As a long time scholar, I would define ESPDT as a Medi-Cal gain for any person below 21 years old. Similarly, title V is a section of Medi-Cal that handles both mothers and children’s problems. According to the Human and Health Services Agency, ESPDT provides services to youths (Health Resources and Services Administration, n.d., para. 1). Note that these youths may be at risk of penetrating into the Juvenile justice system. There are various definitions of the term in question. However, the definition above is sufficient for the scope of my discussion. That said this work provides a detailed overview of ESPDT and title v by providing a clarified discussion on the topics in question. It gives the benefits of ESPDT and discusses how San Diego has implemented the program to tackle health care issues among the youth.
The Early and Periodic Screening, Diagnosis, and Treatment program are structured to meet the regulations of pediatric care by achieving the emotional, developmental, and special physical necessities of low-income children. Developed in 1967, the program has an aim of identifying the handicapped problems for the children of the United States of America. It also provides a constant treatment so that no one overlooks the handicapped children. In fact, the federal law requires that the program covers detailed services and benefits for the children.
There are mainly five steps, which can be retrieved from EPSDT. These initials stand for Early, Periodic, Screening, Diagnosis, and Treatment steps. The first step involves problem identification where the problem has to be identified as early as possible. Secondly, Periodic reveals that it is crucial for the children’s health to be checked regularly. The next step involves performing screening tests in order to identify possible problems for these children. To add onto the list, Diagnosis involves making the necessary follow-ups after a problem is identified. Ultimately, Treatment involves providing remedies to the identified problems (Health Resources and Services Administration, n.d., para. 2).
Title V possesses multiple similarities to the ESPDT program. Just like the ESPDT program, there is a social security act that covers the details of the title V’s section. This act strives at improving the health of all children and all mothers. The health improvement is achieved by coordinating ESPDT and providing treatment to children with individual health care units (Health Resources and Services Administration, n.d., para. 2). It also shares data gathering duties predominantly those connected to infant mortality. Evidently, the main benefits of ESPTD include additional medical services, private duty nursing, mental and nutritional evaluation, and case management (Mollow, 2002, P. 11).
Two systems can be implemented to address the healthcare risk in children. These systems can prove to be very useful for San Diego. To begin with, there is a fee-for-services system. This is whereby physicians receive direct payment from the state. They in turn provide Medicaid services to the American population. In this system, a child is able to get services from a physician devoid of prior permission from the state. It sufficed to note that such a system requires the parent to select a physician for his/her child. The second system available is the managed care system. This is whereby the state reimburses a managed health care plan for providing healthcare solutions. A perfect example of a managed health care plan is the health maintenance organization (Knipper, 2004, P. 7). The county also provides private duty nursing where the nurses their services in the home (Mollow, 2002, P. 11).
There are a number of healthcare services necessary for the at-risk youth. These are some of the services that were omitted by the EPSDT. Nonetheless, these services are a prerequisite for a healthy society. The ESPDT only covers a small section of the possible health risks affecting the youth. It only covers the diseases that were identified previously. This reveals that conditions such as chronic diseases and newly discovered illness must also be included in the program. Moreover, the standards used for EPSDT provide treatment only for the existing illness. These standards should be extended to cover injuries and also prevent development of illness to susceptible individuals (Knipper, 2004, P.12).
In conclusion, the State of San Diego has achieved majestic limits in administering the EPSDT program. This is clarified by Knipper who used data from San Diego to make his arguments. An ESPDT Centre was opened in July 2010 (Knipper, 2004, P.18). It offers a logical screening for all children that enter into foster care. Furthermore, a variety of treatments are available for children with special needs. These treatments include trauma informed treatment, psychotherapy, and cognitive focussed treatment. He further established that 67% of the children exhibited significant improvements in social, emotional, and behavioral problems. The report also reveals that 100% of the children were screened for social and developmental delays. To add insult to injury, 100% of the children received caregiver participation as a remedy to their problems. Evidently, the State of San Diego has done proud to its population.
There exist a profound connection between the way people mentally feel about themselves and physical body health status. Human body reciprocates the manner in which people think. When encountering an abnormal state of emotion, the body makes impeccable attempts to suggest something is terribly wrong.
As a way of example, a mental disorder such as depression can also result to bodily ailments such as stomach ulcers and or hypertension among others, further providing pivotal evidence that there exists direct and subtle connection between the body and the state of the mind in an individual.
Bad emotional health has the capacity to result to diminishing and or impairment of the immune system of an individual, the bottom line being that a direct link between the mind, human behavior and physical body health exist.
Because of the extensive scholastic research that has found substantial evidence of the existence of mind body connection, virtually every leading clinic has a section dealing with mind-body health problems.
However, people can deploy alternative interventions that can result to subtle improvement of personal wellness. Alternative interventions, as opposed to regular treatment approaches do not use medicines, but rather uses body supplements including minerals, vitamins and likes to treat ailments including chronic ones.
They have found this approach incredibly effective particularly where convectional medicines proved ineffective. Eating well, conducting regular exercises and incorporation of vitamin supplements in the diet can improve personal wellness. According to the American Psychological Association, recommendation of such an approach appeared in the journal of American medical association.
Research claims that those who incorporated vitamin supplements in their diets, conducted exercises and ate the right foods posses low probabilities of cancer and cardiovascular infections and as a consequence, their life expectancy raised by 5.8 to 9.5 above the rest of the population (2009, p.21).
More often, a person who employs alternative interventions to foster his or her health wellness has a better and healthier life.
b. Self-assessment Tools
I disagree with the results of the self-awareness test tools, which entangle administration of questionnaires, which permit a person to investigate and come into possession with vital information that can function as a signal of his or her levels of stress.
The entire procedure has five levels, which upon administration; it claims that one comes into cognition of not only his stresses as previously mentioned but also aid in fostering personal wellness. A score of less than zero predicts that one is going through a condition of depleted energy.
Consequently, the afflicted person needs to visit a healthcare center for preventive emotional services. Even though, this may stand out as essential, I raise queries on the precision of the tests to warrant expenditure on emotional health concerns bearing in mind no information on physical, symptoms is required in the assessments process.
Could the tests be administrated through quantitative approaches, the results of the tests would be crucial since they have the capacity to translate to discovery of specific areas in which one may need to put amicable efforts in an attempt to ensure healthy state of emotions management.
This is particularly pertinent since people deserve to explore whether their efforts that render into a healthy state of wellness both emotionally and spiritually bear fruits.
In addition, there is the claim that, the results of the tests also aid in the personalization of strategies that can result in subtle state of emotional balance through gaining accessibility to resources deemed appropriate for ensuring incredible pursuits of wellness goals. The scoring instrument records a score of 70-85 as an indication of a cute life in terms of wellness.
The score shows that there is a proper flow of energy within the system surrounding an individual. For proper management of emotions, it is desirable for an individual to be at a position to conceive and interpret stimuli from the surroundings, flow of energy as indicated by this score, is essential for an overall condition of wellness.
In addition, self-assessment tools claim to enable people to come into cognition with their conceived values: something essential for the inculcation of leadership skills and aid in identification of personal styles of learning.
Even though this is essential since personal wellness starts with information acquisition and possession of the ability to screen out information to control one’s life in the right direction, the prescribed change of behaviors in an attempt to comply with the necessary alignments proposed by self-assessment test results is intriguing.
Behaviors that dictate the reasoning and the capacity of an individual to analyze information are deeply rooted within the societal norm. It is particularly hard to establish a common platform within which to peg the corrective strategies advocated for by the scoring instruments of the self assessment tools in an attempt to inculcate the spirit of ‘self wellness’ in an individual.
DQ2. Treatment of prevalent disorders using alternative interventions in the US
Major depressive disorders constitute one of the prevalent disorders in the US. People can accomplish treatments of the disorder using alternative interventions using techniques of the mind and the body as well as by use of supplements.
However, patients need to take into corporation the anticipated pros and cons before choosing alternative therapies as most clinicians do not advocate for substitution of Medicare with alternative interventions when it comes to complicated depressive disorder. However, they have deployed several mineral and vitamin supplements in the treatment of depressions.
