A Road Map to Achieving a HIMSS level 7 EMR for Metro Hospital - Essay Example

? Making the way Roadmap to achieving a HIMSS level 7 EMR for the Metro Hospital by 2025 Report to Metro Hospital Executive Board, Brisbane (May Cover page Image Url: http://static.zooomr.com/images/8159354_e5e20e07d4_o.jpg Instructions You have recently been employed as the Director of Informatics for the Metro Hospital in Brisbane. The Metro Hospital is a 363 bed facility on the North side of Brisbane. The services include general surgical, general medical, oncology, vascular, ear, nose and throat, palliative care, ophthalmology and maternity and children’s services. It has good links with the Division of General Practitioners in the local area. Your mandate is to lead the hospital to achieve level 7 of the HIMSS EMR Adoption Model by 2025. As a Health Informatics Professional, you took the job for this reason as you have always wanted to work in a fully electronic environment. You are certainly driven to achieve it. Using the below points, outline how you intend on achieving this. Outline what you would do in your analysis and planning when you first start; Articulate your strategy and timeframes to reach ‘fully digital’ status; What technical factors would you need to consider when building your Electronic Health Record and why are these important? HINT: standards, terminologies? What systems would you use to support your strategy? What types of resources would you employ? How would you govern and manage the project? What risks do you see? How does your strategy align with that of Queensland and that of Australia? Format 4,000 words in length in. Use a business report format with each topic presented as a section in your report. You need include only one reference list for the entire report. Proper and consistent academic referencing convention both within the text of the assignment and a compiled list of references at the end of the paper must be provided. References Style: APA Abbreviations & Acronyms Abbreviation/ Acronym Expansion Explanation EMR Electronic Medical Record Contains current and historical patient information eMAR Electronic Medication Administration Record CDS Clinical Decision Support Provides reminders and best-practice guidance for treatment CDR Central Data Repository Repository of information. Includes computerised physician order entry (COPE) COPE Computerised physician order entry (HIE) Health Information Exchange HIT Health information technology Used interchangeably with EMR systems HIMSS Healthcare information management systems society EMRAM Electronic Medical Record Adoption Model HITECH Health Information Technology for Economic and Clinical Health OACIS Open Architecture Clinical Information System Roadmap to achieving a HIMSS level 7 EMR for the Metro Hospital by 2025 Section 1: Background This report delineates a road map to achieving a HIMSS level 7 EMR for Metro Hospital, Brisbane by 2005. Healthcare information management systems society (HIMSS) level 7 identifies the ultimate level of electronic medical record capabilities “full digital status” depicting a paperless electronic medical record (EMR) environment (himssanalytics.org, 2011). The process of achieving the Stage 7 being long, which have to pass through eight stages, and a higher stage can be awarded only after a lower stage is achieved successfully; even if the Stage 7 is achieved by 2025 would provide a significant edge to Metro Hospital. The accomplishment would indicate that Metro Hospital is providing high quality patient care with interoperable electronic medical record in place (HIMSS Analytics, 2011). This status will offer the Metro Hospital the recognition that the hospital has been working in a collaborative work environment wherein the entire organisation has invested its effort towards achieving a more integrated, safer and more efficient way of delivering care to its patients, using information technology (HIMSS Analytics, 2011). The report will demonstrate analysis and planning for achieving full digital status, by clearly articulating the strategies to be adopted and timeframe to reach full digital status. It will also delineate the technical factors that are to be considered while building the electronic health record (EHR) explaining why these are important. The report will also describe the systems that would be used to support the strategy and the resources to be employed. The details of governance and management of the project along with the risks therein will also be covered. Finally, it will delineate a discussion on how the adopted strategy aligns with that of Queensland in particular and that of Australia in General. Section 2: Vision for the EMR 2.1 Vision Due to the impending demise of the results-reporting system support available with the current legacy system, Metro Hospital is exploring the options for introducing an enterprise-wide EMR with full digital capability by year 2025. The IT vision of Metro Hospital would achieve HIMSS Stage 7 EMRAM award by 2025. 2.2 System components In the mature EMR framework, the system will comprise five major dimensions such as (1) capability, (2) pervasiveness, (3) adoption, (3) information exchange and (4) overall automation. Within the EMR maturity framework, these five dimensions will be supported by a number of sub-dimensions, which can indicate an organisation’s overall EMR maturity. The dimensions and the tentative sub-dimensions are placed below. 