What are the positive and negative aspects of managed care?

Managed Care

In the United States, managed care is becoming an increasingly popular method of administering healthcare. It influences the clinical behavior of providers, as it combines the payment and delivery of healthcare into a single system, the purpose of which is to control the cost, quality, and access of healthcare services for a single bracket of health plan enrollees (Scutchfield, Lee, & Patton, 1997).

Yet, managed care often evokes strong or negative reactions from healthcare providers because they are paid a fixed amount for treating their patients, regardless of the actual cost, which may influence their level of efficiency. This can challenge the relationships between doctors and patients (Claxton, Rae, Panchal, Damico, & Lundy, 2012; Sekhri, 2000).

Research managed care’s inception and study some examples. Be sure to investigate the perspectives about managed care from the vantage of both healthcare providers and patients. You can use the following keywords for your research—United States managed care, history of managed care, and managed care timeline.

Based on your research, answer the following questions in a 8- to 10-page Microsoft Word document:

•What are the positive and negative aspects of managed care? Analyze the benefits and the risks for both providers and patients, and how providers should choose among managed care contracts. Conclude with your analysis and recommendations for managed care health plans. Your response should include answers to the following questions:
◦Summarize the history of when, how, and why managed care was developed.
◦Define and discuss each type of managed care organization (MCO)—health maintenance organization (HMO), preferred provider organization (PPO), and point of sale (POS).
◦Explain the positive and negative aspects, respectively, of managed care organization from the provider’s point of view—a physician and a healthcare facility—and from a patient’s point of view.
◦Explain the three types of incentives for providers for efficiency in the delivery of healthcare services. Explain who bears the financial risk—the provider, the patient, or the managed care organization.
◦Offer your recommendations, to accept or decline, for patients considering managed care health plans, with your rationale for each.
References:

Claxton, G., Rae, M., Panchal, N., Damico, A., & Lundy, J. (2012). Employer Health
Benefits Annual 2012 Survey. Retrieved from http://ehbs.kff.org/pdf/2012/
8345.pdf

Sekhri, N. K. (2000). Managed care: The US experience. Retrieved from http://www.
who.int/bulletin/archives/78%286%29830.pdf

Scutchfield F. D., Lee, J., & Patton, D. (1997). Managed care in the United States.
Journal of Public Health Medicine, 19(3), 251–254. Retrieved from http://
jpubhealth.oxfordjournals.org/content/19/3/251.full.pdf

Support your responses with examples.

Cite any sources in APA format.

Submission Details

Name your document SU_HCM3002_W5_A2_LastName_FirstInitial.doc.

 
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What do you think about allowing some people to purchase additional insurance, thereby creating a two-tier health system based on affordability?

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Healthcare Synthesis

Using the South University online library, the Internet, and the data from the Organization for Economic Cooperation and Development (OECD), research comparative international work and compare the United States and Canada with respect to which country is more effective in the areas of (1) economic growth; (2) expenditure (public and private expenditure on health); (3) information and communications technology; and (4) health.

Click here to access data from the OECD.

On the basis of your observations, create a 1- to 2-page report.

Your report should address the following questions:

•After going through the statistics:
◦What information or statistic you find either surprising or reasonable?
◦Do you anticipate the statistics will be similar in ten years? Why or why not?
•The current structure of healthcare coverage in the United States has a combination of employer-based coverage and public program (e.g., Medicare, Medicaid) coverage, with a large uninsured population. If a single-payer system is implemented where Medicare is expanded to cover all citizens for those who prefer private insurance, there will be comparable coverage under the same range of private insurance plans already available. Keeping in mind these considerations, answer the following questions:
◦What do you think about allowing some people to purchase additional insurance, thereby creating a two-tier health system based on affordability?
◦What are the advantages and disadvantages of this initiative?
•Considering the fact that healthcare is not a guaranteed right for everyone in the United States, there are different kinds of barriers and obstacles in obtaining healthcare. In contrast to this fact, the notions of equity and fairness are considered very important. You will notice that these notions aren’t considered when we discuss people’s access to other goods, such as cars and computers.
◦What are these barriers? Give examples of the different barriers to health care under the following headings:
◾Financial barriers
◾Scarcity of healthcare providers
◾Barriers to access healthcare
◾Cultural barriers
◾Barriers of healthcare resources
◦How would you define the term, “equity and fairness”, in the context of the healthcare situations prevailing in the United States and Canada?
◦Why are they considered important when discussing people’s access to care?
•It is believed that government funded healthcare for all citizens is consistent with a capitalist economy and the cultural values of self-determination and free enterprise.
◦Do you agree with this statement? If not, what other approaches do you think will resolve the current inequities in the system?