According to Mayo Clinic Staff (2010), Hypericum perforatum has for a long time has been in use for treat prevalent disorders including depression even though it has remained unregistered by the United States’ food and drug administration (Para. 2).
Mayo Clinic Staff further proposes other alternative interventions such as use of SAMe and Omega-3 fatty acids (Para. 3). Body-mind connection intervention techniques such as massage therapy, Yoga or even acupuncture among others may help much to facilitate the regaining of harmony between the mind and the body: something vital for cute personal maintenance of healthy conditions.
Module 2
DQ1. The concept of holism
Written by Lai and Hsieh, the article ‘Alternative Nursing Interventions for Facilitating Holistic Nursing Based on Eastern Philosophy reveals how the concept of holism entangles a belief or a perception that people have that one cannot explore the existing characteristics of systems sufficiently through the exploration of parts characteristics alone (2003, p. 14).
The article defines the concept of holism as all those practices and approaches that contribute to overall healing of a person as a whole.
Since the initial use of the concept by Jan smut, a South African diplomat, people have coined the concept in both conventional medicine and alternative medicine. In the conventional medicine, the concept treats psychological, biological and social factors as equally vital in the sphere of vigorous health and wellness.
The implication is that any disharmony in any of the constituent element of the entire system causes devastating effects on the system in wholesome.
Alternatively, in alternative interventions, people apply the holistic concept to place incredible concern to the significance of an individual’s emotional, spiritual constituents, mental and or physical sub elements contribution to the entire individual’s health and the process of healing.
A comprehensive study of the identified sub elements is vital especially while coupled with the belief that a whole system stands out more crucial than all of the parts of the entire whole added up together (Lai & Hsieh, 2003, p.17).
Eliopoulos, on the other hand, outlines osteopathy, unani medicine, reflexology, homotherapy, chiropractic medicine, nuropathetic medicine (2010, p.56) among others, as some of the examples of holistic alternative interventions to ailment treatments.
DQ2. Martha Rogers’ philosophy on holism, “The Science of Unitary Human Beings”
The Science of Unitary Human Being theory forms the platforms on which therapeutic touch nursing concepts predominantly depend. The theory is a product of Martha Rogers work in 1975: Seeds of Conceptual Frame Work. The theory advocates for a shift from the old medical models to adoption of new nursing models.
The theory in addition, posses challenges to the conventional nursing models which are seen as reductionist and analytic and entangles approaches that entails breakdown of nursing challenges and then subsequently rearranging them logically (Adams, 1993, p.1).
Science of unitary being theory, considers human beings as fields of energy but rather, they do not possess energy by themselves (Adams, 1993, p.1).
The theory also considers the environment, which constitutes the home in which the human live in as being in a continuous state of change. Humans and the environment consequently interchange energy as the changes take place between the two. Lastly, the theory considers the force of universal order as the substantive force, from which all the energy field emanates.
A professional living in an environment, which has the capacity to influence the fruits of the procedure, comes in handy in conducting a therapeutic touch. Since the health professional is part of the environment, consequently the professional in one way or another is a key contributor of the overall TT process success.
The application of the philosophy of Unitary of Human Beings in nursing practices, results to complex interactions with the intervention of therapeutic touch (TT).
People regard therapeutic touch as entailing interactions of varying energy field in which the responsibility accorded to the medical health practitioner entangles promoting pain reduction and bringing about feelings of the relaxations to the patient (Adams, 1993, p.1). Consciousness of the medical practitioner, as repercussion forms an essential component in the entire patient’s mental process of relaxation.
According to many scholastic views, the theory of science of unitary human being lay theoretical basements for transfer of energy deemed vital in TT. To unveil the efficacy of vivid interactions existing between the two clinically, demand a substantial and critical scrutiny of terms such as ‘pattern’, ‘field’ and ‘energy’ which are utilized throughout the Rogers’ theory.
With regard to Rogers’ theory, during the course of the administration of therapeutic touch, the practitioner conducts balancing and replenishment of energy by inculcation of strategies, which are facilitative of regulation of processes of environment and human. However, many scholars, antagonistic to Rogers’s theory considerably criticize the interrelationship between environmental and human energy.
They claim that Rogers deploy abstract terms with the principle intention to cause perception of existence of such a relationship. In addition, definitions and explanations coined from TT interventions do not concur with Rogers’ definitions. Overall, the concepts of the theory of Unitary Human Beings and TT concept turn out neither precisely analogous nor congruent.
Consequently, anti-Rogers claim that the advocates of Rogers’s theory should not place a claim that Rogers’s theory provides subtle ground on which to peg the therapeutic interventions theoretical perspectives. The opinion of TT interventions as not employing direct touch or use of chemicals, hikes interrogatives on its exact mechanisms of operation.
Perhaps, this may explain why the modern interventions have resulted to the deployment of modern physics concepts in an attempt to provide amicable explanations of the exact criteria of action towards therapeutic touch.
References
Adams, J. (1993). Therapeutic Touch-Principles and Practice. Complementary Therapies in Medicine, 1(1), 1-3.
American Psychological Association. (2009). Publication manual of the American Psychological Association, (6th ed.). Washington, D.C.: American Psychological Association.
Eliopoulos, C. (2010). Invitation to holistic health: A guide to living a balanced life, (2nd ed.).Burlington, MA: Jones and Bartlett.
Lai, H., Hsieh, M. 2003. Alternative Nursing Interventions for Facilitating Holistic Nursing Based on Eastern Philosophy. Alternative Nursing Interventions, 2(1), pp 13-19.
National standard of care from a legal perspective definition is a parameter utilized as a benchmark for evaluating a doctor’s real work. This illustration is considered in a case concerning a medical malpractice. The doctor’s lawyer would insist on proof that activities by the doctor conformed to the expected standard of care. On the other end, it is expected that the complainant’s lawyers reveal what violation of the standard of care or the extent of negligence was committed by a doctor. From a legal perspective, the standard of care definition is based on the concept of “custom” in legal terms. National standards on a clinical perspective mean a formal process of diagnosing and treatment by a doctor, which usually follows. This particularly applies for a sick individual with a specified disease or exhibiting certain patterns of symptoms. The standards of care thus have to be in line with the guidelines that are considered by experts as most appropriate (Grol, 1990).
Licensing of institutions, providers, and accreditation play an important role in quality control of healthcare. Licensing is regarded as a non-voluntary process whereby an agency or department in the government regulates the practices in a certain profession. Giving licenses to individuals in healthcare practice provides them with permission to participate in activities associated with healthcare. Licensing of nurses means that practicing nurses qualify with a given degree of competency that is expected of the nurses in their duty of ensuring that welfare, health status and safety of the patients are appropriately protected. Licensing is usually based on actions by legislative bodies that qualify individuals to practice nursing within a given local state or federal level. A licensing law legitimizes healthcare actions performed by individuals in engaging in the occupation depending on possession of a license in the healthcare profession. Nurses are usually licensed within the state so that they may work as registered nurses (RN) or Licensed Practical Nurse (LPN). Licensing usually aims at eliminating unqualified people to reduce unsafe performance. In licensing, tests are undertaken to gauge performance (Varkey et al., 2007).
Accreditation, on the other hand, is different from the licensed RN/LPN testing in certification. This process usually judges and evaluates institutions, which offer healthcare instead of individuals. Many accreditation programs reveal a merit of institutions as opposed to only providing a guarantee regarding an individual’s safety. The process of nurses’ accreditation can be performed voluntary just like certification but in some cases it is not. Hence, accreditation is needed for such a healthcare institution that presupposes collecting Medicaid bills. Thus, as a process, accreditation evaluates the merits of agencies and institutions, as well as programs meant for educating people on health. In this case, accreditation of healthcare institutions ensures that they are granted with certificates. The licensing and certification engages individual practitioners (Varkey et al., 2007).
The tort law will assist in avoiding errors and, at the same time, promote the quality of higher healthcare. The legal system tries to offer health in a safe manner, with the highest quality and incentives on delivery of healthcare through the tort law. The law moderates specific medical malpractices by the negligence rule (Kessler & McClellan, 2002). Individuals are held liable by the rule, which ensures that ethics of personal acts are adopted to minimize any impending harm and thus foster responsibility of individuals. Such an ethic is appropriate especially when healthcare professionals gain access to treatments and examinations. The tort law ensures accountability of healthcare providers to patients with the public exerting concerns in the jurisdiction of the law that uses different means in addressing healthcare issues.
