Rural Health and General Systems Theory

Rural Health and General Systems Theory

Rural Health and General Systems Theory

This assessment requires application of a nursing theory based on General Systems Theory and it’s relevance to rural health.


Rural populations face many challenges to receiving the health care they need. Social determinants of health such as living environment, education, access to resources, etc., all influence individual and population health. Often times, when resources are available, other determinants, such as a lack of education or self-care, financial limitations, etc., continue to inhibit care. Numerous nursing theories have developed from General Systems Theory and the idea that the “system” is made up of “subsystems” that must work collaboratively and in harmony in order to work effectively. Neuman’s Systems Model and Roy’s Adaptation Model are two of these nursing models that support the principles of General Systems Theory. For the purpose of this assignment, we will explore Roy’s Adaptation Model and answer the following:

  • Identify 2 major issues faced by rural populations in meeting their health care needs.
  • What specific social determinants of health significantly influence these issues?
  • Identify and describe 3 (out of 10) explicit assumptions of Roy’s Adaptation Model.
  • How do these assumptions apply to rural health?
  • What subsystems facilitate or hinder the overall system’s ability to meet the needs of the rural population?
  • Describe a plan or legislative process (may be one currently under review or recently passed) for improving the “healthcare system” and the potential impact on the rural population.

Make sure you also include a clear, separate introduction and conclusion as a part of this assignment, as these are worth separate points on the grading rubric.

Points:  40 Due Date: Sat, May 1 by 8:00 a.m. Eastern Standard Time (EST) of the US. (Please note: No late assignments will be accepted for Module 5 assessments.)

References Minimum of four (4) total references: two (2) references from required course materials and two (2) peer-reviewed references. All references must be no older than five years (unless making a specific point using a seminal piece of information)Peer-reviewed references include references from professional data bases such as PubMed or CINHAL applicable to population and practice area, along with evidence based clinical practice guidelines. Examples of unacceptable references are Wikipedia, UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases.

Style Unless otherwise specified, all the written assignment must follow APA 7th edition formatting, citations and references.

Number of Pages/Words Unless otherwise specified all papers should have a minimum of 600 words (approximately 2.5 pages) excluding the title and reference pages.

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    2015 – 2020

    Prepared by:

    The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary, United States Department of Health and Human Services




    Over the past five years, our nation has experienced a remarkable transformation in the collection, sharing, and use of electronic health information. Updating the Federal Health IT Strategic Plan 2015- 2020 (Plan) has given us a chance to reflect on our health IT journey. When we released the prior Plan in 2011, adoption of health IT among hospitals and health care providers was in its nascent stages, Affordable Care Act implementation was commencing, and the use of mobile health applications, especially by consumers, were far from ubiquitous. Rural Health and General Systems Theory

    Implementation of the prior Plan created a strong foundation for achieving this Plan’s goals and objectives. Over 400,000 eligible hospitals and professionals participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. This incredible achievement was not easy. Hospitals and health care providers have invested capital, time, and hard work to digitize their patient medical records. This has created a strong demand for the seamless sharing of information across technology systems, information platforms, location, provider, or other boundaries. There is also a strong interest among providers not participating in the EHR Incentive Programs to collect, share, and use interoperable health information.

    With this updated Plan, the federal government signals that, while we will continue to work towards more widespread adoption of health IT, efforts will begin to include new sources of information and ways to disseminate knowledge quickly, securely, and efficiently. The first two goals of this Plan prioritize increasing the electronic collection and sharing of health information while protecting individual privacy. The final three goals focus on federal efforts to create an environment where interoperable information is used by health care providers, public health entities, researchers, and individuals to improve health, health care, and reduce costs.

    This Plan aims to remain flexible to our evolving definitions of health and health care. We recognize that both traditional and nontraditional sources will engender valuable health information. Expectations for our information systems and users of these systems will increase. During the information age, innovation and technological advancements have been difficult to predict. This Plan accounts for how the federal government views our nation’s current landscape and articulates our values and priorities in shaping tomorrow’s landscape.

