The introduction of Health Information Systems (HIS) to the health care industry has changed the delivery and reimbursement services in the United States (US). The history of information systems (IS) has enhanced communication between patients, providers, and insurance providers. Prior to the information age, health care use a paper method to maintain patient records. Numerous advancements within the information technology (IT) industry have since evolved. Family physicians and small medical practices have incorporated clinical and administrative and rely on its technology. IS have also influenced federal programs and compliance of regulations. Physician Offices
Health care delivery has changed dramatically over the decades. Prior to the 1930s individuals would visit the doctor or hospital, receive treatment, and receive a bill from the provider. This was known as indemnity insurance or otherwise known as fee-for-service plan. Family physicians would also accept goods as a form of payment. In the 1960s President Lyndon Johnson established two federal programs, Medicaid and Medicare as a means to provide health insurance to the elderly and indigent populations. Federal, state, and municipality funds covered the cost-base of the programs. Medicaid and Medicare altered the paper documentation for fee-for service payment. IS was in its early phase of development and healthcare professionals soon realized the benefits of technology. Most notability, the technology provided faster reimbursements from Medicare and Medicaid. The late 1960s through the 1970s marked furthered developments in healthcare and IS. Hospitals housed large mainframe computers to store financial and administrative information.
The computer technology during this era was expensive and only large healthcare facilities could afford the costs. Small and independent providers continued to use paper documentation for billing purposes. The 1970s characterizes the economy as weak. The Medicaid and Medicare programs increased health care costs and inflation stressed the finances within the United States. IS continued to make advancements and the US was introduced to the minicomputer. Smaller mainframe computers allowed better centralization of administrative duties and developed applications for clinical departments. “The increased demand for patient-specific data coupled with the availability of relatively low-cost minicomputers opened a market for a host of new companies that wanted to develop applications for clinical departments” (Wager, Lee, & Glaser, 2009, p. 95).
The minicomputer offered IS affordability for smaller practices and specialized care. In the 1980s, Medicaid and Medicare changed its reimbursement structure from cost-based to diagnosis related groups (DRGs). Healthcare entities received a fixed payment for patient’s diagnosis and correct corresponding ICD-9 code. Providers soon realized the importance of accuracy to avoid denial of payment. Correspondently, technological advancements to the microcomputer provided the healthcare industry, including small medical practices and physician offices affordability of administrative and clinic software. The delivery of health care in relationship to MCO changed because of disease management and information technology. Managed care provided patient autonomy through tiered options with various costs and benefits (Harris, 2008). Managed care is a form of health insurance and is provided through the employer. The MCO model controls costs and increases accessibility for services. Managed care plans are insurance plans with approved, contracted suppliers to for services at reduced costs. The providers form the network of the plan. Each plan varies in cost because the MCO establishes the guidelines. Physicians followed the structure of MCO, but restrictions applied to reduce duplication and unnecessary tests. Examination
My personal healthcare experience is limited with clinical practices. My experience is in alternative living communities for seniors. I have marketed three assistive living facilities and one independent living community. Sale inquiries, leads, and status’ required computer software to document, track, and maintain various reports. Each facility used different programs, but independently provided the same results. The IS of senior living communities require clinical and administrative applications. I remain in contact with several colleagues and discovered medication administration is paper documentation. I was surprised and shared information learned in HCS/533. Technological Advantages and Events
IS respond to external and internal factors providing technological advancements and enhance a consumer driven market. External factors to include economic conditions, health needs, and technology have altered the delivery, reimbursement methods, and applications. Consequently, most health care IS limit the ability to integrate administrative and clinical data. Healthcare administrators must monitor trend lines and internal factors to maintain knowledgeable of federal initiatives and programmatic changes, reimbursement methods, and delivery of services. The 1990s introduced a different reimbursement method in Medicaid and Medicare.
Resource-based relative value scale (RBRVS), considered physicians “value” of time, physician work, practice expense, and professional liability insurance (Bates, 2005). The RBRVS model increased revenue for routine physician services for educating patients on prevention best practices and incorporating better lifestyles. Physicians treating patients with chronic illnesses followed disease management programs and guidelines for treatment. Disease management programs allowed more patient involvement and resources. Respectively, small medical practices and rural physicians began incorporating administrative and clinical applications. These healthcare providers maximized technology producing an efficient organization, adding valued services to the community, and providing quality of care. Conclusion
From the 1960s to present, the health care industry has advanced with IS. The history of IS and its contributions allows family physicians to expand into rural communities, access prompt reimbursement, and improve quality of care. IS will continue to influence clinical and administrative applications, medical treatments, reimbursement methods, and affect government sponsored initiatives. Remarkably, the IS drawbacks out-weight its positive outcomes by enhancing healthcare providers’ efficiency and patient quality of care. The future of IS within health care are endless.
Bates, D.W. (2005, September). Physicians And Ambulatory Electronic Health Records. Health Affairs, 24(5), 1180-1189. doi:10.1377/hlthaff.24.5.1180 Harris, D. M. (2008). Contemporary issues in healthcare law and ethics (3rd ed.). Chicago, IL: Health Administration Press. Wager, K. A., Lee, F. W., & Glaser, J. P. (2009). Health care information systems: A practical approach for health care management. John Wiley & Sons, Inc.