References
Grol, R. (1990). National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards. The British Journal of General Practice, 40(338), 361.
Kessler, D., & McClellan, M. (2002). Malpractice law and health care reform: optimal liability policy in an era of managed care. Journal of Public Economics, 84(2), 175-197.
Varkey, P., Reller, M.K., & Resar, R.K. (2007). Basics of quality improvement in health care. In Mayo Clinic Proceedings. 82(6), 735-739.
This paper will focus on Heritage Healthcare Agency, which is located in New Mexico. The core business activity of this organization is to provide medical services to patients in their homes. The organization’s target market is the adult and geriatric populations that live in New Mexico and Arizona (Heritage Home Healthcare and Hospice, 2013).
The programs and services provided by the organization include Tele-health, go steady, speech therapy, medical social work, physical therapy, and occupational therapy. Tele-health is a service that enables doctors to monitor patients with chronic diseases such as congestive heart failure and hypertension.
The patients’ health conditions such as blood pressure, pulse rate, and oxygen saturation are monitored from their homes. The go steady program targets patients who are suffering from prolonged dizziness, vertigo, and frequent falls. The clinical operations of the organization involve providing comprehensive health care services at the patients’ home.
The objective of these services is to restore health and to reduce the adverse effects of diseases and disability (Heritage Home Healthcare and Hospice, 2013). The organization has a team of highly skilled registered nurses who provide medical and therapeutic services to patients. The services are provided on occasional visits and on a continuous basis.
The nurses also provide follow-up services by monitoring the progress of the patients after treatment. The services of the organization are marketed through promotional activities such as advertising. The adverts are placed in print and electronic media, as well as, the organization’s website.
Additionally, the organization engages the public in regular conversations about its products in order to obtain the feedback that enables it to improve the quality of its services (Heritage Home Healthcare and Hospice, 2013). The billing for the services is done per visit. Patients pay for every visitation and services provided by the organization. The payments are done through private health insurance and programs such as Medicare.
Vision, Mission, and Values
The vision of Heritage Home Healthcare Agency is “to be the leading regional provider of quality home health services, recognized for uncompromising dedication to the provision of comprehensive, professional, and compassionate care” (Heritage Home Healthcare and Hospice, 2013).
The mission of the organization is “to be creative, innovative, and a trendsetter in healthcare delivery, offering challenging and dynamic employment opportunities, encouraging and supporting the talents and energies of our staff and managing the company in a profitable manner” (Heritage Home Healthcare and Hospice, 2013). Heritage Healthcare Agency’s vision and mission statements are based on its core values, which include creativity, excellence, integrity, and respect.
Strategic Planning Model
Heritage Home Healthcare Agency uses the alignment model to develop its strategic plan. The main objective of this model is to align the organization’s mission to its resources in order to facilitate effective operations. The rationale of choosing this model is that Heritage Home Healthcare intends to fine-tune its strategies and to identify the obstacles that might prevent it from achieving its vision and mission.
The strategic plan of the organization is to improve the quality of its services and to expand its market share. In this regard, the organization intends to improve the productivity of its employees and to reduce the cost of its services in order to make them affordable to the majority of the citizens. The organization’s vision, mission, and values are fundamental in the process of implementing its strategic plan.
The vision statement describes the organization’s desired future, as well as, that of the community in which it operates. It specifies the long-term objectives of the organization. In this regard, it helps the organization to identify the goals to include in its strategic plan. Additionally, the vision inspires the staff and the community to support the organization in its quest to implement its strategic plan.
The role of a mission statement is to describe the purpose of an organization. Thus, Heritage Home Healthcare Agency’s mission statement indicates what the organization stands for and what it is currently doing in order to achieve its mandate. Concisely, it specifies the activities that the organization must include in its strategic plan in order to achieve its vision.
For example, the organization intends to promote creativity and innovation in order to provide excellent services. Value statements describe the core ideology that underlies the operations of an organization. The core values guide the process of executing the organization’s mission. The core values define the limits within which the organization carries out the activities outlined in its strategic plan.
For example, the organization intends to promote excellence and creativity in every activity in order to achieve its mission. The core values also guide the organization’s operational culture, which focuses on staff development, use of advanced technologies, and improving service quality standards.
Organizational Structure and Key Leaders
Heritage Home Healthcare Agency’s organizational structure consists of two levels of management namely, the executive board of directors and line managers. The executive board consists of the Chief Executive Officer (CEO), the Vice President, the Chief Operating Officer (COO), the Director of Quality Improvement and Compliance, and the Chief Financial Officer (CFO).
The executive board is highly involved in the implementation of the organization’s strategic goals. Concisely, they are responsible for setting the goals and identifying the activities that must be done in order to achieve them. They are also responsible for the provision of the resources that are needed to implement the strategic goals. Implementing the goals is essentially a change process that requires effective leadership.
Consequently, the organization uses Kotter’s 8-step change model to pursue its strategic goals. This model involves implementing change in eight steps, which include creating agency for change, forming a powerful change coalition, developing a vision for change, communicating the vision to members of the organization, eliminating obstacles, creating short-term wins, building on the change, and incorporating the change in the organizational culture.
Service Delivery Support Activities and Strategic Resources
The main activities in the organization’s value chain include providing both medical and non-medical services to patients in their homes. The supporting activities in its value chain include technology development and effective management of human resources. The organization is focusing on developing information and communication technology (ICT) in order to monitor its patients effectively.
It is also focusing on effective human resource management in order to provide the best health care services to its customers. The organization’s strategic resources include a highly skilled and professional team of medical personnel and an effective ICT system. These resources enable the organization to deliver health care at the patients’ home in a professional and cost-effective manner.
References
Heritage Home Healthcare and Hospice. (2013). About Us. Web.
Jeffs, C. (2008). Strategic Management. New York: John Wiley and Sons.
Sadler, P. (2003). Strategic Management. New York: McGraw-Hill.
Business environment and the way business is carried out in the modern world are changing at faster rate. Globalization and other factors have been identified to be the key agents to these changes. These changes have not isolated the health care industry, where today, for efficiency and productive health care delivery, there is need of adopting the most efficient information systems.
Medical record processes in most health care organizations are still boggled by traditional manual systems, which remain inefficient and defective in many ways. Many medical errors have originated from old manual system, which has prevented appropriate health care administration procedure and process. As a result, it is established that adoption of electronic medical record (EMR) system is necessary in the modern world.
Organizations with ability to adopt the proposed collaborative EMR system possess the power to improve their overall health care delivery processes. Other related medical benefits are likely to be realized, and all these will improve the overall nature of health care in the country. However, for this to be achieved, there is need for top management to be involved, together with other key stakeholders.
In this manner, it is believed that collaborative effort and input of key stakeholders is necessary. Lastly, achieving objectives of collaborative EMR system requires a clear implementation plan, which gives overall strategies to be used to ensure goals and objectives of the new system are realized effectively.
Therefore, it is suggested that organizations, despite their size and nature, need to start thinking on the best way to initiate and develop appropriate EMR systems.
Health care Systems Analysis and Design
Information systems have become the artery in which modern organizations have the capability and power to navigate through dynamic business environments (Jeffrey and Lonnie, 2005).
In this sense, it has become clear that to be able to delivery appropriately to the designated clients and related stakeholders; many organizations are today involved in activities that aim to position the organization at a superior position using sophisticated information system tools.
This has seen the emergence and dominance of computers and related information system products in aiding an organization to improve and enhance its market performance and delivery strategies (Jeffrey and Lonnie, 2005). Health care sector constitutes one area where information systems have become an issue that can no longer be ignored or underrated.
The health care sector is regarded as one of the most information-intensive, and the need for technology in this sector has increased (Wager, Lee and Glaser, 2009). In carrying out an evaluation of health care providers in the country, one realizes that service delivered has been boggled by absence or inadequate information technology tools.
