Implementation of EMR System - Term Paper Example

?Implementation of EMR System Table of Contents Table of Contents 2 Introduction 3 EMR implementation process 4 Various points of view 8 Results of interviews & observations 10 Comments on evaluation 14 Summary 15 Reference 16 Appendix 1 17 Introduction Electronic Medical Record System or EMR system is a computerized process of handling and managing patients’ data through an automated system in a systematic manner. The data stored in the system can be shared across the different departments of the organization through network at any point of time. These data ranges from simple patient information to complex diagnosis reports and medication of the patients. It can be a complete decision support system with quality management and reporting method. But this implementation process of the EMR incurs a huge investment for the firm which cannot be afforded by many small scale companies. Government plays a vital role in the investment process to help the hospitals to adapt the system. In the year 1996 the Health Insurance Portability and Accountability Act i.e. HIPAA was passed at U.S to setup rules for the access and storing of patients information and auditing to electronic medical records. These rules set a standard for electronic records which is much more stringent than older paper work records. But there are some concerns about the different issues that arise due to the implementation process. The organization faces several challenges in the implementation process which the company needs to evaluate beforehand for a successful implementation of the EMR system. Identifying the key business areas, selecting the appropriate vendor for the software development and implementing in a tactful manner are most important in the adaptation process. Rapid development in IT industry aided in the reduction of cost for setting up the information system and emerging device compatibility gives great flexibility to access the system. The information stored manually through paper work can also be accessed in a simple manner but this cannot be managed for a huge number of records. Networked EMR gives the litheness to connect the different departments and the laboratory data and prompt assistance can be received from the system in an effective way. Various other features like the e-mail and internet communication allows the specialist to take advice from remote organization or physicians. Storage of drugs and availability of the supplementary health care instruments can be tracked by the system. Lastly the report generation of different situational analysis can also be conducted through the system (Fraser, et.al., 2005, p. 84-85). This report is mainly concerned with the issues which arise in the adaptation of EMR system by the hospital administrator and the features of the different EMR systems available from different vendors. The report also will help in the decision process for selecting the right EMR system for the given hospital. EMR implementation process Why EMR implementation? Implementing an EMR system is not an easy task for the hospitals. Identifying the best EMR and deciding the one to buy are two main questions which arise before the implementation process. Identifying the clinical, administrative and the business needs are the very first step one should consider in the process. When searching for the best system one should understand what the process is all about and what can be the implementation process i.e. proper understanding of the systems available in the market are needed to be evaluated first so that there should not be loss of capital in the investment for the system. Proper knowledge of the systems available and the business process and comparison between the two will help the implementation process much easier. Once the product selection is done the process identification and the analysis can be done and the clinic will surely benefit from that if the right product is selected. EMR system facilitates the processes than if done manually. The analysis, calculation and recording of data about the patient and their information are maintained in an effective and faster manner. Thus the proper use of the computer technology needs a proper understanding of the processes in which it was implemented. The implementation process also includes management of the existing employees. If the human intervention are omitted completely then it can cause disturbances amongst the employees due to the fully automated system as they might feel unsafe with their jobs. Thus planning for managing employees is also a part of the implementation process. Next step is the process identification activity. The important high level processes are first identified and then the personnel involved in the processes are evaluated for improvement of the different processes. All the different processes have few things in common. All have an input system and they all produce an output. They all need some information and have some particular way of evaluation of the effectiveness and efficacy of the system. Let’s say in the process of prescription writing if all the particulars about the diseases, patient information, drugs etc are needed to be written manually then it cost huge time. But on the other hand if the whole process is done through EMR system then all this information can be kept automated and only the required information are filled manually through the system and then can be printed, e-mail or fax them to the pharmacy. If all the processes are carried out in this way then the selection of EMR will be a fruitful decision for the management. A reasonable approach to EMR is done with understanding and breaking the activities of the whole system. There should be separate modules for the different departments and they should be interrelated so that access to other departments can be done at one place with easier access to the patients’ information. The different departments like the Laboratory, X-ray, administrative information, medicines and patient examination records are kept at one place to view anytime in a more convenient way. Selecting vendor Evaluation of the EMR products is not an