Literature Review Paper
• Select a recent Health Care Legislature (within 5 years)
• Literature review regarding issue (3 peer reviewed articles)
• 5-Page Maximum (not including title page and references)
• Statistical data related to issue: population impacted, and health outcome of issue and legislature
• Nursing role in passing the legislature
Health Care Legislation: Literature Review Paper
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Health Care Legislation: Literature Review Paper
The selected legislation is the 21st Century Cures Act. The legislation was implemented in 2016 by President Obama and is comprehensive legislation that covers research funding, delivery of mental health services, and the effective use of electronic health records (EHR). The legislation aims to increase fund allocation for research into the treatment and prevention of chronic illnesses and the development of medical devices and drugs. The legislation also focused on addressing the opioid crisis and improving the delivery of mental health services. Furthermore, the Act pushed for improvements in the exchange and flow of healthcare information. Title IV of the legislation focused on improving interoperability and enhancing the accessibility, usability, security, and privacy of health Information Technology (IT). The legislation also prohibited information blocking which refers to organizational, technical or business practices which discourage authorized people from accessing, using, or exchanging health information on electronic media (Healthcare Information and Management Systems Society, 2017). The purpose of this paper is to present a literature review of the 21st Century Cures Act including the impact of the legislation and the role of nurses in passing the legislation.
Literature Review
Numerous research studies have been published on the implications of the Cures Act in the healthcare industry. Goble (2018) researched the implications of the Cures Act on drug development. Goble (2018) explained that the legislation was rather unprecedented and that one of its intentions was to accelerate the development of effective pharmacological therapies that would cure chronic illnesses such as cancer. One of the key implications of the Cures Act is patient-focused drug development. Title III of the legislation required the secretary of the HHS to develop standards for the collection of data on patient experience that would be used by the FDA for drug approval. The Cures Act emphasized patient engagement when collecting data to capture the perspectives that patients have about the treatment burden, treatment experience, and disease burden. The legislation also led to the streamlining of the procedure for approving new drugs as a way of ensuring that only reliable drugs that correlate to positive patient outcomes are approved.
DesRoches et al. (2020) examined the perspectives that clinicians had about some of the requirements of the Cures Act using structured interviews. The legislation requires healthcare providers to give patients full access to information about their health recorded in electronic medical records. The law increased access to personal health information including clinician notes. The practice of note sharing has become more common following the implementation of the Cures Act although some clinicians reported negative implications for health documentation practices and reduced workflow efficiency. The findings of the study illustrated that most physicians supported note-sharing during practice and believed that it enhanced patient involvement in healthcare. However, some physicians also pointed out that they had to modify the strategies they use in documenting patient visits including changing how they present sensitive information.
Cole et al. (2017) examined the implications of the Cures Act to the criminal justice system and pointed out that the legislation focused on improving the health outcomes for people from vulnerable populations such as those diagnosed with mental illness and formerly incarcerated persons. One of the major substance use issues in the country is the opioid crisis which severely affects both middle class and suburban white communities. The Cures Act discourages the criminalization of people with substance use disorders and takes a public health approach when addressing addiction. The laws encourage correction institutions to take a different approach when sentencing offenders with addiction problems by focusing on treatment methods instead of incarceration. The Act also increased grant allocation for the treatment of opioid addiction in different states and enhanced training and funding for corrections officials to improve their responses to offenders with mental health disorders. Cole et al. (2017) also explained that the Cures Act would benefit Hispanic and African American communities who are more likely to serve longer prison sentences for drug possession and abuse and are also less likely to access proper diagnosis and interventions for substance use disorders. Effective mental health treatment through the provision of community-based treatment and support services promotes good physical and mental health for all communities.
Lye et al. (2018) examined the impacts of the Cures Act on patient access to electronic health records. The article focused on patient access and exchange of health information. Lye et al. (2018) explained that the Cures Act addressed some of the implementation challenges of the Health Information Technology for Economic and Clinical Health (HITECH) and Health Insurance Portability and Accountability Acts (HIPAA). Although these two legislations described patients’ rights to access health information and encouraged healthcare facilities to adopt health IT and use them meaningfully, patients still had limited access to digital health information. The Cures Act focuses on improving patient access by encouraging healthcare organizations to partner with information exchange networks to ensure that there are no barriers to health information access. Improved access to health information under the Cures Act also promotes research because patients can choose to share this information with researchers. Incorporating patient perspectives in research facilitates patient engagement and encourages healthcare innovation. The Cures Act also enhanced requirements for health IT certification to ensure that developers facilitate interoperability of health IT.
