Improving Health Care Services Quality - Research Paper Example

Part II – Literature Review Improving the quality of health care services includes minimal or no waiting for patients who are supposed to be scheduled for treatment at an appointed time. According to Graban, M. (2011, p. 166), hospitals have realized the need for improvements in the system to prevent delays. To arrive at solutions, root causes of delays in following the time schedules should first be identified. Those controllable errors in the process can be corrected by providing a better system. There are many causes of delays in the provision of healthcare of cancer patients. Some of them are as follows: (1) patient cooperation in the scheduling, (2) predicting cancer treatment time, (3) failure of the Oncologist to make prior arrangements for the treatment, such as in “properly sending the treatment order, a problem that consistently occurred 20% of the time” (p.166), (4) failure of the Chemotherapy Center administrators to communicate that problem of not providing the physician’s office about improper arrangements for the treatment, (5) busy nurses due to poor planning of “standard patient-to-nurse ratios” (p.166), (6) mismanagement in the spikes of workload or poorly planned schedules, (7) delayed lab results, (8) sent wrong orders for lab tests, (9) misplaced intravenous bags due to poor organization of materials. At Queensland, the outpatient health services are governed by standards which include utilization of Electronic Media to control medical records of patients (O’Connell, T. 2010, p.4) and to allow authorized physicians to access information for faster provision of services. Contained in electronic records would be the “documentation of all communication with referring practitioners . . . regardless of whether the patient commences an episode of care at that facility” (p.5). However, the standard procedure requires that electronic referrals would have to be sent via secured communication transfer in the web of SWT (Secured Web Transfer) which should have a physician signature or PKI (Public Key Infrastructure) (p.6). The Queensland Government Hospitals also maintains an “Appointment Management Scheduling System” (p.9) which utilizes electronic media approved by management and funded by the Australian government. It holds patient information and schedules each patient for health care appointments. An electronic system of scheduling ensures that all those entitled to health care services will be able to receive their turn to have an appointment with a physician. Furthermore, because information about patients are stored in the electronic database, they can be studied and reviewed for purposes of prioritization in the scheduling process. Thus, at the Queensland Hospitals, the management has directed authorized staff to perform the prioritization of patients and the scheduling. The objective has been to “maximize the number of patients seen within the recommended times and expedite appointments” (p.10). Accountability of staff was established by the standards for appointments setting, to give priority where priority is due and to assist in the maximization of patients served. Processes were defined to ensure compliance with the achievement of standards, for example, auditing of schedules and management reviews. The long hospital scheduling processes were listed from booking to service completion or justifiable removal from the list of scheduled patients (pp. 10-14). At the GE Healthcare worldwide provider of medical technologies, although the company’s goal is to lower cost with the use of Electronic Medical Records (EMR) and ongoing innovations, the other goals include “increase access and improving quality” which also means making it possible for more patients to be served and to render such healthcare services to better satisfy patients with accurate scheduling and timely attendance to patient needs (GE Healthcare [1] 2013). That company has been offering what is called the Centricity Practice Solution (CPS) which is a system that utilizes “EMR and Practice Management software” to improve productivity of hospitals and medical professions (GE Healthcare [2] 2013). One of the uses of its Practice Management module is to produce schedules based on referrals and management authorizations meant to satisfy patients with “effective time management and seamless patient experience” (GE Healthcare [3] 2013). By 2005, the Health Care Service industry realized the importance of tapping the use of EMRs in place of written medical records of patients. Those records were important for the proper provision of health care, and also to serve as basis for reimbursements and research. But according to Wager, K.A. et. al. (2005, p. 112), “numerous studies have revealed the problems with paper-based medical records (Burnum, 1989; Hershey, McAloon, & Bertram, 1989, Institute of Medicine, 1991).” The patient records were mostly not readable, incomplete, and not readily available whenever needed. It takes time to find out the accurate contents by verifying with previous physicians. Thus, Oncologists who are about to serve the patient cannot make quick reviews of the medical history and arrive at accurate analysis and decisions. EMRs changed this situation. Since patient information have become computer-based in the EMR technology, and the data are readable, more complete, and readily accessible, “health care organizations and providers are discovering that EMR systems are needed if they are to more efficiently and effectively deliver health care services” (Wager, K.A. et.al. 2005, p.119). Furthermore, many studies conducted during past 20 years proved EMR to have many benefits including the quality of services, the outcome, the safety factor, cost reduction, improved productivity, improved efficiency, and improved satisfaction. All these benefits were reported to the “Kaiser Permanente Institute for Health Policy” (p.119). In the State of New York, over 