A State's use of the electronic medical record: A means to address Arkansas' health care responsibilities to her children - Promoting access to cost-effective care

International Journal of Technology Management

Volumn 15, Issue 3-5, 1998, Pages 458-469

  Gay, E Greer ^a,b,c,d  

^a UNIVERSITY OF MEMPHIS   (United States)

^b UNIVERSITY OF SOUTH CAROLINA   (United States)

^c JOHNS HOPKINS UNIVERSITY   (United States)

^d Health Services Administration   (United States)

Author keywords

Claims system; Clinical markers; Electronic medical record; Medicaid primary care; Real time; Sentinel events

Indexed keywords

ADMINISTRATIVE DATA PROCESSING; COST EFFECTIVENESS; HEALTH CARE; INFORMATION MANAGEMENT; PATIENT TREATMENT; REAL TIME SYSTEMS;

ELECTRONIC MEDICAL RECORD;

MEDICAL COMPUTING;

EID: 0031652260     PISSN: 02675730     EISSN: None     Source Type: Journal    
DOI: 10.1504/ijtm.1998.002610     Document Type: Article

References (66)

1. Medicaid is a federal-/state-financed program, authorized by Title XIX of the Social Security Act, that pays for health care services of persons on public assistance (categorically-needy) and those without enough monies to pay for medical care (Medically-needy). Medicaid costs have rapidly risen in the last decade as Congress mandated expansion of eligibility criteria to pregnant mothers and children, who are at or below the federal poverty level.
2. Children's Defense Fund (1993). The State of America's Children (1992). Washington, D.C. CDF Publication; Raffel, M.W. and Raffel, N.K. (1994) The US Health System: Origins and Functions, 4th edn. Albany, NY; Delmar Publishers, Inc.
3. Children's Defense Fund (1993). The State of America's Children (1992). Washington, D.C. CDF Publication; Raffel, M.W. and Raffel, N.K. (1994) The US Health System: Origins and Functions, 4th edn. Albany, NY; Delmar Publishers, Inc.
4. McCloskey, A.H., Woolwich, J. and Holahan, D. (1995) Reforming the Health Care System: State Profiles 1995, Washington, DC: AARP Public Policy Institute; Raetzman, S.O. and D.A. Jensen (1992) Reforming the Health Care System: State Profiles 1991. Washington, D.C.: The Public Policy Institute of the AARP; and Winterbottom, C., Liska, D.W. and Obermaier, K.M. (1995) State-Level Databook on Health Care and Financing, 2nd edition. Washington, D.C. The Urban Institute.
5. McCloskey, A.H., Woolwich, J. and Holahan, D. (1995) Reforming the Health Care System: State Profiles 1995, Washington, DC: AARP Public Policy Institute; Raetzman, S.O. and D.A. Jensen (1992) Reforming the Health Care System: State Profiles 1991. Washington, D.C.: The Public Policy Institute of the AARP; and Winterbottom, C., Liska, D.W. and Obermaier, K.M. (1995) State-Level Databook on Health Care and Financing, 2nd edition. Washington, D.C. The Urban Institute.
6. McCloskey, A.H., Woolwich, J. and Holahan, D. (1995) Reforming the Health Care System: State Profiles 1995, Washington, DC: AARP Public Policy Institute; Raetzman, S.O. and D.A. Jensen (1992) Reforming the Health Care System: State Profiles 1991. Washington, D.C.: The Public Policy Institute of the AARP; and Winterbottom, C., Liska, D.W. and Obermaier, K.M. (1995) State-Level Databook on Health Care and Financing, 2nd edition. Washington, D.C. The Urban Institute.
7. McCloskey, A.M., Woolwich, J. and Holahan, D. (1995).
8. McCloskey, A.H., Woolwich, J. and Holahan, D. (1995); Raetzman, S.O. and D.A. Jensen (1992); Winterbottom, C., Liska, D.W. and Obermaier, K.M. (1995)
9. There were few, if any, financial incentives in place to encourage private providers to become care-givers for this population. Until the Bourne amendment, which stated that payment for Medicaid services had to be in line with market values, passed, Medicaid payment for services was well below market value. Further, as states felt increasing financial pressures due to expanding benefit and constituency costs, states sought to cut Medicaid expenditures through freezing physician fees.
10. Gapenski, L.C. (1993) Understanding Health Care Financial Management. Ann Arbor, MI: Health Administration Press; Jacobs, P. (1991) The Economics of Health and Medical Care, 3rd ed. Gaithersburg, MD: Aspen Publishers Inc.
11. Gapenski, L.C. (1993) Understanding Health Care Financial Management. Ann Arbor, MI: Health Administration Press; Jacobs, P. (1991) The Economics of Health and Medical Care, 3rd ed. Gaithersburg, MD: Aspen Publishers Inc.
12. States were to cover pregnant women and children to age 6 who were at 133% of FPL; and that coverage was to expand to all children, at 100% FPL to age 18. States could add onto the Medicaid rolls an age group each year as Arkansas chose to do.
