adaptation to technological advancements displays its enduring influence on the practice of medicine. Technology in Healthcare The evolution of technology in the past few decades has taken a quantum leap in managing patient care. For instance, telemedicine has provided patients with a new option to receive remote medical services, consultations, and support without leaving the comfort of their homes. Patients can consult with physicians without commuting long distances which makes healthcare more convenient. Healthcare

practices regularly offer virtual routine check-ups, follow-up appointments, and initial assessments to their patients (Islamia, Ambedkar & Pant, 2021). Through virtual platforms, providers can remotely diagnose and treat a plethora of medical conditions. This technology has also benefited the healthcare delivery process by reducing waiting times for appointments and preventing the aggravating experience of patients waiting in overly crowded offices (Islamia, Ambedkar & Pant, 2021). It allowed more timely interventions that benefit both the healthcare providers and patients. Moreover, telemedicine was the crème de la crème of patient care during the COVID-19 pandemic. Healthcare professionals were able to maintain quality patient care while minimizing the risk of viral transmission. During the pandemic, telemedicine was effective for screening, diagnosing, and treating patients during times of social distancing and federal lockdowns (Islamia, Ambedkar & Pant, 2021). This technology has been proven to overcome traditional barriers, enhance accessibility, and improve the efficiency of healthcare delivery (Islamia, Ambedkar & Pant, 2021). Telemedicine will more than likely continue to evolve and transform how healthcare is delivered and experienced globally. In the 19 th century, Europe was the first to utilize formal medical records in teaching hospitals, and many healthcare systems around the world followed suit. The medical record helped healthcare professionals document and store private information in an organized and standardized format. While the medical record system solved some problems in patient care it had noticeable limitations as well. The electronic health record (EHR) has improved how patient information is collected, stored, and shared (Honavar, 2020). It has also improved accessibility and portability amongst authorized healthcare providers across different specialties (Honavar, 2020). This feature is especially beneficial in emergencies and/or when patients receive care from multiple providers. Moreover, two of my favorite features of the EHR include patient portals that empower me to access health information at any time, and the reduction of errors when coding outpatient accounts. The first feature gives me and other consumers in healthcare the benefit of accessing our personal health information without delays. The latter feature of the EHR

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reduces medical errors associated with illegible handwriting and misinterpretation of documentation when I code outpatient accounts in my coding profession. Overall digitalization of health information paved the way for more connected and data-driven healthcare systems, ultimately leading to improved patient outcomes and a more effective delivery of care. Components of a Healthcare Delivery System The fundamental components of the U.S. healthcare delivery system are organization, funding, and delivery (Wagner, 2020). These three components control how healthcare services are structured, financed, and delivered to the public. Here are the specifics of each component: Organization:  The organization component arranges and coordinates healthcare facilities, professionals, and services. This component includes organizing clinics, long-term care facilities, hospitals, and ambulatory surgery centers (Wagner, 2020).  The administrative structure of this component includes governance, leadership, regulatory agencies, and policies that guide healthcare delivery (Wagner, 2020).  Implementation and management of health information systems which includes electronic health records, organizing interoperability among physicians, and fostering continuity of care (Wagner, 2020). Funding:  This component covers the way healthcare delivery is funded via public and private financing. Government-subsidized programs like Medicare and Medicaid contribute to public financing.

Private financing includes entities such as employer health plans, individual coverage, and self- pay by patients (Wagner, 2020).  Health insurance spreads the financial risk of healthcare expenses and provides individuals with access to necessary medical care (Wagner, 2020). Delivery:  This component consists of healthcare professionals involved in delivering healthcare services such as primary care providers, specialists, nurses, allied health, and support staff (Wagner, 2020).  Healthcare facilities where services are rendered, such as hospitals, ambulatory surgery centers, clinics, and long-term care facilities (Wagner, 2020).  Promotes quality and safety measures to ensure the public receives optimal patient care which is maintained by accreditation standards, adherence to clinical guidelines, and patient safety protocols (Wagner, 2020). Patient Care Access

