Electronic Medical Records: The Actual Implementation Process - Assignment Example

? Electronic Medical Records: The Actual Implementation Process Identifying the implementation tasks and timelines The successful EMRS implementationinvolved more than just choosing a vendor and signing a contract. Just as Fishmen (2012) explains, it is unlikely to find the process of implementing an EMR to be easy because the process has to be able to address everything expected of it from workflow, and software and hardware selection and installing to training of staff. It therefore required the simplification and streamlining of the implementation process through a number of processes. The implementation team had to develop various simultaneous implementation tasks. These included facility modification, installation of hardware, developing a backup system, software configuration, training, entering old data, work-flow analysis and redesign, dealing with paper and training. A work schedule was drawn for the handling the tasks as well as a deadline for each. Work-flow analysis and redesign One of the important jobs was to understand how work was accomplished in the old system and this was achieved by analyzing all functions of each of the tasks involved. The team evaluated the existing work process, pointing out opportunities for improved efficacy and coming up with workflows that could be implemented with the tools available in the EMR. After this, the team developed a transition plan. Plans for essential changes in the workflow that will lead to the best utilization of the EMR were also developed at the monthly meetings between the office and the medical staff. Facility modification With the work-flow redesign complete, the facilities required were identified and tested for their functionality before making installations. To avoid spending a lot of money on renovations, the team ensured the EMR system fitted into the existing infrastructural plans. Having developing a good picture of how the staff and patients will be aligned with the EMR system, it was now possible to identify where to put the new EMR equipment. To end the use of paper records, the hospital availed computers and printers in every essential workstation for staff to check or enter data and print materials for patients. After the locations of the hardware were decided, the hospital installed additional network and electrical wiring where necessary. They also installed other relevant support facilities in each workstation like desk drawer for forms, a pull-out writing surface and a pull-out tray for the keyboard. Hardware selection and installation The choice of hardware for the servers and network were made according to the vendor’s requirements and latest recommendations. Hardwired desktop computers were selected for use at the workstations. With the hardware selections made, the team set up a miniature, off-site test installation of the workstation, server, scanners and printers. The equipments were transferred to the various stations for installation. With the help of technicians, the various components of the system were stationed and the necessary software installed by computer scientists and system experts. Test runs were done on the hardware and on the entire system as a whole and bugs and emerging problems appropriately fixed. Considering that some members of staff had little knowledge in relation to computer and computer systems, a training room was set for the purpose of their training. Software configuration Software from different vendors have different configuration requirements. However, security, templates and laboratory data management are common considerations for all EMR products. In order to limit access to various parts of the records to various users, every EMR user was only allowed gain access to the various areas of the record chart and functions within that the location/area necessary for their duties. The main objective was to restrict access to all users for functions that presented obvious risks for accidental or intentional integrity of the chart like deletion of progress notes. A few high-level users were exempted. The hospital also wanted the results of all laboratory tests to be available as soon as the use of the EMR kicked off. The hospital acquired an electronic interface with each laboratory or manual data entry methods. This enabled the hospital to have all the test results immediately and it has eliminated problems of inconsistency in data entered like incorrect name, age or gender. A template refers to a group of structured text elements that require users to add information to document their medical encounter. Although some EMRs only allow data entry through the use of templates, the hospitals choose a more flexible one. This EMR allowed data to be entered either by direct entry (typing), template, voice recognition or dictation/transcription. This was done because the development of templates normally requires considerable time and effort. Because of this, the hospital’s clinicians were dictating most of the progress notes at the beginning. This also gave the clients time to familiarize with the acquired software and within three months, average users begun inquiring about the use of templates. Six months down the line, the hospital began witnessing a continued increase in the use of templates and a decrease in the use of transcription/dictation. Developing a backup system The team developed and installed a backup system. To prevent data loss from unanticipated human error and technical problems, the team developed and tested multiple methods of backup and data recovery. Training The five-month staff training was three-phased. These were assessment of basic skills, training on basic skills and conducting application-specific training. During the application specific training, employees were supplied with a summary document outlining important work-flow changes for quick reference on tasks they were not sure of how to do under the new system. After all these were completely in place, the hospital went live with its EMR. Entering data in the system According to Scott et al (2007), the amount of old data to be uploaded into the EMR prior to going live is determined by factors like needs and desires of the clinicians and available time and money. This gives the options of not making any data preload to making a lot of abstraction and data entry. The hospital purchased an interface facilitated the loading of all demographic data from the existing billing system to the acquired EMR. This interface also updates any changes in every five minutes. Just before going live, the hospital loaded progress notes for the last three months. This was easily achieved because the hospital’s progress notes were always being typed into a word-processing program by its transcriptionist. She was therefore required to begin saving files in manner that they could be loaded into the EMR. All data was then entered electronically after going live. Filling in past medical, family and social history sections of the EMR required a great deal of time and staff so the hospital scheduled comprehensive examinations that took 10-15 minutes longer. Dealing with paper To work towards the goal of the paperless environment, the hospital had to analyze the various patient documents and results received daily and decide how to manage them. The hospital decided to scan some of the results like radiology reports and pap smears and file the others. Scanned ones are destroyed after a reliable back up has been obtained. Others like unnecessary x-ray reports are simply destroyed. References Fishman, E. (2012). “Implementation Process for an Electronic Medical Record (EMR).” Online: http://www.emrconsultant.com/education/emr-implementation. Viewed on 10th February, 2012. Scott, T, Rundall, T. Vogt, T and Hsu, J. (2007). Implementing an Electronic Medical Record System: successes, failures, lessons. Oxford. Radcliffe publishing. Read More