1. Capability a. CDR b. Order management c. Medical management d. Clinical documentation e. Patient administration f. Report and analytics 2. Pervasiveness a. Inpatient b. Owned/Affiliated Physicians c. Common physicians d. Consumers 3. Adoption a. Inpatient b. Owned/Affiliated Physicians c. Common physicians d. Consumers 4. Information exchange a. Standards b. EMR Platform Certification c. Physicians, consumers, Ext to Physicians/Consumers 5. Overall automation a. Clinical process optimisation b. EMR system workflow optimisation c. Paper reduction Figure 1: Components of HIMSS. Source: 2009 Accenture EMR Study A description of a few selected medical information terminologies are placed at Appendix 1. 2.2.1 System Integration As hospitals are among the most complex organisations, comprising of many different units, each of which are standalone businesses by themselves; each department has its own technology needs. Sometime, the CIOs has to manage as much as 100 or more applications (HIMSS Enterprise Information Systems Steering Committee, 2008). A list of other applications used in hospitals is placed in Appendix 2. The objective is to achieve integration and interconnectivity between various systems in use along with EMR. For implementing EMR the Dorenfest IHDS+ DatabaseTM will be used. 2.2.2 What will it do? Healthcare information management systems society (HIMSS) level 7 will identify Metro Hospital with the ultimate level of electronic medical record capabilities “full digital status”, depicting a paperless electronic medical record (EMR) environment (himssanalytics.org, 2011). This implies that “the hospital no longer uses paper charts to deliver and manage patient care and has a mixture of discrete data, document images, and medical images within its EMR environment” (himssanalytics.org, 2011). Some of the expected advantages and benefits of the EMRAM would be: 1. Decreased time for test results 2. Remote access to imaging 3. Virtual rounds on patients 4. Improved access to another physician 5. Better documentation in all areas including accurate billing and reimbursements and far fewer denials. 6. Dictation savings, which can be up to $1,000 US per physician at current rates. 7. Fewer medication errors. Reports of medication errors can be dropped by 80 per cent. 8. Patient portal. The patient portal can allow thousands of patients of Metro Hospital to schedule appointments, check for test results, e-mail questions or concerns to their physicians and access parts of their own medical records. They can also access their own electronic health records. 9. Improved screening. The improved screening can reduce such MRSA infections up to 70 per cent, partly due to an inbuilt alert in to the EMR that promoted nurses to do the screening. 10. Enhanced communication among physicians. For instance between primary care physicians and specialists (HIMSS Analytics, 2011). 2.2.3 What will it offer? When the Metro Hospital is awarded with the level 7 status, it is imperative that it uses clinical data warehouses to analyse patterns of clinical data to improve quality of care and patient safety. Besides, it has attained the capability to share standardised electronic transactions (i.e. CCD) with all the entities that are authorised to treat the patient. Also, it has the capability to transact with other non-associated hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients in a data sharing environment. The hospital need to demonstrate summary data continuity for all the services it provides, for instance, inpatient, outpatient, ED, and with any owned or managed ambulatory clinics. 2.3 Critical success factors for the EMR To understand the critical success factors, it is essential to understand the barriers to implementing HIT. A 2010 HIMSS CIO Leadership Survey brought out that the greatest barriers to implementing HIT are: 1. Lack of adequate financial support (close to 25 %) 2. Lack of staffing resources (over 15 %) 3. Vendor inability to deliver product (10 %) 4. Difficulty in end user acceptance (over 5 %) 5. Lack of time commitment from clinicians (5 %) 6. Lack of time top management support (close to 5%) 7. Lack of common data standards (close to 5%) 8. Lack of interoperable systems (close to 5%) 9. Constrains at a regionals (close to 5%) (Webb, 2010) Figure 2: Barriers to implementation of HIT. Source: 2010 HIMSS CIO leadership Survey. In a survey of Experiences of Senior IT executives at HIMSS Stage 7 Hospitals conducted in 2010 indicate that the top five success factors are: 1. Training is integral to success 2. Communicate expansively to get everyone on board 3. Cater to the caregivers 4. It’s all about the patient 5. Get the right people at the table Earlier, the 2009 Accenture EMR study revealed the following findings that are critical to success in EMR implementation: 1. A consistent, simultaneous, and sustained focus on multiple dimensions of success, including clinician adoption, from the start 2. A well-defined strategy that is visibly supported and led by executives and clinician leadership 3. Significant focus and investment early in the program in clinical process and technology standardisation 4. An ability to demonstrate continuous improvement in the management and delivery of care as a direct result of improved data, information, and clinical knowledge derived from a mature EMR solution (Webb, 2010). Section 3: Analysing the current situation (500 words) 3.1 Review of current status of informatics Metro Hospital, Brisbane is located at the North side of Brisbane city, the Metro Hospital with a significant capacity of 363 bed facility, this hospital is presently meets medical requirements of the local population. The current staff position at Metro hospital is as follows (Medical Architecture Planning System, 2007): Staff category Number % of Total Staff/Bed ratio Physicians 251 17.4 % 0.7 Nursing 472 32.7 % 1.3 Paramedics 205 14.2 % 0.57 Administrative 179 12.4 % 0.5 Technical 100 7 % 0.28 Domestic 237 16.5 % 0.66 Total 1444 100 % 4.01 With good links with the Division of General Practitioners in the area and an array of medical services such as general surgical, general medical, oncology, vascular, ear, nose and throat, palliative care, ophthalmology and maternity and paediatrics, Metro Hospital serves an important cause in the society. 