Implementation of the Electronic Medical Records System - Essay Example

Table of contents Back ground…………………………………………………………………….. 2 Vision for the EMR…………………………………………………………….. 3 What EMR will offer…………………………………………………………… 4 Critical success factors for EMR………………………………………………. 4 Analyzing the current situation………………………………………………… 6 Aspects critical to supporting an EMR……………………………………........ 6 Roadmap for achieving HIMSS level 7 by 2025……………………………….. 8 Implementation plan……………………………………………………………. 8 Resources needed for project implementation………………………………….. 9 Governance…………………………………………………………………….. 9 Alignment to state and national e-Health programs……………………………. 10 Likelihood of success and identification of risk………………………………... 11 Conclusion/Recommendations………………………………………………..... 13 References ……………………………………………………………………… 14 Metro hospital in Brisbane 1.1. Background / Overview The writing of this report is prompted by the fact that the Metro Hospital Executive board needs to know how the hospital will be led to acquire the HIMSS level 7 EMR by 2025. The report will therefore lay out the roadmap to achieving this status by the year stated above. Level 7 of HIMSS is a stage where a hospital becomes completely paperless. Sharing of clinical information with patients, payers, employers, other hospitals and ambulatory clinics is possible through standard electronic transactions such as CCR, CDA, CCD or transactions mandated by the state. At level seven, the hospital can support sharing and utilization of wellness and health information by both providers and consumers. At the same stage, the hospital makes use of data ware housing and techniques for mining to acquire and analyze data for improving performance (Hansen, Maeder, Schaper 2011). The HIMSS level 7 should be achieved by 2025 because by then the hospital will have ceased to use papers in its operations. With the current rate of technology many hospitals are changing from paper work to electronic systems. The HIMSS level 7 Status is important because it will put the Metro Hospital on the list of the most advanced electronic medical environments in Australia and the entire world. With this, it will have a competitive advantage in business over other hospitals. This report will show that it is possible for the hospital to get the HIMSS level seven EMR award by 2025. The report will also outline the steps needed to achieve this goal (LeBlanc 2009). 1.2. Vision for the EMR The vision that has been laid down for the Metro Hospital is to transform it from paper based record keeping to an electronic system of keeping records. By 2025, the hospital should be able to deliver care to patients without using paper charts. Using paper charts has been the norm for along time since the hospital began and it has been found to be very cumbersome. The method has many disadvantages such as loss of records and wastage of time (Hansen, Maeder, Schaper 2011). With the electronic system the hospital will be able to share information about patients by sending record transactions very securely to other hospitals or care providers. By the year 2025 the Metro Hospital should be able to use its clinical information database to create improvement in the performance of care delivery and outcomes by use of business intelligence solutions. Metro Hospital should also be in a position to serve as an example in the country and the region of how sophisticated medical record environments are implemented to engage the clinicians fully (Hovenga 2010).  The electronic health record will be composed of records in digital format that can be shared among various healthcare settings. The system will be made up of information exchanges and information systems connected through a network as well as other information networks. The Electronic health records will have a data range that has laboratory results, medical history, demographics, allergies and medication, status of immunization, vital signs, radiology images, billing information and other personal statistics. Integration of the electronic health record systems will be done through the MxTranscribe so that productivity can be improved. It is possible to expand care to patients through the reduction of transcription time for staff and doctors. Other activities to be avoided are printing, faxing, searching for information relating to patients and filing documents. Integration will be done easily by implementing special software such as MxChart software as well as the MxTranscribe services (Scott, Rundall, and Vogt 2007).  2.1 What EMR will offer Electronic systems of record keeping will offset many of the problems associated with paper-based record keeping. Storage media costs like film and paper per information unit are different from those of the electronic storage media. Paper records can require a lot of time to gather especially when they are stored in different places. The process can also be very complicated. However electronic records can help avoid these complications. For records that are person centered, there is a difficulty in maintaining them when they are not electronic. One finds a hard time to federate or centralize them (Scott, Rundall, and Vogt 2007).  Whenever paper based records are needed in many places, the costs for copying and faxing are higher in comparison to those of duplicating and transferring digital records. One study estimated that electronic medical records can improve efficiency by 6% every year (Krzysztof, Duplaga, Ingram 2007). Electronic records will help in standardization of forms, input of data and abbreviations and terminology. When forms are digitized it will be easy to collect data for clinical studies and epidemiology. The electronic medical records will also be easy to update under given legal limitations. The possibility of exchanging records between various electronic medical record systems will make it possible and easy to facilitate the delivery of health care in health care facilities not affiliated to the hospital. The Electronic Medical Record system will also provide data for reporting about statistics on matters like surveillance of public health airborne diseases, management of resources and improvement of quality (Hansen, Maeder, Schaper 2011). 