New developments in the digital health field are appearing at a rapid pace. These technologies impact multiple areas of medicine, including diagnosis and treatment, medical records and data, corporate bar, and patient access to care. In recent years, the telehealth industry has developed technologies that aim to increase access to care and improve health outcomes for beneficiaries. The rise of direct-to-consumer telehealth companies offers patients with minor illnesses around-the-clock access to a physician via telephone or videoconferencing and are indicators that consumers and providers want to use technology to increase access. Other modalities include store-and-forward and e-consult. For physicians, the adoption of telehealth technologies in order to increase access, the ability to receive reimbursement for telehealth treatment, corporate bar issues, and concerns around liability have dominated the discussion on how to implement telehealth in one’s practice.
Patients are increasingly using technology to manage and track their own data. Fitness monitors and watches collect an ever-increasing amount of data on individuals, including activity level, heartrate measurements, and sleep patterns. Apple has recently launched Apple Health which partners with health care organizations to let patients use their smartphones to download their own medical records. New prescription apps are being developed to help patients manage their own conditions on a daily basis between their appointments with their physicians. As physicians and patients embrace the use of technology in health, physicians are increasingly using various forms of electronic communication to interact with their patients. In fact, many patients prefer having the option to communicate with their physicians via email, text, or electronic messaging through a patient portal to receive test results, refill prescriptions, and obtain medical advice for nonemergent care. It is important to be mindful of the benefits and risk associated with the use of these new technologies.
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Electronic Health Records (EHR)
Electronic health records (EHR) are now a part of most physician practices and digital health technology, including EHRs, play a key role in the provision of health care. This transition was spurred, in part, by the Health Information Technology for Economic and Clinical Health (HITECH) Act, as enacted by the American Recovery and Reinvestment Act of 2009 (ARRA), which promoted the adoption and implementation of EHR by physician practices. The federal electronic health record (EHR) incentive program is a federally-funded incentive program to encourage health care providers to implement electronic health records in their practices. Eligible physicians may receive these federal incentives if they engage in the “meaningful use” of certified EHR technology to achieve health and efficiency goals. Physicians must meet certain thresholds for a number of objectives and measures in three stages of increasing requirements and attest to demonstrating meaningful use every year to receive the incentive. In October 2015, the Centers for Medicare and Medicaid Services (CMS) streamlined and consolidated Stage 1 and Stage 2 objectives and defined the meaningful use criteria for Stage 3. All participants must meet Stage 3 criteria by 2019. Medi-Cal providers who began the EHR incentive program as late as 2016 can receive the maximum provider incentive.
One of the most daunting tasks facing physicians making the transition to electronic health records (EHR) is selecting the right EHR system for their individual practice. There are hundreds of systems to choose from, and the decision can be influenced by many factors, including a physician’s specialty, practice size, payor mix and comfort with technology. Furthermore, practices pursuing incentive payments through either the Medicare or Medi-Cal EHR Incentive programs must use a system certified by the Office of the National Coordinator for Health IT (ONCHIT). CMA is a founding partner of the California Health Information Partnerships and Services Organization (CalHIPSO), which recently received a $31 million grant to provide education, outreach and technical assistance to help primary care providers select, implement and meaningfully use certified electronic health records. For more information, visit the CalHIPSO website.
Privacy and Security
California physicians must comply with state and federal privacy and security laws to protect patient information.