    I am incredibly grateful for the participation of over thirty-five federal entities who worked in concert to develop this Plan, demonstrating the widespread interest across the government to digitize the health experience for every American. Federal authorities and investments will seek to achieve this Plan’s strategies. However, this is a shared undertaking. Efforts of state, local, and tribal governments, and private stakeholders are vital to ensure that health information is accessible when and where it is needed to improve and protect people’s health and well-being.

    Karen DeSalvo, MD, MPH, MSc National Coordinator for Health Information Technology

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    Health information is accessible when and where it is needed to improve and protect people’s health and well-being


    Improve health, health care, and reduce costs through the use of information and technology

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    Improving the secure availability and use of health information allows individuals to take ownership over their health, partner with their health care providers, and improve their quality of life and health. It strengthens the delivery of health care and long-term services and supports, and allows public health agencies to detect, track, manage, and prevent disease outbreaks. Information also fuels research and innovation, spurring advancements in scientific discovery.

    Health information technology (health IT) allows individuals and health care entities and providers, home- and community-based supports, and public health entities to electronically collect, share, and use health information. The term “health IT” includes a wide range of products, technologies, and services, such as electronic health records (EHRs), mobile and telehealth technology, cloud-based services, medical devices, and remote monitoring devices, assistive technologies, and sensors.

    Federal agencies provide direct care and health insurance, protect public health, fund health and human services for certain populations, invest in infrastructure, develop and implement policies and regulations, and advance groundbreaking research. Given this range of activities, the federal government is also positioned to improve health, health care, and reduce costs through the secure use of information and technology.

    The Federal Health IT Strategic Plan 2015-2020 (Plan) identifies the federal government’s health IT priorities. While this Plan focuses on federal strategies, achieving the vision and goals requires collaboration from state, local, and tribal governments. Efforts by health care entities and providers, public health entities, payers, technology developers, community-based nonprofit organizations, home- based supports, and academic institutions are also essential.


    The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the American Recovery and Reinvestment Act of 2009, requires the National Coordinator for Health Information Technology (National Coordinator), in consultation with other appropriate federal agencies, to update and republish the Plan. The Office of the National Coordinator for Health Information Technology (ONC) released the Federal Health IT Strategic Plan 2011-2015 when the Centers for Medicare & Medicaid Services (CMS) was launching its EHR Incentive Programs and the document was closely aligned with the HITECH Act implementation.

    Since 2011, the health IT ecosystem has changed. As of June 2014, 75 percent (403,000+) of the nation’s eligible professionals and 92 percent (4,500+) of eligible hospitals received incentive payments from the EHR Incentive Programs. Innovation also occurred in mobile health applications and other health technologies. HHS’ 2014 Report to Congress on Health IT Adoption and Exchange highlights federal

    Federal Health IT Strategic Plan 4 | P a g e



    efforts across the government to advance health IT adoption and exchange. Additionally, passage of the Affordable Care Act (ACA) has also directed federal efforts toward ensuring health IT can support higher quality, more affordable care, delivered in efficient ways.

    Strategic Goals, Objectives, and Strategies

    The Federal Health IT Strategic Plan 2015-2020 describes the government’s strategies to achieve five goals:

    Objectives, outcomes, and strategies further define each goal. Outcomes are broken into 3-year and 6-year timeframes to achieve results. Federal departments and agencies listed under each outcome have a role in achieving that respective outcome. That role can include using their authorities and programs to advance progress towards that desired outcome, but may also include the department or agency using health IT while providing direct care or support services. Federal entities will concurrently implement the goals, objectives, and strategies across the Plan, not sequentially working to achieve each goal.

    For this Plan, “providers” is meant to be a broadly inclusive term for health care workers and service providers in all settings – including, for example, acute and ambulatory care, long-term services and supports, post-acute care, behavioral health, emergency medical services, home health, oral health, and end-stage renal disease dialysis facilities, pharmacies, laboratories, and public health entities.

    Federal Health IT Strategic Plan 5 | P a g e



    Successful implementation of the Plan will also mean that health IT is culturally and linguistically sensitive, safe, accessible for everyone (including those with limited English proficiency or with disabilities), intuitive, functional, and provides a rewarding user experience.