For instance, access and utilization of information in the hospital has been a big problem, whereby un-timely, incomplete, inaccurate, unreliable, and sometimes irrelevant information has been utilized to make health care decisions resulting into adverse effects for organization, client, society, and other stakeholders (Wager, Lee and Glaser, 2009).
It is with this understanding that modern-day health care providers are not leaving anything to chance; instead, they have become major and important participants in search for high quality and cost-effective service delivery systems in the form of appropriate, effective, and functional health care information systems.
Statement of Business Operation
The health care sector is perceived to be complex in many of its functions, a situation that has led to inappropriate adoption of health care information systems and related IT products and services. Smith (2007) observes that health care industry in the USA faces many challenges, and the situation affects the entire process of health care delivery.
At the same time, health care providers can no longer stick and depend on traditional methods and techniques of health care provision and delivery, but they need to embrace modern opportunities necessitated by growing urge for information technology and related processes. Information remains one of the fundamental tenets in proper health care delivery process, and there is need for various stakeholders to understand this.
The current situation in most hospitals is characterized by old approaches to information collection, integration, analysis, and then decision-making, which when evaluated and analyzed, has been overrun by modern-day events and more significant business environment dynamics. Therefore, what is needed is adoption of new approaches to health care system design, delivery, and operation in the new century (Smith, 2007).
At the same time, the new information system needs to be a product of numerous and multiple stakeholders’ effort, whose interest, concerns, and needs should be addressed through the process of designing, implementing, monitoring and evaluating the information system proposed.
In this way, the new information system approach should have ability to coordinate between and among different health care entities and those providing health care. Furthermore, the information system should be able to focus on delivery of care to the patient, while being efficient, cost-effective, and available to all that need care.
Analysis of the Organizations and Business Processes
Since the introduction of information technology some decades ago, profound changes have occurred that in one way or the other have transformed the way organizations conduct businesses, and deliver service to their clients. The health care industry, just like other organizations, has been a consumer of information technology products.
However, when comparison is made between information technology adoption and utilization in health care industry and other industries, it becomes clear that the rate and level of IT adoption in health care still lags behind other industries (Wager, Lee and Glaser, 2009). The health care industry is perceived to be complex, and numerous factors have been associated or linked to this nature of complexity.
The health care consumers are increasing, and this situation exerts pressure on the existing infrastructures, a situation that encourages inadequacy and inappropriateness. In addition, there are changes taking place in the health care industry contributed largely by forces of globalization affecting all types and forms of businesses.
As a result, there is increasing interdependence among organizations, while information sharing and dissemination are rampant, organization restructuring is taking place at all levels, and there is emphasis on cost-reduction of services with maintenance of high quality.
All these, together with others, combine to exert forceful pressure on health care industry to remain abreast with new developments in form of IT that will see designing, implementation, and delivery of health care more appropriate.
Smith (2007) observes that use of computers and information systems in health care sector is inevitable, and health care organization have a responsibility to play. The need for information systems in health care is partly contributed by the increasing health care needs and clients demand for better health care services, at faster rate and at reduced cost.
As a result, the current information systems in the sector are overburdened, pressured, or just ineffective to match new developments in the sector. As a result, there is need for almost total overhaul of critical elements that constitute current information systems (Smith, 2007).
In this way, the system’s specialists and analysts in the health care industry will have to design and propose more efficient and effective, coordinated information systems that make use of more sophisticated tools in delivering appropriate health care.
When analyzed and evaluated, effective and more efficient information systems possess the capacity to store extensive data of information that can be used in the health care provision process. Furthermore, data stored is likely to move rapidly from where it is stored to where it is needed.
Coordination is likely to be achieved in provision of health care services, and health care information systems are likely to deliver health care services in the most appropriate way, at reduced cost, and to the satisfaction of the client/patient (Smith, 2007).
Niles (2010) notes that modern-day management teams find it almost impossible to manage without improved and sophisticated computer systems. According to the author, the process of integrating information systems in the organization activities is leading to realization of many goals.
For instance, it has been established that computerization of departments and integration of various activities across departments has led to increase in efficiency and information sharing. Decision making has become possible and faster, redundancy has been eliminated, operation costs reduced, and quality of service delivery improved (Niles, 2010).
Therefore, adopting the most sophisticated information systems in health care sector is seen to be essential and necessary, especially in defining how data is collected and disseminated, how diagnostic procedures are performed, how medicine is delivered, how patients are treated, and primarily, how the health care system operates efficiently and effectively (Niles, 2010).
Given the complex nature of health care sector, coupled with business and operation dynamics present in the world today, it is prudent to suggest that development and utilization of any information systems that possess ability to meet strategic goals and objectives of the organization should be the priority of management teams in health care organizations.
New strategies have to be formulated within the perspectives of information technology, and this requires critical stakeholders in the sector to recognize and comprehend the more significant role of improved, efficient, and sophisticated information systems.
This assumption tends to challenge the existing order where there is excellent deficiency of information systems that perform, which has translated to poor service management and delivery in health care.
As an essential sector in the society that touches people’s lives, the health care industry needs to take a leading role in initiating proper and appropriate information systems. In other words, the significant health care structure in any organization should reflect the input of multiple stakeholders, which subsequently should result in the development and adoption of efficient information systems.
Despite this excellent concern for improved and efficient health care information systems, it has been established through numerous studies that there are certain barriers that exist and limit the appropriateness of organizations’ ability and capacity to develop and adopt sophisticated information systems-IS (Niles, 2010).
For instance, majority of information systems users (physicians, managers, administrators’, and government) find the cost of acquiring IS to be way above affordability power (Niles, 2010).
The cost is further accelerated when the IS has to be developed, tested, implemented, managed, monitored and evaluated. Nevertheless, the problem may be even more discouraging to smaller health care organizations with inadequate capital to install sophisticated IS.
Another barrier originates specifically when the process of developing and implementing IS is not inclusive, does not operate with clear strategy, and the overall implementation plan lacks consensus, education, and training (Niles, 2010). Accordingly, the act of inclusion in developing IS becomes the major tenet upon which success of the process is anchored.
Multiple stakeholders need to be consulted, interviewed, involved, and also motivated to give their best in terms of input for the IS development process. When it reaches a point where the organization acts in isolation, disregard critical opinions, and does not carry out effective organization and market research, then it becomes difficult for such an organization to have a concrete base and foundation for its IS development.
The issue of stakeholder inclusion should be evident from the moment the project is initiated and developed, which again should be accompanied with more education and training, information sharing, and popularizing IS awareness.
The last contributing barrier to adoption of health care information systems has to do with reluctance culture, uncertainty and fear, and absence of strategic planning and organization. The process of developing and integrating IS in an organization is enormous, tedious, and sometimes full of uncertainty.
For instance, Niles (2010) observes that moving from a hard copy system to an electronic system requires several components that may include physician order communication results retrieval, electronic control management, electronic physical order entry and prescribing, and clinical decision support system.
Also, related activities may include providing patients’ portals and automating personal health records and population health (Niles, 2010). All these aspects are likely to bring about changes in workforce and workflow, an aspect that is likely to lead to uncertainty, fear, and stress.
Therefore, organizations need to have pre-and post-training sessions for workforce to reduce the likelihood of resistance and reluctance instances.
Analysis of the Requirements for a Solution to the Business Operation
Health care provision today relies on accurate and effective data and information, which can only be generated through effective medical records procedures and processes. As a result, the quality of health care in modern world relies a lot on the type, nature, reliability, and accuracy of data and information collected by nurses and other medical professionals concerning the patient and related care management (Green and Bowie, 2010).
But even with this in mind, many health care provision processes have continuously relied and utilized traditional medical record data processes, which are inherently ingrained in paper record systems (Lighter, 2011). This conventional method has been found to be tiresome, long, and sometimes complicated, without forgetting that numerous errors have been identified on this traditional system (Lighter, 2011).
Therefore, as the modern-day business and health care environment continues to experience many changes in terms of operations, there is great need to develop new information and data collection systems. This process will enable accurate, faster, and reliable collection, dissemination, and utilization of health information and data more appropriately.
To this end, it has been observed that the best way to achieve or approach this issue is to develop information and data collection systems that possess capability to automatically record patients’ information from the time they enter a health care unit to the moment they leave.
