Electronic Medical Record System - Case Study Example

Introduction and scope This is a proposal of an electronic medical record system in tertiary hospital which is still working using paper records. Every hospital has a mission to provide quality health care for the patients that visit them. To make this possible, there are various things that need to be in place. For starters, the availability of information and the ease of retrieval of records is a must have if a health facility is to be efficient. Much of the ill health, disease, premature death, and suffering we see on such a large scale are needless, as effective and affordable interventions are available for prevention and treatment. In recent years there has been noticeably more attention on building the capacities in of health systems as a means to improving health outcomes. For example, the last G8 presidency focused on this issue, as have recent studies by the World Health Organization (WHO). In addition, development partners including the World Bank and others have stepped up their efforts in this area (Wilson, 2003; Chin, 1998). The proposed system will help in the computerising of operations at the hospital. The system will not replace the work of the health support staff since the two methods of capturing data will happen concurrently. Data entry staff can be employed to capture the paper records into the system and the health professionals can continue using their physical medical files to capture information which will then be entered at a later date into the system. Project outline business case - purpose & rationale The world is currently experiencing a shift in the global health agenda from an emphasis on disease-specific approaches to a focus on health system strengthening. Among the major factors postulated to support this shift, is the growing recognition about the difficulties that health system weaknesses present in achieving the Millennium Development Goals (MDGs). Problems in health system performance are considered major causes for the delays in achieving key targets of the health-related MDGs—those related to child mortality (MDG 4), maternal mortality (MDG 5), and the prevention of HIV/AIDS, malaria, and other diseases (MDG 6) (Grimson & Hasselbring, 2000). The WHO has among its top priorities, the strengthening of health systems to enable achievement of health outcomes. In its framework for action, WHO defines a discrete number of “building blocks” that make up the health system. These are based on the functions defined in World Health Report 2000. The six building blocks are: 1. Service delivery; 2. Health workforce; 3. Health information system; 4. Medical products, vaccines and technologies; 5. Health financing; and 6. Leadership and Governance and leadership (stewardship) (Raghupathi, 2002). Sound and reliable information is the foundation of decision-making across all health system building blocks, and is essential for health system policy development and implementation, governance and regulation, health research, human resources development, health education and training, service delivery and financing (WHO, 2008). There is growing global interest in health information, particularly in metrics and evaluation, as exemplified by the MDGs and such major global health initiatives as performance-based financing. It’s imperative to note that without sound measurements to benchmark achievements and efficiency of resource use, debates on priorities for health and what does or does not work tend to be based more on ideology than on evidence (Raghupathi, 2002). Options for project delivery There are three main options for the organisation namely, doing nothing, switching completely and partially switching. The option of doing nothing is usually the comfortable approach to most organisations since organisations are naturally resistant to change.In the complete switch approach, the organisation will computerise all operations and thereby shifts from pen and paper completely. The partial approach is the gradual introduction, in which the organisation will computerise the operations but still continue using the traditional methods of keeping records. The rationale behind this approach is to have some form of backup both as soft copy and as hard copy (Kane &Sands, 1998). I recommend the gradual approach since it will help provide the alternative backup and it will help the organisation to grow gradually into the new system High-level project risk management There are a couple of risks involved in the project. Firstly, health information systems are still in the development stages. There are still many questions that remain unsolved especially with respect to the infrastructures, functionality and management (Mun Turner, 1999). Universality of health information systems is another risk that is bound to arise. This goes hand in hand with the issue of scalability. A good system should not only be available when needed but it should be easy to grow as the organisation grows. I propose the use of cloud computing infrastructure which will ensure that these risks are addressed. For instance, updates to the system will be easily