Texas Childrens Health Plan - Essay Example

? Outline Summary of Texas Children’s Hospital Executive summary Organization Information Electronic Medical record (EMR) Reasons for the developmentNeeds assessment EMR management and location End users involvement Security and privacy issues Funding for EMR Planned or unplanned downtime Effect of health care reform and related legislation on EMR Innovative Aspects of the System Utilize technological innovations Evidence-based practice References Summary of Texas Children’s Hospital Texas Children’s Hospital located in Houston in the Texas Medical center is one of the country’s biggest freestanding pediatric hospitals. It is a 469-bed children hospital and it operates the Texas Children’s Pediatrics the biggest primary pediatric care network in the country. The hospital enjoys lead ranking in the United States in different service spheres owing to its dedicated commitment to providing excellent pediatric clinical care and research. For instance, the facility was one of the only 12 hospitals countrywide to make its Honor Roll in 2012. The hospital also boasts of having the first Health Maintenance Organization (HMO) for children called Texas Children’s Health Plan in the county. I plan to interview a number of individuals from the facility regarding Electronic Medical Records (EMR) and they include Mark Wallace- President and chief executive officer, Charles Fraser - Surgeon-in-Chief, Shannon McCord-Director of patient service, Mona Jaimee Westfall-Nurse leader, Jessica Emerald- Sergion, and Jennifer Yborra-Billing staff. I am planning to conduct a personal face-to-face interview with the above named persons in order to gain their perspectives about the organizations EMR. In other words, my aim is to analyze Texas Children’s Hospital Electronic Medical Record (EMR) considering that it is one of the major hospitals in the country with EMR. EMR was of interest to me because it is the dominant clinical computing issue in the entire healthcare industry presently. This is due to a number of reasons key among them being the way it has revolutionized patient care and the involvement of the federal government. Executive summary No one can imagine what the future holds for the healthcare industry especially with the trending influence of digital technologies. For instance, currently the entire healthcare industry is engulfed in the issue of digitalizing medical records compared to other medical computing issues. Comprehensive and up to date is not only important for medical purposes but also for strategic planning. Healthcare institutions can effectively use well-documented patient data to map their progress and establish desired achievements. Electronic Medical Records have revolutionized the workflow of various healthcare operators especially with regard to handling of patient records and many more medical facilities across the globe are in the mad rush to adopt EMR to improve efficiency, and safety of care. In the united states the federal government has made it mandatory for healthcare organization to adopt by a particular date (2016) while those facilities and practice demonstrate effective use of EMR are offered some monetary incentives. Texas Children's Hospital made tremendous effort in adopting EMR and a number of reasons motivated the hospitals decision key among them being need to cut high cost of record handling, increased patient participation and safe patient care, support medical research, reduction of medical errors, as well as provision up-to-date clinical information. Other reasons include the need for sharing of patient records, as well as easier and faster access to records. However, before identifying these needs the management of the hospital involved the entire organization in a needs assessment whereby the organization was able to identify its current problems and a comparison was made to desire outcomes. All stakeholders to an EMR ranging from the management team, administrators, billing staff, physicians to clinical technicians were involved in a series of interviews and meets to promote full participation of everyone. The staffs were later trained for implementation of the EMR after a prospective vendor was successful identified. Additionally security measures were put in place in order to protect patient information from unauthorized access and authorized person’s breach of existing security regulations. Electronic Medical record (EMR) An electronic medical record (EMR) refers to an automated medical record that is used in healthcare setup for patient care. EMR have become a significant part of healthcare delivery over the recent past, as most healthcare setups especially in the United States strive to meet the 2016 deadline for universally application of EMR is every medical facility across the country (Spruell, Vicknair, & Dochterman, 2010). In other words, EMR has become synonymous with healthcare practice as the entire world is growing tech savvy in all aspects. The core objective of EMR is to centralized patient records for easier storage, retrieval and modification. It is only through EMR that physicians as well as other healthcare specialist can for instance, record patient’s histories, write prescription, display test results, receive clinical reminders and enter orders with ease. In essence, advancement in technology has made it possible for the electronic medical record (EMR) to eliminate the entire functions of traditional paper based patient care (Stanberry, 