The operations of a healthcare delivery system can enhance or disrupt patient care access. Healthcare operations must be efficient, organized, and effective to create an environment where healthcare services are easily accessible to patients. For instance, the location and distribution of healthcare facilities, including hospitals, clinics, and primary care centers influence the physical accessibility of healthcare services (Heath, 2022). Individuals residing in rural or underserved geographic areas may face difficulties accessing timely and convenient care. As a result, the incorporation of telehealth and digital technologies into healthcare operations expands access by providing remote consultations, virtual follow-ups, and digital health services to individuals who experience problems commuting to doctors’ appointments (Heath, 2022). Patient Care Cost The operations of a healthcare delivery system are instrumental in driving patient care costs. The utilization and efficient use of resources, which includes optimizing staff schedules, minimizing medical equipment downtime, and streamlining administrative processes, reduces the overall cost of patient care (Oachs & Watters, 2020). Healthcare organizations can also contribute to cost-effective patient care by fostering care coordination and avoidance of unnecessary services. Hence, coordinated efforts among healthcare providers that involve effective communication and information sharing can prevent redundant tests, procedures, and consultations (Oachs & Watters, 2020). These standards aim to improve patient outcomes at the lowest possible cost and create valuable relationships between provider and patient. Quality of Patient Care Acute care hospitals are rewarded with incentive payments for the quality of care provided in the inpatient hospital setting under the Hospital Value-based Purchasing Program (CMS, 2023). The Inpatient Prospective Payment System (IPPS) adjusts compensation based on the quality of patient care

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delivered (CMS, 2023). The main objective of the Hospital VBP Program is to improve the quality of care for inpatient services and ensure a better patient experience during inpatient stays. The program rewards hospitals based on the quality of care provided to Medicare Part A patients, not just the quantity of services provided (CMS, 2023). This program’s operations include performance measures that assess various aspects of patient care, patient outcomes, patient experience, and efficiency. The participating hospitals receive two scores for each performance measure, contributing to their Total Performance Score (TPS) (CMS, 2023). Consequently, the Total Performance Score determines the financial incentives or penalties a hospital may receive. Moreover, hospitals with higher TPS may receive financial incentives, while those with lower scores may face payment reductions (CMS. 2023). The payment structure is designed to compensate hospitals for delivering high-quality care while fostering continuous improvement in patient outcomes and experiences. Rewards are allocated through the Medicare Base Operating Diagnosis-Related Group and Value-Based Incentive payment systems. The Merit-Based Incentive Payment System (MIPS) operates by evaluating clinicians based on performance in four categories, quality, cost, improvement activities, and promoting interoperability (Quality Payment Program. 2021). Each performance category contributes to an MIPS final score (0 to 100 points) which reflects a positive, negative, or neutral payment adjustment. The program calculates an MIPS Final Score and then allocates adjustments to Medicare Part B payments (Quality Payment Program. 2021). MIPS payment structure is budget-neutral which means that the total amount of positive payment adjustments must be offset by the total amount of negative payment adjustments. This payment system has proven to be a better option than the sustainable growth rate because providers no longer experience double-digit annual cuts (Quality Payment Program). 2021). Providers with exceptional performance may also be eligible for additional positive payment adjustments as part of the Exceptional Performance Bonus (Quality Payment Program. 2021). The main purpose of the

