For the Course Project, you will prepare a quality improvement program. Continuous quality improvement covers many areas. Throughout the course, pay particular attention to what attributes constitute a quality improvement team and what questions this team attempts to answer.

Select one of the following six high-risk areas for your project.

1. Psychiatry
2. Long-term care
3. Home healthcare
4. Emergency room
5. Obstetrics and neonatology
6. Surgery

Research the area you selected using at least three scholarly sources. Identify and classify all of the risks associated with these areas. Describe the nature of the risks to patients, healthcare professionals, and healthcare facilities. You may develop a table to present this information, create a Word document report, or a PowerPoint presentation.

• Identify the event in the history of medicine and health care delivery that you see as the most significant. Explain why you feel it is significant and what impact is has on health care today

• Identify and explain two commonly attributed reasons for the unremitting rises we are experiencing with regards to health care costs.

• Differentiate between the two methods for physician reimbursement: capitation and fee for service

• Choose on health care profession that you learned about this quarter and briefly describe the profession. (Cancer Registrars)
• Explain the intent of the Flexner Report. Identify the reports result on medical education.

• Discuss the importance of ambulatory care services as a part of the U.S. health care system today.

• Explain the role of the Board of Trustees and CEO/President in the hospital organization.

• What is a long-term care and how is it different from other types of health services?Describe one type of long-term care facility. (Nursing Home)

• Describe two types of mental health providers and the role that they play in the mental health sector.

• Discuss three benefits of Electronic Health Record and how this has transformed health information technology.

Healthcare Programs

Research a local health policy issue that is a hot topic in your state. You can also contact a local county commissioner or state Congressional member in your state to gain insight on the issue or (you may also research local or state government websites or refer to the local news media).

On the basis of your research, answer the following:

• Discuss the implications of the selected issue on the community as a whole.
• Who all are affected by the policy?
• Who are the key stakeholders in the development of the policy? Discuss their individual roles in policy development?
• Explain the roles of those responsible for implementing the policy.
• Does federal government play any role in the policy development process and its relationship in terms of funding? If yes, explain.
• If the federal government is not involved in the policy development process and its relationship in terms of funding, should it be involved? Why or why not?

Research the policy demographics of CHIP in your state. Also examine the adequacy of the CHIP program in your state.

• In your opinion, if Medicaid was meant to cover families living below the poverty line, then what is the purpose of CHIP?
• Illustrate the differences and similarities between the two programs?
• Every state has its own variation of CHIP. What does your state call the program?
• Who all are covered in CHIP and what are the eligibility requirements?
• In your state, if CHIP is meant to cover uninsured children, why are there so many uninsured families with children?

In many national healthcare systems, the providers of care are either subsidized or work directly for government-owned facilities. In the United States, the government-operated programs, such as Medicare and Medicaid, contract with providers. The VA, on the other hand operates its own system of hospitals, clinics, and long-term care facilities. Medicare and Medicaid set the rules regarding which services are offered and the amount to be paid for those services.

• Compare and contrast the VA Health System with Medicare and Medicaid. Describe in detail the similarities and differences.
• What lessons can the programs learn from each other when looking at administration of services and programs offered by recipients? Discuss the implications in terms of access to care, controlling costs, and ensuring quality care.

Case Study, Stage 4: IT and Legal Considerations for Proposed EHR Technology Solution

Before you begin this assignment, be sure you have read the “UMUC Family Clinic Case Study”, the Case Study Stages 1-3, your required readings and feedback on your graded work so far.

Purpose of this Assignment

This assignment gives you the opportunity to apply the concepts of this course to address the implementation and on-going management of the certified EHR technology solution you have proposed for the UMUC Family Clinic.  This assignment addresses the following course outcomes to enable you to:

• Evaluate the organizational environment in the health care industry to recognize how technology solutions enable strategic outcomes.
• Evaluate technology solutions in the health care industry to improve the quality of care, safety, and financial management decisions.
• Examine the implications of ethical, legal, and regulatory policy issues on health care information systems.

IT, Legal, Ethical and Regulatory Considerations for Proposed EHR Technology Solution 

Following your report of the Meaningful Use reporting requirements in your Stage 3 project, the owner of the UMUC Family Clinic has still not authorized the needed project funding.  In evaluating an IT proposal, there are several areas that need to be considered.  Prior to authorizing the needed project funding, the owner has asked you to prepare a table addressing the important aspects/considerations of the project. These considerations are listed in the table provided with this assignment. Considerations include such areas as IT operational safeguard, architectural, project/implementation, legal and ethical considerations.