2011). The EMR system has improved the physician’s ability to deal with information intensive errands. There is an increased rush to adopt EMR across the United States in response to legislative requirements in particular the Health Information Technology for Economic and Clinical Health (HITECH) Act (Spruell, Vicknair, & Dochterman, 2010). Texas Children's Hospital located in Houston, Texas is one of the major hospitals in the country that adopted electronic medical record (EMR) in the recent past to improve quality, safety, and efficiency of patient care. Texas Children's Hospital, which is currently one of the best children’s hospitals in the country, has streamlined most of its tasks in its efforts to automate management of its patient and this has enabled the facility to deliver highly effective patient care much more efficiently. DesRoches, et al. (2008) assert that the biggest challenge that the healthcare arena has faced for a number of years has been the ability and ease of providing and sharing, relevant, reliable, timely and accessible patient information between members of the healthcare teams. However, since the adoption of EMR in Texas Children's Hospital, healthcare professionals have never had any problem with real-time sharing of patients’ critical information. Clinical and administrative application of EMR The Electronic Medical record (EMR) serves two major purposes, which include both administrative and clinical. As much, as the EMR is highly concerned about patient information it is widely used by physicians as well as other healthcare providers to carry out a number of clinical functions (Kelly, 2010). For instance, clinicians especially doctors use EMR to record patient information and much importantly to issue prescription. ERM allows medical practitioners to capture all patient related information and this makes it easy for nurses to administer physician instructions especially those relating to patent care such conducting test, routine checkup as well as administering medication and doses (Kazley, Diana, & Menachemi, 2011). The fact that EMR ‘provides up to date clinical information and above all fitted with decision support tools makes it easy for the medical practitioners to carry out their clinical tasks effectively. In fact, some EMRs come with smart software that can guide clinician though diagnosis. This type of software are capable of providing diagnosis for a combination of symptoms, signs and test results or make therapeutic recommendations regarding a particular heath problem. For instance, an EMR with a stroke protocol can assist ER doctor to respond to emergency stroke cases swiftly considering that the guide will lead the ER through the recommended treatment plan for that class of patients. The administrative function of the EMR is evident in management and sharing of patient records. EMR provides and effectively platform for storage, retrieval and modification of client information with the organization. The EMR ensures that documents and vital client information is shared appropriate and secured from unauthorized users. This makes EMR an effective administrative tool for vital patients’ information. EMR also supports sharing of client information between different departs within the facility. For instance, clinicians can view lab reports, radiology results and pharmacy report while the same time billing department can link up to all the services render to produce an invoice. Key reasons for the development of EMR There is no doubt that digital technology is radically transforming not only our lifestyle but also most importantly how we work. The seamless flow of technology in the healthcare infrastructure seems to be inevitable in this digital age and the creation of computerized health records in particular EMR (electronic medical records) software is one of such evidence demonstrating influence of technology in workspace. Kelly (2010) elucidates that the paper-based system has been in existence in our healthcare industry for centuries but the gradual entry of computer based medical record into our healthcare system is a sign of new practice in storage, handling, retrieval and modification of patient records. It is evident that the level of penetration of digital technology in the healthcare is yet to match that in other sectors such as manufacturing, finance and retail but it is plausible that the adoption rate is growing at a considerable speed. In fact the US government has learn of the importance of computerizing patient records and it has moved swiftly through the Department of Health and Human Services to provide financial sensitive to medical facilities and physicians that makes “meaningful use” of computerized records by specific dates. Texas Children's Hospital is one of those healthcare facilities that realized great need for electronic medical records (EMR). According to the management, EMR was critical to Texas Children's Hospital capability to deliver not only efficient but also safe, coordinated and high quality patient care. As noted by the management of the facility their reason for adopting EMR was not motivated by the HITECH Act but by other important reasons key among them being sharing of patient records, easier and faster access to records. Other reasons include but not limited to high cost of record handling, increased patient participation, safe patient care, support medical research, reduction of medical errors, as well as provision up-to-date clinical information. This is a