Implementation Process of Health Portal System - Coursework Example

?Implementation of Health Information Technology Executive summary. This paper examined published peer-reviewedjournals and included other documentation of organization type and implementation of patient portal within paragon. The report looked at its use, administration and general effect in dialysis clinic. Further, secondary data was extracted from face to face and online interviews with patient portal Providers as well as physicians using the system in dialysis clinics. Our goal was to develop a reporting system that would provide a series of monthly reports for all our dialysis patients in a safe and timely manner Objectives of this study. To identify obstacles during the management and implementation process of health portal system for a dialysis unit that serves hemodialysis and peritoneal dialysis to renal chronic disease patients. To validate with secondary research conducted by way of peer review journals the procedure that sought to implement health portal on patient care system. Hospitals implementing health portal have documented positive results in patient care. A remarkable improvement is noted in Patient Access to heath related Information. It is also worth noting that most physicians have reported that they don’t use this system because of maintenance cost. Health Information Technology: Implementation of Patient Portal within Paragon Organization Information In order to effectively manage our patients, access of data is imperative especially when performing clinical meetings. My interest is on applications within the electronic health record for the treatment of chronic kidney disease (CKD). Patient portals are clinical, administrative and educational-related online applications which facilitate communication between patients and healthcare providers such as hospital and physicians. Terry (2010) said that patient portal is used by care providers and patients (Terry, 2010). Patient portal applications may be a single entity website and sell its services to health providers or it can be intergraded into existing website electronic medical record (EMR). The system exists as software application that is regulated by government legislation. Kannan (2009) outlined the uses of health information technologies and online resources to include; great potential to boast health care quality by improving care access, efficiency, chronic disease management, and patient family involvement (Kannan,2009). Patient portal is a form of communication based on the web between a patient and the doctor. It has the following features; messaging, making requests or new appointments, examine past and present medical fix and modifies patient data. Bodenheimer et al, (2003) reported that patient portals can enhance patient-provider communication, increase overall satisfaction with care, lead to more communication with psychosocial content and increase identification and management of chronic conditions, increase access to health information, and improve disease management for conditions such as diabetes and congestive heart (Bodenheimer et al, 2003). (An illustration of this is provided in appendix B).The reporting system that is implemented here develops monthly report for all our dialysis patients in a safe and timely manner. Information Technology Application Technician is in charge of patient portal application but it is quite unfortunate that the IT department is not within the organization; at this moment we have contracted personnel from a private company who is providing IT related services. Most institutions would hire application service provider to work hand in hand with Information Technology Application Technician to setup and maintain health and information system hardware and software. An internet report that was developed provided a screen which displayed three tabs with the capability to be activated and viewed on a separate page as shown bellow: Laboratory (Health view) tab: a screen that provided grouped laboratory results according to patient’s name, date of birth, medical record number, date, time and test type assuring a correct selection of tests, providing a cross check with same tests and future audits for system integrity. Report Results Tab (Summary tab): a monthly serial data sheet report Follow-up (Maintain Patient tab) screen that provides easy management for the active patients in the clinic provides a laboratory summary Information System Application: Design (5 points) Implementation called for a cross-functional team that sought to exceed satisfaction of stakeholders in addition to strengthening the name of the institution. Stakeholders consist of board of governors (to include government representatives) and hospital management team and in this case before arriving at any decision, health information system is prominently on senior staff and Board meeting agendas. During one of the Meetings, the Information Technology Application Technician presented the issue, the current practices and suggested solutions. Criteria to be included in the monthly as suggested by the technician’s report to include; 1. Population of interest outpatient dialysis population 2. Dialysis staffs’ suggestions and recommendations. 3. The program should have the ability to add or remove patients from the generated reports 4. Multiple tests results must be displayed in an agreed format (specific order according to their availability) options of hidden or visible fields must also be taken into consideration 5. Text capability for tracking decisions (hematopoietin doses according to iron and or haemoglobin serum laboratory results) Executives were assigned to address related issues in budget allocation and asked for updates from the technician. In addition, the clinic management provided for separate patient orientation session by requesting brief presentation with patients representatives. The project manager was then selected and asked how the senior staff could be helpful in supporting this work. Stakeholders including patients, physicians, nurses, finance department, marketing, and administration were then briefed and consulted to determine how much medical information will be available on a portal. A budget was then drawn. Fleming, (2011) A 2011 survey estimated a cost of $32,000 per physician in a 5-physician practice during the first 60 days of implementation (Fleming, 2011). The project is costly and most physicians