Health Outcomes and Population impacted by The Cures Act
According to DesRoches et al. (2020), the Cures Act is fairly new legislation and most of its requirements are yet to be implemented. Therefore, it is difficult to accurately assess the health outcomes and impacts of the legislation. As per Waseem et al. (2021), the health information and note-sharing requirement of the legislation went into effect in April 2021 and there have been many positive effects especially among patients who have a better understanding of their health information and feel that they have more control of their health. Patients now have the right to access consultation notes, laboratory reports, imaging narratives, findings for physical examinations, progress notes, and discharge narratives. The Cures Act has ensured that millions of patients in the country can access health information through digital platforms. Pageler et al. (2020) explain that the data shared as per the requirements of the Cures Act should expand to encompass all forms of electronic health information by 2022. Although the legislation was implemented to improve healthcare, there are several anticipated limitations to its implementation. As per Lye et al. (2018), issues such as budget cuts to the Office of the National Coordinator for Health Information Technology (ONC) by the Trump administration is among the major setbacks to the improvement of interoperability of health IT. Furthermore, effective health information exchange is limited to stakeholder participation which may be hard to regulate.
Nursing Role in Passing the Legislation
Nurses are among the frontline healthcare providers hence they play a significant role in passing the Cures Act. Nurses have interconnected roles that are not limited to clinical care but also extend to healthcare research and administration. About the patient engagement in the approval of medication by the FDA, nurses are responsible for ensuring that patients and sufficiently protected from harm and exploitation through advocacy and ensuring research protocols follow legal and ethical standards. Nurses also have the opportunity to take advantage of research funding to help with innovative practices that improve the quality of care processes. Nursing organizations can also educate policymakers on patient safety considerations that may arise with improved interoperability of health IT. Furthermore, nurse leaders can help promote health information access by initiating policies that examine the functionality of health IT software through user feedback and suggesting strategies for improving interoperability (Martin, 2020).
Conclusion
The Cures Act was implemented to transform healthcare research, access and utilization of healthcare information, mental health treatment, and treatment of chronic illnesses. Although most of the requirements have not been implemented, the legislation has already improved patient access to health information including laboratory records, progress reports, and consultation notes. The Cares Act also intends to improve the utilization of health information in the research, development, and approval of pharmacological interventions. Nurses can support the implementation of the legislation by advocating on behalf of patients to ensure that researchers follow legal and ethical methods when using patient health information and engaging in actions that promote better access to health information.
References
Cole, D., Thomas, D., Field, K., Wool, A., Lipiner, T., Massenberg, N., & Guthrie, B. (2017). The 21st Century Cures Act Implications for the Reduction of Racial Health Disparities in the US Criminal Justice System: A Public Health Approach. Journal of Racial and Ethnic Health Disparities, 5(4), 885-893. https://doi.org/10.1007/s40615-017-0435-0
DesRoches, C., Leveille, S., Bell, S., Dong, Z., Elmore, J., & Fernandez, L. (2020). The Views and Experiences of Clinicians Sharing Medical Record Notes with Patients. JAMA Network Open, 3(3), e201753. https://doi.org/10.1001/jamanetworkopen.2020.1753
Goble, J. (2018). The Potential Effect of the 21st Century Cures Act on Drug Development. Journal of Managed Care & Specialty Pharmacy, 24(7), 677-681. https://doi.org/10.18553/jmcp.2018.24.7.677
Healthcare Information and Management Systems Society. (2017). 21st Century Cures Act—A Summary. https://www.himss.org/resources/21st-century-cures-act-summary.
Lye, C., Forman, H., Daniel, J., & Krumholz, H. (2018). The 21st Century Cures Act and electronic health records one year later: will patients see the benefits? Journal of The American Medical Informatics Association, 25(9), 1218-1220. https://doi.org/10.1093/jamia/ocy065
Martin, M. (2020). The Ethics of Emergent Health Technologies: Implications of the 21st Century Cures Act for Nursing. Policy, Politics, & Nursing Practice, 21(4), 195-201. https://doi.org/10.1177/1527154420947028
Pageler, N., Webber, E., & Lund, D. (2020). Implications of the 21st Century Cures Act in Pediatrics. Pediatrics, 147(3), e2020034199. https://doi.org/10.1542/peds.2020-034199
Waseem, N., Bircher, S., & Feliciano, J. (2021). Information Blocking and Oncology. JAMA Oncology. https://doi.org/10.1001/jamaoncol.2021.3520