 
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Explain what you believe the U.S. healthcare system will look like in the next 10 years.

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For your Final Presentation you will be presenting on the U.S. healthcare system. Imagine you are a community health director educating a group of new healthcare professionals on the U.S. healthcare system. You have been asked to create a PowerPoint presentation, which includes the elements listed below:

Note: You will be using Part 1 from week three for the first section of the Final Presentation. Please make sure to correct issues and address any recommendations from your instructor’s Week 3 Assignment feedback.

Introduction: Include a title slide. Next, include an introductory slide where you introduce yourself and explain what you are about to present.
Part I: The U.S. Healthcare System – Define the U.S. healthcare system by addressing the items below:

•Describe the history of the U.S. health care system. Include at least three of the revolutionary factors (e.g., teacher’s union in Dallas, Texas; the American Medical Association; Civil War, and the First Marine Hospital, etc.). Chapter two in our textbook discusses the evolution of our system and is a good resource for this part of your presentation.
•Identify at least one major development from each of the following: financial, legal, ethical, regulatory, and social [i.e., consumer demand]) that transformed the system into what it is today. You may want to revisit the health care timelines available in your course textbook.
•Differentiate the stakeholders and their roles (i.e., health care professionals, clients [patients], government, colleges, and health care agencies.◦Include the positive and negative contributions of how they affect our health care system.

Part II: The Cost of the U.S. Healthcare System

•Describe the costs and how they are set (i.e., reimbursement methods, managed care organizations, Medicare, Medicaid, and private insurance).
•Explain how technology has affected costs (e.g., EHR, medical research, equipment improvements like MRI, mammography, etc.) and delivery of quality care (e.g., personalized medicine, mobile services like ePrescribing, disease registries, etc.).

Part III: The United States Versus Other Health Care Systems—an International Perspective

•Contrast the U.S. health care system with at least one other (e.g., Canada’s universal health care vs. U.S. healthcare or South Africa vs. U.S. health care, etc.).◦Include at least one positive aspect from the other country’s health care system that you would like to see added to the U.S. healthcare system. Explain why you would like to see this in our system.

Part IV: Reforms and Improvements

•Describe any potential reforms and improvements that are currently being discussed at either the local, state, or federal level. Your work must be based upon scholarly research, not media commentary.◦Examples could include the following:◾Federal modifications (i.e., Medicare reform, repealing PPACA, universal type system, etc.)
◾State modifications(i.e., Medicaid reform, income tax credits, etc.)
◾Increased consumer controls

Note: The PPACA is not an appropriate reform or improvement to be described here because it is already law and not a future improvement. However, if there is a proposal to amend or eliminate, then you can include that potential reform.

Conclusion: Future of the U.S. healthcare system

•Explain what you believe the U.S. healthcare system will look like in the next 10 years. Give at least two recommendations for change.
•Address access to care, quality of care, and cost of care including an example of each in your vision of our future healthcare system.

Creating the Final Presentation
The Final Presentation must:

◦Be 15 to 20 slides, which includes Part 1, (excludes the title slide and reference slides) and formatted according to APA style as outlined in the Ashford Writing Center.

◦Be presented using Microsoft PowerPoint slide presentation. You have a choice of one of the following options for adding the narrative to your presentation. Option 1 is using voice or Option 2 is adding speaker notes to each slide.

◾Option 1: Recording your voice on each slide. You can view the tutorial using this link: adding and recording voice to each slide.You can also click on the following links to view the Accessibility Statement and Privacy Policy. If you choose this option, you must include your APA formatted citation in the speaker note section of the PPT as well.

◾Note: if you use the voice option, make sure your recordings are clear and concise. It is also important to know that adding voice narrations that are too lengthy and adding graphics may cause your PPT file to be very large (megabytes). You may have trouble loading it to Waypoint. Revisions may be necessary if this occurs.

◾Option 2: Using speaker notes for each slide in the PPT. You can review the tutorial using this link: adding speaker notes to your presentation. You can also click on the following links to view the Accessibility Statement , and the Privacy Policy.
◾Speaker notes are the typed notes that appear below the slide that complement the presentation slides. Whereas the slides will have short bulleted items, the speaker notes will be more detailed. They are essentially what the presenter would say during the presentation to explain each of the bulleted points on the slide. Therefore, it is important that the speaker notes are concise and detailed when explaining the bullet points.

insert notes

◾It is recommended that PowerPoint Slides contain no more than five bullet points and should not contain more than 5 – 7 words each. Do not type paragraphs or long sentences on the slide. The information that explains each bullet point is conveyed via speaker notes or by recording your voice to each slide.