2.2 Critical success factors for the EMR Implementing an electronic medical records system is not easy. Before success is achieved, there are hindrances of cost, resistance to change and complexity. Getting the right knowledge and strategy is important for ensuring that the hospital succeeds in using the technology. Success factors will have to include the right processes of implementation, the right people, and right technology and change management. All these components should be present at the same time. The hospital must have right leadership at the top that is committed to making the success of the hospital its priority. Operational and clinical executives must be accountable for success and be there to show true commitment (Scott, Rundall, and Vogt 2007).  Another critical success factor is a shared vision which the entire hospital should embrace and understand. The safety of the patients should be given priority. The benefits and goals should be defined clearly in a measurable and meaningful way. The hospital should be in a position to understand what success is and how that success will be achieved. There needs to be the right culture as well. The hospital will have to prepare, sustain and support people via proper change management. Needed are the relevant things such as the equipment, training, education and technology. These changes will prepare the hospital for future changes. Planning early enough helps to identify any resistance, potential hindrances and prepares the stage for change to be embraced. Resistance may come from the change needed. Some clinicians may resist the technology because they think it may not last long. Getting to learn the technology also requires commitment (Scott, Rundall, and Vogt 2007).  Governance and proper governance for that matter will be necessary for the success of the new technology. There will need to be in place very efficient structures for decision making. Finally the major stake holders, nurses and physicians will be engaged at a very early date and made accountable to spear head the transformation in Metro Hospital. The clinicians will design, champion and lead the new flow of work enhanced by the new technology. The clinicians will work in collaboration with the Information Technology department to translate the requirements of technology (Hovenga 2010).  1.3. Analyzing the current situation Reviewing the present informatics status in Metro hospital will be done based on certain factors. These factors include diagnosing the picture at the hospital and the problems being encountered in informatics. Since the current status is paper based it will be necessary to analyze the advantages of the paper based system as well as its problems. The efficiency, cost, speed, reliability and other factors must be analyzed in depth. The history of the system at the hospital should be used as the basis for review and analysis. The success of the paper based system in the past and at present should be used in the review. The performance of the paper based system will then be compared to the electronic system. The drivers must be considered and their context will also be considered. Information needs will also be reviewed alongside the changes that are needed and the manner in which they should occur. Information systems and information management will be assessed to increase integration, prevent duplication and avail the information required for the hospital operations. The review will also consider the proper structures of management and demarcation in the hospital. The process of review must assess the current programs of informatics, their strategic importance, cohesion so that risks are minimized and benefits optimized (Hansen, Maeder, Schaper 2011). 1.4. Aspects critical to supporting an EMR Adopting the electronic Medical Record system cannot work properly unless the technical side of it is taken good care of. Adoption and implementation of the EMR technology will require eligible server hardware, network hardware that is properly designed, eligible and properly written software and internet connectivity. The network must be set up with proper installation and cabling for proper connectivity. The technology requires a lot of IT maintenance and support. Complex networks and servers need a lot of maintenance and support. There should be good availability of network with proper speed. The information technology department should be set up complete with the necessary equipment and qualified personnel. Such people will include IT specialists, software developers, computer engineers and programmers (Finn, Bria 2009). The information management practices to be used in the adoption of EMR for Metro Hospital will include collection of the information, storage, retrieval of this information, communication and distributing that information. Documentation of patient records will be part of information management. There will be a very high standard of documentation for the records of patients so that the process can meet both professional and legislative requirements. This will help in communication facilitation between the staff and health. Patient record documentation will be done under the guidance of principles and standards of good practice (Scott, Rundall, and Vogt 2007).  Maintenance of patient management systems will be done to support the functions related to managing patients. This process will involve recording and accessing the records of patients, making referrals, accessing results and managing the caseload. Data collection on patient statistics will be set up as a system to collect information for services provided. Information included here will include type of patients; the time they spend at the hospital and the number of times they come (Scott, Rundall, and Vogt 2007). Data collection will be done electronically. Document management is another practice for information management. This will involve managing documents as well as other information. The process involves storage, indexing and retrieving information in a manner that is organized. Keeping electronic library services with journals, books and other materials for reference will also be done. The intranet will be maintained at the hospital. It will comprise of computer networks using internet technologies for sharing information (Demetriades, Kolodner, Gary 2005). 