Despite the great need for effective medical record systems in majority of USA health care centers, it has been established that the rate of developing and utilizing EMR still rated low in most of these health units (Lighter, 2011). In a survey carried out in 2008 involving 2,758 physicians, it was established that only 4% of health care hospitals and centers have integrated use of effective EMR in their operation (Lighter, 2011).
Moreover, it was found out that only 13% possess the basic EMR system, while 16% were found to have acquired EMR but due to various boggling factors, such systems were still inactive (Lighter, 2011).
On a lighter note, 26% of respondents expressed optimism that in the near future, the issue of EMR would be part of their organizational strategic planning and acquiring an effective EMR would be key priority in their organizations (Lighter, 2011).
Therefore, on overall, the EMR adoption in the health care industry in the country still faces challenges that need re-dress and practical actions. This is so, given the inevitability of operating in new world in absence of effective information systems such as EMR.
Decision-making process in the field of medicine, especially with regard to patient diagnosis, treatment, and recommendation, has been boggled with errors in the past. In attempt to minimize these errors, there have been growth of health care decision support systems in form of electronic medical record (EMR) information systems (Wager, Lee and Glaser, 2009).
EMR generally constitutes computer systems developed with the aim of improving health care decision-making about individual patients at the point in time that these decisions are generated (Berner, 2007).
When EMR functions together with computer-based physician order entry (CPOE), it has been evaluated and found to possess the ability of improving patient safety, reduce overall operating cost and at the same time, impact positively on the medical care process (Berner, 2007). EMR has become useful in the provision of recommendations for managing health care needs, specifically patients’ health needs.
In most cases, EMR is described as the computer system that enables clinical decision process by delivering guideline-based patient-specific recommendations about health status of individual patients (Wager, Lee and Glaser, 2009).
In order to operate or function to the desirability of the needs of critical stakeholders, EMR should possess essential characteristics that make it suitable. As a result, the symptoms manifested by EMR should be reflected in the overall functioning of the system.
Some notable critical functions of EMR that an effective EMR should have include ability to integrate health information and data into a sophisticated but productive system (Green and Bowie, 2010). Some of the data and health information to be integrated include medical and nursing diagnoses, medication list, allergies, demographics, clinical narratives, and laboratory test results (Wager, Lee and Glaser, 2009).
At the same time, EMR should reflect ability to support and function based on electronic communication and connectivity. In this way, the appropriate EMR should enable those directly and indirectly involved in patient care to communicate effectively with each other and the patient. This should also involve communication connectivity among key stakeholders via means such as e-mail, Web messaging, and more so, the telemedicine.
It is further observed that effective EMR should support results management process and this should involve all the health care results. Such results may include laboratory test results, radiology procedure results, pharmacological results and requirements, clinical documentation, and administrative modules, and all these should be integrated and made to function efficiently electronically.
The desire for effective EMR should further involve developing and enhancing order entry and support, which should incorporate use of computerized provider order entry, specifically in ordering medications.
Other critical notable features of EMR should include enhanced decision support system, whereby, the whole process is computerized in terms of clinical decision-support capabilities, which may consist of having reminders, alerts, and computer-assisted diagnosing (Wager, Lee and Glaser, 2009).
Related to this aspect should be an attempt to develop an EMR that supports holistic patient care and management in terms of everything from patient education materials to home monitoring to telehealth. Another key feature to put into consideration is the development of EMR, which supports administrative processes.
In this manner, an effective EMR should facilitate and simplify key health care processes such as scheduling, prior authorizations, and insurance verification. Also included in the sub-system of administrative EMR system are the decision-support tools that identify eligible patients for clinical trials or chronic disease management programs (Wager, Lee and Glaser, 2009).
More importantly, EMR system should have and effective clinical vocabularies system, interoperability capacity, and capability, EMR ontologies about the structure of the system, and EMR should be conducive to fitting with varying aspects of the system (Lighter, 2011).
Lastly, an effective EMR should possess the ability and capacity to enhance reporting and health management process. This should be so specifically in establishing standardized terminology and data formats for public and private sector reporting requirements (Wager, Lee and Glaser, 2009).
Discussion of Health Care Application Systems Solutions
In order to solve the issue of manual medical record process in health care institutions, there has been suggestion and recommendations to adopt different types of EMR. What needs to be known is that an EMR to be adopted by any organization depends on various factors and issues ranging from cost, sustainability, time, knowledge, and capacity of the organization.
Therefore, the process of developing and implementing an EMR should be holistic, inclusive, and strategic, incorporating organization’s goals, objectives, and financial power. In most cases, it has been noted that smaller organizations have mostly expressed reservations and rarely adopt sophisticated information systems.
The barriers associated with finances, expertise, capacity, and overall perception of EMR are outlined as some reasons that act to discourage organizations from adopting effective and efficient EMR (Murray and American Society of Critical Care Anesthesiologists, 2002).
On the other hand, large organizations adopt EMR in varying capacity, but research shows that even in large organizations, presence of sophisticated and effective EMR is still a problem and ineffectively carried out. Therefore, what is needed is that, despite their size and nature, organizations have to conduct an effective needs assessment study that identifies the most appropriate way to adopt or initiate an EMR system.
Two prominent EMR systems have been proposed in the past that some organizations have taken forward steps of implementing. The Clinicomp International Clinical Information System (CIS) constitutes one of the critical EMR systems that majority of health care organizations have adopted (Murray and American Society of Critical Care Anesthesiologists, 2002).
The EMR information system is designed ambulatory, outpatient, and inpatient use. The system has been designed and possesses capability to integrate current patient information and subsequently displays it at the point-of-care, at central stations, and from remote locations (Murray and American Society of Critical Care Anesthesiologists, 2002).
The system further supports patient care functions that include charting, managing order entry, and analyzing data as part of improved clinical decision support system. CIS exchanges information through the HL-7 language hence, it can effectively be integrated into an existing hospital information system.
The second information system is the Picis CareSuite, which has become prevalent in health care as an EMR system (Murray and American Society of Critical Care Anesthesiologists, 2002). Some key features of this EMR system are that it has an order entry system, decision support tool, and a reporting system.
Picis CareSuite is further enhanced by Chart+ program, which enables the system to collect automatically, manage, integrate, and store critical and essential patient information. The information integrated becomes necessary in evaluating patient’s condition, providing care, and further generating the medical-legal record of the patient.
In addition, the system has the capability to connect to a variety of medical devices, laboratory systems, and hospital information systems. The two systems have been unified by advantages of being faster, effective, time managing, and cost-effective.
Moreover, the systems have revolutionalized the way health care is administered and executed and the overall medical record management in hospitals has improved. On the negative side, most of these systems are expensive, sophisticated, and when not well managed, can destabilize patient’s medical administration process.
Recommended Solution and Implementation Issues
Designing an effective IS should follow particular steps and in each case, there should be successful integration of sub-system to the larger system.
As the health care continues to change as more dynamism take place in the industry, there is need to design and develop an effective EMR that addresses multiple health care needs in harmony with other systems of the organization. In other words, the proposed EMR system should be collaborative. Therefore, collaborative EMR system is what this study proposes.
Proposed Collaborative EMR System
The proposed collaborative EMR system can be seen to integrate different departments of the organization. Key departments include Finance, Engineering, administration, IT, Human resource, and many more. Designing the IS requires collaborative efforts of human resource in these departments. Cost, time, applicability, organization capacity, and clients’ needs should inform the development of the new EMR system.
The clinician puts the relevant data in the system, which, through the execution engine, is able to process, integrate, and disseminate information and data according to communication pattern installed in the system. Input information that the system absorbs includes radiology information, laboratory information, picture archiving information, pharmacology documentation, and clinical documentation.
Computerized system after that is able to carry out order entry that is built on system reminders, alerts, and computer-assisted technologies. The output data reflects products of enhanced EMR system in form of medical and nursing diagnosis, medical listing, allergies, demographics, clinical narratives, and laboratory test results.
Adoption and implementation of this collaborative EMR system are likely to results in some benefits, and health care, specifically patient care is going to improve.