3.2 Current status of IT specific aspects Metro Hospital’s current core clinical information system is primarily an in-house developed legacy system, with results review provided through the open architecture clinical information system. Presently, it has interfaces to current technology ancillary systems such as IDX-Rad in radiology and SunQuest in the laboratory. The present system conformance is highly manual and redundant. Besides, they are highly interfaced, with limited integration lacking real-time clinician performance monitoring. Consequently, there is no significant integration among these information systems at Metro Hospital. In addition, presently, there are no digital documentation systems for outpatient care, and only a partially automated legacy system is available in the inpatient setting. Section 4: Aspects critical to supporting an EMR 4.1 Minimum functional requirements At the outset, the EMR system at Metro Hospital must address some minimum functional requirements (1) basic demographic and clinical health information; (2) clinical decision support; (3) order entry and prescribing; (4) health information and reporting; (5) security and confidentiality; (6) exchange of electronic information. 4.2 Aspects critical to supporting an EMR While supporting and EMR, several technical factors critical to need to be considered. Firstly, the integration of issues among business and clinical systems and standards, coding elements, well defined interfaces, intraoperability along with interoperability and resources (HIMSS Enterprise Information Systems Steering Committee, 2008). A survey conducted by CIOs of HIMSS (2008) revealed that with time the number of interfaces would continue to grow. Secondly, there has to be a need to consolidate with just one clinical vendor. Thirdly, enabling the physicians to adopt would be a key factor in driving integration and connectivity. Other factors critical to HER adoption would include technical project management issues, documentation management, wireless and mobile capabilities along with supply chain issues (HIMSS Enterprise Information Systems Steering Committee, 2008). Another important aspect would be total cost of ownership. The goal should be to select a technology so that the TCO can be minimised, while meeting minimum operational and functional standards (I-Tech, 2010). Wherever possible, it is intended that open source technology platforms will be used. Overall interfacing and integration would be the most important issues that needs to be addressed through such enables as standards-and systems-oriented architecture; integration with a single core vendor; physician leadership; value and cost; and establishing interfaces for HIE and interoperability packages. 4.3 Standards To ensure effectiveness, several information management practices needs to be implemented which are delineated by the following standards: 1. ISO /TR 20514: Health Informatics – Electronic Health Record – Definition, scope and context 2. ISO/TS 22220: Health Informatics Identification of Subjects of health care 3. HL7 Electronic Health Record – System Functional Model, Release 1 February 2007 4. ISO/TS 18303: Health informatics — Requirements for an electronic health record architecture 5. CCHIT Certified 2009 EMR Certification Criteria Section 5: Roadmap for achieving HIMSS level 7 by 2025 To enable achieving HIMSS level 7 by 2025 successfully, a comprehensive implementation and management plan covering all phases of EMR implementation shall be developed by Metro Hospital. The EMR implementers shall identify a suitable in-house EMR implementation team guide the implementation process. A reputed vendor also will be recruited to assist in the process. To minimise service interruptions, a phased approach to EMR rollout will be adopted. The implementation team will also plan for a post-implementation review within a reasonable time after rollout of EMR. The following is a roadmap for the sequencing of the implementation plan. 1. Ancillaries – Lab, Rad, Pharmacy; all installed 2. CDR, Controlled Medical Vocabulary, CDS, Document Imaging, HIE capable 3. Nursing/clinical documentation (flow sheets), CDSS error checking, PACs available outside Radiology 4. COPE, Clinical Decision Support (clinical protocols) 5. Closed loop medication administration 6. Physician documentation (structured templates), full CDSS (variance and compliance), full R-PACS 7. Complete EMR CCD to share data; data warehousing; Data continuity with ED, ambulatory, OP Table 1: Gantt Chart for HIMSS EMR adoption schedule for Metro Hospital Stage Objective for developing cumulative capability 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 1 Ancillaries – Lab, Rad, Pharmacy; all installed Level 7 Certification year 2 CDR, Controlled Medical Vocabulary, CDS, Document Imaging, HIE capable 3 Nursing/clinical documentation (flow sheets), CDSS error checking, PACs available outside Radiology 4 COPE, Clinical Decision Support (clinical protocols) 5 Closed loop medication administration 6 Physician documentation (structured templates), full CDSS (variance and compliance), full R-PACS 7 Complete EMR CCD to share data; data warehousing; Data continuity with ED, ambulatory, OP Based on US EMR Adoption Model. Source: (himssanalytics.org, 2011) Section 6: Implementation Plan (500 words) 