1.5. Roadmap for achieving HIMSS level 7 by 2025 For the hospital to achieve the HIMSS level 7 by 2025, Metro Hospital must have developed a completely electronic medical record keeping environment. To get to level 7 the hospital will have to go through the preceding six stages and get the approval of HIMSS. The electronic system will be achieved through achievable set goals and timelines. The time available from 2012 to 2025 is approximately 12 years. This may seem to be a long time but in reality it is not. There are four major goals in the implementation process. These are gathering enough and appropriate resources, setting up facilities, acquiring personnel and education and traini9ng of people about the use of the electronic system (Lodewijk, Bernd 2007). Since the project requires massive resources for its completion, the first three years will be used to ensure that everything needed in terms of money, software, hardware and any other necessary thing is acquired. From 2012 to 2015 all the resources will be gathered. Setting up of facilities will be done from then to 2020. This exercise will run concurrently with the acquisition of personnel for operating the new system. Acquisition of personnel will start from 2018 to 2020. Setting up of facilities will be in two phases with the second phase coming later in 2023 to run to 2024. Education and training will begin in 2021 and it will be carried out continuously to 2024 as the facilities are set up (Saranummi 2005). 1.6. Implementation Plan The implementation plan for EMR adoption at the hospital will have to define the responsibilities, roles, timelines, staff communication, deadlines and time lines for accomplishment of various activities. The plan will then have to be reviewed with the rest of the hospital. Stakeholders will then be required to bring in their feedback about the plan. Continuous evaluation and review of the plan will be a priority as long as implementation is still underway. A top down approach during the implementation process will be appropriate (Kleinman 2009). This will include first the hospital board followed by the other people within the hospital. These people should consider that bringing the change is a priority to the hospital. This must be communicated to them and where possible they should get assistance to help them embrace the idea. Vision sessions will be important in the course of time. These will be opportunities to remind the hospital staff and board and other stake holders that the technology is important. These forums can provide opportunities for the stake holders to talk about how the technology can enhance the care and safety of the patients (Bersten, Soni 2009). Resources needed for project implementation For EMR implementation a lot of resources are needed to facilitate the entire process. Money will be needed to purchase all the hardware and software required for the networks. More money will be needed for labor especially at the time of installation of the networks. Broad band as well as high speed connections to the internet, other connections to the network, computer locations, stationary workstations and scanning options will all be needed. IT personnel from within and outside the hospital will have to be identified. More IT resources required for practice management software implementation will also be needed. Money must be set aside for the productivity shift in the early stages of implementation (Hansen, Maeder, Schaper 2011).  1.7. Governance Project governance will require that there be a structure, people and information. All these three are very important. Project governance will be based on various principles as discussed below. For the project to succeed it should have a single accountability point. There should be leadership that takes responsibility in the entire project. This will ensure that difficult issues are solved. The second principle requires that the ownership of the project be totally independent from service ownership, asset ownership and any other group of stake holders. Another thing will be to ensure that the decision making activities of the project are separated from stake holder management (Blobel, Pharow, Nerlich 2008). Large committees may not make good decisions on time. Project governance should also be separated from governance structures of the hospital. This is the fourth principle. Structures of project governance are created because the structures of the organization cannot facilitate the project in the required manner. The framework for project governance should be separated from the structure of the organization. The overall responsibility of governing the project will rest on the board (Etienne, Bellon 2008). Through the entire cycle of the project, there will be applied disciplined arrangements for governance, controls and appropriate techniques. A supportive relationship that is very coherent will be displayed between the strategy of the business and the portfolio of the project. Decisions made for the project at all the authorization points will be communicated after being recorded. The business case for the project will be realistic information providing a good basis for authorization decision making (Klaus, Warren, Tze-Yun 2007). 1.8. Alignment to state and national e-Health programs E-health has to do with a lot of medical informatics but services, care, and clinical information delivery are given priority over technology functions. In Australia health care services view e-health systems and infrastructure as very important to the delivery of good quality health care to citizens. Plans to improve the use of e-Health in Australia have been taken up by the government. The government in South Australia for example plans to spend $191.7 million on the development of three more electronic health care systems (Khalil, Yogesh, Aradhana 2010).  