13. Moffitt, R. and Wolfe, B. (1993) 'Medicaid, welfare dependency, and work: is there a causal link'. Health Care Financing Review 15 (4): pp. 12-133.
14. The Council would, at a later time, expand its efforts to include all uninsured/under-insured residents in the state.
15. Children's Defense Fund (1993)
16. Arkansas covered pregnant women and children to age 6 at 133% FPL through the state's Medicaid program. By 1991, the state had also expanded the program of coverage to include children to age 9 who lived at or below the FPL.
17. Hadley, J.P. (1993) ' Overview: Medicare and Medicaid managed care'. Health Care Financing Review 15 (1): pp.1-5.
18. McCloskey et al. (1995).
19. Miller, M.E. and Gengler, D.J. (1993) 'Medicaid case management: Kentucky's patient access and care program'. Health Care Financing Review 15 (1), pp.55-69.
20. Kongstvedt, P.R. (1995) 'Use of data and reports in medical management'. In Essential of Managed Health Care, Kongstvedt, M.D., P.R., editor. Gaithersburg, MD: An Aspen Publication.
21. McIlrath, S. (1992) 'HCFA moves to broaden electronic claims filing'. American Medical News, pp.40-41.
22. Worthley, J.A. and DiSalvio, P.S. (1995) 'Managing resistance'. In Managing Computers in Health Care, 3rd edn. Ann Arbor, MI: Health Administration Press. Inside quote is attributed to Shoshona Zuboff, Harvard Business School, as quoted in the Chapter and cited New York Times, 7 February 1988, B-1.
23. Worthley, J.A. and DiSalvio, P.S. (1995) 'Managing resistance'. In Managing Computers in Health Care, 3rd edn. Ann Arbor, MI: Health Administration Press. Inside quote is attributed to Shoshona Zuboff, Harvard Business School, as quoted in the Chapter and cited New York Times, 7 February 1988, B-1.
24. Darby, M. (1993) 'Multi-pronged campaign most effective at dissemination practice guidelines'. Report on Medical Guidelines and Outcomes Research 4 (2): pp.5-7.
25. Iglehart, J.K. (1992) 'Reply to a response to the article, the American health care system: private insurance'. The New England Journal of Medicine 326, article; 327, reply: 1715-20 article and 1246 reply.
26. Governor's Health Care Task Force (1994) Health Care Reform in Arkansas. Little Rock, AR: A report to the Governor.
27. Bria II, M.D., W.F. (1933) 'Patient care information systems and physicians: the transition from technology icon to health care instrument'. Topics in Health Information Management, 14 (2), pp.1-8.
28. McIlrath (1992).
29. Worthley, J.A. and DiSalvio, P.S. (1995) 'Understanding computer technology'. In Managing Computers in Health Care, 3rd edn. Ann Arbor, MI: Health Administration Press.
30. McIlrath (1992).
31. Kunitz, S.C. (1994) 'Barriers to automation in health care settings'. Topics in Health Information Management 15 (1), pp. 1-9.
32. An Emerald Supersystem and Printer, a small personal computer, POS device that transmits Medicaid claims and can verify eligibility electronically to be used by those without a computer or who choose not to use their office computer for claims transmission; an OMNI 380 and printer, which serves as a payment processing and management tool, similar to an automatic teller machine; or a PNC 330 microcomputer, a transaction automation system that works through an office's management system as the means to communicate with AVECS (EDS Vendor Specification Notebook).
33. Gardener, E. (1993) 'Get the computers right and physicians will get with the program'. Modem Healthcare 23, 9: pp.35-40.
34. Rhodes, L. (1992) $3.6 million contract approved; will aid DHS claims review. Arkansas Democrat-Gazette: 5B.
35. In this instance, children in the state can receive care at school-based health clinics (an active program in the state given that the state is a medically underserved area), public health clinics, and other provider offices/clinics.
36. Staff, DHS (1992).
37. Milio, N. (1996) 'Linking health, communities, information technology and policy'. In Engines of Empowerment: Using Information Technology to Create Healthy Communities and Challenge Public Policy, Chicago, IL: Health Administration Press.
38. Davis, K., Anderson, G.F., Rowland, D. and Steinberg, E.P. (1990) Health Care Cost Containment. Baltimore, MD: The Johns Hopkins University Press.
39. With 25% of the state's children in poverty, the state ranks 46th in the percent of children in poverty. As already noted, around 20% are uninsured (Children's Defense Fund). Hence, the likelihood of 'presumed eligible' becoming eligible is high, particularly as the state continues each year to expand child eligibility on the basis of living in a family at or below the federal poverty line. Each year child eligibility increases by age group, the current cut-off now being age 13.