◾It is required that the Microsoft PowerPoint presentation include the use of a voice or speaker notes. If you choose to use the voice capabilities within PowerPoint, you must include your citations in the speaker notes for each slide.

◦Be visually engaging. For assistance with designing the visuals for your presentation, view the video Don McMillan: Life after death by PowerPoint (click on the following links to view the Accessibility Statement or the Privacy Policy) or the PowerPoint Best Practices tool.

◦Include a title slide with the following:◾Title of the presentation
◾Student name
◾Course name and number
◾Instructor name
◾Date submitted

◦Address the sections in the order outlined above (Introduction, Part I, II, III, and IV).

◦Present the issues with critical thought.

◦Use at least two scholarly sources (none of which should be media commentary, at least one should be from the Ashford University Library).

◦Document all sources in APA format (including graphics, charts and pictures that may be used within the presentation). Wikimedia Commons is a recommended source for creative commons images (to view the privacy policy, click here).

•Include a separate reference slide formatted according to APA style as outlined in the Ashford Writing Center.
If you are unable to access the technology for this assignment due to a documented accommodations on file with the Office of Access and Wellness, inform your instructor as soon as possible.

Carefully review the Grading Rubric for the criteria that will be used to evaluate your assignment.

 
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Describe how improved communication, collaboration, and teamwork can improve conditions in your department.

*must also complete handout*

Choose two issues or challenges that the leaders of today’s health care organizations face. Select from among the following topics:

1. Staff Shortage (Physicians, Nurses, Allied Health Providers, Ancillary Services)
2. Reorganization in Response to Merger or Consolidation of Services
3. Layoffs as a Result of Declining Revenues
4. Influx of Registry, Part-Time, and Temporary Contract Staff
5. Poor Performance Outcomes Leading to a Reduction in Medicare Reimbursement Dollars

6. Poor Job Satisfaction Rates Resulting in Turnover

You are the manager of an ancillary service department at a large, 500+ bed hospital. Develop a proposal (750-1,200 words) that is directed toward your staff, in which you address the following:

• Inform the staff of the two issues (from the topics provided) your organization is facing.

• Describe the impact of these issues on your department.

• Describe how improved communication, collaboration, and teamwork can improve conditions in your department.

• Identify at least two examples from the required or recommended readings of techniques found to foster inclusion and improve communication and collaboration.

• A minimum of three academic references from credible sources are required for this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

Rubric:

1.Two issues/challenges are identified from among those listed in the assignment instructions.
2.Comprehensive and compelling discussion regarding organizational issues, their impact, opportunities for improvement, and recommendations to foster a shared vision is offered.
3.Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
4.There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
5.Writer is clearly in command of standard, written, academic English.
p

 
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Differentiate the stakeholders and their roles (e.g., healthcare professionals, clients [patients], health insurance organizations, government,colleges, and health care agencies

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Final Presentation: Part I

Look ahead at the Final Presentation directions in Week Five. The assignment this week is Part I of that presentation. For this assignment, Part 1, you will provide an overview of the U.S. healthcare system. Follow the instructions below to complete this part of your Final Presentation:

Introduction: Include a title slide. Next, include an introductory slide where you will identify yourself and describe the nature of this presentation.
Part I (of the Final Presentation): The U.S. healthcare system. Define the U.S. healthcare system by addressing the following:

◦Describe the history of the U.S. health care system. Include at least three of the revolutionary factors (e.g., the teacher’s union in Dallas, Texas; The American Medical Association; Civil War, first Marine Hospital, etc.). Chapter two in our textbook discusses the evolution of our healthcare system and is a good resource for this part of the presentation.

◦Identify at least one major development from each of the following: financial, legal, ethical, regulatory, and social [e.g., consumer demand] that transformed the system into what it is today. You may want to revisit the healthcare timeline.

•Differentiate the stakeholders and their roles (e.g., healthcare professionals, clients [patients], health insurance organizations, government,colleges, and health care agencies◦Include the positive and negative contributions of how they affect the health care system).

Creating Part 1 of the Final Presentation for the Week 3 Assignment
Part 1 of the Final Presentation must:

◦Be 5 to 7 slides (excludes the title slide and reference slides) and be formatted according to APA style as outlined in the Ashford Writing Center.

◦Be presented using Microsoft PowerPoint slide presentation. You have a choice of one of the following options for adding the narrative to your presentation. Option 1 is using voice or Option 2 is adding speaker notes to each slide.

◾Option 1: Recording your voice on each slide. You can view the tutorial using this link: adding and recording voice to each slide.You can also click on the following links to view the Accessibility Statement and Privacy Policy. If you choose this option, you must include your APA formatted citation in the speaker note section of the PPT as well.

