The Major Concerns of Each Clinical Head - Article Example

? Health Level Seven International (HL7) Letter John Jones As the informatics director of our facility the COO has tasked me to prepare the following report entailing my plans for modernization of communication and technology. You are well aware that Toledo Medical Center is a 300 bed rural facility in the pine woods of east Texas, providing outpatient and inpatient medical care for roughly ten thousand people, as well as the more recent but fast growing innovation of ambulatory (in-home) nursing services. Since my hiring I have observed the work of various departments (admitting, laboratory, pharmacy and clinical) and concluded that all seem to operate efficiently based upon current standards. However, they all also function as separate entities with their own systems. Various mandated changes looming on the horizon will not allow this practice to continue, for communication and cooperation between departments is essential. Therefore, the COO has made that my major function and the following are my recommendations for doing so. Discussion First, I will present background information as to why these changes are so necessary. President Bush signed Executive Order 13335 in 2004 mandating that Electronic Health Records (EHR) will be in place nationwide within ten years. Congress went a step farther, creating the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH), and President Obama signed it into law. The act extended the deadline to 2015 but that is only two years away. After that, health facilities such as Toledo stand to lose millions of dollars in Federal Medicare and Medicaid monies if they are not in compliance. All would agree that would be a serious financial blow to our center. Fortunately, the Department of Health and Human Services (HHS) has created the HIT coordinator to help us navigate through the seemingly complex maze of regulations (HHS, 2013). There is a nonprofit organization called Health Level Seven (HL7), which has developed a series of standards generally accepted by both the health community and HHS and it is the intention of Toledo to comply with HL7 initiatives. Yet Corepoint points out that HL7 is a “non-standard standard” (2009) meaning that as no two snowflakes are alike, neither are any two healthcare facilities the same. The main point is that Toledo complies with the laws within the specific timeframe and conformity with HL7 standards will ensure this occurs. Much time and money has spent on developing the software currently utilized by Toledo’s various departments and I do not intend to dismantle any of their operations. Rather, it is my recommendation that we purchase new hardware that can accommodate all of the departments’ current software systems. Interfaces take into account the lack of interchange between clinics and are commercially available, improving communication and interoperability. That is where HL7 comes into play. Without it, my staff and I would be forced to create said interface from scratch, a costly and time consuming process. Fortunately, HL7 V2 brought together software vendors and informatics specialists such as me to create said commercial products. Although V3 has largely superseded V2 in Europe, it will be some years before that happens in the United States, so Toledo will concentrate on V2 compliance. One of the major concerns of each clinical head is maintaining patient and provider privacy, still another requirement of Federal law. Therefore, it is tantamount that the interfaces provide the security necessary to ensure only the necessary information for patient care be provided across Toledo’s health informatics network. There is a very interesting case study concerning Lake Forest Hospital in Illinois (CDW 2013), which was faced with the same dilemma, In addition, when the clinics interfaced, the physicians and nurses had many passwords for the different clinical access (one for lab results, one for pharmaceutical, etc.). It is my intention that the interface chosen for Toledo will be as painless and easy for staff ass possible, as well as providing ultimate security. The thumbprint and Access Card technology utilized by the US Government and many businesses would be secure and a cost effective measure. As CDW pointed out, Lake Forest’s IT staff spent a good measure of their time resetting passwords. Corepoint offers another very impressive white paper concerning which interface to purchase, while giving its pitch for its own interface software. I will say of the many vendors I explored in preparing this paper, that the company has impressed me with its advantages and detailed technical explanations on its software application. Of course, it is up to Purchasing to decide whether to solicit bids or do a straight purchase. Yet I will list some of the advantages of Corepoint, straight from its website (2013). 1) My office will have an administration console so that each interface will be monitored for operability. 2) HL7 V2 is supported wholeheartedly. 3) Corepoint furnishes derivatives so that standards deviations (as discussed above) are implemented as needed. 4) Emergency and high volume times (such as the current the flu pandemic) would be handled efficiently without bottlenecks. Although the clinics can still utilize their current software, it is my opinion that Toledo’s hardware is relatively antiquated and must be replaced in order to maintain increased traffic and workload required by the interface system. Information is spotty at best concerning specific informatics hardware requirements, although Iguana (a large interface vendor) recommends a processor of 3.47 GB Pentium I7, 24 GB of RAM, and at least a 3 TB Hard Drive (Iguana 2013). By the way, Iguana’s major disadvantage is that is uses a Linux Operating System. Corepoint and most other interface vendors utilize the Microsoft Server OS and are Windows friendly. Therefore, I recommend we transition to the server and workstation environment, also purchasing a redundant server for backup purposes. On its website (2013), Dell purports to be committed to HIT and EHR and claims to gear their servers to the healthcare industry’s needs, even preloading their servers with such requirements as EHR software as necessary. Their Power Edge servers seem to offer all of what Iguana noted as the minimum hardware necessities and come with the added features of growth flexibility. Throughput would be increased while still maintaining clinical integrity. With Windows Server software and two year maintenance agreements, two T420 servers could be purchased and installed for less than five thousand dollars. It would not be advantageous to implement the new system hospital wide at once, as it would for a certain necessitate closing the facility, not an option. Since the admitting department is responsible for almost every facet of the hospital’s functions (including administrative and finance), I therefore propose that department transition first to EHR and HL7 standards. This stands to reason, since admitting also has a subsection devoted to hospital records. When the implementation is successful, further integration will happen in the order determined by the COO and board. I feel that healthcare providers would embrace technology, for flipping through cumbersome paper medical records trying to find patient info is no doubt frustrating. Conclusion The loss of Federal monies for Medicare and Medicaid would be a huge financial loss for Toledo, one that we can ill afford. Although it has not been specifically threatened, lack of compliance would also spell the end of hospital accreditation. Therefore, it is absolutely essential that we become HIT and EHR compliant well before the 2015 deadline. With implementing the changes I have listed above, I am confident that Toledo will survive and thrive in the electronic world presented to us. New technologies will probably mean far less stress for the providers and they can then spend more time treating their patients, ensuring their health and safety, Toledo’s number one concern. References HHS (2013), Regulations & Guidance, Retrieved from: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__regulations _and_guidance/1496. Corepoint (2009), The HL7 Evolution, Retrieved from: http://www.corepointhealth.com/sites/default/files/whitepapers/hl7-v2-v3- evolution.pdf. CDW (2013), Two hospitals. A single OneSign™ solution, Retrieved from: http://www.cdw.com/content/solutions/case-studies/security/lake-forest- hospital.aspx. Corepoint (2013), HL7 Interface - Corepoint Health, Retrieved from: http://www.corepointhealth.com/products/hl7-interface. Iguana (2013), HL7 Message throughput is a critical metric for interface engines, Retrieved from: http://www.interfaceware.com/HL7-Message-Throughput.html. Dell (2013), Data Center virtualization, Retrieved from: http://content.dell.com/us/en/healthcare/virtualization.aspx. Read More