Depending on the specific EHR technology solution you proposed, some of the considerations would be more important than others, and some may not need specific consideration for the initial implementation of your proposed solution.  (If a consideration is not relevant for the solution as described and at implementation but might be something for the future, mark it “N/A”.  If for instance cloud computing is not in the solution being implemented, but may be considered in the future it would be N/A and not required for the solution.  Please note that even N/A items require an explanation.)

The responses that you enter into the table for each consideration must be aligned to the one specific solution you proposed and appropriate to the UMUC Family Clinic.

Assignment

Using the EHR technology solution you proposed in Stage 2, you should briefly explain it and then copy the table below and complete the remaining three columns.  For each area of consideration, you should rate it as high, medium, low, or N/A (Not Applicable) in importance or relevance at time of implementation (and not sometime in the future) for the specific EHR technology solution you proposed for the UMUC Family Clinic.  Then, provide a brief description, a minimum of two sentences, and a brief explanation, a minimum of two sentences, to justify that rating or the N/A.  Do not try to create a reason if there is none, but carefully analyze each consideration and determine whether it applies and how.  Explanations must provide enough information to convey the reasoning behind the rating.  DO NOT copy the definitions from the textbook or other sources but put into your own words to demonstrate your understanding of the concept as you provide your explanation for the rating.  Use the Grading Rubric to be sure you have covered everything.  Submit your paper with answers to parts 1 and 2 below via your Assignment Folder as a Microsoft Word document with your last name included in the filename.

Part 1: Briefly explain your proposed EHR technology solution.  Identify what the solution is, what it is expected to do for the UMUC Family Clinic, and what major hardware, software and communications components will be used, summarizing the information you provided for Stage 2.

Part 2:  Table of Considerations.  The Areas for consideration are defined in the section “Concepts” which follows the table of considerations.  An example for one entry is also provided below (you cannot use the area identified in the example for your assignment).  Click on the upper left corner of the table to copy it into your paper.

Table of Considerations
	Area	High/Medium/Low Rating or Not Applicable (N/A)	Description of the Area	Explanation for Rating /How you will address it
(minimum 2 sentences for each)	(minimum 2 sentences for each, linked to specific EHR technology solution proposed)
I.IT – Operational Safeguards
1.	Identity Management & Authorization
2.	Training Programs
3.	Continuity of Operations
4.	Incident Procedures
5.	Accountability
6.	Risk Assessment
7.	System Activity Review
II.IT – Architectural Safeguards
8.	Reliability
9.	Availability
10.	Maintainability
11.	Scalability
12.	Safety
13.	Cloud Computing
III.IT – Project Management Considerations
14.	Project Resources (Human, Financial)
15.	Medical Paper Record Migration
16.	Change Management during Implementation
17.	Change Management after Implementation
IV.Legal, Ethical, and Regulatory Reporting Considerations
18.	Business Associate Contracts
19.	HIPAA
V.Additional Consideration
20.	Research and add a consideration from your knowledge of the course

Concepts:

The 19 considerations covered in the above table can be found in the following readings:

• Operational, Security and Architectural Safeguards – Ch. 27 & 28 & 29
• Ethical and Legal consideration – Ch. 3 & 13 (Week 7 readings)

You can also use sources outside of the text but make sure they are used in the same context and cite your sources.

For consideration #20, it is up to you to add a consideration that you feel is important, and that was not covered in the 19 considerations listed in the table.  It is expected that you may do some external research, if you can’t find an additional consideration through your course readings. This is part of the assignment and is not additional credit.

Example from another industry:  For example, for a fitness center that is adopting a new technology solution involving a kiosk for customers to use to pay for their membership at the gym, then for the Area of Accessibility, the following might be entered.  Note the thorough explanation of the rating. You CAN NOT use this area for your “Additional Consideration” area in the assignment.
Area	High/Medium/Low Importance or Relevance or Not Applicable (N/A)	Description of Area	Explanation for Rating
Accessibility	Medium	Accessibility is the degree to which a product, device, service, or environment is available to as many people as possible. This includes accessibility to people with various impairments such as: cognitive, visual, hearing and / or dexterity.	Since the customers will use the kiosk to pay their membership fees, it must be accessible to everyone.  Customers need a convenient and individual method of logging into the system that enables them to perform the needed tasks quickly and efficiently.  The customers should have controlled access that prohibits them from entering any areas or performing any functions not intended for customer use. It is rated “Medium” because it is important for some customers who choose to use the kiosk and the system cannot be accessed without some type of login so it is important; however, it is not “High” since there are other methods of paying membership fees.

The “right” and “wrong” answers have to do with whether or not you correctly rated each consideration as it relates to your proposed EHR technology solution and have provided a well-supported explanation for the rating you assigned.  Your responses will be evaluated on whether they are applicable to the solution, correctly rated, adequately explained, and are appropriate to the UMUC Family Clinic.  Use the Rubric below to be sure you have covered all aspects.