done and the organisation will have the most recent application at their disposal. There will be no need of having installations on the client machines as all files will be clouded. Project resource costs Adoption of health information systems comes with some important Implications. For starters, there will be a need to educate the health professionals in the use of informatics. This will in no wise be a cheap undertaking but in the long term, it will save the health facilities a lot of money. It can therefore be termed as a sustainable development. Education courses and programs on health information systems have to be tailored and given as supplementary courses for medical health workers. These will ensure that the health workers are sufficiently trained and informed in medical informatics which will ultimately guarantee productivity in the field (Doolittle & Cook, 1999). Project appraisal The costs involved in digitising health services are huge. However, health information systems eliminate the need for duplication of efforts, improve the process of retrieval of information especially when treating patients that have been at the health facility before, and generally make the running of the health facility more efficient. The end result is that the hospital or the health facility ultimately saves a lot of money. It is therefore true to state that the costs involved in the adoption of hospital information systems are nothing in comparison to the operational costs that will greatly be reduced at the end of the day (Kane &Sands,1998). Given the attention given to the global health agenda and ratified in different countries legislations and policies, the amount of funding being poured in the health sector, the dynamics of a rapidly changing environment within which health is practiced, It’s imperative that we understand the promises and challenges that eHealth holds in a bid to contextualize it’s application in a manner that guarantees return on investment and the achievement of anticipated goals (Raghupathi, 2002). Project interface The system will have two sides, the client side and the admin side. The external users will log into the system as guests and they can be able to view public information. The staff will be able to access the private area of the system and there will be different access levels depending on the job requirements of the person. For instance, only authorised staff will be able to update the records of patients. The system will have a user friendly human computer interface. Associated documents The following documents can be referenced in order to understand the advantages of adopting an electronic medical record system. Doolittle Godson & Cook Dennnis.1999. Defining the needs of a telemedicine service. Introduction to Telemedicine (Wootton R, and Craig J, eds.) Royal Society of Medicine Press, London, England Forkner-Dunn J. 2003. Internet-based Patient Self-care: The Next Generation of Health Care Delivery. J Med Internet Res 5(2) Mun Turner.1999. Telemedicine: emerging e-medicine. Annu Rev Biomed Eng 1:589-610. Raghupathi Tan.2002. Strategic IT applications in health care. Commun ACM 2002; 45(12): 56-61. Project stages & timescales Activity Predecessor Time estimates Expected time Opt.(0) Normal (M) Pess. (P) Appraisal - 2 4 6 4.00 System specification - 3 5 9 5.33 System Development Appraisal 4 5 7 5.17 Implementation Development 4 6 10 6.33 Feedback Implementation, development Project quality expectations The ability to provide good and equitable health services for all people depends, in part, on the performance of health systems—networks of organizations, individuals, government entities, and technological resources dedicated to promoting, maintaining, or restoring health. Failing or inadequate health systems are one of the main obstacles to scaling up effective distribution of such life-saving interventions, and therefore also a key barrier to achieving the internationally agreed Millennium Development Goals (MDGs) and goals set in the WHO/ UNICEF Global Immunization Vision and Strategy (GIVS) and local goals such as Vision 2030 to mention but a few (Wilson, 2003). The term eHealth encompasses a number of services and applications that aim at improving healthcare through the use of information and communication technologies. The World Health Organization (WHO) defines eHealth as the cost-effective and secure use of information and communication technologies (ICTs) for health and health-related fields (Gerber, Eiser, 200; Wilson, 2003). eHealth is poised to bring a lot of benefits as has been articulated in numerous whitepapers. Most health systems in the world have received massive attention with regard to reforms and health system strengthening. Over the years harnessing of information has been a challenge both in the public and private subsectors. This has partly been due to the weak health information infrastructure, a poor information culture that does not spur demand for information, multiple and parallel information systems, a thin and stretched human resource to support data collection, transformation, presentation and archiving among others (Forkner-Dunn, 