◾Note: if you use the voice option, make sure your recordings are clear and concise. It is also important to know that adding voice narrations that are too lengthy and adding graphics may cause your PPT file to be very large (megabytes). You may have trouble loading it to Waypoint. Revisions may be necessary if this occurs.

◾Option 2: Using speaker notes for each slide in the PPT. You can review the tutorial using this link: adding speaker notes to your presentation. You can also click on the following links to view the Accessibility Statement , and thePrivacy Policy.
◾Speaker notes are the typed notes that appear below the slide that complement the presentation slides. Whereas the slides will have short bulleted items, the speaker notes will be more detailed. They are essentially what the presenter would say during the presentation to explain each of the bulleted points on the slide. Therefore, it is important that the speaker notes are concise and detailed when explaining the bullet points.
insert notes

◾It is recommended that PowerPoint Slides contain no more than five bullet points and should not contain more than 5 – 7 words each. Do not type paragraphs or long sentences on the slide. The information that explains each bullet point is conveyed via speaker notes or by recording your voice to each slide.

◾It is required that the Microsoft PowerPoint presentation include the use of a voice or speaker notes. If you choose to use the voice capabilities within PowerPoint, you must include your citations in the speaker notes for each slide.

◦Be visually engaging. For assistance with designing the visuals for your presentation, view the video Don McMillan: Life after death by PowerPoint (click on the following links to view theAccessibility Statement or the Privacy Policy) or the PowerPoint Best Practices tool.

◦Include a title slide with the following:◾Title of the presentation
◾Student name
◾Course name and number
◾Instructor name
◾Date submitted

◦Address the sections in the order outlined above (Introduction, Part I, II, III, and IV).

◦Present the issues with critical thought.

◦Use at least two scholarly sources (none of which should be media commentary, at least one should be from the Ashford University Library).

◦Document all sources in APA format (including graphics, charts and pictures that may be used within the presentation).Wikimedia Commons is a recommended source for creative commons images (to view the privacy policy, click here).

•Include a separate reference slide formatted according to APA style as outlined in the Ashford Writing Center.
If you are unable to access the technology for this assignment due to a documented accommodations on file with the Office of Access and Wellness, inform your instructor as soon as possible.

Carefully review the Grading Rubric for the criteria that will be used to evaluate your assignment.

 
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Differentiate the stakeholders and their roles (e.g., healthcare professionals, clients [patients], health insurance organizations, government,colleges, and health care agencies◦Include the positive and negative contributions of how they affect the health care system).

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Final Presentation: Part I

Look ahead at the Final Presentation directions in Week Five. The assignment this week is Part I of that presentation. For this assignment, Part 1, you will provide an overview of the U.S. healthcare system. Follow the instructions below to complete this part of your Final Presentation:

Introduction: Include a title slide. Next, include an introductory slide where you will identify yourself and describe the nature of this presentation.
Part I (of the Final Presentation): The U.S. healthcare system. Define the U.S. healthcare system by addressing the following:

◦Describe the history of the U.S. health care system. Include at least three of the revolutionary factors (e.g., the teacher’s union in Dallas, Texas; The American Medical Association; Civil War, first Marine Hospital, etc.). Chapter two in our textbook discusses the evolution of our healthcare system and is a good resource for this part of the presentation.

◦Identify at least one major development from each of the following: financial, legal, ethical, regulatory, and social [e.g., consumer demand] that transformed the system into what it is today. You may want to revisit the healthcare timeline.

•Differentiate the stakeholders and their roles (e.g., healthcare professionals, clients [patients], health insurance organizations, government,colleges, and health care agencies◦Include the positive and negative contributions of how they affect the health care system).

Creating Part 1 of the Final Presentation for the Week 3 Assignment
Part 1 of the Final Presentation must:

◦Be 5 to 7 slides (excludes the title slide and reference slides) and be formatted according to APA style as outlined in the Ashford Writing Center.

◦Be presented using Microsoft PowerPoint slide presentation. You have a choice of one of the following options for adding the narrative to your presentation. Option 1 is using voice or Option 2 is adding speaker notes to each slide.

◾Option 1: Recording your voice on each slide. You can view the tutorial using this link: adding and recording voice to each slide.You can also click on the following links to view the Accessibility Statement and Privacy Policy. If you choose this option, you must include your APA formatted citation in the speaker note section of the PPT as well.

◾Note: if you use the voice option, make sure your recordings are clear and concise. It is also important to know that adding voice narrations that are too lengthy and adding graphics may cause your PPT file to be very large (megabytes). You may have trouble loading it to Waypoint. Revisions may be necessary if this occurs.