6.1 Implementation Goals The following EMR implementation goals are worked out to achieve HIMSS level 7 EMR. 1. Select EMR vendor 2. Redesign new care delivery paradigms 3. Implement a variety of the EMR applications, including the entire revenue cycle suite 4. Train end users 5. Select a team to maintain, enhance, and optimise its EMR platform 6. Enhance “meaningful use” of the system 7. Achieve HIMSS Level 7 Status 8. Achieve Hospital and Health Networks “Most Wired” Status 9. Select a Health IT team with responsibility to a. Virtualise IT platform b. Enhance and optimise all of its IT applications c. Establish a VIP help desk that serves all its clinicians with single call resolution of IT issues d. Enhance clinical processes and deploy new capabilities, including business intelligence, health analytic tools, and patient-centred technologies It is expected that Goals 1 to 4 may take up to seven years. While Goal 5 to 7 may take as much as 4 years; while for goals 8 & 9, three more years are likely to be required. The implementation design is placed in the figure below. Figure 3: Metro Hospital Goals to achieve HIMSS level-7 EMR implementation 6.2 Implementation plan It planned that the EMR adoption Model is based on the lines of US EMR adoption model. A detailed description of the activities under each objective is placed at below: Table 2: HIMSS level 7 EMR Implementation plan with activities and likely achievements during each level Stage Objective for developing cumulative capability Activities and likely achievements 1 Ancillaries – Lab, Rad, Pharmacy; all installed Major ancillary clinical systems are installed. This is a preparatory phase for the next stage. 2 CDR, Controlled Medical Vocabulary, CDS, Document Imaging, HIE capable Major ancillary clinical systems feed data to a clinical data repository (CDR) would provide physicians access for retrieving and reviewing results. The CDR contains a controlled medical vocabulary, and the clinical decision support/rules engine (CDS) for rudimentary conflict checking. Information from document imaging systems may be linked to the CDR at this stage. The hospital is health information exchange (HIE) capable at this stage and can share whatever information it has in the CDR with other patient care stakeholders. 3 Nursing/clinical documentation (flow sheets), CDSS error checking, PACs available outside Radiology Nursing/clinical documentation (e.g. vital signs, flow sheets) is required; nursing notes, care plan charting, and/or the electronic medication administration record (eMAR) system are scored with extra points, and are implemented and integrated with the CDR for at least one service in the hospital. The first level of clinical decision support is implemented to conduct error checking with order entry (i.e., drug/drug, drug/food, drug/lab conflict checking normally found in the pharmacy). At this stage, some level of medical image access from picture archive and communication systems (PACS) is available for access by physicians outside the Radiology department via the organization’s intranet. 4 COPE, Clinical Decision Support (clinical protocols) Computerized Practitioner Order Entry (CPOE) for use by any clinician is added to the nursing and CDR environment along with the second level of clinical decision support capabilities related to evidence based medicine protocols. At this stage, if one patient service area has implemented CPOE with physicians entering orders and completed the previous stages, then this stage has been achieved. 5 Closed loop medication administration The closed loop medication administration environment is fully implemented. At this stage, the eMAR and bar coding or other auto identification technology, such as radio frequency identification (RFID), are implemented and integrated with CPOE and pharmacy to maximize point of care patient safety processes for medication administration. 6 Physician documentation (structured templates), full CDSS (variance and compliance), full R-PACS Full physician documentation/charting (structured templates) is implemented for at least one patient care service area. Level three of clinical decision support provides guidance for all clinician activities related to protocols and outcomes in the form of variance and compliance alerts. A full complement of PACS systems provides medical images to physicians via an intranet and displaces all film-based images. 7 Complete EMR CCD to share data; data warehousing; Data continuity with ED, ambulatory, OP The hospital no longer uses paper charts to deliver and manage patient care and has a mixture of discrete data, document images, and medical images within its EMR environment. Clinical data warehouses are being used to analyse patterns of clinical data to improve quality of care and patient safety. Clinical information can be readily shared via standardized electronic transactions (i.e. CCD) with all entities that are authorized to treat the patient or a health information exchange (i.e., other non-associated hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients in a data sharing environment). The hospital demonstrates summary data continuity for all hospital services (e.g. inpatient, outpatient, ED, and with any owned or managed ambulatory clinics). Source: (himssanalytics.org, 2011). 