55% of physicians in big medical corporations utilized EMR and the system that goes with it. But in smaller medical groups, only 45% used EMRs (Kelly, K.A., et. al. 2008, p.142). Table 1 below shows that as of 2008, only 14.9% of all physicians in NY State had implemented using EMR. But by December 2012, data gathered by Hsiao C.J and Hing, E. (2012) for National Center for Health Statistics showed that 43.5 % of NY State office-based physicians were already using EMR. And on the overall throughout the USA, the trend is towards increasing number of physicians using EMR. See Figure 1 below. Table 1 – Status of EMR Implementation as of 2008 [Source: Kelly, K.A., (2008). Translating Research into Practice: The Physician’s Perspective. A Dissertation for PhD at Albany State University, ProQuest, p. 139 ] Figure 1 – Trend of USA Physicians Using EMR/EHR from 2001 to 2012 [Source: Hsiao C.J and Hing, E. (2012). Use and Characteristics of Electronic Health Record Systems Among Office-Based Physician Practices. United States, 2001–2012. NCHS data brief, no 111. Hyattsville, MD: National Center for Health Statistics. 2012. Retrieved April 5, 2013 from http://www.cdc.gov/nchs/data/databriefs/db111.htm.] This is indicative of the fact that physicians are becoming convinced of the overwhelming benefits of EMR. From only 18.2% in 2001, the percentage of physicians using Electronic Medical Records/Electronic Health Record soared to 71.8% by the end of 2012. 10,302 physicians were surveyed for this discovery to be known. The first priority objective of using EMR was to “ensure adequate privacy and security for personal health information” while the 2nd priority is where quality and efficiency are part of the “15 Mandatory Objectives” (4MedApproved 2013, p.1). The timeliness of health care services falls under the objective that specifically says, “Provide patients with timely electronic access to their health information” (CMS 2010, pp.14 and 17). And in order to understand how all these would lead to improvements in patients’ satisfaction over the scheduling to serve them, one would have to be aware of the different stages of EMR / EHR implementation. See Figure 2 – A Conceptual Approach to Meaningful Use. As can be seen from Figure 2, after Stage 1 wherein data are captured, secured, and shared in a secured manner, there will be “Advanced Clinical Processes” (p.4) which implies having more organized, more accurate, and readily accessible data to facilitate better planning and scheduling based on priorities, standards, and the ultimately desired “Improved Outcome” (p.4). Timeliness of health care services and patient satisfaction are parts of the desirable outcome also for Oncologists. There are many activities and preparations to be able to serve outpatient cancer patients on time, depending on the Oncology specialty wherein the patient was recommended. Those specialties can be in any one of the following: (a)”chemotherapy-biotherapy”, (b) “breast oncology – hematology/oncology”, (c) “radiation – surgical oncology”, (d) “GYN oncology – head and neck oncology”, (e) “bone marrow transplant – cancer genetic counselling”, (f) “prevention and early detection – symptom management”, and (g) “palliative care” (NurseSource.org 2013). Assuming EMR and Stage 1 of the implementation process are done and there is almost no problem with accessibility of customer data as soon as needed, most probably, another software like that offered by GE Health which was called CPS or Centricity Practice Solution, can process the available information according to standard priorities and arrive at the best schedule following the standards similar to those mentioned by Queensland hospital’s policies in earlier paragraphs. Figure 2 – A Conceptual Approach to Meaningful Use of EMR / HER [Source: CMS (2010). Medicare & Medicaid HER Incentive Program: Meaningful Use- Stage 1 Requirements Overview. USA: Center for Medicare & Medicaid Services, p.4] References CMS (2010). Medicare & Medicaid HER Incentive Program: Meaningful Use- Stage 1 Requirements Overview. USA: Center for Medicare & Medicaid Services. Retrieved April 5, 2013 from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf GE Healthcare [1] 2013. About GE Healthcare. Retrieved April 5, 2013 from http://www3.gehealthcare.com/en/About_Us GE Healthcare [2] 2013. Flexibility for Today’s Challenges. Retrieved April 5, 2013 from http://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Electronic_Medical_Records/Centricity_Practice_Solution GE Healthcare [3] 2013. PM Module. Retrieved April 5, 2013 from http://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Electronic_Medical_Records/Centricity_Practice_Solution#tabs/tab0810DA14786042F58D7FD21B1C341EF7 Graban, Mark (2011). Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, 2nd Edition. Florida, USA: CRC Press Taylor & Francis Group Hsiao Chun-Ju and Hing, Esther. (2012). Use and Characteristics of Electronic Health Record Systems Among Office-Based Physician Practices. United States, 2001–2012. NCHS data brief, no 111. Hyattsville, MD: National Center for Health Statistics. 2012. Retrieved April 5, 2013 from http://www.cdc.gov/nchs/data/databriefs/db111.htm. NurseSource.org (2013). Oncology Nurse. Nurses for a Healthier Tomorrow. Retrieved April 5, 2013 from http://www.nursesource.org/oncology.html O’Connell, Dr. Tony (2011). Queensland Health. Queensland Government Centre for Health Improvement Health Policy and Implementation Standard. Vol. 10, pp.1-20. November 23, 2010. Retrieved April 4, 2013 from http://www.health.qld.gov.au/qhpolicy/docs/imp/qh-imp-300-1.pdf . Wager, Karen A., Lee, Frances W., and Glaser, John P. Managing Healt Care Information Systems: A Practical Approach for Health. P.. USA: John Wiley & Sons, 2005, p.120 4MedApproved (2013). Meaningful Use, Stage 1: 15 Mandatory Objectives. Chicago: EMRApproved.com. Retrieved April 5, 2013 from http://www.emrapproved.com/meaningful-use-stage-1.php Appendix Sample Source Read More