Running head: CRITIQUE OF BUSINESS ARTICLE 1

Critique of Business Article

Elaine Dean

Jacksonville University

November 7, 2017
CRITIQUE OF BUSINESS ARTICLE 2

Critique of Business Article

Introduction

The title of the article is “Down to the wire: Time is running out to take advantage of

EHR meaningful use incentive payments “ by Daniel Sosnoski (2014). A critical review of this

article will be performed throughout this paper. The overall tone of the article appears to be a call

to action in the implementation of meaningful use electronic health records (EHR). The author

outlined the strong financial incentive available through the federal government and the fringe

benefits associated with the accomplishment of certified EHR. EHRs replaces paper health

records in an electronic format and while this may seem minimal the author highlighted the

advantage of effective information exchange and the strengthening of the Health Insurance

Portability and Accountability Act (HIPAA). Sosnoski (2014), advocated for providers to be

informed consumers of the meaningful use of EHR reinforcing that while the incentive payments

to adhere to this reform may be a strong motivation factor EHR will provide a significant push in

the improvement of quality healthcare. EHR will integrate all the points of care thus supporting

continued efficient care. The Department of Health and Human Services through the Centers for

Medicare and Medicaid established three different stages for meaningful use of EHR each with

its own objectives. CMS is the decision-maker on when a provider has successfully satisfied

each objective. Research has shown that computerized accessibility of health data can enhance

surveillance, improve monitoring ability, decrease medical errors, and promote adherence to

guideline-based health care (Goveia, Stiphout, Cheung, Kamita, Keijsers, Valk & Braak, 2013).

Based on evidence-based findings the Health Information Technology Act (HITECH) of 2009

provided $27 billion in incentive rewards for providers to adopt meaningful use EHR (Galbraith,

2013). However, the author theorizes that all computerized health record systems are not created
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equal therefore providers need to be aware of the language outlined in the initiative. He also

advised against overinflated expectations (Sosnoski, 2014).

Evaluation of Concept Presented

It is clear that the author focused a lot on the incentive portion of this concept that the

fundamental goal was practically missed. In fact, the article seemed geared towards convincing

providers who were on the fence or against the meaningful use of EHR concept to take a second

look. The author referenced multiple important points in assisting providers to see the overall

connection between EHR and healthcare delivery benefits. An incentive reward grid showing

prospective dollar amount provided a good visual reference. However, while I would say the

author excellently laid out his case the focus on the monetary value was on grand display. The

article was devoid of the comprehensive use of EHR that could be accomplished with its

implementation including improvement in coordination of care, improved efficiency, increased

patient participation, the creation of a more patient-centered care system, cost containment,

improved privacy and security of patient information, and reduced medical errors. The inherent

concept of meaningful use of EHR is based on multiple research studies into patient safety. The

Institute of Medicine (IOM) report, “ To Err is Human” encourages the use of EHR to increase

the quality of care and patient safety (Effiken, 2011). These evidence-based studies translated

into this healthcare initiative championed by the Department of Health and Human Services

(HHS) through Centers for Medicare and Medicaid (CMS) to incentivize the adoption of EHR to

improve care and manage cost (Murphy, 2010). The author delivery strategy in pushing for

meaningful use of EHR lacked the substantive element of patient care gains that is the core

functionality of EHR instead it felt like a sales pitch. The meaningful use of EHR came about as

part of the Recovery Act of 2009. In this stimulus bill, $147 billion was allocated to reform and
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strengthen the United States healthcare industry. Of that amount, $19 billion was earmarked over

five years to reform the use of technology and the adoption of EHR (Murphy, 2010).

Application of Presented Concept to Financial Management of Nursing Systems

The transition of the United States healthcare payment system to a value-based payment

system arrangement resulted in healthcare organizations and healthcare providers redesigning

their efforts to improve clinical outcome while lowering cost. Nursing staffing is critical in the

world of value-based reimbursement. Staffing levels and nursing competency not only affect

patient safety but other key determinants critical to patient outcome example medication errors,

post-surgical complication, and infection rate. The adoption of EHR presents the opportunity to

develop a value-based metrics that would extract key data for measuring clinical, operational,

and economic outcome (Welton & Harper, 2016). If EHR is integrated with an analytical tool it

would generate aggregated and summarized data on operational workflow, quality outcome,

clinical care, and nursing care cost. With this data available in real time to nurses, clinicians,

nurse managers, nurse leaders and hospital executives it will empower the combined group with

a new business intelligence tool to measure exact nursing care cost and hours of care for each

episode of care. The ability to identify individual patients’ nursing care needs would provide the

capacity to track and trend nurse-patient data relative to the level of staffing, skill mix,

competency, and the effect they have on the outcome of care. Another approach would be to

construct a model to link the patient and the nurse example through the patient encounter. This

process is done in the VA. With this framework, data will be extracted from EHR for comparing

and benchmarking nursing care across multiple care settings.

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Conclusion

The use of manual data retrieval, paper documentation, manual monitoring of nursing

resources, manual tracking of hospital finances, and the manual process of tracking patient acuity

are just some of the factors that is labor intensive and extremely costly. A study done in 2005

found that the implementation of EHR could significantly improve healthcare delivery processes

and reduce spending nationally by over $160 billion (DeAngles, 2015). It is well documented to

date that the adoption of EHR under the meaningful use incentive program has produced positive

outcome. According to data from the Office of the National Coordinator for Health IT (ONC),

96% of hospitals and 78% of office-based physicians now have certified EHR (Eramo, 2017). It

is safe to say then that EHR can have a positive effect on nursing financial management systems

and ultimately the fiscal health of the organization.

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References

DeAngles, M. (2015). Network regulation and synchronization of network and state privacy laws

needed to increase efficiency and reduce cost in healthcare. Journal of Legal Medicine.

Effken, J. A., & Carrington, J. (2011). Communication and the electronic health record:

Challenges to achieving the meaningful use standard. Online Journal of Nursing

Informatics, 15(2).

Eramo, L. A. (2017). Time out: Where is the U.S. healthcare system on interoperability and a

quality strategy. Journal of AHIMA.

Galbraith, K. L. (2013). Whats so meaningful about meaningful use. Hastings Center Report,

43(2), 15-17.

Goveia, J., Stiphout, F. V., Chueng, Z., Kamta, B., Keijsers, C., Valk, G., & Braak, E. T. (2013).

Educational interventions to improve the meaningful use of electronic health records: A

review of the literature. Medical Teacher, 35, 1551-1560.

Murphy, J. (2010). The journey to meaningful use of electronic health records. Nursing

Informatics, 28(4).

Sosnoski, D. (2014). Down to the wire: Time is running out to take advantage of EHR

meaningful use incentive payments. Chiropractic Economics.

Welton, J. M., & Harper, E. M. (2016). Measuring nursing value from the electronic health

record. Nursing Informatics.