40. Children's Defense Fund (1993); and The Governor's Health Care Task Force (1994).
41. Early and periodic screening, detection, and treatment services (well-child visits/immunizations), physician visits, in- and out-patient services, laboratory services, prescriptions, and transportation to and from treatment centres.
42. Arkansas Medicaid Payment Rules, Department of Health and Human Services, Division of Economic Medical Assistance.
43. Alpha Center (1996). States turn to EDI to cut health care costs. State Initiatives in Health Care Reform 16, pp.5-6, 12; Milio, N. (1996) 'Health services delivery using information technology'. In Engines of Empowerment: Using Information Technology to Create Health Communities and Challenge Public Policy. Chicago, IL: Health Administration Press.
44. Alpha Center (1996). States turn to EDI to cut health care costs. State Initiatives in Health Care Reform 16, pp.5-6, 12; Milio, N. (1996) 'Health services delivery using information technology'. In Engines of Empowerment: Using Information Technology to Create Health Communities and Challenge Public Policy. Chicago, IL: Health Administration Press.
45. Tierney, W.M., Miller, M.E., Ovehage, J.M. and McDonald, C.J. (1993) 'Physician inpatient order writing on microcomputer work stations'. JAMA 269 (3): pp.379-383.
46. Though immunization programs have been in place for years at the health departments in Arkansas, a problem observed in the state was that children were not getting their vaccinations when they were in a provider's office or clinic. The paper-trail tracking system did not permit cross-facility tracking. Hence, age-specific immunization fell between the cracks even though a means to provide immunizations was in place. The state's rate was below that set nationally.
47. McCloskey, Woolwich, and Holahan (1995)
48. Bria II (1993); and Eisenberg, J.M. (1991) 'Economics', JAMA 265: pp.3113-3115.
49. Bria II (1993); and Eisenberg, J.M. (1991) 'Economics', JAMA 265: pp.3113-3115.
50. McCloskey, Woolwich and Holahan (1995).
51. Provider surveys (1995).
52. Rhodes (1992)
53. Weiner, J.P., Powe, N.R., Steinwachs, D.M. and Dent, G. (1990) 'Applying insurance claims data to assess quality of care: a compilation of potential indicators'. Quality Review Bulletin: Journal of Quality Assurance 16 (12): pp.424-438.
54. Muller, A. and Baker, J. (1995) Report on Cost-Savings of the Primary Care Case Management Program. Little Rock, AR: Center for Health Services Research.
55. A direct measure of avoidable, adverse health incident or unwanted healthcare outcome (PPRC (1993): Weiner, Powe, Steinwachs and Dent (1990)).
56. A quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities (JCAHO 1989).
57. Physician Payment Review Commission (PPRC) (1993). 'Monitoring access for medicaid beneficiaries'. In Annual Report to Congress, Washington, D.C.
58. Electronic Data Systems (EDS) (1992). AEVCS Vendor Specification. Little Rock, AVECS: Department of Human Services, Division of Medical Services.
59. EDS (1992) AVECS Vendor Specifications: Building a Partnership for a Healthier Arkansas. Appendix B, p. 15.
60. That is, immunizations, diabetes, lead poisoning, sickle cell anaemia and other clinical entities as well as expecting states to look at six HCFA-priorities relative to the delivery of care, in particular access to and coordination of care.
61. Physician Payment Review Commission (1993). 'Monitoring access for medicaid beneficiaries'. In Annual Report to Congress 1993: pp.277-303.
62. Muller, A. and Baker, J. (1995).
63. Loprest, P. and Gates, M. (1993) State-Level Data Book on Health Care Access and Financing. Washington, D.C. The Urban Institute.
64. Kunitz, S.C. (1994) 'Barriers to automation in health care settings'. Topics in Health Information Management 15 (1), pp. 1-9. Milio, N. (1996). 'The US landscape, information superhighway, and electronic hitchhikers: how the wonders of information technology are not all blessings'. Engines of Empowerment: Using Information Technology to Create Healthy Communities and Challenge Public Policy. Chicago, IL: Health Administration Press, pp.21-31.
65. Kunitz, S.C. (1994) 'Barriers to automation in health care settings'. Topics in Health Information Management 15 (1), pp. 1-9. Milio, N. (1996). 'The US landscape, information superhighway, and electronic hitchhikers: how the wonders of information technology are not all blessings'. Engines of Empowerment: Using Information Technology to Create Healthy Communities and Challenge Public Policy. Chicago, IL: Health Administration Press, pp.21-31.
66. The Governor's Task Force Report (1994).