easy task. With a huge availability of the EMR products it’s very difficult to select the best one amongst the available. But selection of the vendor is not only going through their services alone. It also needs the evaluation of the business process in which it should be implemented. The practice size also plays a vital role in the selection process. If the EMR system is to be installed in a single user environment then it is quite simple to analyze the processes than in a system where it demands multiple users or multiple accesses at multiple sites. With more number of accesses then system should also provide enough security and log procedure for different users. These things are needed to be available from the vendors’ software. The product from the vendor needs to provide both the primary and the secondary requirements of the system. The primary uses like the information directly related to the patient and also the secondary requirements like analyzing data, researches and different diagnostic studies should be processed by the EMR software provided by the vendor. Medication management is also an important aspect which should be maintained in any hospital. Maintaining the medicine list and the allergy list, writing the prescription, automatic alert to the practitioner and automatic drug check are some advanced features which will help the vendors to get an edge over the other for being selected. Laboratory, X-ray reports and Pathology reports are few advanced features are very difficult to include into the EMR system. Automatic downloading of the reports and the test conducted on other department gives a great advantage for the providers as the implementer analyzes these before choosing the vendor that that provides this feature. Redundant test alerts and abnormal test report alert are something which can really attract the hospital to choose the vendor. With more and more decision support system the EMR becomes more complex system and require better manufacturer of the system. Preventive Medicine feature is another issue which is of great demand for the EMR users. Predefined set of protocols for the patients based on their age, sex, and disease and alert system for wrong diagnosis and producing reports for the same can be a very sophisticated system to implement. Other features like easy search engines and communication system through the system if included in the vendor’s EMR system it gives more friendly experience for the user and communication system like using remote access with e-mail, fax and internet facility improves the value of the EMR system to great extent. Successful implementation In order to carry out a successful implementation of the EMR system the company need to evaluate the actually work load of the process which are needed to be performed by the system. Creating a proper project plan is needed to be done to analyze the different processes and for more complex processes the company should discuss with the vendors about the process and set the deadlines and responsibilities for the implementation task. The vendor needs to analyze the whole system and co-ordinate the employees of the company or doctors to eliminate the confusion which might arise from the complex processes. A single point of view is very required for easy understanding of the processes. All the legal paper works like for example destruction of medical records law etc should be performed and design should be in accordance with those aspects. The implementer should buy as much training as needed from the vendors to clear all doubts and understand the whole system so that it can work in a flawless manner. There should be no difficulty for the employees to handle the system due to lack of training as it could lead to serious trouble when implemented. The vendors just provide the training but it’s the personnel of the clinic or hospital who should get the training and work with responsibilities and should be prepared to do the work. Choosing a good hardware is also an important issue to be mentioned. Slow and out dated machine can fell short of memory and might just fail to implement the process in a smooth way. For successful implementation the hospital need to discuss the hardware requirements for the system and setup systems accordingly. The transformation process from paper work to the EMR system needs to be done slowly. It cannot be implemented in a single day. Though the system will not be very easy for the workers at first but with practice it will be more productive than paper work. So the authority should be patient about process. After proper implementation the system should be evaluated regularly and the productivity are needed to be improved from time to time. With successful implementation EMR system can be a very productive instrument for the hospital and improve its quality of service to the care of the patients. Various points of view The advancement in the technology and the improving health care at a low cost gave rise to the implementation of EMR softwares with acceleration from the federal government for adoption. Since EMR implementation process incurs a huge investment it’s not possible for the small and middle sized hospitals or clinics to adopt the system thus incentives are provided by the government to espouse for these organizations. The modern trend towards EMR will become the default system in recent future for practicing medicines. Various other sectors also experienced this kind of transformation like in case of banking and insurance sector the paper based work are now transformed to electronic system for the transaction process. This transformation in delivering services invites several unique challenges for each adopter of the system. The impact of EMR can be recognized on every aspect like people, process and technology. People are resistant to change and this transitional loss in productivity and the disturbances in the services during the change are some common people barriers that are needed to be addressed beforehand. There is a sudden modification in the workflow of the clinical and administrative processes from paper work to electronic implementations. Foreseeing the possible challenges