The New Sculptors of Clinical Practice

   Spring is a prime season for medical symposia. National and international multidisciplinary healthcare professionals and associated industry types gather to learn about the latest developments in wound, ostomy, and continence care in a rapidly changing and evolving healthcare environment. Even as sophisticated technological and therapeutic advances are apparent in journals and exhibit halls, changes are taking place that will have as great an impact on clinical practice as the bounding advances in research and technology.

   What are these new sculptors of practice? The national nursing shortage, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Medicare and Medicaid reform, SARS, and budget shortfalls. The cogs on the gears of American healthcare continue to be ratcheted down tighter and tighter, increasing demands on an already overtaxed (pun intended) system.

   The Health Insurance Portability and Accountability Act of 1996, multifaceted legislation passed during the Clinton administration, was intended to streamline inefficiencies within the insurance system, reduce paperwork, protect against fraud and abuse, and enable workers (regardless of any pre-existing medical conditions) to change jobs with their healthcare insurance coverage intact. One of the major components of HIPAA, however, is preparing the healthcare industry for standardized electronic transmission (ie, Electronic Data Interchange or EDI, used by Medicare and others for years) for administrative and financial transactions associated with medical care. Integral to these requirements are drastic changes for healthcare providers who must comply with privacy and security rules - in essence, to develop and implement performance and monitoring tools regarding who has access to patient records.

   Already toiling under financial constraints and struggling to find enough qualified nurses to safely cover patient needs, healthcare providers grapple with justifying the expense of more sophisticated security measures and/or encrypting their entire data base to ensure the protection of individually identifiable patient data. Because of the way the regulations are scripted, however, (and as we have seen in past years with medical regulations) a lack of uniformity in HIPAA compliance and implementation is probable, based on how each organization interprets the rules and what each can afford. What measures, for example, will an institution implement for photographing a wound while concurrently protecting the patient's privacy? How and in what format will this photograph be transmitted to outside consultants or to payors for claims approval and payment? How will the practice of photographing wounds vary among providers? Due to the variances, who will be considered compliant and who will be considered non-compliant? This is only a minuscule aspect of the impact HIPAA has on ostomy, wound, and continence care. The flow of information must be tracked to ensure viable Business Associate agreements are in place all along the pathway and that each entity or individual is HIPAA compliant. How will healthcare organizations deal with the millions of family members, loved ones, and outside visitors from all walks of life moving through their institutions in the course of daily business?

   Regulations are costly to implement and appear to take valuable time away from direct patient care. In addition to currently mandated regular staff education requirements, the burden is also on providers to educate and train their staff to be in compliance and perform ongoing compliance monitoring.

   It is fortunate that our country values the individual's right to privacy and acknowledges our out-of-control healthcare costs. It is unfortunate, however, that so many overwhelming changes in our healthcare system (prospective payment, OASIS, MDS, EDI, cost cutbacks, and the like) have occurred in such a short time span in an era when an insufficient number of nurses face a future of never-before-seen patient needs. Even though these changes are painful, they have benefits. In a country with more than 30 million uninsured people, the need for portable insurance coverage is evident. Protecting a patient's right to privacy always has been and should continue to remain a priority. And certainly, efforts to reduce overall healthcare costs by reducing fraud and abuse should be ongoing.

   Changes related to medical care advancements such as we are experiencing as we begin to negotiate high-tech highways of electronic information exchange are inevitable, never comfortable, but almost always necessary. We can only hope that these latest artisans enable a renaissance of improved outcomes and respect for the rights of individuals as they craft a new vision of healthcare.