◾Option 2: Using speaker notes for each slide in the PPT. You can review the tutorial using this link: adding speaker notes to your presentation. You can also click on the following links to view the Accessibility Statement , and thePrivacy Policy.
◾Speaker notes are the typed notes that appear below the slide that complement the presentation slides. Whereas the slides will have short bulleted items, the speaker notes will be more detailed. They are essentially what the presenter would say during the presentation to explain each of the bulleted points on the slide. Therefore, it is important that the speaker notes are concise and detailed when explaining the bullet points.
insert notes

◾It is recommended that PowerPoint Slides contain no more than five bullet points and should not contain more than 5 – 7 words each. Do not type paragraphs or long sentences on the slide. The information that explains each bullet point is conveyed via speaker notes or by recording your voice to each slide.

◾It is required that the Microsoft PowerPoint presentation include the use of a voice or speaker notes. If you choose to use the voice capabilities within PowerPoint, you must include your citations in the speaker notes for each slide.

◦Be visually engaging. For assistance with designing the visuals for your presentation, view the video Don McMillan: Life after death by PowerPoint (click on the following links to view theAccessibility Statement or the Privacy Policy) or the PowerPoint Best Practices tool.

◦Include a title slide with the following:◾Title of the presentation
◾Student name
◾Course name and number
◾Instructor name
◾Date submitted

◦Address the sections in the order outlined above (Introduction, Part I, II, III, and IV).

◦Present the issues with critical thought.

◦Use at least two scholarly sources (none of which should be media commentary, at least one should be from the Ashford University Library).

◦Document all sources in APA format (including graphics, charts and pictures that may be used within the presentation).Wikimedia Commons is a recommended source for creative commons images (to view the privacy policy, click here).

•Include a separate reference slide formatted according to APA style as outlined in the Ashford Writing Center.
If you are unable to access the technology for this assignment due to a documented accommodations on file with the Office of Access and Wellness, inform your instructor as soon as possible.

Carefully review the Grading Rubric for the criteria that will be used to evaluate your assignment.

 
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Explain what Mucor is and how a patient is likely to become infected with Mucor.

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A. Use the image in “Discussion Question Resource: Chest X-Ray” to answer the following Critical Thinking Questions.

Examine the x-ray of a patient diagnosed with pneumonia due to infection with Mucor. Refer to the “Module 4 DQ Chest Xray” resource in order to complete the following questions.

Critical Thinking Questions

1.Explain what Mucor is and how a patient is likely to become infected with Mucor. Describe the pathophysiologic progression of the infection into pneumonia and at least two medical/nursing interventions that would be helpful in treating the patient.
2.Examine the laboratory blood test results and arterial blood gases provided in “Discussion Question Resource: Laboratory Blood Test Results.” What laboratory values are considered abnormal? Explain each abnormality and discuss the probable causes from a pathophysiologic perspective.
3.What medications and medical treatments are likely to be prescribed by the attending physician on this case? List at least three medications and three treatments. Provide rationale for each of the medications and treatments you suggest.
B. in 200-250 words. Choose one legislator on the state or federal level who is also a nurse, and discuss the importance of their role as advocate for improving health care delivery. What specific bill(s) have they sponsored or supported that has/have influenced health care?

C. in 200-250 words. Discuss how the CMS reimbursement rules for never events required a shift in the patient care delivery model in inpatient facilities.

 
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Define the fundamental responsibilities and key characteristics of the Chief Information Officer (CIO) and Chief Technology Officer (CTO) within health care organizations.

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Assignment 2: Competiveness and Performance Effectiveness for Health Care IT Systems

Due Week 8 and worth 250 points

Write a six to eight (6-8) page paper in which you:

1.Define the fundamental responsibilities and key characteristics of the Chief Information Officer (CIO) and Chief Technology Officer (CTO) within health care organizations. Make one (1) recommendation where they can utilize their expertise to assist with employee and patient satisfaction. Support your response with related examples of such expertise in use.
2.Suggest two (2) developing technologies that health care systems should use in order to improve health care processes and thus increase the quality and lower the cost of health services. Provide a rationale to support your response.
3.Determine two (2) significant methods that health care systems should use in order to prevent misuse of information and protect data privacy and thus achieve a high level of security of health information. Provide a rationale to support your response.
4.Suggest one (1) strategy for health care organizations to train providers in using technology in health care. Provide a rationale to support your response.
5.Provide three (3) best practices for effective IT alignment and strategic planning initiatives. Justify your response.
6.Use at least three (3) quality academic resources in this assignment. Note: Wikipedia and similar type Websites do not qualify as academic resources.

Your assignment must follow these formatting guidelines:

•Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; references must follow APA or school-specific format. Check with your professor for any additional instructions.
•Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required page length.

