The Factors Affecting Electronic Health Record System Implementation - Essay Example

? and Today’s world is fast changing and is becoming more and more digitized. The world is also increasingly becoming data driven and soon the one with the most information will be considered the richest. The medicine world has been on the forefront in embracing this cutting edge technology the latest being the adoption of electronic health record systems. These are systems that will act as physicians’ personal assistants, collating and keeping tabs on a particular patient’s progress health-wise. The program has been modestly rolled out even as the government pushes for its full adoption. This paper seeks to establish some of the factors that affect their adoption and implementation and how they can be navigated. Table of Contents Abstract……………………………………………………………………………….2 Introduction…………………………………………………………………………...4 Team …………………………………………………………………………...6 Change Management…………………………………………………………....6 Project Team Selection………………………………………………………….7 Team Communication………………………………………………………...…8 Process………………………………………………………………………………...8 Planning…………………………………………………………………………9 Workflow Analysis and Redesign……………………………………………….9 Training………………………………………………………………………....10 Technology…………………………………………………………………………......11 Data Preload…………………………………………………………….….….11 Software Selection…….....................................................................................11 Interoperability………………………………………………………………….12 Conclusion…………………………………………………………………………..…12 References……………………………………………………………………………..14 Factors Affecting Successful Implementation of Electronic Health Record System Introduction Today’s world is radically being transformed by digital technology. The digitization process has been spearheaded by the increased value of information. The world is increasingly becoming a data driven world and more decisions are made based on clinically generated information (Holden and Karsh, 2010; Jian et al, 2007). Medicine is one of these enterprises that are information rich and are in dire need of being digitized (Ludwick and Doucette, 2008; Ludwick and Doucette, 2009; Lorenzi and Riley, 2004). According to Pitcher (2010) the seamless flow of information leverages digital progress and helps the country stay abreast technology-wise. Furthermore, this mechanization should revolutionize the quality and efficiency of service provision and ease of accessing medical services (Adams and Culp, 2005; Krumbholz and Maiden, 2001). An electronic Health Record system (EHR) is a system that records individual patient’s information and stores it in a digital format (Adler, 2005; Adler and Edsall, 2007). In theory, this should enable such information to be shared across all health institution included within the system (Miranda, Field and Lund, 2001, Lopez and Blobel, 2009). The EHR contains a wide range of data including; the patient demographic details such as age, race, weight, location and such details, their medical history, immunization history, their past laboratory tests results and much more depending on the institution and the EHR system being used (Steele, 2006; Ebell and Frame, 2001; DesRoches et al, 2008). Adams and Culp (2005) assert that the main purpose of this system is therefore to collate all the information that there is about a particular patient. This should in turn make it easier for physicians to accurately diagnose ailments in future. Apart from that, the system also ensures that the data is presented accurately by having a centralized and standardized way of updating information (Ash and Bates, 2005; Amatayakul, 2007). Despite the remarkable advantages EHR have, many institutions are not keen on adopting and implementing these systems that represent technological reforms (Handel and Hackman, 2010; Ash, Stavri and Kuperman, 2003). Nearly 50% of those who have adopted it have failed to properly utilize it due to the technical challenges of implementing (Adler, 2005; Adler, 2007). This paper will examine the factors that affect their adoption and implementation. The paper will loosely be based on a case study of Parkland Hospital located in Dallas, USA. Presently, it is one of the hospitals that have successfully adopted and implemented the EHR systems (Handel and Hackman, 2010; Holden and Karsh, 2010). However, just like other institutions and organizations that are adopting new technologies, they faced challenges during implemented which they successfully addressed. The factors that affect EHR systems implementation vary from people-related, process-related to technological-related and have been discussed in context herein after. Factors Affecting Successful HER System Adoption and Implementation The US, UK, Australia and Canada are among the pioneers in the implementation of electronic health record systems (Linder et al, 2006; Crosson et al, 2005). Later on, the UK will shelve its systems because the cost-benefit analysis done by the taxpayers was showing negative returns on investment. The US rolled out this project in 2005 and was to be implemented in a 5-year phase (Han et al, 2006; Badger, Basch and Toteja, 2005, Linder et al, 2006). To date, it has been moderately embraced by healthcare providers. A survey conducted in 2010 by Health Care National Watch found out that only 4% of the EHR systems were fully functional, 13% had the basic EHR system, another 13% had adopted it but were yet to implement it, 22% ad plans of implementing it in the future, while 48% had no EHR systems and had no plans of adopting them anytime soon (Holden and Karsh, 2010; Al-Mudimigh, 2010). For Parkland Hospital, the following are some of the factors that influenced and how they were managed; most of them are human-change factors. Team The implementation could not be successful without the co-operation of all the stakeholders who included the government, other health care providers, the