The Patient Protection and Affordable Care Act (ACA) was a defining piece of legislation, signed into law in 2010 under the Obama administration, that would transform the delivery of healthcare and the way it was paid for. Under the ACA, the following requirements would be met:
- Insurance coverage for every individual
- Health insurance policy standards
- Matching insurance rates for all individuals, regardless of pre-existing conditions
- No cancellation of policies or care limits based on chronic conditions
- Individuals could remain on a parental policy until 26 years of age
- Health insurance exchanges created to incite competition between payers (Shanholtzer, 2016, p.12)
ACA broadened the patient population that would be receiving government-sponsored care through Medicaid and Medicare. And because providers and facilities would expect payment for services rendered, it was important that they adhere to both federal and state policies, specifically regarding the quality of the care rendered. Several government departments have such policies in place to regulate the use of health information technology (HIT) and ensure requirements of the ACA are met. These include Health and Human Services (HHS) which regulates healthcare nationwide and the Office of the National Coordinator for Health Information Technology (ONC) which regulates HIT. Additionally, policies are developed with the assistance of The National Academy of Medicine (NAM), which provides evidence-based advice to policymakers.
Additional legislation came in the form of the American Recovery and Reinvestment Act in 2009, which made sweeping changes to health informatics regulation with the creation of an HIT Policy Committee and HIT Standards Committee, as well as the Health Information Technology for Economic and Clinical Health Act (HITECH). All were designed to incentivize providers monetarily to increase meaningful use of electronic health records, promote electronic exchange of health information and to allow legislative bodies to ensure that clinical quality measures were being met (Bell, 2018).
With policies now requiring increased EHR use and HIT exchange, privacy laws have become increasingly important. The most notable, the Health Insurance Portability and Accountability Act (HIPAA), which was established in 1996, would be crucial for protecting health information. Today, the communication of protected health information (PHI) occurs through digital health exchange, be it for care coordination or billing, thanks to the deployment of ACA and HITECH statutes
Most recently, the COVID-19 pandemic has put renewed focus on policies that govern the exchange of PHI, such as with contact tracing applications, vaccine passports or the pharmacovigilance for novel vaccines (Lievevrouw, 2022).. It is incredibly important for governing bodies to continue monitoring and amending HIT governance to accommodate the changes that seem to happen at an exponential pace when it comes to digital technology. It is also vital that consumers and patients be aware of their rights under current legislation.
The Bible gives instruction on wisdom and discernment in the first book of Kings which says “So give your servant a discerning heart to govern your people and to distinguish between right and wrong” (biblegateway.com, n.d.). One of my own frequent prayers is for our political leaders – that they have this God-given discernment. This wisdom is just as important for developing IT-related policy as it is for right-to-life legislation. At the heart of all policies, the well-being of people should be central to the decisions made, if it is seeking the heart of God.
References
Bell, K. (2018). Public policy and health informatics. Seminars in Oncology Nursing. 34(2), 184-187.
Lievevrouw, E., Marelli, L., Van Hoyweghen, I. (2022) The role of US policymaking in the emergence of a digital health assemblage, Science as Culture, 31(1), 72-91, DOI: 10.1080/09505431.2021.2025214Links to an external site.
Shanholtzer