clear indication that Texas Children's Hospital was motivated by implementing an automated patient record long enough considering their diverse reasons for adopting EMR. It is plausible that the facility has enjoyed a number of benefits associated with EMR since its adoption and the management is looking forwards to a blissful future. The first key reason for adopting EMR in Texas Children's Hospital was the need to enhance access to patient record especially during emergencies in order to speed up response. Based on its size the facility is prone to receiving large number of emergency health case and effective delivery of services during such cases depends on faster and eases access to patient records. For instance, in the recent year alone the facility had more than 80, 000 visits on its emergency room. Retrieving paper based files proved a toll order even in ordinary circumstance considering that they have to be physically accessed thus leading to delay in care delivery. An automated medical record seemed appealing to the facility considering that it supported centralized storage of medical records in computer system, which makes it easy to retrieve patient records because it is real-time (Harrison & Ramanujan, 2011). The facility realized that they could save more lives if they have access to past patient’s medical history as this facilitates quick decision-making process. Ease of sharing patient information was another major reason why Texas Children's Hospital decided to adopt EMR. Under a paper, based medical team could not share crucial information about the client during or before service delivery. For instance, in a paper based system every medical specialist dealing with the patient raging from lab, radiology, pharmacy to admissions department must record all the services on the paper and send to the other specialist. Additionally, in a paper based system every specialist records and maintain their own chart and this leads to duplication of tests as well as questions to the patient. Texas Children's Hospital understood the effectiveness and efficiency of patient care when information can easily be shared. MacKinnon and Wasserman (2009) elucidate that EMR provides an effective platform for sharing critical client information such blood type, prescriptions issued, radiology reports, existing medical conditions and past diagnosis between multiple physicians in real time thus enhancing quick delivery of services. The facility leaders was in need of a platform where different care providers could have access to patients’ health information simultaneously and get updated data on various tests results and recommendation of other specialists irrespective of their location. The only solution was to adopt an Electronic Medical Record (EMR). The need to increased patient participation in the medical care was another motivator for Texas Children's Hospital to adopt EMR. It is often very expensive and time consuming to make physical follow up about patient’s progress once they are out of medical facility. The hospital wanted to come up with an effective means of enhancing communication with patients while away from the facility in order to maximize patients’ satisfaction. Making follow ups to enquire about children with chronic conditions was realized by the hospital as an important way of motivating parents to continue enjoying hospital services. EMR through its patient portal was considered by the facility as highly important for parents to update information about their ailing children by themselves especially changes in condition. Parents could also use the portal to request for refills of medication, ask questions and book appointments. The need to reduce high cost of record handling especially with paper-based system was good reason for Texas Children's Hospital to adopt EMR. Paper based system was very expensive to the hospital in terms of handling and storage. First, the hospital is required to purchase papers that would facilitate their operations of record taking and the cost comes in storage media that is the file folders, cabinets and storage space apart from the cost of labor. According to Ayers, etal (2009) the massive fragmentation of medical data as patients continue to troop into the hospital increased the cost of handling data considerably because more storage space, folders and cabinets are a major requirement. However, with EMR handling of data tends to be very different from the paper-based system especially when cost is put into perspective. In other words, handling patient information using EMR is least expensive considering that no file folders, cabinets, storage space as well as employees to take care of the records are required. The only thing that matters is computerized storage device and a database that will capture all the digital information. The need to promote safe patient care, and considerably reduce medical errors was another major reason for developing an EMR for Texas Children's Hospital. The facility realized that in a paper based system patients were prone to health risk promoted by lack of information about past medical care administered by other doctors. In paper based system doctors obtain information from clients through question before they make diagnosis and every time a patient sees another physician it is the same routine of question about medical history, currently administered drugs and previous surgery that takes place. It is probable that a client can forget to tell about currently