GRADING RUBRIC:

Criteria	90-100%Far Above Standards	80-89%Above Standards	70-79%Meets Standards	60-69%Below Standards	< 60%Well Below Standards	Possible Points
Explanation of Proposed Solution	9-10 PointsExplanation uses course vocabulary and concepts to clearly identify what the IT solution is, what it is expected to do for the organization in the case study; and it sets the stage well for the rankings.  A well-written introduction to the Table of Considerations is provided.	8 PointsExplanation uses course vocabulary and concepts to clearly identify what the IT solution is; and it appropriately sets the stage for the rankings.  A good introduction to the Table of Considerations is provided.	7 PointsExplanation describes the IT solution; an introduction to the Table of Considerations is provided.	6 PointsExplanation of solution does not clearly explain what it is expected to do for the business in the case study, is not a technical solution for a specific process, or is not adequate to set stage for rankings; and/or introduction to Table of Considerations is missing.	0-5 PointsNo explanation provided, or very poor explanation of proposed solution provided; and/or solution described is not a technical solution; and/or little effort demonstrated	10
High/Medium/Low or N/A Rankings	18-20 Points Rankings all demonstrate a strong understanding of course concepts, analysis and critical thinking; and are appropriate for the organization in the case study and the proposed EHR solution.	16-17 PointsMost rankings demonstrate an understanding of course concepts, analysis and critical thinking; and are appropriate for the organization in the case study and the proposed EHR solution.	14-15 PointsRankings are designated and demonstrate a basic understanding of course concepts or analysis.	12-13 PointsRankings are provided but selection may be somewhat inappropriate for the case study or the EHR solution.	0-11 PointsFew, if any rankings provided, or rankings are not appropriate for the EHR solution and/or the case study.	20
Descriptions	18-20 Points Descriptions are at least two good sentences and all demonstrate a strong understanding of course concepts, analysis and critical thinking.	16-17 PointsDescriptions are at least two good sentences and most demonstrate an understanding of course concepts, analysis and critical thinking.	14-15 PointsDescriptions are at least two sentences and demonstrate a basic understanding of course concepts or analysis.	12-13 PointsSome descriptions are less than two sentences, and/or may be somewhat incomplete or inaccurate.	0-11 PointsFew, if any descriptions are provided, or many descriptions are incomplete or inaccurate.	20
Explanation for Rankings	36-40 Points Explanations are at least two good sentences each and use course vocabulary to justify rankings and demonstrate a strong understanding of course concepts, analysis, and critical thinking; and are focused on the case study and the proposed EHR solution.  Additional consideration (#20) is appropriate to the case study and the EHR solution.	32-35 PointsExplanations are at least two good sentences each and use course vocabulary to justify most rankings and demonstrate an understanding of course concepts, analysis, and critical thinking; and are focused on the case study and the proposed EHR solution.  Additional consideration (#20) is appropriate to the case study and the EHR solution.	28-31 PointsExplanations are at least two sentences that justify each ranking and are relevant to the case study and proposed EHR solution.  Additional consideration (#20) is appropriate to the case study and the EHR solution.	24-27 PointsSome explanations are less than two sentences, and/or do not adequately justify rankings; may be lacking in the use of course vocabulary; or are not focused on the case study and/or the proposed EHR solution.  Additional consideration (#20) may not be appropriate to the case study and the EHR solution.	0-23 PointsFew, if any explanations provided, are not compatible with rankings; or little effort demonstrated.	40
Table Format	9-10 PointsInformation is professionally presented; and uses course vocabulary, correct sentence structure, grammar, and spelling.	8 PointsInformation is presented well; uses correct sentence structure, and has few grammar, and spelling errors.	7 PointsInformation is presented with some grammar and/or spelling errors.	6 PointsInformation is not professionally presented, and/or contains several grammar and/or spelling errors.	0-5 PointsInformation is extremely poorly written; has many grammar and/or spelling errors; and/or does not convey the information adequately.	10
					TOTAL Points Possible	100

1. Who pays? Should health care be a privilege and each individual’s responsibility? Should you be allowed to decide if you want to spend your money on some form of health care insurance or use it for other purchases? Should you be allowed to decide that you live a healthy lifestyle, and you will pay out of pocket for your needs? If you get into a situation that is beyond your ability to pay, should you have to suffer the consequences? Should those consequences include permanent damage or death?

Is illness and infirmity a burden on society and health care for every citizen a right? Think of other rights extended to American citizens. We are entitled to free primary education, a safe food and water supply, public health surveillance for communicable diseases, and police and fire protection. These are all funded by public money, which comes from taxes. Should health care join that list? Is the average taxpayer willing to assume that burden?