These improvements will be evident in easy access to relevant patient data, shifting and stimulation of management change, and improvement in patient screening and diagnosis process. When well managed, collaborative EMR is likely to be cost-effective and at the same time, enhance efficiency in health care delivery process.
Collaborative EMR system
Source: Sources: Shankar, et al., n.d; Goldstein, 2008; Varshney, 2009; Jeffrey and Lonnie, 2005.
Implementation, Support and Maintenance
Successful establishment of an EMR requires a clear plan of the purposes of the EMR before it is developed and implemented. The plan should address and outline strategies to overcome issues such as education and training, engineering, installation, culture change, support, and maintenance.
The entire process of EMR should start with a vision, whereby, an outline that is clear and succinct on why the EMR is necessary is developed. After that, the vision is translated into concrete plan addressing the identified and specified needs and goals. Therefore, the organization management team should embark on process of identifying and forming the right project team to oversee the development of the new collaborative EMR.
The project team should have the right leadership structure, roles, and responsibilities of members identified. The project team should be at the center stage to carry out research assessment, and evaluation of the existing EMR systems, and subsequently, create recommendations and procedure for adopting the new system.
After all processes of identifying their various roles, the project team should now embark on process of gathering necessary and relevant information about the organization staff, patients, and practice habits which will be necessary and important in informing the type of EMR system to develop and implement (Scott, Rundall, Vogt and Hsu, 2007).
Cost-benefit analysis should be the core business of the team at this stage on various EMR systems and their suitability and applicability to the organization.
Therefore, the design process should start that puts into consideration multiple aspects of organization’s coding uncertainties, defensive down-coding, inefficiencies of manual processes, overcrowding in the waiting room, and how chronic disease follow-up visits should be, together with slowness in patient flow in the organization.
As a result, attempt should be made to design a system that supports preventive care reminders, patient follow-up activities, labor cost reduction, and ease documentation of data and information.
The plan should further elaborate on how well the team should conduct an examination of workflow. This is where the workflow discrepancies that lead to waste are identified. After that, selection of the right vendor should be the priority. This should be done with consideration of critical functional requirements that collaborative EMR should have.
This process should culminate in training and education of key stakeholders to be affected by the new system (Scott, Rundall, Vogt and Hsu, 2007).
The training and education needs should address the basics of knowledge about the system, how it works, what skills are required, how operation can be carried, how feedback can be realized, and role of system in the organization needs. The training and education period should not be rushed, but progressively carried out to ensure all stakeholders are accustomed to the new system.
In addition, the system’s maintenance and support process should be defined and communicated to stakeholders (Scott, Rundall, Vogt and Hsu, 2007). This involves identifying the back-up systems for the proposed new system, the knowledge of operating, what to do when the system fails, carrying out of continuous maintenance of the system, and the IT expert to ensure the functionality of the system.
This should again be in form of training, education, and awareness activities largely ingrained in the engineering and installation needs of the new system. The next stage to precede this should be outlining clearly, how monitoring, evaluation, and feedback of the whole system will be realized.
This should include outlining, formulating and communicating M& E strategies, together with the feedback system to ensure the system achieve the organization goals.
Conclusion
As it has been established through this study, computerization in the health care industry is necessary and urgent to ensure activities in the industry are successfully executed. EMR remains a challenge in most organization; a majority of them still operate on the old manual system of medical records.
Therefore, it is envisioned that with adoption of new enhanced collaborative EMR system, health care delivery in most hospitals will be faster, accurate, and with fewer errors. Also, the entire process of patient care will be improved and enhanced greatly.
However, realization of success can only be achieved when there is a clear formulated implementation plan that adequately addresses the issues of education and training, system support and maintenance, and M& E and feedback processes of the new system. On overall analysis and evaluation, the new EMR system has the capability to enhance health care delivery in the country if adopted by health care organizations.
References
Berner, E. T. (2007). Clinical decision support systems: theory and practice. NY: Springer.
Goldstein, M. K. (2008). Evaluating Clinical Decision Support Systems. VA HSR&D Cyber Seminar. VA Palo Alto Health Care System and Stanford University. Web.
Green, M. A., & Bowie, M. J. (2010). Essentials of health information management: principles and practices. OH: Cengage Learning.
Jeffrey, W. & Lonnie, B. (2005). Systems analysis and design method. NY: McGraw-Hill.
Lighter, D. E. (2011). Advanced performance improvement in health care: principles and methods. MA: Jones & Bartlett Publishers.
Murray and American Society of Critical Care Anesthesiologists. (2002). Critical care medicine: perioperative management. PA: Lippincott Williams & Wilkins.
Niles, N. J. (2010). Basics of the U.S. health care system. MA: Jones & Bartlett Learning.
Scott, T., Rundall, T. G., Vogt, T. M & Hsu, J. (2007). Implementing an electronic medical record system: successes, failures, lessons. London: Radcliffe Publishing.
Shankar, R.D., Martins, S. B., Tu, S. W., Goldstein, M. K., & Musen, M. A. (N.d). Building an explanation function for a Hypertension Decision-Support System. Stanford Medical Informatics. Web.
Smith, A. L. (2007). Integrated healthcare information systems: Physician based information systems. NY: Lulu.com.
Varshney, U. (2009). Pervasive healthcare computing: EMR/EHR, wireless and health monitoring. NY: Springer.
Wager, K. A., Lee, F. W., & Glaser, J. P. (2009). Health care information systems: A practical approach for health care management. MA: John Wiley and Sons.
In the face of limited financial and manpower resources, nursing practitioners are expected to prioritize health needs in the planning and implementation of healthcare initiatives (Hodges & Videto, 2010). Nurses have a key role in planning and implementing healthcare programs by identifying the most immediate needs and increasingly assuming responsibility to plan, manage, control, and assess specific health concerns affecting diverse groups of the population within the community and/or workplace settings (Maurer & Smith, 2009).
This essay evaluates specific dimensions related to the prioritization of healthcare needs in the workplace context. Among the health needs provided in the case scenario, it would be plausible to start planning and implementing healthcare programs dealing with more severe needs such as hypertension, cancer and respiratory problems.
This prioritization is informed by factors such as the previous knowledge on the nature and scope of existing health needs, input from workers through active participation, and resources availed by management to implement healthcare programs (Maurer & Smith, 2009).
Given the scarcity of financial resources and manpower, it would be plausible to start targeting the primary level of prevention before proceeding to other levels. The primary level of prevention deals with educating the client population about safety and health practices that could be used to prevent the mentioned health challenges.
An effective and efficient healthcare program, according to extant literature, should start by informing community members about the dangers of ineffective protection against the health conditions that the program aims to curtail (Maurer & Smith, 2009). The primary level of prevention has several positive implications and some negative implications as well.
Among the positive implications, it can be argued that this strategy is not only easily applicable to the client population through the use of pamphlets and slide shows, but is also cost effective as it does not require sustained funding or additional human resources. Additionally, it empowers people to take control of their own health needs through the provision of relevant information (Hodges & Videto, 2010).
A major negative implication of this level of prevention, however, arises from its incapacity to provide early detection and prompt treatment of various health conditions affecting the client population (Maurer & Smith, 2009). This implies that the level may not be of much assistance to employees who are already dealing with the condition because treatment interventions are initiated in the secondary level of prevention. It is important to note that the tertiary level is a higher-level prevention strategy employed after specific health needs or conditions have already resulted in damage to individuals within the population (Maurer & Smith, 2009).
This level may not fit into the financial and human resource parameters of the textile factory as it involves limiting disability and restoring the affected members to their maximum possible capacities through clinical and rehabilitation means, implying that it is capital and labor intensive (Hodges & Videto, 2010). Nursing professionals need to gather a lot of relevant information and data if they expect to be effective and efficient in prioritizing the needs of their client populations (Hodges & Videto, 2010).
To effectively prioritize the health needs of the client population in the case scenario, information about the severity of specific health needs, number and age categories of the affected, benefits and drawbacks of specific interventions, material and non-material resources available and the likelihood of the client population to actively participate in the healthcare programs and take charge over their health needs (Hodges & Videto, 2010; Maurer & Smith, 2009), must be availed to the team involved in the planning and implementation of healthcare programs in the textile factory.