    Strategic Plan Development & Update

    To update the federal health IT goals and objectives, ONC convened the Federal Health IT Advisory Council, an internal forum to discuss program alignments for existing and emerging health and health IT matters, to prioritize strategies and define implementation accountabilities within the Plan, and to coordinate federal health IT policy decisions. ONC drafted the Plan in consultation with over thirty-five participating agencies comprising the Federal Health IT Advisory Council. These federal partners encompass broad departmental missions with regulatory, health care provider, payer, human services, and privacy and security responsibilities. Collectively, the Council conveyed a diverse understanding of the unique needs and concerns of their stakeholders to ensure the Plan’s direction would allow for varied approaches and methods to improve individuals’ well-being and advance health IT’s capacity to achieve broad health and care goals. Representative entities comprising the Federal Health IT Advisory Council are included at the conclusion of this Plan.

    Through a framework established for ONC’s federal advisory groups, particularly the Health IT Policy Committee and its Strategy and Innovation Workgroup, ONC will obtain public input and request stakeholder engagement to continue development of the Plan’s content. Additionally, ONC will accept formal public comments on the Plan through February 2015. Based on this feedback, the federal government will release a final version of the updated Plan in 2015.

    Federal partners, in coordination with federal advisory committees, including the Health IT Policy and Standards Committees, interagency groups, and ONC, will implement the Plan and review progress for each goal, including identifying milestones, measurement and reporting tools, and risk mitigation. Each department and agency listed under an outcome will report on progress measures or milestones annually through the Federal Health IT Advisory Council. The participating agencies are committed to continually assessing and maintaining the Plan as a living document that will serve as a basis for future health IT initiatives.

    ONC is also developing a shared Nationwide Interoperability Roadmap to advance the use of interoperable health information. Interoperability is a crosscutting component of this Plan, and implementation of the Roadmap will be necessary to advance the Plan’s goals.

    Furthermore, continued outreach to stakeholders for all the federal partners involved in the Plan’s development and implementation will allow the Plan to evolve as the health IT marketplace matures, subsequently requiring new or modified approaches to policies and federal activities. This engagement will also seek to provide the public with a better understanding of the federal government’s direction to improve health care, individual and community health, and research through the collection, sharing, and use of interoperable health information. Rural Health and General Systems Theory

    Federal Health IT Strategic Plan 6 | P a g e




    Federal agencies will collaborate with one another and with state, local, tribal, and private stakeholders to:

     Focus on value. Federal health IT policy will continuously target solutions that improve health and care quality, efficiency, safety, affordability, and access.

     Respect individual preferences. Person-centered care embraces the value of the individual inside and outside the health system, where all entities honor individuals’ privacy, needs, values, and choices regarding their information, health, and care.

     Build a culture of electronic health information access and use. Federal actions will help establish an environment where secure universal health information exchange and use are expected and accepted so that everyone benefits from simple, timely, equitable, efficient, and appropriate electronic access to and sharing of health information.

     Create an environment of continuous learning and improvement. Federal policies and actions seek to strengthen feedback loops between scientific and health care communities to translate evidence into clinical practice and other settings, and learn how to perform better.

     Encourage innovation and competition. The government’s policies, guidance, and programs will support continued innovation and competition in the health IT marketplace to foster highly useful health IT solutions that lead to better health and care.

     Be a worthy steward of the country’s money and trust. The government seeks to use its resources judiciously. This means relying to the extent possible on private markets to accomplish important societal objectives, and acting to correct market failures when necessary. It also means developing governmental policies through open and transparent processes.

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    Goal Objective

    C ol

    le ct


    Goal 1: Expand Adoption of Health IT

    • Objective A: Increase the adoption and effective use of health IT products, systems, and services

    • Objective B: Increase user and market confidence in the safety and safe use of health IT products, systems, and services

    • Objective C: Advance a national communications infrastructure that supports health, safety, and care delivery

    Sh ar


    Goal 2: Advance Secure and Interoperable Health Information

    • Objective A: Enable individuals, providers, and public health entities to securely send, receive, find, and use electronic health information

    • Objective B: Identify, prioritize, and advance technical standards to support secure and interoperable health information

