Progress on the Frontiers of Health and Medicine

The frontiers of medicine are not only in the development and transformation of delivering health care, but is also a physical impediment to delivering a level of quality health care.Rural health care presents unique challenges for delivery of care. There are fewer providers, facilities, and less economic support.

As described by Leila Samy, Meghan Gabriel, and   Jennifer King on HealthITBuzz , 

Leila Samy

  

                                                                Meghan Gabriel
                                                                                                               Jennifer King

              

Critical Access Hospitals (CAHs), some with a census of fewer than 10 patients, are the smallest of the small rural hospitals. In some regions, such as frontier areas, a CAH may be the only local health care provider serving an area the width of the state of Rhode Island! CAHs are small, geographically isolated and have limited resources.

CAHs are found in every region of the country, and represent roughly 30 percent of hospitals nationwide. Often serving as the focal point for all health care services in a rural area, CAHs often own and run the local rural health clinics and skilled nursing facilities. They may also be responsible for public health and emergency medical system services. These hospitals extend services to places where they wouldn’t otherwise be available. And those are the reasons why it is important for CAHs to have access to health IT systems and capabilities.

As of 2013, 89 percent of CAHs had an EHR in place; 62 percent of CAHs with an EHR had a fully electronic health record system, and 27 percent had a health record system that was part electronic and part paper.

Most CAHs adopted (as of 2013) or planned to adopt (by the end of 2014) the health IT capabilities evaluated in this study (i.e., telehealth, teleradiology, care coordination and health information exchange with other providers and patients).

As of 2013, CAHs reported the highest rates of adoption for teleradiology (70 percent) and telehealth (59 percent) capabilities. Fewer CAHs reported other capabilities related to electronic exchange of key clinical information with other providers. Even fewer (15 percent) of CAHs reported patient engagement capabilities (i.e., offer patients ability to view, download and transmit their health information

Among the challenges to health IT adoption among CAHs, financing and workforce related challenges were most commonly reported.

CAHs that pooled resources with other hospitals were more likely to have EHR and capabilities related to health information exchange and care coordination, compared to those that did not pool resources or engage in group purchasing.

CAHs with faster Internet upload speeds were more likely to have the capability to provide patients with the option to view, download, and transmit their health information compared to those with slower upload speeds.

The Federal Government is offering funding opportunities and offers Creative Solutions to Expand  Rural Health IT Funding

Benefits of Health IT adoption among CAHs and other small, rural hospitals

• 
  

The Doctor's Lounge' The VA Crisis

The impact of Medical Information Technology, "meaningful use" HITECH regulations, and the ongoing VA scandal are on tap, at  America's Web Radio 

The Docs4Patient Care organization is featured on the initial episode of The Doctor's  Lounge, as Hal Scherz M.D. and Michael Koriwchak discuss HITECH and the V.A. Crisis.  Listen in

Dr. Koriwchak heads up the conversation, being the policy expert on Medical Information Technology and primary author of our D4PC white paper, "Policy on Medical Information Technology" - available online atwww.docs4patientcare.org/policy-emr

Tune in on Thursdays at 8 AM for 'The Doctor's Lounge" for future topics: 

Digital Health Space will carry these weekly presentations.

HealthCare.gov Online User Experiences

Similar to the roll out of Covered California, the nationwide Health.gov exchange was even more flawed and unreachable for more than one month.

Short Videos of Users on the HealthCare.gov Website

The brief videos below highlight some of the challenges faced by the study participants outside California as they used the federal HealthCare.gov website to enroll in health coverage under the Affordable Care Act.

• Positive Impressions: Participants had anxiety about applying for health insurance and were surprised and relieved by the ease-of-use and clean look and feel of HealthCare.gov. Watch Video
• Quitting Points: There were several points at which participants abandoned, or would have abandoned, the online process to seek phone or in-person help. Watch Video
• Areas of Uncertainty - General Context: Participants were unsure about some ACA concepts such as "deadlines" and "tax credits," and they didn't always find adequate explanations or help. Watch Video
• Areas of Uncertainty - Site Elements: Some participants had challenges providing income and household information, logging into the system and navigating through certain parts of the site. Watch Video

The Affordable Care Act expands coverage options and provides an opportunity to streamline the enrollment process in public and private coverage. CHCF funded an assessment of HealthCare.gov to identify actionable ways to improve consumer experience with online enrollment.

The assessment uses a methodology not common in the public sector — direct observation of consumers as they move through the website. This technique captures sources of consumer satisfaction, knowledge, confusion, and frustration. The most compelling findings relate to assisting consumers with plan shopping and selection, providing adequate help throughout the process, and ensuring accuracy in consumers' responses to application questions. The report concludes with researchers' recommendations for improvement.

Compare these findings with those of  Covered  California in our earlier blog post.

The California Health Care Foundation also published a study of Health.gov for comparison of states using the national Health.gov website.

Both reports illustrate the poor design and performance characteristics of sites not ready to 'go live'.

Were this a private enterprise it would have stood little chance of success. Supervision and implementation were poor from the bottom to the top of the chain of command.


Health.gov User Experience  download

Assessing the Covered California Online User Experience

The rollout of Covered  California presented many challenges, and turned out to be an expensive learning exercise. Many of the issues were clearly identified late in the game and are illuminated in this excellent report and videos sponsored by a grant from the the California Health Care Foundation

California enrolled 1.4 million people in new private health insurance plans during the first open enrollment period under the Affordable Care Act. In February, as state officials were administering the sign-up campaign, research supported by the California HealthCare Foundation (CHCF) was conducted to study the experiences of consumers attempting to enroll online at www.CoveredCA.com.

CHCF commissioned gotomedia, a San Francisco-based user interface research and design firm, to observe and interview a diverse group of Californians applying from computers in their own homes. Researchers observed consumers as they explored the site, created accounts, entered household and income data, and compared health plan options.

Online ACA Marketplaces: the Value of Consumer Experience Assessments

The result is reported and may be downloaded here in this white-paper.

Several videos are available which demonstrate several users attempting to use the Covered California Website.

 A video clip of a consumer trying to use the CoveredCA.com website shows this problem and illuminates how direct observation can be a revealing way to more fully understand the consumer experience.

Confusing Eligibility Results and Next Steps: Many users were not sure what they qualified for. Those eligible for Medi-Cal were disappointed at not being able to complete the enrollment process online. Watch Video

Understanding Questions: Some participants resorted to guessing and online searching when they didn't understand questions and when definitions and help were not available or inadequate. Watch Video

Steps and Sequences: Some participants were uncertain where to start on the site and about next steps as they progressed through the process. Watch Video

Entering Simple Data: Some users struggled to enter simple data, such as phone numbers, in the format required by the online system. Watch Video

State leaders and consumer advocates have identified several report recommendations as high priorities when planned enhancements are made to CoveredCA.com. The full reports on CoveredCA.com and HealthCare.gov are available on CHCF’s website.



Read more: http://www.chcf.org/publications/2014/05/covered-california-online-user-experience#ixzz35iOhi5O2