The Impact of Technology Attitudes and Skills of Rural Health Clinic Nurses on the Level of Adoption of Electronic Health Records in Mississippi

The evolution of health information technology continues to reform the delivery of efficient, safe, and equitable healthcare in the United States. One such example is the emergence of electronic health records (EHRs) and the discerning emphasis placed on using this technology in meaningful ways. While the integration of EHRs into daily practice impacts all healthcare professionals, nurses remain a prominent driver in the successful adoption and usage of these systems. It is therefore imperative to understand the impact of nurses’ technology attitudes and skills on the level of EHR adoption in Mississippi. This quantitative study examined the technology attitudes and skills of rural health clinic nurses on the level of adoption and meaningful use (as defined by CMS) of electronic health records. Approximately 44 rural health clinic nurses (or those serving in a rural health clinic nursing capacity) participated in a survey that solicited demographic information, healthcare facility information, electronic health record information; and information regarding the technology skills, and technology attitudes of the respective participant. The findings show no significant relationships between current stage of EHR meaningful use and rural health clinic practice ownership; nor do factors that impede or facilitate the diffusion process significantly differ by practice ownership. Findings also indicate that the technology attitude of a nurse is not significantly impacted by (1) the age of the nurse, (2) the number of years of nursing experience, or (3) the current stage of EHR meaningful use at the nurses’ respective rural health clinic. Results of the study indicate that Mississippi’s rural health clinics are at varying levels of EHR meaningful use with some clinics still at a level of no adoption. In addition, technology attitudes of rural health clinic nurses still remain low. As evidenced by technology attitude scores, clinic nurses lack confidence in using technology and in the technology itself. Training should be focused on the application of health information technologies to increase nurses’ self-confidence and understanding of effective use. Further, administrators and practice owners should involve nurses throughout the adoption lifecycle to ensure nurses are a vital component in the development and integration of EHRs

A Portrait of Rural Health in America

introduction to special issu

Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long-Term Care Facilities

Analyzes Medicare spending on and utilization by beneficiaries in long-term care facilities for hospitalizations, emergency room visits, and skilled nursing facilities. Explores ways to reduce hospitalizations, save costs, and improve the quality of care

Public Policy Implications for Access to Remote Monitoring and Consultation in Healthcare

Enrollees of Medicare and Medicaid are going to grow dramatically in the next ten years, due in part to the new health reform legislation and the aging baby boomer generation (UnitedHealth Center for Health Reform Modernization, 2010). This growth, in concert with concerns about aggregate health care costs, calls for more efficient and effective delivery of long term supports and services (Stone Weiner, 2001). One approach to address this specific healthcare demand is an effort to increase use of telehealth1 (Field Grigsby, 2002). The use of telehealth in the form of remote monitoring and consultation would increase accessibility to long term supports by leveraging technology to provide medical care when distance separates the participants (American Association of Telemedicine). At this time, Medicare and Medicaid do not broadly reimburse for telehealth services (Neumann Tunis, 2010). There are provisions in the Patient Protection and Affordable Care Act (HR 3590 2010) that would allow for greater use of technology to deliver long term services and supports and set the stage for greater public reimbursement for such services through Medicare and Medicaid. This paper will explore the policy issues related to telehealth included in the Patient Protection and Affordable Care Act (PPACA), and how it may increase accessibility to telehealth services for Medicaid and Medicare enrollees seeking long term monitoring and consultation services.Master of Public Healt

Clinical Integration of Next Generation Sequencing: Coverage and Reimbursement Challenges

Public and private payers face complex decisions regarding whether, when, and how to cover and reimburse for next generation sequencing (NGS)-based tests. Yet a predictable reimbursement pathway is critical both for patient access and incentives to provide the market with better clinical evidence. While preliminary data suggests that payers will use similar evidentiary standards as those used to evaluate established molecular diagnostic tests, the volume and complexity of information generated by NGS raises a host of additional considerations for payers that are specific to this technology

Paper Cuts: Reducing Health Care Administrative Costs

Economic

Health Care In America: How To Fix Costs and Employer Provided Insurance Through Consumer Driven Health Care