    • Objective C: Protect the privacy and security of health information

    Federal Health IT Strategic Plan 8 | P a g e

    U se

    Goal 3: Strengthen Health Care Delivery

    • Objective A: Improve health care quality, access, and experience through safe, timely, effective, efficient, equitable, and person-centered care

    • Objective B: Support the delivery of high-value health care

    • Objective C: Improve clinical and community services and population health

    U se

    Goal 4: Advance the Health and Well-Being of Individuals and Communities

    • Objective A: Empower individual, family, and caregiver health management and engagement

    • Objective B: Protect and promote public health and healthy, resilient communities

    U se

    Goal 5: Advance Research, Scientific Knowledge, and Innovation

    • Objective A: Increase access to and usability of high-quality electronic health information and services

    • Objective B: Accelerate the development and commercialization of innovative technologies and solutions

    • Objective C: Invest, disseminate, and translate research on how health IT can improve health and care delivery





    Goal 1: Expand Adoption of Health IT

    The HITECH Act intended to accelerate the adoption and use of health IT. The HITECH Act authorized CMS to provide financial incentives to eligible hospitals, Critical Access Hospitals, and eligible professionals to adopt and meaningfully use certified EHR technology to improve patient care.

    Incentive payments dramatically accelerated broad use of EHRs by hospitals and providers. However, gaps and challenges remain for nationwide health IT use.

    This goal aims to expand health IT adoption and use efforts across the care continuum, emphasizing assistance for health care providers serving long-term and post-acute care, behavioral health, community- based, and other populations ineligible to participate in the Medicare and Medicaid EHR Incentives Programs. In addition, this goal aims to expand the adoption and use of a broader set of technologies, including telehealth and mobile health.

    Digitizing health information collection allows for easier, appropriate sharing of that high-quality, accurate, and relevant information to connect care and empower individuals to manage their health and well-being.

    Federal Health IT Strategic Plan 9 | P a g e



    Objective 1A: Increase the adoption and effective use of health IT products, systems, and services

    To realize information-fueled health and well-being, federal efforts aim to encourage broad adoption and use of health IT solutions across all provider and care settings.

    EHR adoption among hospitals and physicians has dramatically increased since the passage of the HITECH Act, but health IT use remains low among providers practicing in long-term services and supports, post-acute care, and behavioral health settings. It is important to capture electronic health information from all sources in order to obtain a more complete picture of overall health. The use of telehealth and mobile health technologies also remains low. Greater use of these technologies has the potential to significantly impact the quality and cost of care.


    1. Encourage the use of certified health IT products through federal payment policies, contracts, and public and private programs that fund or provide health care and long- term supports and services

    2. Expand the capacity of the workforce to support use of health IT

    3. Establish technical guidance and standards, provide technical assistance, and identify and promote proven practices in the development, design, purchase, tailoring, and deployment of health IT

    4. Encourage the adoption of telehealth and mobile technologies among providers and individuals, focusing on federal programs funding and/or providing health care, in care and payment innovation model initiatives, and those encouraging broadband adoption

    5. Expand the ONC HIT Certification Program to certify products useful for providers across the care continuum

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    Objective 1B: Increase user and market confidence in the safety and safe use of health IT products, systems, and services

    For the nation to collectively move to an electronic health environment, individuals, health care providers, and organizations need confidence that health IT solutions are secure, safe, and useful.

    Evidence suggests health IT improves patient safety; however, health IT products can also lead to medication errors and other adverse outcomes. Additionally, poor implementation or improper use of otherwise safe systems can also lead to adverse outcomes. Clinical and other health providers and individuals must be able to rely on health IT systems to perform safely. Rural Health and General Systems Theory

    Individuals and providers must also have the ability to change health IT products, systems, or services without undue financial burden or the loss of valuable information. The implementation of this Plan, as well as the 2013 HHS Health IT Patient Safety Action and Surveillance Plan and the 2014 FDASIA Health IT Report, will build and maintain confidence in the safety of the health IT solutions, as well as support a competitive and innovative market.