References
Hodges, B.C., & Videto, D.M. (2010). Assessment and planning in health programs (2nd. ed.). Sudbury, MA: Jones & Bartlett Learning.
Maurer, F.A., & Smith, C.M. (2009). Community/public health nursing practice: Health for families and populations (5th ed.). St. Louis, Missouri: Saunders Elsevier.
All the nations of the world fall into economic, social and political strata of some sort. As a result, terms such as developing and industrialised nations have come into existence. Developing nations are often characterised by poor socio-economic and political conditions. As such, the existing international system expects industrialised nations to support the developing nations in their economic development endeavours. Rwanda is one of the poorest countries across the world, but courtesy of foreign aid, it has made spectacular progress in the right direction. This progress is especially noticeable in its health care sector.
Introduction
The world’s nations are diversely stratified along political, economic, and social lines. This stratification serves as the basis for the classification of countries into developed and developing nations. The latter category is characterised by low national income, excessive poverty levels, poor infrastructure, and low education. Additionally, low life expectancy and poor health care systems are key features of developing countries. Nielsen (2011) notes that most of the world’s countries fall into this category. Nations in this category require official development assistance (ODA) because they cannot raise adequate funds on their own to facilitate their development (Dicks-Mireaux, Mecagni & Schadler, 2000). This assistance comes from industrialised nations and international lending institutions such as the International Monetary Fund (IMF) and the World Bank. This paper explores the economic, social, and political impact of ODA on Rwanda with special attention to the health care sector.
Overview of Rwanda
Apparently, developing countries exist all over the world. Nonetheless, of particular interest to this discourse is the Republic of Rwanda. It is a small country located in the Great Lakes region of central Africa (Assessment of Development Results, n.d.). What makes it a subject of interest in this paper is its widely touted spectacular economic growth in the last two decades. After its devastating genocide of 1994, the international community decided to support Rwanda to expedite its recovery. Ezemenar, Kebede & Lahiri (2008) assert that for several years, Rwanda received close to US$1 billion constituting over 50 percent of its budget.
Social, Economic, and Political Impact of ODA on Rwanda
According to Ezemenari, Kebede and Lahiri (2008), ODA plays an instrumental role in the Rwandan economy. It serves as the major source of capital inflows and funds for the budget. Since foreign direct investment is scarce, the country also uses ODA to establish macroeconomic stability. In this respect, the aid arguably serves a meaningful economic purpose. On the flip side, the foreign aid influx instigated the increase of inflation as well as other significant changes in GDP. The effects of these changes include devaluation of the Rwandan currency by up to 45 per cent and higher domestic borrowing.
In the social sense, foreign aid has helped Rwanda to make notable steps in the right direction. The U.S., the U.K., the World Bank, and the IMF have rated Rwanda’s overall progress in terms of attaining the millennium development goals MDGs positively. One of the prominent aspects of the MGDs is the empowerment of women. Rwanda is one of the two countries across the world that has a higher percentage of women in the legislative assembly than men (Ezemenari, Kebede and Lahiri (2008). Apparently, Rwanda’s desire to impress its donors has enabled it to make major steps in the social sense.
In the political sense, Rwanda’s political elite is obliged to maintain a cordial relationship with the donors since the absence of such a relationship can mean reduced or no foreign aid. On the one hand, this unwritten rule has helped strengthen the governance structures of Rwanda because establishing a cordial relationship with the World Bank and the IMF does not necessarily require good personal relationships, but rather the ability to maintain high levels of integrity and commitment to existing agreements.
The Benefits of a Healthy Population to the Economy of Rwanda
Rwanda has expressed a desire to move from the aid-dependent economy to a self-sustaining economy. This transition calls for a healthy population. Incidentally, the country’s achievements in health-related MDGs have delivered a healthier population for Rwanda. As a result, the country has recorded steady growth in its revenue collection. Ezemenari, Kebede and Lahiri (2008) note that between 1994 and 2002 revenue as a percentage of GDP grew from 4 percent to 12.2 percent.
Second, Musango et al. (2006) assert that Rwanda’s population has universal health insurance. Since the government caters for the costs, a healthy population implies that less money goes into hospital bills. Consequently, the funds can be used elsewhere to fast track economic development. Third, the increase in revenue collection implies that apart from a stronger and more reliable labour force, the private sector is also coming up strongly in Rwanda. This assertion stems from the fact that the Rwandan government currently places emphasis on TVET programmes to foster entrepreneurship.
Fourth, Rwanda is looking to achieve a per capita income of US$1000 (Ezemenari, Kebede & Lahiri, 2008). This feat requires a healthy and productively engaged population. However, an important to note is that for the country to make such a projection, it has done some groundwork and concluded that the feat is achievable. As such, Rwanda’s progress in building a healthy population is opening the country up for sustainable economic growth.
The Impact of Foreign Aid on Rwanda’s Health Care System
The first and most notable example of using foreign aid to develop health care in Rwanda is the establishment of universal health insurance for all citizens. This investment has placed Rwanda among the counties with the most elaborate health care systems in the world (Musango et al., 2006). Clearly, without foreign aid, such an achievement would have been impossible for Rwanda considering its situation immediately after the genocide. Elsewhere, when Global Fund, PEPFAR and other partners decided to pump health aid into Rwanda to combat HIV, the country’s leadership capitalised on the opportunity and concentrated the funds on enhancing primary care (Price et al., 2009).
As a result, Rwanda has realised unprecedented results in terms of caring for HIV patients. Reportedly, it retains over 90 percent of HIV patients in care (Price et al., 2009). This achievement has been made possible by the country’s decision to train about 45,000 community health workers to take primary care to people’s homes. The efforts of this group are supported by a robust network of health care facilities that were built courtesy of health aid and the leadership’s commitment to ensuring that every citizen could access health care (Musango et al., 2006). Other examples exist to support the leadership’s use of donor aid to support health care, but purposes of this discourse, the cited instances will suffice.
Conclusion
Rwanda is clearly a special case insofar as the use of donor aid is concerned. It has received more aid than the average developing country and has put the funds to good use. Although some concern about aid dependency exists, the fact remains that foreign aid has made a notable impact in Rwanda. Critics may argue in many different ways, but Rwanda shall remain a spectacular example of proper aid utilization as long as the current goodwill persists. The international community and international lending institutions all agree that Rwanda has done a commendable job in all aspects of development, but most notably, in its health care sector.
Dicks-Mireaux, L., Mecagni, M., & Schadler, S. (2000). Evaluating the effect of IMF lending to low-income countries. Journal of Development Economics, 61(2), 495-526.
Musango, L., Butera, J., Inyarubuga, H., & Dujardin, B. (2006). Rwanda’s Health System and Sickness Insurance Schemes. International Social Security Review, 59(1), 93-103. Web.
Price, J. E., Leslie, J., Welsh, M., & Binagwaho, A. (2009). Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects. AIDS Care, 21(5), 608-614. Web.
It is imperative to note that the role of coding in health care has been increasing over the years. It has become a vital part of most processes, and its primary goal is to enhance the level of efficiency of operations and increase the number of positive outcomes. The problem is that many professionals are reluctant to accept this approach because of many factors.
One of the primary reasons that should not be overlooked is that clinicians already have many tasks and responsibilities that they have to deal with in the workplace. Furthermore, the introduction of coding is not met with approval because such changes are quite significant. Many health professionals are used to standard approaches, and it may not be an easy task to change their opinion. The issue is that they are not provided with additional time for learning most of the time, and it complicates the situation. Another issue that needs to be highlighted is that the level of understanding of coding is not sufficient because health care professionals do not understand that it makes the process of documentation much easier (Jurek, Mosay, and Neris 4).
The problem is that errors are possible, and one may have to lose significant amounts of time when checking if everything is correct (DeVore 170). Also, they may think that it is the responsibility of medical coders, but it is not the case. Numerous issues can be introduced during the process of coding. For instance, it may not be an easy task to identify how procedures should be sequenced on paper (Buck 696). Clinicians may need assistance in such situations because the process is quite complicated and they may be too worried about making mistakes. The fact that it is necessary to remember such enormous amounts of information is quite problematic.