6.3 Resource requirement for project The implementation project will be divided into four phases such as (1) preparatory phase, (2) implementation phase, (3) transition phase, and (4) review phase. Apart from budget, the resources required for the project will be undertaken as follows: Facility EMR readiness requirement comprising assessment of Trained personnel; Desired infrastructure; Adequate security, support and maintenance protocols, and systems, and; Accessible management support. HR requirement. The HR requirement will be governed by The size of implementation The functionality implemented in the EMR system How those functions are to be performed (workflow) and by whom The infrastructure requirements – hardware, networking, and Internet connectivity etc. The vendor agreement – some vendor systems will come with a support agreement. Section 7: Governance Keshavjee et al (2006) state that success of IT projects and forms of IT deployments depend upon how well it is governed. “Governance refers to senior management’s activities or substantive personal interventions in the management of the EMR implementation. Governance concerns with mission, vision, and top management’s behaviour related to pre-implementation, implementation and post-implementation of the EMR (Keshavjee, et al., 2006, p. 986). The EMR implementation programme at Metro Hospital will be governed in three different dimensions as (1) people, (2) process, and (3) technology. Figure 4: EMR implementation governance issues will be dealt with at Metro Hospital in three dimensions – people, process, and technology Governance of the EMR implementation project will be guided along the three dimensions as suggested by Keshavjee et al (2006) in all the three phases of implementation. For instance, during the pre-implementation phase issues such as the following will be addressed: (1) setting vision, mission, and objectives; (2) assigning role and responsibilities; (3) communicating benefits; (4) managing attitudes of people involved in the programme; (5) making preparedness assessment; (6) addressing barriers to implementation; (7) involving multiple stakeholders; (8) choosing the software carefully; (9) addressing data-preload and integration issues diligently; and (10) judging the technology usability factors carefully. During the implementation phase, Metro Hospital’s EMR programme implementation will address such governance issues as: (1) workflow and redesign, (2) training, (3) providing assistance in implementation, (4) providing support, (5) getting feedback and continuing dialogue, and finally (6) maintaining privacy and confidentiality. Similarly, in the post-implementation phase, the governance of the project will consider such aspects as (1) providing technical support and maintaining business continuity; (2) addressing concerns of all the user groups; and (3) incentivising the programme. Figure 5: EMR project governance during pre-implementation, implementation, and post-implementation phases Section 8: Likelihood of success and identification of risk 8.1 Likelihood of success Since the beginning of 2009, the HIMSS Analytics Stage 7 Award has been honouring hospitals achieving the highest electronic medical record adoption model (EMRAM) level. According to a report by HIMSS Analyst, by the end of November 2010, there were only 52 recognised hospitals in the US from a database of more than 5,000 hospitals with Stage 7 award. However, EMR implementation still faces daunting odds. It is estimated that nearly half of EMR implementations fail, resulting in considerable financial losses, lost opportunities for improved patient care and causing significant anguish for implementers, clinicians and senior managers (Keshavjee, et al., 2006). However, with fool proof planning and solid ground work, and taking cue from hospitals both that have succeeded and that have failed, there is sufficient reason to believe that the implementation in Metro Hospital will succeed. 8.2 Programme risk As Keshavjee et al (2006) the EMR implementation programme obviously runs financial risk, and the risk of lost opportunities. Thakkar & Davis (2006) identified from a US national survey of respondents that using electronic health record (EHR) system can have multiple risks such as (1) privacy of data (access control); (2) inaccurate patient information due to periodic and not real-time updates; (3) EHR system being unavailable due to technical problems due to downtime, (4) security of data; (5) legal issues; (6) staff not seeking other information due to over reliance on HER system; and (7) patients finding out things about their condition that may frighten them (Thakkar & Davis, 2006). The respondents in Thakkar & Davis’ study ranked these risks in the following order. Risks of Using an EHR System Table 3: Risks of using EHR system as ranked by respondents. (Thakkar & Davis, 2006) Risk Mean Rank Privacy of data (access control) 4.63 Inaccurate patient information due to periodic and not real-time updates 4.34 EHR system being unavailable due to technical problems (i.e., downtime) 4.31 Security of data 4.29 Legal issues 3.82 Staff not seeking other information due to over reliance on EHR system 3.78 Patients finding out things about their condition that may frighten them 2.88 While the risks discussed above, the EMR implementation at Metro Hospital is likely to face additional challenges such as: situations arising due to multiplicity of screens, options, and navigational aids. Further, there are likelihood of problems with EMR usability; steep learning curves may degrade existing workflow. 8.3 Benchmarking success The 2010 EMR Support Benchmarking Study conducted by Accenture (2010) which followed up on 2009 EMR maturity Study and collected benchmark data from a variety of organisations with mature EMRs. The data was supplemented with CIO interviews and other benchmark data. The study indicated that the three most concerns with the EMR implementation are: 1. Shortage of capital 2. Shortage of qualified resources 3. Lack of vendor readiness The study also indicated that on average, hospitals increase the number of IT FTEs/bed by ? 