administered drugs and crucial medical history thus risking his/her medical safety. The hospital realized that when doctors have access to and share past and present patient information electronically before making diagnosis they minimize the risk of endangering the life of the patient who may not remember or misrepresent his/her medical condition. Texas Children's Hospital wanted to address cases of medical errors and issue that is a menace in the entire public health. Medical providers are prone to making errors especially in administration of medication owing to illegible notes written by physicians as per a number of studies carried out in the recent past. However, with EMR such medical errors cannot take place because medications are administered electronically and reports generated for everyone in need thus promoting safe patient care (“EMR market 2016”, 2011). EMR are also built with intelligence capabilities, which can easily recognize abnormal results or the impending side effect of a particular prescription on specified symptoms, and for this reason, it provides instant medical alerts and reminders to the physician. This is an important risk management and damage control tool that could be used by Texas Children's Hospital to minimize medical records and consequently promote safe patient care. The need to provide up to date clinical information as well as support for medical research are part of the reason why Texas Children's Hospital adopted Electronic Medical Record (EMR). It is impossible to update paper-based records considering that they are handwritten and they do no leave space for modification (Brooks, & Grotz, 2010). This means that incase the physicians wants to update client information such as change in physical address then he/she has to add a new paper record containing new address in the current folder and this only leads to bulkiness of the patient’s file. Updating paper-based system is also cumbersome considering the time required to retrieve physical folders and add new medical documents manually. Texas Children's Hospital believed in EMR to solve this problem because of the ease and speed of modifying patients’ medical information electronically. Because electronic records are easy to access and additionally data is capture electronically, this makes it easy to modify existing data and enable medical providers retrieve up-to-date patient information (Ayers, etal. 2009). Practice of medicine is a field that has attracted several researches in the past several years. Most of these researches are often geared towards discovering new as well as improving existing care. For instance Texas Children’s Hospital is affiliated with Baylor College of Medicine (BCM) one of the biggest medical research institution in the United States. Patients’ medical information is integral to the success of this research. Paper based system does not support fast analysis of large amount of patient data considering that everything has to be done manually starting with retrieval, classification to analysis of data. However, EMR provides amicable solution to this problem considering that authorized researchers within the organization can easily retrieve patient information based on preferred category, which may include medical condition, physician name, symptoms and date of treatment. This gives them adequate time to concentrate on research rather than manual retrieval of required patient data. Need assessment The management of Texas Children's Hospital carried out needs assessment before developing the exiting Electronic Medical Record. This was aimed at ensuring that the facility maximized on the benefits attributed to the EMR. It is through these needs assessment that the facility managed to determine its list of key needs. No specific tool was applied to carry out the needs assessment however; key stakeholders involved in the process were involved in a series of meetings and interviews. The meeting was meant for a walkthrough of a facility sites and key stakeholders involved in this process include management, physicians, administrators, and nurses. Additional group meetings took place and representatives from every affected sector of the organization were involved in order to gain better understanding of the facility’s needs. A proper documentation of the answers acquired through interviews was made and a final review was conducted to prioritize the needs of the facility. A detailed list of the needs of the facility was presented to the Electronic Medical Record vendors who came up with the final design of the computerized medical record. Texas Children's Hospital did a gap analysis of the practice site and the results were presented to the prospective vendor in order to establish whether the chosen EMR would meet the predetermined needs of the company. The gap analysis assisted the company in identifying the existing difference between the present and the preferred state of practice. Fortunately, the prospective vendor of EMR took time to review the preferred needs of the company relative to their product offering. It turned out that the EMR software offered by the vendor matched every need of the facility and much more importantly, it met the CCHIT certification requirements. This was only affirmed after the vendor provided a demo template and it seemed perfect for key stakeholders ranging from the management team, physician team, nurse leaders to the administrators. In other words all the stakeholders displayed their trust and belief