Parkland Hospital management, its employees or workers and the patients themselves (Pitcher, 2010; Walker et al, 2006). a) Change Management While there existed other factors that proved detrimental to successful adoption and implementation of EHR systems at Parkland Hospital, resistance to change was certainly the major factor. This fear of moving into the unknown created anxiety and stress and led to resistance, notes Hayes (2007), and Lorenzi and Riley (2003). Resistance is exacerbated by the fact that the stakeholders are a diverse group of people who do not have the same objectives and priorities (Ash and Bates, 2005; Grol and Grimshaw, 2003). If the institution does not use a correct change management model then implementation failure is highly probable. The proposed change management strategy for EHR implementation is the use of Evidence Based Intervention approach. The first step when there is change resistance is usually to communicate and reassure employees and the other stakeholders concerned (Lorenzi and Riley, 2000; Lorenzi and Riley, 2004; Lorenzi and Riley, 2003). The hospital conducted seminars to educate the workers on the need to adopt the electronic models and the benefits that would accrue to each level of management (Al-Mudimigh, 2010; Evstad, 2003). They included demonstrating meaningful use of EHRs so that they can receive more funding under the 2009 economic stimulus package rolled out by the US government. It is also a requirement that all the health institutions comply with this standard by January 2015 (DesRoches et al, 2008; Greenhalgh et al, 2009). It is imperative that the fears of moving into the unknown be allayed lest the whole process is sabotaged (Badger, Bosch and Toteja, 2005; Crosson et al, 2005). Any reluctance, apprehension or outright resistance will lead to failure in implementation. b) Project Team Selection According to Adams and Culp (2005) the second step of implementation is to select a team that will spearhead the implementation. This team should have the organizational or institutional outlook and should be inclusive and representative of all the people that the project will affect (Del Beccaro, Jeffries and Eisenberg, 2006; Keshavjee et al, 2006). The project team size will depend on the size of the institution where the EHR system is being rolled out, the domains and the ability of the personnel chosen to successfully implement the project (Bates et al, 2003; Bingi, Sharma and Godla, 1999). Ideally, the project should be headed by a project manager who may be a physician, a technologist or even an administrator. Under the manager there will be a group of individuals known as the project champions. These should be individuals with the technical know-how to implement the EHR systems project (Ash and Bates, 2005; Ahmad et al, 2002). They act as an interface between the EHR system, the management and the end users who are mostly the frontline workers such as the nurses and the physicians. In this case the implementation committee was chaired by the hospital senior vice president, Mr. Jack Kowitt, who doubles up as the hospital’s chief information officer. The other members were drawn across the board so as to ensure inclusion and representativeness (Handel and Hackman, 2010; Schellhase, Koepsell, and Norris, 2003, Walker et al, 2006). The inclusion was meant to soften any resistance while the active and visible participation by the top management served as an example to the junior employees (Grol and Grimshaw, 2003; Han et al, 2006; Linder et al, 2006). c) Team Communication Having established an implementation committee the next step was to establish a communication channel (Ash and Bates, 2005; Lorenzi et al, 2009). For there to be successful implementation there must be an established communication channel that is authoritative. The communication channel should be accessible to all and should be active providing a constant flow of information a on the progress and other aspects of the projects. This mostly involves conducting regular meetings (Linder et al, 2006; Handel and Hackman, 2010). The team established an office that answered the employees’ questions with regards to implementation and provide directions on the same. Process Texas is one of the federal states that were quick to implement EHR systems. Within Dallas alone there are more than seven EHRs provided by different organizations (Pitcher, 2010; Al-mudimigh, 2010). Parkland Hospital started by installing only two; the Methodist Health System and The Baylor Health Care System. The aim of this health institution was not just to attract more funding from the federal government or to comply with provisions but to streamline its own service provision to its clients (Al-Mudimigh, 2010). The process generally comprises of planning, workflow analysis and design and lastly training (Walker et al, 2006; Lorenzi et al, 2009, Pitcher, 2010). Planning The implementation process should be divided into the pre-implementation, the implementation and the post-implementation phases (Adler, 2005; Handel and Hackman, 2010). Planning falls under the pre-implementation category. The management did the planning in consultation with all the project team members. For a project of significant magnitude such as EHR implementation it is imperative that the planning stage be as inclusive of all the stakeholders as possible (Ahmad et al, 2002; Ash and Bates, 2005). Proper planning raises the chances of the implementation being a success. The planning stage ideally involves budgeting, identification of the EHR system and the vendors supplying them and lastly identifying the risks involved and how they can be mitigated, avoided, accommodated or shifted (Amatayakul, 2007; Houser and Johnson, 2008). In the case of Parkland hospital the budgeted cost was US $ 120 million for the 5 year period with the federal government expected to provide US 70 