Health Care Delivery

In 2009, the American Law on Rehabilitation and Reinvestment included provisions for creating incentives for the adoption and meaningful use of information health information technology (HIT). ARRA strengthens standards to maintain the confidentiality and security of health information. ARRA provided grants to help state and local governments, as well as health care providers, in their efforts to implement and use HIT. The CMS also provided incentives within the ARRA to encourage hospitals and health care workers eligible for assistance to become "meaningful users" of certified EHRs. The definition of "meaningful use" was developed by the HHS Secretary through formal rulemaking procedures, providing an opportunity for the participation of the public and professionals. Appropriate use targets are likely to continue to be specified, but to outline the basic requirements that should be included in each EHR. By adopting these recommendations, users will be eligible for federal incentive payments and will be able to report information on the clinical quality of care. States can add or modify additional targets for this definition for their Medicaid programs.

A recent article in the New England Journal of Medicine sums up the meaningful use criteria as follows: "the use of providers to achieve significant improvements in treatment". Given the nature of patient data collection, nurses will be an integral part of proper collection of meaningful use data. For example, among the first set of criteria to be measured include patient demographics, vital signs and lists of patient diagnoses, allergies and active medicines. As the EHR becomes more sophisticated and integrated, nurses will be able to help identify additional meaningful uses.
Consequences for time and place of care

Care, supported by interoperable digital networks, will depend on the importance of time and place. The patient / consumer does not always have to be in the same place as the provider, and the provider does not always have to interact with the patient in real time. Because EHR, computerized doctoral order recording systems, laboratory results, imaging systems and pharmacies are linked to the same network, many types of care can be provided regardless of location, since the "care grid" is available anywhere and anytime.

Monitoring of the remote patient expands exponentially. A constantly growing array of biometric devices (for example, permanent heart monitors or blood sugar) can collect, monitor and report patient information in real time in any institution or in the home. Some of these devices can also provide direct digital support-mediated care; Automated insulin pump and implantable defibrillators are two examples.

The consequences of these events for care of patients will be significant and not yet fully understood.