in the delivery of the system and this is how the facility established that this specific EMR could meet its predetermined needs. Management and location of EMR Electronic Medical Record (EMR) is an important part of the overall Texas Children's Hospital management system and it is left in the hands of technologically proficient members of the staff. This group of employees is called super users considering the level of training they receive from the vendors on technical aspect of the EMR system. This group of employees though drawn from different practice areas with the organization did prove to the management of Texas Children's Hospital regarding their technical knowhow about computer systems and operations compared to other end users of the systems, which consist of fellow physicians, nurses and billing department staff before they received specialized technical training about the facility’s EMR. These super users have technical training on how to conduct on site troubleshooting of the system and they are often alert to ensure that everything runs smooth (“Electronic medical”, 2009). The vendors can only come in to correct serious technical problems with the EMR system. Involvement of different stakeholders and training of end users It is noteworthy that every practice stakeholder was involved in the needs assessment process. Texas Children's Hospital recognized the role of each practice entity in successful implementation and operation of the EMR and as such, a team of department interviewers was designed. This team was mandated to have personal conversation with each employee in respective practice sites through either phone call or face-to-face discussion. Meeting was widely used by the interviewer to ensure that the limited available time was used effectively. Key among the stakeholders involved in the development of the development of Texas Children's Hospital EMR include physicians, nurses, billing department, IT department, clinical technicians, and managers. End users were encouraged to make suggestions, relay their thoughts and ideas about their current workflow and desired one. IT is fortunate that some of the stakeholders in the practice site had already come across the EMR system in their previous practice and their contributions were highly valued. This is because they were knowledgeable about care deliver through EMR. Effective training of end users is an integral success factor in the implementation of an EMR system in the medical facility (Reardon & Davidson, 2007). The vendors often come with a wide range of training procedures for the clients to make their choices appropriately. Texas Children's Hospital being a large institution it was a big concern to train all the employees at once considering the work time to be lost. For this reason, the management decided to train all the employees about basics of the new system but in shifts. The employees were later divided into groups depending on their practice areas and the focus was on training them on specific areas of the system, which they were to deal with daily. All training was being carried out within the organization through workshops and classes. The vendors provide several training manuals especially audiovisual demos and detailed instructions, which was important in reinforcing training need. A team of high technologically proficient end users from each practice area was selected for detailed training on the entire aspects of the system. These super users were to be used for proceeding with post-live EMR training especially in reminding those who might have forgotten certain aspects of training. The super users were also trained on how to carry out on site troubleshooting. Addressing privacy and security issues Texas Children's Hospital understand the importance of protecting medical information and the facility has made significant undertakings to ensure that all its electronic medical information not only within the organization but also on the organization website especially the patient portals. All facilities strictly follow clear guidelines with respect to HIPAA security and privacy laws by ensuring that the EMR software has zero gaps for security and privacy breach (Harrington, et al, 2011). The biggest security risk to electronic medical record involves unauthorized access to the system and authorized users violating security regulations. The first initiative taken by the facility to protect medical information involved installing of firewall protection to avoid unauthorized access to facility computer system. The entire pool of authorized users of the system has security code and it changes every 60 days. According to Harrison and Ramanujan (2011), facilities should operate the concept of role based access in the EMR and this means that an authorized user can only perform specific task related to his/her specialization. The fact that organization use online services with patients was considered a major security risk and the facility is using data encryption to provide a safe online interaction platform and patients can make enquiries, correspond with physician through mails, order prescription refills and book appoint without any worry for security breach. Texas Children's Hospital made a bold move in hiring a privacy officer as per the requirement of HIPAA regulations and she doing a plausible role in ensuring that the organization complies with all the HIPAA regulations to the EMR. Funding issues and budget management It is noteworthy that funding