    Support the identification, monitoring, and reporting of complete, precise, and accurate challenges and hazards of health IT design and use

    Integrate evidence on safe use of health IT into health IT certification

    Encourage the application of human factors, health literacy, and user-centered design in the development and use of health IT products, systems, and services Implement a balanced, transparent, and risk-based approach to health IT oversight

    Develop, select, promote, and implement health IT standards in transparent ways that promote competition, foster innovation, and minimize barriers to market entry for developers and users






    6. Promote data portability and interoperability to encourage competition, foster innovation, improve individuals’ and providers’ choices, and reduce barriers to change health IT products, systems, and services

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    Objective 1C: Advance a national communications infrastructure that supports health, safety, and care delivery

    A strong national communications infrastructure is a prerequisite for sharing electronic health information among providers and individuals, delivering telehealth solutions, and using mobile health applications.

    While efforts are underway to bring broadband to all Americans, in rural areas, nearly one-fourth of the population, and in tribal areas, nearly one-third of the population lack access to broadband services. Even in areas where broadband is available, approximately 100 million Americans still do not subscribe. This inhibits the sharing of high-quality data and graphics, such as medical images, and the ability to leverage video telecommunications needed for telehealth. Rural Health and General Systems Theory

    Expanded high-speed wireless and broadband services will support health information sharing and use, support the communication needs required for care delivery, and support the continuity of health care and public health services during public health emergencies and natural disasters.


    1. Use federal authorities and investments to improve access to and choice of broadband and wireless networks

    2. Encourage comparable upload and download speeds for consumers and providers in rural and other underserved communities

    3. Ensure that the national health IT and telecommunications infrastructure are secure, resilient, and operational during public health emergencies and disasters

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    Goal 2: Advance Secure and Interoperable Health Information

    The significant progress in digitizing the collection of health information has increased the demand to securely share health information electronically and use it to improve health and health care.

    Aligning closely with the Nationwide Interoperability Roadmap, this goal aims to stimulate secure and seamless health information sharing and use, advancing the five core building blocks for a nationwide interoperable1 health information infrastructure: core technical and vocabulary standards and functions; certification to support the adoption and effective use of health IT products and services; privacy and security protections for health information; supportive business, clinical, cultural, and regulatory environments; and rules of engagement and governance.

    The ONC HIT Certification Program serves as a valuable mechanism for promoting the use of common standards for interoperability; however, significant work remains. In order to promote consistent standards implementation and reduce implementation variability, the federal government will continue to work with standards development organizations (SDOs) and industry stakeholders to assure that newer versions of standards and implementation specifications more clearly and more often describe discrete requirements. We will also identify and collaborate on the development and deployment of more modular technical standards and specifications for nationwide interoperability that can allow for more seamless transitions to new technology systems in the future. Initially, federal efforts will focus on efficiently addressing prioritized standards that enable sending, receiving, finding, and using a basic set of essential health information. Rural Health and General Systems Theory

    Interoperable health information and health IT solutions will lead to more efficient and effective health systems, better clinical decision support, scientific advancement, and a continuously learning health system.

    1 “the ability of two or more systems or components to exchange information and to use the information that has been exchanged” IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries (New York, NY: 1990)

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    Objective 2A: Enable individuals, providers, and public health entities to securely send, receive, find, and use electronic health information

    Since the passage of the HITECH Act, certain types of health information exchange and use among providers have increased; however, gaps and challenges remain for widespread secure and interoperable health information across health care and long-term supports and services providers, settings of care, individuals, health IT platforms, and payers.

    Interoperable exchange of health information allows individuals, providers, public health departments, and payers to find, securely exchange, and use vital health information, enhancing care delivery, public health, and research, and empowering individuals to make informed choices regarding their health. Rural Health and General Systems Theory


    1. Establish rules of engagement and a governance mechanism related to standards, data policy, and operations, for electronic health information exchange to facilitate security and interoperability across all types of entities and networks that provide exchange services and safeguards for appropriate levels of information access

    2. Work with partners to reduce regulatory and business challenges that impact health information exchange

    3. Promote the coordination of care for individuals across the care continuum through innovative care and payment models, shared care plans, and value-based purchasing

    4. Ensure health IT products and services support the privacy, technical, and vocabulary standards necessary for capturing, finding, exchanging, and using standard health information across the health care and long-term services and supports continuum, and with individuals and public health entities

    5. Encourage electronic information sharing between public and private health providers and payers to promote care continuity

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