Consumer driven health care is a viable solution to reduce America’s high overall health care costs and to rectify the lack of portability in the current employer driven health insurance model. Health care costs have risen greatly due to factors such as hospital administration and care, medical equipment, pharmaceutical companies, age, malpractice suits, and red tape. Health insurance is a complex field with components such as premiums, deductibles, co-payments, and both public and private providers of insurance. Health insurance in the United States is mainly provided by private insurance companies and these companies allow employers to pick insurance plans for their employees with the employee having little or no say on what is covered by these plans. Also, many employer based insurance plans are not able to travel from one company to another. Consumer driven health care can fix those issues. First, consumer driven health care is a system in which the individual controls their own health care choices and consumer health care is paid for by the individual instead of the government or employers. Consumer driven health care is also portable as health insurance plans are tied to the individual and not to a single company

Genetic testing outcomes in utilization management genetic counseling clinic compared to genetic testing ordered by non-genetics providers

UPMC Children’s Hospital of Pittsburgh started the Genetic Testing Clinic (GTC) in January 2018. The GTC is a genetic counseling-only clinic that offers same-day and advance-scheduled appointments for referrals from non-genetic providers ordering a genetic test. This clinic is unique in that it incorporates utilization management (UM) for the requested genetic test while providing comprehensive genetic counseling. After one year and 459 patients, outcomes of the clinic, such as test order modifications, family history risk assessment and triage, and genetic test uptake were assessed. Upon IRB approval, retrospective chart review of the electronic medical record and internal databases were performed for 206 of the GTC patients to obtain detailed outcomes of the clinic. Additionally, chart review of genetic testing completed by non-genetics providers prior to the GTC’s inception in 2017 was performed for a comparison. Chart review identified 14.6% (30/206) of the GTC patients had unrelated family history risk factors, for which a referral to cancer genetics or cardiogenetics was provided and 7.3% (15/206) of GTC patients had their test modified based upon genetic counselor review. Finally, review of possible results, risks, benefits and limitations of genetic testing were discussed and documented routinely for GTC patients. In contrast, non-genetics providers often lacked documentation of the informed consent process. 77/150 (51%) of the non-genetics providers did not document any of the possible types of genetic testing results, 67/150 (45%) documented one type of possible genetic testing result; 112/150 (75%) did not document any risks, benefits or limitations; and 149/150 (99%) did not document the possibility of incidental findings. Genetic counseling is valuable for patients undergoing genetic testing; however, not every patient receives genetic counseling. This clinic represents a service delivery model that provides genetic counseling and UM for patients who may not have otherwise received it. This has public health significance as it improves access to genetic counseling services, ensures comprehensive pre- and post- test counseling, and has improved insurance authorization approval

Cardiovascular risk factors and cognitive decline in older people with type 2 diabetes

AIMS/HYPOTHESIS: The aim of this work was to assess the role of well-established cardiovascular risk factors in the late-life cognitive decline of patients with type 2 diabetes. METHODS: Data from 831 participants (aged 60-75 years) attending the 4 year follow-up of the Edinburgh Type 2 Diabetes Study (ET2DS) were used. Smoking history (pack-years), BP, HbA1c, plasma glucose and cholesterol were determined at baseline clinics (single time measurements) and/or from serial data recorded on a clinical management database from diagnosis until recruitment ('historical' data). Principal component analysis derived a factor, g, of general ability from seven cognitive tests. Linear regression models of follow-up g were adjusted for baseline g to represent 4 year cognitive change. 'Accelerated late-life cognitive decline' was defined as scoring in the lowest tertile of '4 year cognitive change' regression scores. Analyses controlled for age and sex. RESULTS: A baseline history of moderate/heavy smoking (>/= 10 pack-years) and a 1% increased historical HbA1c (equivalent to an increase by 11 mmol/mol) predicted a 64% (OR 1.64; 95% CI 1.14, 2.34; p = 0.007) and 21% (OR 1.21; 95% CI 1.00, 1.45; p = 0.046) increased risk of accelerated cognitive decline, respectively. When treated as continuous measures, higher pack-years, historical HbA1c and historical BP emerged as significant independent predictors of 4 year decline in g (standardised beta range -0.07 to -0.14; all p </= 0.05). CONCLUSIONS/INTERPRETATION: Increased smoking and poorer glycaemic control (with relatively weaker findings for BP) during the life-course were independently associated with accelerated late-life cognitive decline. Where possible, evaluation is warranted of these risk factors as targets for intervention to reduce the burden of cognitive impairment in diabetes