The specific course learning outcomes associated with this assignment are:

•Examine the impact technologies have on health care information systems.
•Describe the basic components of a strategic information system plan.
•Describe the major types and classifications of health care information standards and the specific organizations that develop and regulate these standards.
•Discuss the need for, and identify methods of, accomplishing the security of information systems.
•Evaluate the impact of strategic information system plans on organizational competiveness and performance.
•Use technology and information resources to research issues in health information systems.
•Write clearly and concisely about health information systems using proper writing mechanics.

Critical Factors in Implementing an IT System in Health Facilities

Model Paper

Strayer University

HSA 315 Health Information Systems

What are Critical Factors in Implementing an IT System in Healthcare Facilities?

The focus of this paper is to address the following topics: identify key reasons why healthcare organizations (HCO) are reluctant to implement electronic medical record (EMR) programs. Review how the Health Insurance Portability and Accountability Act (HIPAA) has an impact on the storage and security of patient medical records (PMRs). Describe several pros-and-cons of how the Health Information Technology for Economic and Clinical Health (HITECH) Act affects healthcare professionals. Analyze the primary ways that federal initiatives impact the standards of health care information. Specify the advantages of applying the information technology (IT) system within an HCO, and predict new IT developments in the healthcare field in the upcoming decades.

Why are HCOs Reluctant to Implement EMRs?

HCOs cite various reasons for not converting to EMRs. Three of these are financial barriers, organizational and behavioral barriers, and privacy and security barriers (Wager, Lee, & Glaser, 2013). Financial cost is the most common barrier given for not updating to EMRs. The cost to install a fully-operational EMR system is estimated to be from $15,000 to $50,000 (Wager et al.,2013). For a small practice, typically eight or fewer physicians, this is an unaffordable expense. Approximately seventy-eight percent of practicing physician’s in the U.S. fall into this category (Wager et al., 2013). Larger HCOs can justify the cost of implementing a new EMR system, but the setup time and personnel training usually result in a decrease of productivity. Production loss is estimated to be from ten to fifteen percent during the first few months of EMR usage (Wager et al., 2013). Many HCOs are not willing to accept this monetary loss in production.

Organizational and behavioral barriers include physician resistance to conversion from PMR to EMR. Provider workflow is affected in the early application of the EMR system. Caretakers must respond to various alerts and reminders while typing notes into patient’s files. Once an individual becomes familiar with the software, they can maneuver about the system without difficulty. Another problem is different state regulations concerning the installation of EMR systems, security, and licensing (Wager et al., 2013).

Privacy and security barriers are a major concern in the healthcare industry. With all the documented cases of personal information being compromised, and the subsequent lawsuits, no one is willing to accept the responsibility to ensure that patient information is kept confidential. HIPAA, and especially HITECH, are written specifically to address these issues (Wager et al., 2013).

How HIPAA Impacts Patient Medical Records (PMR).

HIPAA or Public Law 104-191 became effective on August 21, 1996. There are several parts of this Act. Under Title II, you have the Privacy Rule, Transactions Rule, Security Rule, Identifiers Rule, and the Enforcement Rule (104th Congress, 1996).

The Privacy Act is one of the key contributors to Privacy and Security Barriers. The law applies federal standards to the security and handling of protected health information (PHI). PHI refers to any information that describes an individual’s health status; the type of healthcare provided or its subsequent payment. It also pertains to patient identification information handled, stored, or transmitted (104th Congress, 1996). All information is protected by law in any form (physical, electronic, or oral-based) (104th Congress, 1996). This Act also permits the patient’s to examine and obtain copies of their personal healthcare information (Wager et al., 2013).

The Transactions Rule mandates the usage of medical terms, concepts, diagnosis and procedure codes. ICD-9-CM was the standard for medical coding but effective October 1, 2014 ICD-10-CM diagnosis codes, and ICD-10-PCS procedural codes became the medical coding standard (Wager et al., 2013). A new set of internationally accepted codes is already being developed to replace the ICD-10 codes. Systemized Nomenclature of Medicine-Clinical Terms (SNOMEDCT) are, “a comprehensive set of standard terms for clinical information for use in electronic health records” (White & Griffith, 2014). This system is in use in many countries, including the United States (U.S.).

The Security Rule establishes guidelines on the accessing, auditing, storing, and transmitting of EMRs (104th Congress, 1996). Meeting HIPAAs standards under this rule is another critical factor in the Privacy and Security Barriers. Two plans enforced under this rule are the Backup and Recovery Plan and Incidence Response Plan. Backup and recovery focuses on the ability to restore electronic PHI and EMRs if it is corrupted or lost. HCOs must have an in-place strategy that meets HIPAA standards to ensure ongoing business operations in the case of a catastrophic EMR system event. Incidence response applies when PHI become compromised in some manner. A plan on how to respond to such an issue is essential (104th Congress, 1996).