million towards the same. Workflow Analysis and Design EHR implementation will change the workflow of an organization; the variance of the change will depend on the degree of similarity between the EHR workflow model and the existing model (Jan et al, 2007; Koppel et al, 2005). It is imperative that the EHR workflow be integrated with that already in existence with the redundant, inefficient or inessential parts and procedures removed (Ash and Bates, 2005; Ahmad et al, 2002). This is what is referred to as redesigning. A pilot project may be rolled out so that the effectiveness of the real project can be estimated. This pilot will test referral making, lab test results indicating, chart drawing, prescription writing among other things. An expert was contacted to design the work flow and to handle the technical part of the project just like other projects that require special expertise (Holden and Karsh, 2010; Handel and Hackman, 2010). It included internal networking between the several departments and external networking for example with the public health department and immunization registry among others (Amatayakul, 2007; Benham-Hutchins, 2009). Training Training should be included in the planning phase. It is essential especially for an institution that is adopting a new technological system for the first time. Training helps neutralize resistance to change by employees and is key to successful implementation (Adler, 2007; Krumbholz and Maiden, 2001). Trainees are divided into two groups; the regular users and the super users. The difference between the two categories is that the super users receive comprehensive training and are responsible for monitoring the implementation by the regular users (Adams and Culp, 2005; Adler, 2005). The super users are tasked with assessing how fast the regular users are learning and may be made up of physicians and nurses. Training provided a major stumbling block, over 2500 nurses and other health care providers were to be trained. Doctors required an average of 8 hours while the nurses required 12 hours (Morris and Evans, 2008; Greenhalgh et al, 2009). This is exclusive of the new employees, temporary or permanent, who will join the institution and will require training to maintain their efficiency (Greenhargh et al, 2009; Ash and Bates, 2005). Training is thus a continuous process and not a one-off thing. Continuous assessment of the effectiveness of training should be conducted. Technology Data Preload Data preload is all about transferring of data from the old physical storage system to the digital EHR system. An EHR is an interconnectivity system that relies on networking technology to operate (Fenton et al, 2006; Steele, 2006; Amatayakul, 2007). The technology used to set up the system will influence the choice of network that is used. The choice of network in turn will affect the effectiveness of the EHR by determining the number of functions that it can perform (Keshavjee et al, 2006; DesRoches et al, 2008). A good EHR system should have a good data preload mechanism. It should allow real-time updating and accessing of information; the Methodist and the Baylor health care systems provided this (Pitcher, 2010; Handel and Hackman, 2010). They are based on a centralized remote server that effect the changes made to the records as and when made by authorized portals. Software Selection After adopting a system an organization selects software that best suits them (Holden and Karsh, 2010; Fenton et al, 2006). According to Ash and Bates (2005), the ideal software should be able to store lifelong information, have an interactive graphical user interface, maintain data integrity, have a 24 hours 7 days a week access to patients records, support interoperability and limit access to authorized people only. Parkland Hospital settled for free open source health care software called FreeMed (Al-Mudimigh, 2010; Ludwick and Doucette, 2008). There are hundreds of softwares to choose from. The choice by the selection team should be made in the initial stages of planning. The optimal software has a good usability rating, is reliable, is cost-effective and easy to modify or customize to suit the particular context of that organization (Handel and Hackman, 2010; Grol and Grimshaw, 2003). Interoperability Interoperability refers to the feature of the system connecting with other similar systems. An EHR is meant to provide a platform from where medical personnel can access centralized data. The idea is thus information collating and sharing (Houser and Johnson, 2008; Bates et al, 2003). An organization’s system should be able to connect with a similar organization’s system to create large pool information. The information is supposed to help physicians better diagnose patient’s illness and make better prescriptions (Adler, 2005; Adler, 2007). Interoperability is not only outward looking but inward looking too. The EHR systems should be operable from all the departments of the institution for effective collation and sharing of information (Crosson et al, Koppel et al, 2005). Conclusion EHR systems have revolutionized information storage in the health care sector. It has made information sharing fast and easy and has also enabled easier diagnose of illnesses and conditions (Adler, 2007; Adler 2005). In the US the government is spearheading its adoption through subsidizing the costs of installation and offering incentives to those institutions that are demonstration meaningful use of EHR systems. However, the adoption rate is still behind schedule given the January 2015 deadline (Handel and Hackman, 2010; Greenhalgh et al, 2009). The adoption has mainly been hindered by human-change factors that elicit resistance to change. These factors include co-operation and teamwork, successful planning, designing and training of staff and the right choice of technology. 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