If a public health care system is selected, who should be the administrator? Should the same people who run Medicare run a national health system? Is the Medicare system running well enough to be expanded to everyone? If a public option is selected, what happens to the current health care insurance industry? How would the transition from private to public be orchestrated?Click Here For More Information On This Paper

The issues of how much and to whom is further complicated by the aging of the population and the rapid advance in health care technology. Both factors have contributed to marked increases in health care costs. How will anyone predict costs in the future? Is rationing health care the only solution? 200 words

1. It is a scary trend especially, that we have the opportunity to model other healthcare systems that are in place and functional.  We also have the option to create a system that works for the American people.  Where do we fail?  How does a European system of healthcare compare with technology, cost structures, reimbursement, etc… ?  150 words
2. What is your opinion about this article: The constitutionality of current legal barriers to telemedicine in the United States: analysis and future directions of its relationship to national and international health care reform.  150 words

1. What is your opinion about this article: The key to real health care reform is tackling barriers standing in way of clinical integration.
2. What is your opinion about this article: Challenges ahead of health care finance:150 words 

1. What will have a greater effect on the future cost of health care in the United States: political and social changes or medicinal and technological advances? Support your response. Your response should be 200-300 words.  Please ensure to substantiate your response with scholarly sources or a personal account of your own experience in the work place.

1. Crystal: I am thinking that medical and technological advances will have a greater effect on future cost of health care in the United States rather political and social changes.  The world already relies on technology for everything.  Look at today versus the early 1900’s.  House phones and pagers to cell phones, dial-up internet to now broad band.  Social networking sites like, facebook, linkedln, twitter and more many utilize for conversing, advertising, word of mouth, job search and more.  That does not even include some if the latest technology in health care.  Beginning with electronic health records, mHealth, telemedicine and teleheath, e-prescribing, to self-service kiosks.  More of the latest technology is still yet to come with the 2015 microchip modeling clinical trials that aim to replace the use of animals in clinical trials to more accurately test the safety and efficacy of treatment for human patients and spare the lives of countless animals typically used in testing, and Google Glass that connects to your smart phone and allows for video and images.  Soon the health care robots will be in all health care facilities.  Technology is only getting more better as the years go by. Do you agree or disagree with Crystal? Why or why not? 150 words

1. The emergence of new disease may be another area of concern.  I would venture to say that in general, the cost of health care is not only what we see at face value, but also what goes on behind the scene.  The impact will exponentially come from all sectors not only social, but also technologically, in both the private and public sector.  Another area of great concern about the rise of health care is the baby boomer impact on health care in general and the social structure.  Do you think this is a problem that will cause great change? 150 words

1. Linda: The cost of health care is at an all time high and at the rate we are going there probably will not be any relief from the costs skyrocketing even further. As of 2012 the spending in health care had exceeded $2.6 trillion which equals about 18 percent of gross domestic product. Medical spending races past inflation and medical providers contribute to the rising costs just as much as we do as patients. The insurance companies would pay for each test or procedure including visits that a provider would bill for which has become an issue because of over billing, In this day and age as we age we are very unhealthy, and make unhealthy choices with the fast food that is available which in turn exposes us to weight gain, high blood pressure, and heart disease. We are also moving further along in technology and the more we learn the more we want which includes services for testing, and new drugs. However, at this point we do not have enough information to decide what is best for us and what we can do to keep the costs down which is what needs to be our focus if we plan to get control of the ever increasing costs.

Appleby, J. (2012). Seven Factors Driving Up Your Health Care Costs. PBS NEWHOUR.

Do you agree or disagree with Linda? Why or why not? 150 words

1. Question 10 is attached already, see powerpoint- meaning the work is done; you don’t need to write anything. I only need you to just organize the PowerPoint for me. Edit, add or remove anything you think is missing or not supposed to be there. Format in APA style. Preparea Microsoft® PowerPoint® presentation in which you summarize health care reform material. Assume you are making a presentation to the board of directors concerning your investigation into the economic issue you submitted for your Health Care Reform Project assignments in Weeks Two and Three.

Have a minimum of 10 to 15 slides with extensive speaker notes, augmenting and expanding on the information presented in each slide. Include the following in your presentation:

• Describe the economic issue selected.
• Identify methods and tools common to addressing economic challenges in the health care industry.
• Discuss how the methods and tools identified relate to health care reform.
• Determine the most effective method(s) and tool(s) that could be used to resolve the economic issue selected.
• Identify various payment sources and mechanism used in the health care industry.
• Determine which payment source(s) and mechanism(s) are the most effective to resolve the economic issue selected.
• List the steps needed to implement your solution.