160 % and require a different type of support. Besides, on average the IT operational expenses as a per cent of total operational expenses by roughly 80 % as organisations support a mature EMR. Further, high performing hospitals design their analytics strategy early and /or have dedicated clinical analytics resources (Webb, 2010). Section 9: Conclusions/Recommendations 9.1 Conclusion Achieving HIMSS level 7 EMR implementation is a major evolution for Metro Hospital, which would steer the course of action for the hospital and define its clinical processes for many years to come (McDowell, Wahl, & Michelson, 2003). Besides, EMR implementation itself is a journey. Hospitals those which have achieved level 7 demonstrated that the real work begins after ‘going live’. But the irony is that these successful hospitals have invested heavily in clinical and operational goals optimisation, enhancements, and developing a “new breed” of IT staff that are (1) clinically/operationally aware i.e. they understand clinical operations as well as the applications; (2) customer-centric i.e. they solve real world problems in real time; (3) analytic-focused i.e. they measure and monitor. However, there are many stakes to overcome, which include hard-to-find human resources, particularly in the current market. Moreover, there may not be economies of scale for small/medium hospitals such as Metro Hospital. 9.2 Recommendations The following recommendations are made: Allocation of adequate budgetary provisions Direct management involvement and support Identifying a suitable vendor Identifying the IT workforce, which needs to be able (1) create value, (2) should have clinical IT skills, (3) need to work with a focus on clinical and operational results, (4) and need to be able to leverage highly skilled workforce across multiple clients. Appendix 1 Technologies in use in Healthcare Table 4: Other Technologies in Health Care. Application Type Key Constituent Technologies Business Office Patient Billing, Patient Registration, Patient Scheduling, Credit / Collections, Electronic Claims Financial General Ledger, Account Payable, Enterprise Resource Planning; Material Management Human Resource Payroll, Time and Attendance, Personnel Administration, Benefits Administration Decision Support Cost Accounting, Flexible Budgeting, Case Mix Analysis; Executive Information System, Outcomes and Quality Management Managed Care Premium Billing, Eligibility, Contract Management Medical Charts Master Patient Index, Abstracting, Encoder, Transcription, Chart Tracking/Locator, Dictation, Chart Deficiency Clinical Applications Cardiology, Emergency Department, Surgery, Intensive Care (Critical Care), Nurse Staffing, Obstetrical, Order Communication / Results, Point of Care (Medical/Surgical Bedside Terminal) Source. Dey, A. K. (2009). Managing Information Technology Integration and Implementation in Healthcare Supply Chains. Retrieved May 27, 2011, from conservancy.umn.edu: http://conservancy.umn.edu/bitstream/51955/1/Dey_umn_0130E_10356.pdf, p.123. Appendix 2 Description of Clinical Information Technology (Refer Appendix 1) Source: (Dey, 2009, pp. 124-130) Laboratory Information System An application that manages the functions within the laboratory, the system receives patient information from registration system and reports laboratory results to nursing station units. The system must have functions such as specimen collection, quality control, automated instrument interfaces, and other aspects of laboratory management. Pharmacy Information System The focus of this application is to meet the administrative needs of the pharmacy and does not include pharmacy dispensing. The system provides functions such as patient medication profiles, drug interactions, dosing calculations, inventory control, and narcotic control. This system provides screening for a variety of drug alerts including drug-drug interactions, food-drug interactions, allergy alerts, therapeutic duplication, correct dosing, and dosage ranges. Radiology Information System This application specifically automates functions in the radiology department. The application must provide some of the following: order processing, permanent patient history index maintenance, film storage and location, transcribing and distributing results, prep instruction cards maintenance, appointment scheduling, and management reporting. Clinical Data Repository This is a database that integrates clinical data from several systems into one central repository so that data relationships can be examined and reported. The application includes an easy-to-use front-end interface to manipulate data views and the application is intended to provide long-term (lifetime) storage of clinical data. Clinical Documentation An application that allows nurses to create, modify, and evaluate patient care plans, producing appropriate documentation for patient charts. This application can also produce task lists by skill level for each shift. Clinical Decision Support An application that uses pre-established rules and guidelines and integrates clinical data from several sources to generate alerts and treatment suggestions. This application also produces physician clinical activity, physician cost and clinical utilization comparison, and clinical guidelines/protocol or standard of care exception reports. Medical Records Imaging An application that enables the storage of information electronically, the system includes electronic storage of patient paper charts, x-rays, images, scanned documents, etc. Medical records imaging does not include microfiche. Picture Archiving and Communication System (PACS) This application is a storage solution that