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Idea Relax scope of practice laws to explore changing workflows

By Liana Woskie | 01 Dec, 2014

Key to leveraging HIT to drive efficient patient centered care is determining how the introduction of technologies changes the work flow of providers. In other industries, IT has created efficiencies by enabling workers to perform at a higher level than they could previously and fundamentally change jobs. Yet, in healthcare regulatory restrictions around “scope of practice” (while protective in intent) may have the unintended consequence of limiting innovation.

Without the opportunity to experiment with these rules in a safe, patient-focused environment, we may miss an opportunity to improve workforce productivity. An example is the utilization of Community Health Workers (CHWs) to engage in tasks previously done by more highly trained medical professionals. CHWs are often excluded from the formal medical workforce due to scope of practice laws. Yet CHWs' potential to reach high need populations when adequately supported can be immense. Many key activities of CHWs, such as case identification, adherence support and care coordination can be facilitated by HIT (e.g. electronic communication of patient data, referral and opportunities for remote supervision and consultation).

Many pilot HIT projects in the US utilize human resources in a way that isn't sustainable through fee for service funding infrastructure. In FFS, scope of practice is extremely relevant—you can only bill for a given scope of work (or in the case of CHWs, you may not be able to bill for services rendered at all in most states unless you're in a flexibly funded care model, e.g. bundled payment pilot, some ACOs, etc).

Ensuring scope of practice laws are flexible enough that if these pilot projects do work they have a chance of being sustainably scaled will be important to the continued implementation and uptake of innovative approaches.

(Adapted from 2013 Report to the White House Office of Science and Technology Policy)

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A/Prof. Terry HANNAN Advisor Replied at 6:19 PM, 2 Dec 2014

This is a whole new topic for research because what we are seeing are both good and harmful disruptions to clinical workflows. This is predominantly being seen in hospital environments but is very likely that when the “technology and languages” of eHealth for patient engagement are being implemented we will see similar outcomes.

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Joaquin Blaya, PhD Advisor Replied at 9:35 AM, 13 Dec 2014

Liana,
I think this is another great idea which could change the way care is provided, how can we make this happen?

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