for EMR is one of the biggest drawbacks to EMR implementation and utilization not only in the United States but also in other countries (“Electronic medical”, 2009). A facility has to part with millions of dollars depending on the size of the organization to acquire and effective EMR. Texas Children's Hospital is no doubt one of the biggest healthcare facilities in the US considering its diverse departments, hospital visits and large pool of staff. Funding for the EMR was not an easy task to the management and the facility had to combine a wide range of funding sources in order to meet its funding needs. The IT spend on facility’s electronic medical record (EPIC platform) which was fully implemented by the first quarter of fiscal 2012 attracted funding from three major sources which include debt, fundraising and remainder from cash flow. The MD of the entire hospital manages the budge of the facility and coordinates all the financial issues concerning the facility’s EMR. The Facility has not had any political or organizational issues regarding funding for EMR considering that a single head coordinate the project but the contribution of each department has often been taken into consideration. Arrangements for planned or unplanned downtime The management of various institutions understands that at one time all the IT system will go down and this can be planned or unplanned. System downtime is a common occurrence in automated healthcare setup, the leaders of Texas Children’s Hospital are aware of this fact, and necessary policies and procedures have been put in place to deal with both planned and unplanned downtime. How to respond to system downtime was part of the training that was offered to the end user and every stakeholder is up-to-date on how to respond to such situations. The first arrangement for dealing with this challenge involves communication to various stakeholders. This entails all the communication procedures, considering that the staff must be notified in advance regarding the date and time for planned system upgrades or maintenance. The same case applies with unplanned downtime; as all the practice will be notified through the formal communication channel mainly phone calls and emails. Notification of impending downtime is aimed at alerting staff to prepare for necessary adjustment in workflow. Upon notification the scheduling department, billing and all other practice will print out the paper version of forms, charge slips, appointment slips and charts to enable them carryout their tasks effectively without inconvenience. The hospital already has a template of the paper version of the system and it can be printed with easy without making any adjustments. Upon notification of system back up designated individuals will enter all the medical and billing information captured on the papers into the system. Effect of health care reform and related legislation A number of legislations have been passed over the recent past to reinforce reforms in the electronic healthcare systems. Key among these legislations include the Health Information Technology for Economic and Clinical Health Act (HITECH) and the HIPAA security and privacy laws which seeks to entice practice to adopt EMR and address security and privacy concerns of EMR respectively. These legislations especially HITECH has led to significant penetration of EMR in the healthcare sector considering that it comes with penalties for those facilities that shall not have met the deadline for adopting EMR (Spruell, Vicknair, & Dochterman, 2010). I would suggest that more laws should be enacted to cushion facilities from high cost of funding EMR considering that this is the number one barrier to penetration of EMR in the health sector. Innovative Aspects of the System Electronic Medical Record has utilized different forms of technological innovations, which include networking of different hospital departments (lab, billing, radiology, scheduling, and management), online billing, and virtualization which allow a team of physicians to access and share patient records remotely. However, the most credible technological innovation in EMR involves automation of paper based health records. Capturing different forms of paper based health records in healthcare set up is the biggest achievement made in handling of healthcare records. There is no doubt that many technological inventions have been made in medical research but patient information handling has remained unexploited. Texas Children’s Hospital can take advantage of new technological advancements in data management such as cloud computing. With cloud computing an organization will not have to worry about disaster recovery plan, server maintenance and security updates, document control and capital expenditure on networking tools. References Ayers, D., etal. (2009). Adoption of electronic medical records: The role of network effects. The Journal of Product and Brand Management, 18(2), 127-135. Brooks, R., & Grotz, C. (2010). Implementation of electronic medical records: How healthcare providers are managing the challenges of going digital. Journal of Business & Economics Research, 8(6), 73-84. DesRoches, C., et al. (2008). Electronic health records in ambulatory care: A national survey of physicians. New England Journal of Medicine;359:50-60. Electronic medical record technology uptake faces challenges. (2009). International Journal of Micrographics & Optical Technology, 27(3), 4-4. 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