automates images for multimedia review and clinical diagnosis. Features of this system include digital image retrieval, routing, and display. The system is integrated/interfaced to radiology and cardiology applications. Computerized Physician Order Entry (CPOE) System CPOE refers to a variety of computer-based systems of ordering medications that share common features for automating the medication ordering process. Basic CPOE ensures standardized, legible complete orders by only accepting typed orders in a standard and complete format. Almost all CPOE systems include or interface with a CDSS (Clinical Decision Support System) of varying sophistication. CDSSs may include suggestions or default values for drug doses, routes, and frequencies based on a predetermined guideline or rule. CDSSs can also perform drug allergy reminders and corollary orders or drug guidelines to the physician at the time of drug ordering. Patient Billing System An application to automate inpatient billing and discharged accounts receivable. The application automates billing and collection procedures daily, providing timely information in areas such as posting and audit, billing receivable management, and revenue and management reporting. It may also provide outpatient billing. Patient Registration System An application that automates the hospital’s patient registration functions in an on-line, real-time mode. The system includes on-line census, pre-registration, patient history, and patient admission, discharge, and transfer (ADT). This must be more than an order entry system. Patient Scheduling System This application coordinates scheduling of all the provider components and flags conflicts with other appointments. It may include preparation requirements, staff workload lists, and patient care notifications. Credit / Collections System An application that manages the collection of billed services and bad debt. This application may automatically produce letters for overdue accounts and record collection data and terms of payment. Electronic Claims System This application electronically sends insurance claims from the provider to the insurance company. In some cases, the provider is also paid electronically. Medicare and other claims are sent directly to the health care system via modem or terminal. General Ledger This application automates general ledger accounting and provides the information necessary for financial analysis and planning. This application may include budgeting, cost allocations, consolidations, and on-line entry, update, and inquiry. Accounts Payable System This application provides control over cash flow with specific information on disbursement and invoices. The application includes on-line entry, inquiry, and reporting capabilities. Enterprise Resource Planning System An enterprise-wide business management system that integrates all administrative facets of the business, including human resources, payroll, materials management, supply procurement, accounts payable, general ledger, and/or patient scheduling. The system also provides an integrated view and reports on information from all areas. Materials Management Information System This application enables hospitals to better manage and negotiate vendor relationships and more effectively manage internal hospital inventories. This application may include purchasing, receiving, inventory control and distribution, bar coding, electronic order entry, and multi-location stock management. Payroll Information System An application that manages payroll processing, keeps records of all employees for timely compensation payment, and processes employees’ paychecks. Time and Attendance System An application that automates the collection, processing, and reporting of employee hours, the functions of this system include real-time data on employee absenteeism, tardiness, total number of hours worked, and scheduling. Many of these systems also interface with the payroll system for paycheck processing. Personnel Administration System An application that manages administrative functions so that employment history can be seen easily including application tracking, salary administration, continuing education credits, employee health requests, evaluation history, and position tracking. Benefits Administration An application that manages human resource benefits including defined contributions, defined benefits, flexible benefits, and health and welfare plans. Cost Accounting System An application that attempts to match the exact cost of specific resources utilized with the associated revenue generating services. For example, supplies, costs of physical facilities, specific procedure costs, etc. Flexible Budgeting System This application accommodates different budgeting styles and permits budget revisions to reflect business fluctuation. Examples of fluctuation are acquisitions, divestitures, staffing cuts, etc. Case Mix Analysis An application that provides integrated information from ADT (Patient admission, discharge, and transfer), utilization review, patient billing, and medical records abstracting used to monitor and understand the mix of patient types and patient services provided. Executive Information System A specific application that provides sophisticated software tools to integrate, process, and present data to executives in an easy-to-learn and user-friendly format. An executive information system integrates and presents existing data but typically does not create data. An executive information system may provide facility utilization, staffing ratios, or revenue and profit figures. Outcomes and Quality Management An application that provides a clinical data set utilized in monitoring overall