payment system is to incentivize clinicians to deliver high-quality, cost-effective care and consistently engage in improvement activities. Federal Government Initiative The Privacy Act of 1974 is a federal government initiative to safeguard the privacy of individuals by regulating the collection, use, and dissemination of personal information by federal agencies (U.S. Department of Justice, 2022). Enactment of the initiative occurred on December 31, 1974, and its main objective was to achieve a balance between the government’s need for information with the rights of individuals to be protected against unwarranted invasions of their privacy (U.S. Department of Justice, 2022). The Privacy Act applies to federal agencies and governs the collection, maintenance, use, and disclosure of personal information about individuals. Individuals have the right to be notified of the purpose for which their personal information is collected, have access to their records, consent to the disclosure, and sue federal agencies for violations of the Privacy Act (U.S. Department of Justice, 2022). This government initiative reflects a recognition of the importance of privacy rights and the need to balance those rights with the legitimate interests of the government. It revolutionized the way federal agencies handle and protect personal information. Emerging Technology One of the emerging technologies that captured my attention is Computer-Assisted Coding (CAC), which uses natural language processing (NLP) coupled with machine learning algorithms to assist healthcare professionals in assigning medical codes to clinical documentation (Groh, 2023). It was first introduced in the 1980s to assist with coding medical procedures. Hence, widespread adoption of CAC didn’t occur until the 2000s (Groh, 2023). This transformative technology quickly analyzes large volumes of clinical documentation and assists coding professionals in appropriate codes for diagnoses and procedures.

Though CAC enhances productivity by automating routine coding tasks, human oversight is critical for complex cases to ensure accurate coding assignments. However, simple visit coding can be completed by CAC at a fast pace without any coding professional’s oversight. Other key features of the CAC system include clinical documentation improvement, regulatory compliance with coding standards, and interoperability with electronic health records (EHR) platforms (Groh, 2023). These features help to maintain a seamless workflow that enhances the overall coding process. While CAC brings many benefits it is not intended to replace coding professionals or clinical judgment. This emerging technology serves as a valuable tool to enhance the efficiency and accuracy of coding processes in the practice of medicine.

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References Oachs, P.K., & Watters, A. (2020) Lesson 1.1: Historical Foundations Chapter 2 “History and Development of the United States Healthcare System: Overview, Driving Forces, and Outlook for the Future , Pages 37- 43 Flewett, T. H. (1972) Some Recent Contributions from the Electron Microscope Laboratories. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1787735/pdf/brmedj02193-0041.pdf Ringel & Wasserman (2011) The Public Health System a Decade After 9/11 - Key Successes and Continuing Challenges Retrieved from https://www.rand.org/pubs/research_briefs/RB9608.html # Sandvick, Clinton (2009) Enforcing Medical Licensing in Illinois: 1877-1890 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701151/ Reiser, Joel Stanley (1979) The Medical Influence of the Stethoscope Retrieved from https://www.jstor.org/stable/24965132 Islamia, Ambedkar & Pant (2021) Telemedicine for healthcare: Capabilities, features, barriers, and applications Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590973/ Honavar, G Santosh (2020) Electronic Medical Records – The good, the bad, and the ugly. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043175/

Wagner, Stephen L. (2020) Operation of Healthcare Systems, Components of the U.S. Healthcare System. (Publisher: Health Administration Press) Heath, Sara (2022) Top Challenges Impacting Patient Access to Healthcare. Retrieved from https://patientengagementhit.com Oachs, P.K., Watters (2020) Health Information Management, Concepts, Principles, and Practice 6 th edition. American Health Information Management Association Centers for Medicare & Medicaid Services (CMS) (2023) The Hospital Value-Based Purchasing (VBP) Program. Retrieved from https://www.cms.gov/medicare/quality/value-based-programs/hospital-purchasing Quality Payment Program (2021) Merit-Based Incentive Payment System (MIPS) 2020 Promoting Interoperability Performance Category https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/ American Medical Association (2023) Understanding Medicare’s Merit-based Incentive Payment System (MIPS) https://www.ama-assn.org/practice-management/payment-delivery-models/understanding U.S. Department of Justice (2022) The Privacy Act of 1974 https://www.justice.gov/opcl/privacy-act-1974 Groh, Kevin (2023) Computer Assisted Coding: What is it and Does it Work? Streamline Health https://streamlinehealth.net/computer-assisted-coding/

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C799 #2 Task - Copy

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