cannot afford it (This disparity is illustrated in appendix C). Initially, the project is partially funded by federal stimulus funding whose focus is increasing utilization of electronic health records. Further funding come from HEAL 17 that funds physicians. Terry ( 2010) reports that Patient portals are also regarded as a key tool to help physicians meet "meaningful use" requirements in order to receive federal incentive checks, especially for providing health information to patients(Terry, 2010). This means that the federal government will use the tool to supervise healthcare providers and for administrative functions. This has met resistance from physicians who feel that incentive check is unnecessary. Doctors are trained to be autonomous and such a move is considered a threat to this autonomy. Within the organization, federal funding of this project has been viewed suspiciously. In view of this and to avoid federal checks, some organizations opt to use private providers. In a 2008 survey by DesRoches et al. (2008) of 4484 physicians (62% response rate), 83% of all physicians, 80% of primary care physicians, and 86% of non-primary care physicians had no EHRs. "Among the 83% of respondents who did not have electronic health records, 16%" had bought, but not implemented an EHR system yet (DesRoches et al. 2008). A summary is provided as appendix C This statistics clearly indicate that physicians are not implementing the system because of its high cost. Another reason for this resistance is conservativeness since some physician are skeptical about HIT, they resist it. Information System Application: Implementation (5 points) Liederman, et al (2003); Kleiner, et al (2003) reported that “there is a fear of clinical inaccuracies in patient populated medical studies leading to misdiagnosis and treatment. There is also a fear of non-secure channels revealing private health information leading to HIPAA violations” (Liederman, et al 2003 and Kleiner, et al 2003). However, patient portal is password secured that provide personalized portal that access their information. The use of patient portal is secured by existing laws. Health insurance portability is capable of tracing down where patient portal is accessed, when they are accessed and by whom to prevent possible intrusion and breaches. Nurses and physicians are trained in relation to patient portal applications and database. Seminar programs are offered for half day to build confidence in practicing effective management of patient portal. Seminars are interactive and encourage administrators and staff to ask questions about how the equipment works. The seminar focused on appointments, monitoring and management of hemodialysis and peritoneal dialysis to our renal chronic disease (CKD) patients using the system. Staff will learn effective ways of communication with angry, grieving or belligerent patients. Training manuals are also provided on the new application. As a directive in Provider HIPAA Checklist (2003), health care providers in the US are bound to comply with HIPAA regulations. These regulations specify what patient information must be held in confidence. Something as seemingly trivial as a name is viewed by HIPAA as protected health information. For this reason, security has always been a top concern for the industry when dealing with the adoption of patient portals. While there may be systems that are not HIPAA compliant, certainly most patient and practice portals are secure and compliant with HIPAA regulations. Patient access is typically validated with a user name and password (Provider HIPAA Checklist, 2003). Each member in the dialysis unit is provided with a password and login details to access and use this application. Downtime means to decide to take the patient portal website down because of on going site maintenance or legal requirements. With the advice of information technician, we have a planned downtime arranged quarterly. This is important for updates and further integrations of related features. We usually use 5003 HTTP result code that indicate service unavailable rather than use 404 (not found) the latter indicate that server does not exist. Application upgrade is conducted as advised by the hospital’s internal program manager. To begin with, the internal project manager prepares a paper chart strategy while considering existing paper charts (their may be legal and moral restriction on destruction of medical records therefore, one has to seek permission from practice owners and legal counsel). It is reasonable to provide complete self guide study online or CD on the new aspects to be implemented into the existing one. A pilot for physician-patient communications with only six to twelve physician practices for at least one year program is then run concurrently with the normal program. During this time, monitor response rates Legislation requires health providers to maintain the confidentiality of the patient health records. This legislation became known as health insurance portability and accountability act. (HIPAA. Section 1561 of the affordable care act requires HHS in consultation with health information technology) policy committee and the HIT standards committee to develop secure standard and protocols which facilitate enrollment of individuals in federal and state health and human services program electronically.(electronic eligibility and enrollment act section 1561) According to Blumenthal, (2010) The Health Information Technology for Economic and Clinical Health Act (a part of the 2009 stimulus package) set meaningful use of interoperable EHR adoption in the health care system as a critical national goal and incentivized EHR adoption (Blumenthal, 2010) The "goal is not adoption alone but 'meaningful use' of EHRs — that is, their use by providers to achieve significant improvements in cares (Blumenthal & Tavenner 2010)." Mr. Michael Nazario in regards to health information technology changes claimed the concept of ‘meaningful use’ is integrated to monitor physicians who use the system, how effective they are, are they diligent? And so on (Personal communication, April 20, 2012). To support healthcare reforms, I suggest minimum standards for federal incentive checks that are established to supervise implementation of the program. Incentive checks should be the domain of the hospital administration closely monitored by the federal government. Innovative Aspects of the System (5 points) The potential for automating