2003). Customers & users of project deliverables Health systems should provide equitable access to effective and acceptable healthcare corresponding to the needs and priorities of the entire population. In order to achieve this, with limited resources, health systems need to be organized efficiently and adequately financed; capacities of individuals and institutions have to be developed. The world has opened up; technology is increasing and improving each and every sector, changing the way business is being done and with that influencing the outcome. Despite the emphasis placed on ICT and the availability of with the improved infrastructure which has increased computer speeds and capacities and affordable hardware prices, enormous mobile phone penetration, millions of subscribers, etc., there has been a massive shift to ICT’s in almost every sector of the economy (Anderson, 1997). The environment under which health is being practiced is dramatically changing, be it on the policy front or in terms of technology, the dynamics of operation are changing. This necessitates a new look into the opportunities and challenges that these changes affords the players in the health sector and especially with the application of e- health towards health service delivery (Wilson, 2003). It is the mandate of the health service workers to provide quality health services, to promote equity in access to health services across the board, financial risk protection and overall governance and stewardship of the health sector. To execute this mandate there is an absolute need for information to guide policy making, intervention options, programming and effective management of health facilities and health districts (Raghupathi, 2002). Improved performance in controlling emerging and re-emerging diseases in the world is dependent on the quality, equity and efficiency of health systems. Rapid progress towards targets is greatly hampered by weak, poorly functioning or in some cases non-existent health systems. In recent years, the global health field has focused on disease and population-specific programs, with insufficient attention paid to health systems. This has resulted in dysfunctional health service delivery and inequitable financing, especially in under-resourced areas (Wilson, 2003). New technologies and demographic, epidemiologic, and economic shifts are transforming health systems in countries around the world. There is now a window of opportunity to promote strategies that steer this transformation toward better health outcomes and financial protection through improved health systems performance and the expansion of universal health coverage in low- and middle income countries. Growing numbers of experts believe that e - Health—the innovative application of emerging information and communications technology in health systems—will fuel the next breakthrough in health systems improvement (Raghupathi, 2002). Project governance In order to ensure the principle of single accountability point is maintained, the IT manager will be in charge of the implementation of the project. He will be directly answerable to the CEO and Human resource managers in a flat governance structure as opposed to a pyramid. This will help to reduce the bureaucracies which will ultimately reduce on the time spent in the decision making process. The developers will work hand in hand with the IT manager until the system is fully functional and operational. Conclusion Modern technological advancement has revolutionised the way business is carried out. Every sector has been impacted and the health sector has definitely not been left out. The days of manually recording records on patients are slowly ebbing away as health information systems are gradually introduced. Health workers should endeavour to embrace the change that is brought about by health information systems and reap the benefits of a more efficient system albeit the challenges that will be faced when adopting the system References Anderson John.1997.Clearing the way for physicians’ use of clinical information systems. Commun ACM. 40(8): 83-90. Chin TL.1998. Secrets to success. Health Data Management 6(7): 76-9. Doolittle Godson & Cook Dennnis.1999. Defining the needs of a telemedicine service. Introduction to Telemedicine (Wootton R, and Craig J, eds.) Royal Society of Medicine Press, London, England Forkner-Dunn J. 2003. Internet-based Patient Self-care: The Next Generation of Health Care Delivery. J Med Internet Res 5(2): e8. Gerber, Eiser.2001. The patient-physician relationship in the Internet age: future prospects and the research agenda. J Med Internet Res. Apr-Jun; 3(2): e15. Grimson J, Grimson & Hasselbring Wilkenson.2000.The SI challenge in health care. Commun. ACM 43(6): 49-55. Kane Brunt &Sands Diane.1998 Guidelines for the clinical use of electronic mail with patients. J Amer Med Inform Assoc. 5(1): 104-111. Mun Turner.1999. Telemedicine: emerging e-medicine. Annu Rev Biomed Eng 1:589- 610. Raghupathi Tan.2002. Strategic IT applications in health care. Commun ACM 2002; 45(12): 56-61. Wilson Evans. 2003 Asynchronous health care communication. Commun ACM; 46(6): 79-84. . Read More