Introduction
In recent years, health institutions and systems have been effective to realize the pledge of health information technology in order to provide safer, more effective, and affordable care. Although there have been several success stories out there, many institutions are still in the initial phases of implementing health information technology (HIT) in order to advance and improve care and lower costs. Realizing true Health Information Technology pledges, especially in providing effective Affordable Care Act, is challenging than it looks.
Affordable Care Act Portal
To begin with, an affordable Health Care Act-based online application is not just a website, it is more of a platform for marketplaces. According to Polakoff (2012), “Visiting an Affordable Health Care Act website is like a restaurant having both dining area as front end and kitchenette as the back end.” It consists of a front end, with several buttons to click and forms to fill, and a back end that encompasses all the databases and services. GCF Federal is the most responsible contractor for these back-end elements. Adopting a sustainable Affordable Care Act web application can be very challenging.
The application requires coordination of several policies, each having its own level of coverage, that work simultaneously to achieve the set outcome, not mentioning applicant privacy protection, guaranteeing security, and managing host sever. Any malfunction at these points could result in a total fatal. Like any other major technology adoption, several barriers are expected during the rollout. This barrier can be technology-based, management, or political issues. This paper will highlight the technological and management issues that should be considered during the implementation of the provisions of the Affordable Health Care Act.
Several Interfaces
Affordable Care Act web applications are huge systems. It is not easier to manage all supporting applications even in the best cases. This is due to many interfaces with varied assumptions that control how a particular system should work. It is difficult to achieve flexibility and scalability (Thomas, 2013).
Complex System Architecture
Like any other software application, designs of web-based systems usually have complications in achieving the expected functional requirements. Affordable Care Act integrated portal enables users to personalize required contents, make necessary payments, and other complex operations through a single interface. However, this can sometimes appear difficult to achieve (Thomas, 2013). A user attempting to create an account on the Affordable Care Act website serving insurance exchanges all over United State will prompt the system to load unnecessarily large amounts of data and software. Further, the system architecture may limit what applications can be extended.
System Capacity
Since so much traffic is expected to flow back and forth between users and the application saver, caching problems are expected. Cookies created on some parts of web applications can be a big issue, as they can exceed the site’s capacity and deny login information. Thomas (2013) affirms that “this can make the system look like it is attacking itself”.
Security Issue
Protecting web applications from attacks demands a comprehensive understanding of all application communications. To secure these applications, devices must demonstrate a full deconstruction of the HyperText Marker data payload, while tracking the state of each application. Information Vendors are responsible for delivering that shield web applications from unethical attacks. Since security susceptibilities can be used to hijack an account, all personal details over the internet should be fully encrypted in order to improve security (Phillip, 2012). Affordable Care Act web application is a huge application that citizens are directed to use, thus it should be of a high standard.
Accessibility.
This is an integral aspect of a web application. A web system needs to put into considerations supportive technologies such as server, as well as compliance to the available standards. This issue can affect other web application characteristics such as input types, interaction styles as well as devices. For instance, a single click causes several files, plugins, and other data to stream between personal computers and servers. This can overpower the browser if a good server technology is not employed (Edward and Lynette, 2012).
Historically the rollout of the Affordable Health Care Act has proved to be another mess. According to Wilensky (2012), just about one percent of about 4 million people who attempted to register on the federal exchange during the initial phases actually managed to enroll. This could due to the inability of the application to handle page requests, or several files overloading the server.
Management Issues
However, even if the above issues are left aside, past tragedies in implementing the Affordable Health Care Act web applications make it even obvious that the government should now change the way it ships code by adopting a software development approach. Again, policies such as health insurance applicants’ income verification mean that the data hub that contains all this information be integrated. The federal also requires other technology to allow individuals to sign-up for private insurance via the state exchanges, which has always slowed the implementation rate. The provision of the Affordable Health Care Act presents a list of challenges.
Technological aspect, such as database capacity, sever capability among others, is critical for successful implementation. Besides, several policies and regulations bring underlying concern into the open: “Is the federal government able of managing the provision of a fundamental service through an extraordinarily complex system?” (Thomas, 2013). The system itself requires coordination of several policies such as tax credit eligibility. Several tax provisions are correlated. As such, health organization managers are faced with difficulties in ensuring that the set planning efforts establish the relationships among various tax and data reporting provisions (Phillip, 2012). They must ensure that all relevant data needed to accurately manage these provisions is provided. Lastly, like many other health institutions, the long-standing financial pressure raises anxiety on the ability to secure and employ the administrative assets such as technical expertise that are required to implement health care web-based system (Menachemi& Singh, 2012).