and understanding the documentation of workflow is critical for the implementation process. Technological need is another aspect to be evaluated by the management team. The need of core functionality and choosing the appropriate vendor with the desired technical support should be the focus of the management team while selecting the EMR software. From the quality point of view the EMR system flow need a detailed assessment of the organizations state, clinical processes, available resources, training needs, understanding the possible disruption pre and post implementation. Proper perception will help a smooth transformation and easy adoption of the new system. Implementation is not the end of EMR system. It should also include the evaluation of the additional areas and need to address the outcomes and improve the quality of service with proper assessment of the patient health records. The core areas along with the non-core departmental analysis will help to address issues and avoid certain surprises which can arise at later stage. From the business point of view, if implementation is done is right manner, EMR can derive a competitive advantage for the management in the market with the trouble free environment provided by the system (Cognizant, 2009, p. 4). For a successful implementation the management need to access from the different points of view from the organizational perspective, IT system needs, policies and procedures and from the reporting views. If the assessment if carried out in a meaningful manner it in-turn improves the quality of services, ensures adequate privacy and security for the health department and also improves care co-ordination from the execution. All the departments must be improved for an effective improvement in the whole system and gain the advantage over the manual process of paperwork. EMR system can reduce redundancy to great extent with the automatic processes and minimize the work pressure for the employees but if implemented in a wrong way it can cause fatal error in the whole system. Results of interviews & observations Before signing an agreement to an EMR system the administration should look after several dimensions for a proper selection of vendor and successful implementation process. The authority need to ask several questions before the decision making. The interview conducted consists of the following questions and the respondents view is given on the respective issues in the following section- 1> Does the software improves the system The interview with two IT managers gives an idea of the benefits of the EMR system and its automation within the system is going to facilitate each process of the hospital. There are some features which the hospital would not like to use at present like the communication system within itself. But this can be a helpful tool in future. 2> How the data are populated The data stored manually till date are needed to be converted to the system. The vendor will give the support of transforming the data into the system at certain cost but it will take some time for the vendor to record electronically to the new system from the papers. 3> Can the software be used before purchasing A prototype of the software can be designed with few features of EMR to test the software and its features to understand the system. This demo version will cost little for the authority but will give a better understanding of the system. 4> Do you comply with all federal and Health Insurance Portability and Accountability Act Privacy and Security Rules All the security and the modular approach of the software comply with the laws of HIPAA standards and the vendors will guarantee with an agreement about the privacy issues and its authorized certificates by ONC and ATCB. 5> How the EMR system licensed The software is licensed in two ways. If it is used as a single user for a single machine then the company will license for a single computer. If it is used in a network for multiple machines then it should be licensed accordingly otherwise it will not work for many users. The license can also be done for using online under the site license facility from both the vendors. But both the vendors are charging a huge amount for the multiple licensing programs than the single use program (Meyers, 2001). 6> What are the different facilities for licensing the product The license programs are done on separate modules like licensing for billing, patient records or some other modules of the system. With separate license the owner will be able to use the features of the different module fully. The authority also has the option for separate modular licenses which they need. The first vendor interviewed provides customized licensing but the second one provides license for the whole system. But on the other hand customized licensing also incurs a much more investment for the system than the single licensing program from the second vendor. 7> Technical support facility from the vendor All the vendors provide technical supports for the EMR system. But the point to consider in this case is how the support is provided. Vendors who provide support 24X7 are more preferable in this type of issues as at some point of time it can be a very critical situation regarding patient support if the system fails to function and technical support are not provided for hours. Both the vendors provide 24 hrs a day support for their customers. 8> Cost of technical support The vendors provide support free of cost for the first one year and then with an amount of 15 percent of the cost of the software the first vendor provides support to the system. While the second vendor has a yearly support scheme with a voucher purchase of certain amount for certain number of supports. 9> Hardware support required for the system The hardware support for EMR system is a vital issue which the company should look after before buying the system. Both the vendors suggested updated systems for the implementation process. 10> If the system is needed to be replaced how the data stored will be retrieved All the data stored will be kept secured into the database and even if the software license are not extended after it get expired then both the vendors provide the option of accessing their data in view mode only to check their already entered data into the system. 