Moreover, it is important to provide clinicians with materials that would make the process much easier and may help to prevent possible mistakes. Also, need to utilize modern technologies should not be overlooked because they have enormous potential that is not yet fully realized in healthcare. Any issues related to coding compliance should be reported because it may lead to severe consequences and can hurt the institution (Becker 102). It may be necessary to conduct pieces of training, and the level of knowledge that has been gained by health care providers needs to be assessed. It is paramount to explain that one should keep track of the latest techniques to stay competent (Johnson and Linker 6). They should be informed that this field is actively developing, and professionals that have an understanding of these approaches are highly valued (Aalseth 215).
In conclusion, it is evident that the situation is quite problematic and necessary measures should be taken to ensure that clinicians are aware of the benefits of coding and understand why it is so important. Overall, most attention should be devoted to education and development of guidelines that would help health care professionals to get used to such processes.
Response 1
It is necessary to mention that I agree with the points raised, and I think that outstanding knowledge has been shown in this case.
Response 2
The information provided is convincing, and I believe that much more attention should be devoted to this subject matter because this is an area that is relatively understudied.
Works Cited
Aalseth, Patricia T. Medical Coding. Burlington, MA: Jones & Bartlett Learning, 2014. Print.
Becker, Joanne M. Guide to Coding Compliance. Boston, MA: Cengage Learning, 2012. Print.
Buck, Carol J. Step-by-Step Medical Coding. Philadelphia, PA: Elsevier Health Sciences, 2015. Print.
DeVore, Amy. The Electronic Health Record for the Physician’s Office for SimChart for the Medical Office. Philadelphia, PA: Elsevier Health Sciences, 2015. Print.
Johnson, Sandra L., and Robin Linker. Understanding Medical Coding: A Comprehensive Guide. 4th ed. Boston, MA: Cengage Learning, 2015. Print.
Jurek, Jean, Stacey Mosay, and Daphne Neris. Conquer Medical Coding: A Critical Thinking Approach with Coding Simulations. Philadelphia, PA: F.A. Davis, 2016. Print.
Quality healthcare services are paramount to human beings irrespective of their age, gender, ethnicity, or culture. Different governments have enacted policies to facilitate access to quality medical care services; however, some children are facing challenges accessing quality healthcare services. The challenges range from political, social, economic, and resources distribution factors.
From economics and resources-distribution perspective, some places have limited number of medical facilities; such a situation reflects in the poor performance of the health care system of that area. In those places where the medical facilities are near, poor families hardly can afford to cover the medical costs. Thus, the fees paid for medical service provision become another challenge.
From sociological, cultural, language and ethnicity-related perspectives, some regions have beliefs that discourage the natives of the use of modern medical facilities. The above mentioned social-economics challenges are also combined with the lack of knowledge and awareness mostly from illiterate communities (Siponen, Ahonen, Savolainen & Hämeen-Anttila, 2011).
Medical insurance policies have been developed to cater for medical needs of communities. However, majority of people fail to enroll in such programs leading to limited provision of the last. Children are the main victims as they depend on their parents to be able to get an appropriate medical care.
There are also other policies that discriminate against children. On the other hand, those people who have insurance policies are facing challenging times since some hospitals offer high quality services only to those people who pay cash and have lower keenness on those with insurance policies. The end result is a society where medical services within community are not of the right quality.
Children can hardly express what they feel, so it depends on the experts in the medical field if they are able to understand them. However, it is a challenge in most cases. Another challenge facing children from poor families arises from the structure of modern medical industry as there is a tendency that health facilities serving poor and marginalized population are typically of worse quality than those taking care of rich people; this disadvantages the poor on the socio-economic basis (Bhuiya, & Chowdury, 2002).
Current policy that aims at eliminating barriers for children
The United States Department of Health and Human Services has noted the need for quality and affordable medical care services to its citizens, particularly children from poor families. It developed Medicaid program which is funded and managed both by the state and federal governments to ensure that everybody in the community gets access to quality medical care.
Under the program, patients, both the outpatients and the inpatients, requiring special attention or other services can get the services at subsidised rates at eligible facilities.
To ensure that the numbers of facilities under the programs are well distributed, the United States government has started aggressive upgrading of the medical facilities in low income areas. Other than the upgrading exercise, the government also finances new facilities.
The coverage of Medicaid extends to prenatal care, vaccination, family planning services, and provision of home health care for persons eligible for skilled-nursing services, and paediatric and family nurse practitioner services. It supplies rural health clinic services. Though some services are mobile, but to some areas, the current system has never been able to reach.
The program initiated by the United States government aims at ensuring that there is quality medical care provision in the country. The medical department is determined to prove that irrespective of one’s age, socio-economical status or cultural orientation, access to medical care facilities is easy. Through Medicaid, the government advances the pillars of a quality medical care provision which are accessibility, affordability, high-quality, and improved community health (MediLexicon International Limited, 2010).
References
Bhuiya, A., & Chowdury, M. (2002). Beneficial effects of a women-focused development on child survival: evidence from rural Bangladesh. Social Science and Medicine, 55(9): 1553-1560.
MediLexicon International Limited. (2010). What is Medicare / Medicaid. New York: Wiley.
Siponen, S. M., Ahonen, R. S., Savolainen, P. H., & Hämeen-Anttila, K. P. (2011). Children’s health and parental socioeconomic factors: a population-based survey in Finland. BMC Public Health, 11(1), 457-464.
It Would Not Be Ethically Right for a Hospital to Charge People Who Are Not Insured More Than Those Insured For the Same Medical Procedure
Introduction
Health insurance is mostly provided by private sector but there are programs set by the government such as children health insurance, veterans programs, and Medicaid.
According to U.S census bureau 16.7% of the population was uninsured for medical services in 2009. People in the USA use a lot of money in health care than in any other country. Total income in the USA used in health care is higher than any other nation of the United Nations. A study carried out in five states in 2001 found that medical expenses have been causing bankruptcy to many people.
With this the number of uninsured person in health has greatly increased and the health services costs have gone up (Johnson, 2010). This paper will look at a standpoint that it would not be ethically right for a hospital to charge people who are not insured more than those insured for the same medical procedure.
Right to Health Care
Every person has a right to health care whether insured or not. Lack of health insurance has been known to cause unnecessary deaths as services are not provided with urgency to those who are not covered and do not have money. Every person is entitled to health care and all should be charged equally regardless of whether they have insurance cover or not. It would not be ethical to charge people who are not insured more than those who are insured (Spicer, 2008).
Why Uninsured
Some people do not qualify for government insurance and they are not supported by their employers for insurance. Some of this people do not afford to buy insurance from private insurers and they go with some of medical needs not attended due to lack of insurance. It has been a challenge to provide cover to all people who are eligible.
Studies done in U.S in 2007 showed that 29% of the population was uninsured and most of this people could not afford it and they were in need of financial assistance. From this it would therefore be unethical to charge uninsured people more for the same medical procedure for most of them cannot afford it.
Uninsured people do not seek preventive measures and do not seek medical services at the onset of a chronic condition. This has greatly contributed to medical crisis in the country. Treatment of uninsured patients should often be taken as charity care by care providers (Johnson, 2010).
Rules and regulations in private and government programs force many people to stay without care coverage. States has enacted legislation concerning reimbursement of funds to the care providers and hospitals. Economic problems have greatly affected the Medicaid and other government programs of insurance.
With this cost of health care is shared by increasing taxes or high premiums to the insured. Public programs are set for the elderly , disabled and children to access health care whether they are able to pay or not. Federal laws are in place to ensure that all people access health care and emergency care whether they are insured or not.
The government should provide insurance coverage to all (Doig & Rocker, 2003). With all these considerations it is therefore unethical to charge the uninsured people more than insured people for the same medical procedure for there are many reasons that can lead to one not being insured.
Conclusion
It would not be ethically right for hospitals and care providers to charge uninsured more than insured for the same medical procedure. There are many reasons that lead to people not being medically covered. This includes lack of finances, high cost of private insurances, and not being eligible for government coverage.
Medical expenses have gone up and this has led many people to bankruptcy. Government should take responsibility and ensure all its citizens are medically covered. Strict rules should be set for hospitals to ensure all people whether insured or not are charged equally for the same medical procedure.