The Way Forward
Implementing an Affordable Health Care Act is an expensive proposition. However, there is no generally existing framework for ensuring that all related resources are budgeted and understood. Investing in Health Information Technology, such as online portal and processing enrollments or premium payments is significant to enhancing the quality and safety of patients (Edward and Lynette, 2012). Since the increased significance of quality improvement and value-based purchasing, critical strategic consideration of health care institutions include:
- What are the set strategies that align physicians with the institution’s improvement initiatives? Do the physician’s clinical information systems align with the hospital’s information system?
- What are the set strategies to improve performance? What are the key targets?
- What technology and other assets does the institution require to advance care, avoid harm, and achieve the meaningful functionality requirements?
For the success of the Affordable Health Care Act online applications, the state and organizations should operate in a really transparent manner. These can be achieved by deploying small unit teams to enable the continuous shipment of novel features and fixes. According to Edward and Lynette, (2012) code shipment can result in misunderstandings, missed deadlines, as well as faulty releases. The application’s development team’s primary goal should be to create solutions to these issues. This includes conducting transparent code reviews, unit tests that will automatically find bugs, scheduling stand-up meetings, and constantly pushing new code into the open where actual people use it.
Web applications used for the Affordable Health Care Act can be a critical tool for complying with reporting regulations of health agencies such as payers, CMS, and governmental agencies. Consistency in pay-for-performance policies and practices is integral and will allow workflow and reporting requirements to be easily integrated into other Electronic Health Record extensions, thus supporting the further implementation of those extensions in the physician practice(Edward and Lynette, 2012). The practice towards transparency in healthcare provision is another pilot for gathering the Affordable Health Care Act web application’s adoption and performance improvement.
Availability of well-trained resources for Affordable Health Care Act web systems selection, implementation, and optimization is a primary aspect in the successful implementation. Omitting continuous support from trained expertise can result in selecting a system that cannot map and sustain the clinical practices. Vendors can offer some support, however, it is highly recommended to allocate enough resources for the development of “super users” that will emphasize quality maintenance and improvement (Menachemi& Singh, 2012). Furthermore, training personnel can reduce misunderstandings regarding how various functions and records are operated and generated.
Carrying out extensive research on web application tools such as server and database capabilities could improve the adoption and sustainability of the Affordable Health Care Act. Another focus could be the determination of medical necessity. This should be a continuous subject for an organization’s strategy. Health care necessity determinations could be expressively marked by the greatly varied amount of information about actual data that will be obtained as the organization increase its use of Health Information Technology.
Again, in order to realize the full benefit of automated web applications, the organization should thoroughly assess how various elements that support the success of the system will work, create any necessary revised workflows, obtain various input data about the initial settings, and create a process for periodic maintenance and re-evaluation(Menachemi& Singh, 2012). For instance, there are various report alerts that can be overlooked since they are not considered appropriate for the practice, which results in physicians becoming more frustrated with the system and alerts. These issues can be solved by periodically assessing and modifying how alerts are set and identifying what to follow up is suitable for disregarding these alerts.
Conclusion
Electronic applications affect almost all components of health care delivery (Edward and Lynette, 2012). As such it should be seen as a tool to develop health care systems through redesigning and optimizing workflow. Several states and the federal government have experienced technical issues with the Affordable Health Care Act web applications. The implementation has been more than a disaster. However, the core issue is based on developing a web-based health insurance marketplace that can sync up with other systems such as the federal databases.
References
Edward H, and Lynette, M. (2012). Strategies and Priorities for Information Technology at the
Centers for Medicare and Medicaid Services. Washington, D.C: National Academies Press.
Menachemi, N., & Singh, S. K. (2012). Management Issues in the International Context of
Health Information Technology (HIT). Bingley: Emerald.
Phillip L. (2012). The Affordable Care Act and Beyond: Winners and Losers in the New Era of
Healthcare. FTIJournal. Retrieved from http://ftijournal.com/article/the-affordable-care-act-and-beyond.
Thomas B. (Nov. 2013). The Obamacare Crisis. The New York Times. Retrieved from
http://www.nytimes.com/2013/11/20/opinion/edsall-the-obamacare-crisis.html.
Wilensky R. (2012). Perspective: The Shortfalls of “Obamacare.” The New England Journal of
Medicine, 367, 1479-1481. http://www.nejm.org/doi/full/10.1056/NEJMp1210763#t=article