The Identifiers Rule standardizes specific codes used on PHI to regulate administrative data. These rules fall into three categories; Standard Unique Employment Identifier, National Provider Identifier (NPI), and the Health Plan Identifier (HPID). The Standard Unique Employment Identifier is the same as the Employer Identification Number (EIN) used by the Internal Revenue Service (IRS) and identifies an employer providing healthcare benefits to an employee. The NPI is a ten-digit number that identifies healthcare providers. HIPPA uses this unique identifier for administrative and financial transactions (104th Congress, 1996).

Approved by the HHS on September 5, 2012, the HPID is a unique identifier used by the Center for Medicare and Medicaid Services (CMS). Controlling health plans (except small health plans) must be compliant with this regulation and get HPIDs by November 5, 2014. Small health plans must obtain HPIDs by November 5. 2015 (Centers for Medicare and Medicaid Services, 2014).

Advantages and Disadvantages of HITECH?

The Enforcement Rule or HITECH become effective on February 17, 2009. It is part of the American Recovery and Reinvestment Act (ARRA) of 2009 and is also a part of HIPAA. The Act is designed to promote, support, and financially assist with the transition from paper PMR to EMR. EMR compliance provides multiple benefits in overall healthcare performance (Wager et al, 2013).

Advantages include a reduction in medical errors. Most medical errors occur from erroneous interpretation of illegible handwritten physician notes or prescriptions. EMR systems make accessibility to personal health information easier for caregivers. More complete and current EMR decrease redundant medical procedures. Filing and sorting are no longer necessary with the elimination of paper health records improving overall patient care workflow (Wager, et al., 2013).

 
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How would you define the term, “equity and fairness”, in the context of the healthcare situations prevailing in the United States and Canada?

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Healthcare Synthesis

Using the South University online library, the Internet, and the data from the Organization for Economic Cooperation and Development (OECD), research comparative international work and compare the United States and Canada with respect to which country is more effective in the areas of (1) economic growth; (2) expenditure (public and private expenditure on health); (3) information and communications technology; and (4) health.

Click here to access data from the OECD.

On the basis of your observations, create a 1- to 2-page report.

Your report should address the following questions:

•After going through the statistics:
◦What information or statistic you find either surprising or reasonable?
◦Do you anticipate the statistics will be similar in ten years? Why or why not?
•The current structure of healthcare coverage in the United States has a combination of employer-based coverage and public program (e.g., Medicare, Medicaid) coverage, with a large uninsured population. If a single-payer system is implemented where Medicare is expanded to cover all citizens for those who prefer private insurance, there will be comparable coverage under the same range of private insurance plans already available. Keeping in mind these considerations, answer the following questions:
◦What do you think about allowing some people to purchase additional insurance, thereby creating a two-tier health system based on affordability?
◦What are the advantages and disadvantages of this initiative?
•Considering the fact that healthcare is not a guaranteed right for everyone in the United States, there are different kinds of barriers and obstacles in obtaining healthcare. In contrast to this fact, the notions of equity and fairness are considered very important. You will notice that these notions aren’t considered when we discuss people’s access to other goods, such as cars and computers.
◦What are these barriers? Give examples of the different barriers to health care under the following headings:
◾Financial barriers
◾Scarcity of healthcare providers
◾Barriers to access healthcare
◾Cultural barriers
◾Barriers of healthcare resources
◦How would you define the term, “equity and fairness”, in the context of the healthcare situations prevailing in the United States and Canada?
◦Why are they considered important when discussing people’s access to care?
•It is believed that government funded healthcare for all citizens is consistent with a capitalist economy and the cultural values of self-determination and free enterprise.
◦Do you agree with this statement? If not, what other approaches do you think will resolve the current inequities in the system?

 
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What are the advantages and disadvantages of RCTs in comparison to other types of studies?

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NR 505 Advance Research Methods Complete Course (Updated – Spring 2016)

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bus 517

NR 505 Week 1 TD 1 Qualitative Research
You will be conducting a participant observation study for this TD. The research question is: What are the health and safety issues in Ironridge compared to Summerville? Record the health and safety issues you find in Ironridge and Summerville. Describe one health issue and one safety issue in each city (Ironridge and Summerville). Try to avoid repeating an issue identified by another student if possible.
Why is this participant observation an example of qualitative research? What are other ways, both qualitative and quantitative, that you could research this question? Finally, how are theory, research, and practice advanced by the combination of qualitative and quantitative approaches?