performance, efficiency, cost, and quality of clinical care by analyzing, comparing, and trending information of detailed clinical practice patterns and parameters. Premium Billing System This application automates managed care invoicing for both individual subscribers and employer groups. Features include determination of correct premium amounts and assignment of premiums and automatic adjustments for new subscribers. Eligibility System An application that allows on-line verification of participation in managed care organizations by members and groups. Features of this application include communication to obtain complete historical and demographic information on members, including benefit plan, deductible, co-payment, and primary physician information. Managed Care Contract Management Information System This application allows organizations to track and manage the contracts they hold with managed care organizations. Contract management allows providers to review contract terms prior to the provision of services to maximize profitability. Features include identification of covered and non-covered services, pre-authorization requirements, and other prerequisites to treatment. Master Patient Index An application to maintain an on-line master list of patients treated in a specific health care organization. Information maintained includes admission, registration, and discharge dates; all the data pertinent for re-registration; and capabilities to avoid/correct duplicates. Abstracting An application that facilitates the collection and maintenance of coded patient information with selected patient demographic and clinical and admissions data from the medical record. This is usually performed post-discharge. This information can be used for internal control, analysis, regulatory reports, etc. Encoder An application that enables medical record technicians to determine and assign ICD-9-CM and CPT-4 codes on-line and provides complete and accurate codes and code modifiers. Transcription System An application utilized in translating dictated or recorded subject matter to an electronic narrative document. Chart Tracking / Locator System This application monitors current and previous chart location histories. Chart Tracking may additionally monitor the status of requests for records. Dictation System This application captures, stores, and makes voice-originated information available for referral. Chart Deficiency System An application that monitors the completion status of a patient’s chart and length of time a record is delinquent before chart completion. Deficiencies in charts may also be classified into levels of severity. Cardiology Systems This application specifically automates functions in the cardiology department. The application must provide some of the following: order processing, permanent patient history index maintenance, image and EKG tracing storage, transcribing and distributing results, prep instruction cards maintenance, appointment scheduling, and management reporting. Emergency Department An application that identifies and collects data and reports on the patient care interactions for the entire emergency department visit. Surgery Information System This application specifically automates the functions of the surgical suite. The application also automates scheduling of surgical cases; produces schedules and case records; generates daily, monthly, and year-to-date statistics; provides inventory control; and maintains a permanent database pertaining to staff members, rooms, procedures and capital equipment. Intensive Care (Critical Care) System Entry and display devices in the intensive care unit that can be computer terminals, portable handheld units, or wall mounted units. The opposite of this would be to have terminals at the nurse stations. Nurse Staffing System This application automates decisions about staffing, nursing stations, and scheduling nurses’ time. This may include functions that enable a hospital to quickly review and generate its nurse scheduling; adjust staffing and scheduling based on patient volume, acuity, and staff ability; keep records for budgeting; produce management reports on productivity and census; and maintain records on personnel qualifications. Obstetrical Systems Also called Peri-natal, this application gathers, records, and reports patient information across the continuum of care for the entire birthing process from labour and delivery, pre-natal through recovery. Order Communication / Results An elementary version of order entry may include significant levels of results reporting. This application includes the entry of patient care orders, communication of these orders to ancillary departments, and the collection of patient charges for entry into the accounting system. This must be done in an on-line, real-time mode. More extensive systems may also provide extensive results reporting capabilities. Point of Care System (Medical / Surgical Bedside Terminal) This application allows nursing personnel to record data into the system at the patient bedside. References A. Bower, TheDiffusion and Value of Healthcare Information Technology, Pub. no.MG-272-HLTH (SantaMonica,Calif.: RAND, 2005). Chaiken, B. P. (2003). Clinical ROI: Not Just Costs Versus Benefits. Journal of Healthcare Information Management, 36-41. Davis, M. W. (2005). The State of U.S. Hospitals Relative to Achieving Meaningful Use Measurements. 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Communications of The ACM - CACM, 51(11), 140-144. Webb, K. (2010, November 10). Supporting your EMR in the era of meaningful use. Retrieved May 27, 2011, from www.himss.org: http://www.himss.org/content/files/MiddleEast10_presentations/LS6_KipWebb.pdf Read More