11> How to get the training for using EMR The vendors provide training support for the users of the system for about 3 months. But for the first vendor the training are provided at vendors place where as in case of the second vendor the trainings are provided onsite which is a good option for the authority to cut cost of travelling for the people who will be trained. Also the second vendor gives online training if required by the people. 12> Type of warranty for the system Both the vendors have strong warranty policy. They will provide defence and also will pay damages if any problem occurs. This is an important issue which the company should look after to get maximum benefits in case of emergency (American Medical Association, 2011, p. 1-5). Comments on evaluation The interview conducted with the two IT managers who are the vendors of the EMR softwares gives a clear idea about the software functionalities and the feature set of their systems. From the available options when we evaluate the features both the parties almost provides with the same type of services but the things which draws the line in the buying decision is their support system and license policies of the different companies. If the hospital needs all the modules to be licensed then the second vendor is more suitable for the company as they provide whole system licensing at lower cost. But if the hospital doesn’t operate in all the departments then it will cost more for the company to buy the customized version of the software from the first vendor. With a future plan of expansion into other departments the company should buy the whole licensed system if they can meet the expenses for the same. For the cost of technical support also the second vendor is more apposite for the company as they provide technical support scheme voucher for their customers. Whenever required the company can buy more voucher and avail the services. On the other hand the first vendor provides technical support at a rental of 15 % of the cost of software yearly which can be a loss for the company if no support required during the period. The training facility also the second vendor is more convenient as they provide the training onsite. The travelling cost of the employees of the hospital can be cut down by the authority if the training is provided at their own place and also the employees will feel easier to adopt the system at their own system than learning at different location. With more user friendly environment the process of learning will be faster for the people and the vendors can also be able to understand the system if any problem arises in the process. Thus after the evaluation process we can see that the features available are almost the same for both the vendors but the extra facilities from the second vendor are more convenient for the hospital to adopt their EMR system than the one provided by the first vendor. Summary The uses of EMR system are growing rapidly in developed countries with the belief that it can improve the quality of the health care to great extent. But the major challenge is to decide which EMR system is to be adapted. Promising ideas don’t make a system to work but it should be validated in the field properly to get the real benefit from the system. The use of telemedicine and new laboratory report result and monitoring patients’ data system are widely used within EMR and improve the accuracy and reduce the redundancy in the information management of patient diagnosis. The whole process is done in a very cost effective manner and improves the overall quality of patient care system. But while implementation of the EMR system there are several issues which the hospital need to evaluate beforehand. The organization should choose the EMR which was designed keeping in mind the long-term objective and vision of the hospital. The data models from small to large clinics are different in many respect thus same system cannot be implemented to all the business processes. Customizable system can sometimes be more effective for the processes in an organization. Without adequate knowledge of the business process there can be loss of resources and money for the company. Thus proper understanding of processes and allocation of resources with accurate learning and development with post evaluation and feedback system is the key to the success of EMR system (Fraser, et.al., 2005, p. 93). Reference American Medical Association, (2011). 15 questions to ask before signing an EMR/EHR agreement. Retrieved on June 16th 2011 from: http://www.ama-assn.org/resources/doc/hit/emragreement.pdf. Cognizant, (2009). Cognizant’s Point of View. Retrieved on June 16th 2011 from: http://www.cognizant.com/InsightsWhitepapers/WP_EHR.pdf. Fraser, et.al. (2005). Implementing electronic medical record systems in developing countries. Informatics in Primary Care. Volume 13. Pp.83-95. Retrieved on June 17th 2011 from: http://www.globalhivmeinfo.org/HIS/Annotated%20Bibliography/Article%201d.pdf. Meyers, J. (2001). Electronic Medical Records: 10 Questions I Didn’t Know to Ask. Retrieved on June 16th 2011 from: http://www.aafp.org/fpm/2001/0300/p29.html. Appendix 1 Questionnaire Name: _______________________ Place: ________________________ Organization: _________________ 1> Does the software improve the hospital management process? 2> How the data are populated into the system? 3> Can the software be used before purchasing it for testing? 4> Do you comply with all federal and Health Insurance Portability and Accountability Act Privacy and Security Rules? 5> How the EMR system is licensed? 6> What are the different facilities for licensing the product? 7> What type of Technical support facility we will get from you? 8> What is the cost for providing Technical support for the system? 9> What kinds of Hardware support are required for the system? 10> If the system is needed to be replaced how the data stored will be retrieved in future? 11> How to get the training for using EMR system? 12> What type of warranty does the company provide for the system? Read More