the process of “pulling” required data form a variety of laboratory reporting sites into one report per patient in defined format is the most important innovative aspect of the system. Besides, the patient portal software can be integrated into an EHR an Electronic Health Records (EHR) product or it can be interfaced with EHR via vendor products. This is advantageous as it serves various purposes. It is possible that dialysis patients can be provided with a web page to post medical update to either friends or family members. I will recommend the extensive use of direct project (discussed in appendix A) that includes physicians, nurses and pharmacists and its integration into patient portal without compromising security. Indeed we expect that more features and integration of EHR/PM as future prospects will be incorporated Appendix A Interview 1 Name: Mr. Michael Nazario Date: April 20, 2012 Time: 2:30pm- 3:45pm Reason Chosen: an Information Technology Application Developer who doubles up as the regional coordinator for health information technology, department of health and human service. Interviewer: What are the benefits associated with health information technology(HIT)? Mr. Michael Nazario: the main idea is to have care that is safer. Few years back reports had been published reading ‘in the out patient side: hundreds of thousand errors related to medication. Most of them were due to illegible handwriting and occurred during transition or transfer of either a patient or a physician. Just look at that paper prescription, you will wonder whether it is one can make meaning out of it besides, pharmacist agreed that it is difficult to make sense out of it. In addition the HIT is interactive, convenient and informative to both patients and doctors and aims at better care. Interviewer: it is good that you talked about better care, Habib JL (2010) Talks about meaningful use; do you have an idea what this is? Mr. Michael Nazario: that’s a good one. Doctors and hospitals don’t just qualify for payments, while hospitals cannot be paid because they purchased the system. Rather, they are paid for using the system as recommended. Interviewer: how do you rate the federal government input into the health information technology? Mr. Michael Nazario: sufficiently remarkable. All this dates back to October, 2009 when the IT incentive program was passed by congress as part of the stimulus bill. Before this incentive, doctors and hospital administration were to put up the money and expected to accommodate these changes. Interviewer: what part do you play in these changes? I mean the whole process, its implementation, its monitoring, and administration. Mr. Michael Nazario: we give the doctors and primary care providers the much needed support to adjust during the period of transition and implementation of the new application. And for the last three years, it has been successful. Our duty is to facilitate transition from paperwork to software application. Although we advise that one of the physicians to be system manager, most institutions approach us to work as part of the administration. Interviewer: you rightly said that you facilitate the transition from handwritten to software application, how then do you induct physicians, hospitals and institutions on using the system? Mr. Michael Nazario: we alias with other parties such as vendors and other private firms who facilitate seminars and workshop on how to use the system. Further, the manufacturers provide CD modules and written manuals to facilitate its use. Interviewer: any other innovative projects that is in use or about to be used? Mr. Michael Nazario: yeah, we have the direct project maybe you saw it advertised as health email? Interviewer: no, never had of it. Mr. Michael Nazario: initially doctors and hospital could not talk to each other. If a patient is admitted in hospital there was no paperwork thanks to HHIT and nobody within the hospital would know of such admission during hospital course. Direct project facilitates communication between doctors and the hospital. Interviewer: that is incredible. I can’t wait experience it. Thanks for your time. Good day. Appendix B Assessment of benefits of health portal as discussed by (Bodenheimer et al, 2003). Appendix C 2008 survey by DesRoches et al. of 4484 physicians (62% response rate), 83% of all physicians, 80% of primary care physicians, and 86% of non-primary care physicians had no EHRs. "Among the 83% of respondents who did not have electronic health records, 16%" had bought, but not implemented an EHR system yet Work cited DesRoches, C. M.; Campbell, E. G.; Rao, S. R.; Donelan, K.; Ferris, T. G.; Jha, A.; Kaushal, R.; Levy, D. E. et al (2008). "Electronic Health Records in Ambulatory Care — A National Survey of Physicians". New England Journal of Medicine 359 (1): 50–60. doi:10.1056/NEJMsa0802005. "Provider HIPAA Checklist". CMS. March 2003. http://cms.hhs.gov/Regulations-and- Guidance/HIPAA-Administrative Simplification/EducationMaterials/downloads//HIPAAChecklist.pdf. Retrieved may, 04 2012. Terry, Ken (2010). "Patient Portals: Beyond Meaningful Use". Physicians Practice. Bodenheimer, T., and K. Grumbach. (2003) "Electronic Technology: A Spark to Revitalize Primary Care? " JAMA 290(2) 259–264. Habib JL. (2010) EHRs, meaningful use, and a model EMR. Drug Benefit Trends. May;22(4):99-101. Blumenthal, D. (2010). "Launching HITECH". New England Journal of Medicine 362 (5): 382– 385. doi:10.1056/NEJMp0912825. PMID 20042745.  Blumenthal, D.; Tavenner, M. (2010). "The "Meaningful Use" Regulation for Electronic Health Records". New England Journal of Medicine 363 (6): 501–504. doi:10.1056/NEJMp1006114. PMID 20647183.  Fleming, N. S.; Culler, S. D.; McCorkle, R.; Becker, E. R.; Ballard, D. J. (2011). "The Financial and Nonfinancial Costs of Implementing Electronic Health Records in Primary Care Practices". Health Affairs 30 (3): 481–489. doi:10.1377/hlthaff.2010.0768. Menachemi, N.; Collum (2011). "Benefits and drawbacks of electronic health record systems". Risk Management and Healthcare Policy: 47. doi:10.2147/RMHP.S12985 Liederman, E. M., and C. S. Morefield. (2003) "Web Messaging: A New Tool for Patient- Physician Communication. " Journal of the American Medical Informatics Association 10(3): 260–270. Kleiner, K. D., R. Akers, B. L. Burke, and E. J. Werner. "Parent and Physician Attitudes Regarding Electronic Communication in Pediatric Practices." Pediatrics 109, no. 5: 740– 744. Read More