NR 505 Week 1 TD 2 Ask a PICO(T) Question
Conduct a search of the literature on one of the problems you have identified, using the PICO(T) format. How many “randomized, controlled trials (RCTs)” have you found in comparison to other types of studies? What are the advantages and disadvantages of RCTs in comparison to other types of studies? Generally, how would you summarize your articles?

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Week 2
NR 505 Week 2 TD1 Purposes of research
This week the instructor will divide the class into four (4) collaboration committees so that each committee can discuss a different top priority issue from Week 1 that the instructor has identified.THIS IS NOT A GROUP PROJECT OR GROUP ASSIGNMENT. Each student will be graded individually based on their performance. Since we usually participate in collaborative committees in the practice setting to discuss priority issue, this format will allow our class to discuss four priority issues within the same discussion board.

Each student will need to post twice (once by Wednesday deadline at 11:59 p.m. MT and a peer response to someone in your collaborative committee). In your collaborative committee, discuss what information you will need to know about the issue? What types of research would be most useful (descriptive, explanatory, predictive, prescriptive)? What databases are the most helpful? Please place all committee discussion in the discussion thread forum so everyone can benefit from the discussion.

NR 505 Week 2 TD 2 Theory and Variables
Review the differences in descriptive, explanatory, predictive, and prescriptive studies and select one of the predictiveor prescriptive articles you find. What are the independent variables (IV), dependent variables (DV), and mediating variables (MVs) you find in the article? How do determining IVs, DVs, and MVs help you discern the theory tested in the research? In your particular article, what risk factors are identified or what recommendations are provided?

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Week 3
Week 3 Assignment Research Summary Table
(Rodents & Associated Health Risks to Humans)
(Injuries of Children with Non-Helmet Use)
NR 505 Week 3 TD 1 Plan a Quantitative Study
You will continue to work with the priority issue from your Week 2 committee discussion. First look at your priority issue from Week 2 and describe a quantitative study to address the issue. What would be your research question? How will you select your sample to make sure that your study has external validity? What factors would affect the internal validity of your study? Remember to pick an article that is different from someone else in your committee. You should each have a quantitative study article for this discussion board.

NR 505 Week 3 TD 2 Plan a Qualitative Study
You will continue to work with the priority issue from your Week 2 committee. First look at your priority issue from Week 2 and describe a qualitative study to address the issue. Which qualitative design would you use? How will you make sure that the information you obtain is trustworthy? How is trustworthiness in qualitative research similar and different from reliability and validity?

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Week 4
NR 505 Week 4 TD 1 Sampling Issues
Staying in discussion with your fellow consultants, what type of sample would you need to examine your question and learn more about your issue? What are the various types of sampling you could use, along with their advantages and disadvantages?

NR 505 Week 4 TD 2 Ethical Issues
Read these two documents on ethical issues in research:
o Tuskegee syphilis study at http://www.cdc.gov/tuskegee/.
o An overview of questionable studies – Milestones in the history of human subjects protection

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Week 5
Week 5 Assignment Critique of a Systematic Research Review
NR 505 Week 5 TD 1 Descriptive Statistics
Complete a PICO(T) search on bicycle safety. What does the research say about this issue? Select one of the articles from your search. Identify the descriptive statistics. Is anything missing? To what extent are minorities included in the study (or is that demographic information available?)? How does the descriptive data help you understand the research?

NR 505 Week 5 TD 2 Inferential Statistics
Describe the inferential tests that were used (e.g., t-tests and chi-squares). Given the p-values related to the tests, how do you interpret the results? Are statistically significant findings also clinically significant? What are the recommendations, based on this paper? Share some alternate explanations (mediating or intervening variables) for the results of the study.

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Week 6
NR 505 Week 6 TD 1 Research Summaries
Preliminarily, you need to help the staff understand the differences between various translation documents. Therefore, in this TD, compare and contrast two of these five types of research summaries: Meta-analysis, meta-synthesis, systematic research reviews, clinical practice guidelines, and care protocols. What are the differences in their purposes, audiences, and authors?

NR 505 Week 6 TD 2 Evidence-based(EBP) Models
Compare and contrast two of the models in the Week 7 lesson. Which would you recommend in this situation and why?

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Week 7
Week 7 Assignment Analysis and Application of a Clinical Practice Guideline
NR 505 Week 7 TD 1 Quality, Safety, and Costs
Cuts is healthcare is a current concern for patients, clinicians and insurances. All entities are challenged daily to provide cost effective, safe and quality care for our patients.

NR 505 Week 7 TD 2 Patient and Family Concerns
What does the literature say about patient and Family engagement and what would you recommend?(Hint: Use that phrase in your search.) How are patient and Family concerns related to clinical significance?

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Week 8
NR 505 Week 8 TD 1 Applying Evidence-based Practice

 
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