Historical Hospital Innovations

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Historical Hospital Innovations

Different ways in which hospitals in the U.S. have been innovative in the past include implementing electronic health records, implementing telehealth, introducing bundled payments, transplanting organs. Below is an overview of the findings.

Electronic Health RecordS (EHR)

  • In 1965, the Mayo Clinic in Rochester, Minnesota, implemented the electronic medical records for the first time in the United States. Electronic health records involves maintaining health records in a digital version on computers.
  • The main and immediate goals for implementing electronic health records was to share and track information and medical data on patients as and when required. The long-term goals are to have instant access to patient data, effective procedures, centralized cloud-based computing, and increased patient satisfaction, among others.
  • In 2004, President George W. Bush proposed to implement EHR within a decade. In 2009, President Barack Obama signed the "Health Information Technology for Economic and Clinical Health (HITECH) Act" to implement EHR by 2014.
  • By 2015, 96% of hospitals had implemented electronic health records in the United States and 87% of doctors had done the same. As the payers and government regulators preferred the EHR, all hospital in the U.S. adopted it.

Telehealth

  • In 1959, the hospital of the University of Nebraska first implemented the telehealth system to connect with medical students across its campus. Telehealth is an innovation that enables patients to access and interact with a doctor 24/7 via teleconference and uses technologies such as Facetime and Skype.
  • The immediate goal of telemedicine/telehealth was to provide healthcare access to rural areas where there are a limited number of medical specialists. The long-term goals of telehealth include implementing telehealth services across all rural communities in the U.S., using smart gadgets such as smart glasses and smart watches to transcribe medical records, track patient vital data in real-time, and reduce paperwork.
  • Around 33 states in the U.S. enacted “parity” laws which promote telehealth insurance. So these laws impacted the implementation of telehealth in U.S. hospitals.
  • As of now, 65% of U.S. hospitals have implemented telehealth service. Telehealth parity laws across various states in U.S. mandate hospitals to implement the telehealth system.

Bundled Payments

  • Bundled payments were first initiated in the United States in 1984 by the Texas Heart Institute. Bundled payments is a payment model by means of which the post-acute expenses can be established in advance for an episode of care. It helps in cutting down the cost.
  • The main goals of the bundled payments model are to assume risks and reduce the cost of care. The long-term goals of bundled payments are to stimulate accurate decision-making by physicians on treatment procedures, stimulate early mobility, reduce the burden among rural hospitals, and promote the predicted analysis of patients.
  • The enactment of the "Patient Protection and Affordable Care Act (PPACA)" promoted the implementation of the bundled payments model.
  • As per the JAMA study, the implementation of the bundled payments model saved 20.8% (or $5,577) of the cost for joint replacement care episode per patient in 2017. After launching the CMS mandatory bundled-payment program in 2016, around 400 hospitals implemented this model across the United States.

Organ Transplantation


Research Strategy

We searched for information on different ways in which hospitals in the U.S. have been innovative in the past and were able to locate many articles mentioning multiple innovations in the healthcare system in the past. We filtered the lists of innovations found and chose only hospital-centric innovations, programs that were needed in the healthcare system, and innovations that were implemented on a large scale. Four innovations were chosen: the electronic health records, telehealth, bundled payments, and organ transplantation systems specific to the U.S. For each innovation, we further researched diverse aspects such as the place and year of implementation, the goals, the enactment, and the results of each innovation. For all four innovations, government bills were enacted across the U.S.



Sources
Sources

Quotes
  • " Electronic health records President George W. Bush in his state-of-the-union address in 2004 called for universal, portable electronic health records within a decade. Despite over $30 billion in federal expenditures and tens of billions more by providers, easily transferable EHRs still don't exist in most of the country."
  • "Telemedicine From its beginnings in the NASA space program, telemedicine or telehealth has grown into a booming business with CMS now having over 70 HCPCS/CPT codes to pay for various telehealth services."
  • "United Network for Organ Sharing Congress passed the National Organ Transplant Act to coordinate the allocation of organs in 1984. UNOS was incorporated in March of that year and received its initial contract in 1986."
Quotes
  • "2013: The Center of Medicare & Medicaid Services developed a Bundled Payments for Care Improvement initiative. Acute care hospitals and other providers will enter into payment arrangements that include financial and performance accountability for episodes of care for each patient."
Quotes
  • "The Mayo Clinic in Rochester, Minnesota, was one of the early adopters."
  • " By 1965, electronic medical records were being used in about 73 hospitals."
  • "In 2009, President Barack Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act (ARRA). to adopt electronic health records by 2014 and set several stages of electronic health record adoption — referred to as “meaningful use"
  • "As of 2015, electronic health record adoption had doubled in just seven years. 96 percent of hospitals and 87 percent of physician practices were using electronic health records."
Quotes
  • "The first people to use video communication for medical purposes were clinicians at the University of Nebraska. In 1959, the university established a two-way television setup to transmit information to medical students across campus, and five years later linked with a state hospital to perform video consultations."
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  • "Currently, 65 percent of U.S. hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology. "
  • " Today, 33 states and the District of Columbia have enacted “parity” laws, which generally require health insurers to cover and pay for services provided via telehealth the same way they would pay for services provided in person"
Quotes
  • "First introduced at the Texas Heart Institute in 1984, bundled payments rose to prominence with the passage of the Patient Protection and Affordable Care Act (PPACA). "
  • "One area where bundled payment models are showing great promise is in joint replacement procedures. Several providers demonstrated cost savings, particularly in post-acute care costs, under CMS’s CJR payment bundle."
  • "In fact, according to McKesson and ORC International, payers are forecasting bundled payments to account for 17% of payments by 2021. "
Quotes
  • "The first successful human organ transplant, a kidney transplanted from one identical twin to another, is accomplished. In 1990, Joseph Murray, MD, receives the Nobel Prize for this work and the subsequent development of immunosuppressive drugs (Peter Bent Brigham Hospital)."
Quotes
  • "UNOS developed the online database system, called UNet℠, to collect, store, analyze and publish all OPTN data that pertains to the patient waiting list, organ matching, and number of transplants performed. The OPTN tracks every organ donation and transplant event occurring in the United States since October 1, 1987."
  • "Transplant professionals use UNet℠ to register transplant candidates on the national waiting list, match them with donated organs, and enter vital medical data on candidates, donors and transplant recipients. All 58 OPOs and over 250 transplant hospitals across the country work in the UNOS UNet℠ data portals every day, making it a constant platform for information exchange and collection."
Quotes
  • "As of January 2019, there are more than 113,000 candidates for transplant on the U.S. national waiting list. 2 out of every 3 people on the waiting list are over the age of 50. Almost 2,000 children under 18 are on the waiting list. Almost 70,000 people (59 percent) on the list are ethnic minorities."
  • "36,528 transplants were performed in 2018 – a new record high for the sixth consecutive year."
Quotes
  • " In 2016, CMS launched its first and only mandatory bundled-payment program, Comprehensive Care for Joint Replacement (CJR), in about a quarter of urban markets nationwide. In its first year, nearly 50 percent of the 799 hospitals required to participate kept joint-replacement costs below target while maintaining quality."