The government has a tight budget but its commitment to the digital health system cannot be rivaled. These plans by the government sound as a threat to EMR implementation at Metro Hospital. The government plans to create a digital system that will tie patient records together from disparate hospitals and health systems. This program will definitely impact negatively on EMR. It may not be necessary to implement EMR is another digital system is being rolled out by the government to cover hospitals in the region. The Metro Hospital EMR strategy of installing electronic record keeping by 2025 goes in line with the state plans of digitizing hospitals and health systems. The government seeks to eliminate the use of paper work in these hospitals and health systems and this is the same thing with Metro Hospital. The national government is also moving towards digital operations since it has rolled out the plans to ensure that e-health is implemented in the entire Australia (Krzysztof, Duplaga, Ingram 2006).  1.9. Likelihood of success and identification of risk Definitely the vision of implementing the Electronic Medical Record system will succeed. It will succeed because most of the required resources and personnel are available and the strategy and the necessary structures have been laid down. There are a number of challenges that may affect this implementation. Since electronic medical records are more portable than paper records, there will be the risk of them being stolen or accessed by unscrupulous or unauthorized people. Electronic records will therefore demand high security compared to paper records. People are bound to break the rule of confidentiality by trying to access confidential health records (Information Resources Management Association 2011). There may also be a lot of resistance to the implementation of this system since people like resisting change. This is a risk since it can threaten the survival of the program is enough support is not secured from stake holders. The plan is also threatened by the government’s implementation of the e-health programs nationally and within the state (Barraclough, Heather 2007). The benchmarks have been set and they include complete demographics for patients with information on race, gender, language, date of birth and other requirements. Other benchmarks are vital signs including blood pressure, weight and height, problems lists, medication list, records for smoking status, detail medical summary provided to patients in 3 days, electronic copies of medical records provided to patients within 3 days, production of electronic prescriptions and use of computerized doctor order entry. The system must allow for the security and privacy of the medical data of patients by use of security risk analysis. Clinical quality measures will have to be reported to Medicaid or Medicare centers or the State of the physician. Medical providers should be able to exchange important clinical information such as testing the electronic capability of the EMR system. The clinical decision support rule will be implemented and tracking compliance to this rule should be done. These are some of the most important benchmarks and they would be available almost all the time (Hiroshi 2010). Conclusions/Recommendations The report has shown how the implementation of the electronic medical records system will be carried out in Metro Hospital. It has outlined the plans for the departure of the hospital from paper based record keeping to electronic medical records. Since the strategy and every necessary structure and resources have been planned for, it is expected that the implementation will be a success. The plans by national and state governments to increase digital health record systems will be integrated with the Metro Hospital Strategy. These plans are therefore not expected to hinder the implementation of the program. The recommendations that this report makes is that much effort should be made to align the strategy of the project to the state and national plans about digital health records. Another recommendation is that proper governance for the project should be done to ensure its success. The project should not be left to the hospital structures because this will spell its failure. It is also recommended that every effort should be done by the board and the project managers to win the support of all the stake holders. If this is not done then there would be a lot of resistance to change which create a lot of challenges for the implementation process. References Barraclough, S., Heather G. (2007) Analyzing Health Policy: A problem oriented approach. Bersten, A. D., Soni, N. (2009) Oh’s Intensive Care Manual Blobel, B., Pharow, P., Nerlich, M. (2008) E-Health: Combining Health Telematics, Telemedicine and Biomedical Engineering. IOS press Borycki, M. E., Bartle-Clar A. J. (2011) International Perspectives in Health Informatics IOS Press. Demetriades, J. E., Kolodner, R.M., Gary A. C. (2005) Person Centered Health Records, Etienne D. C., Bellon, J. (2008), Collaborative Patient Centered E-Health Finn, B.N., Bria, W. F. (2009) Digital Communication in Medical Practice, MacMillan Publishers , Australia Hansen, D. P., Maeder, A. Schaper, K.L., (2011) Health Informatics: The transformative power of innovation, Selected Papers from the 19th Australian National Health Informatics Conference (HIC 2011). IOS Press. Hansen, D. P., Maeder, A., Schaper, L. K. (2011), Health Informatics: The Transformative power of innovation, Oxford. Hiroshi T. (2010) E-Health: First Imia/Ifip Joint Symposium, E-Health, Springer Hovenga, E. J. (2010), Health Informatics: An Overview. New Holland Information Resources Management Association, Usa Information Management Association - 2011 Clinical technologies Khalil K., Yogesh K. D., Aradhana S. (2010) Handbook of Research and on Advances in Health Informatics and electronic medical records Klaus A. K., Warren, J. R., Tze-Yun L. (2007), MedInfo 2007: Volume 1 Kleinman, S. (2009) The Culture of Efficiency: Technology in Everyday Life. Krzysztof Z., Duplaga, M., Ingram, D. (2006), Information Technology Solutions for Health care, Cengage Learning. LeBlanc, A. M. (2009), Revisiting Informatics in Southern Australia, Sage Lodewijk B., Bernd B. (2007) Medical and Care Compunetics, IOS. Saranummi, N. (2005) Regional Health Economies and ICT services Scott, T., Rundall, T.G., Vogt, M.T., (2007) Implementing an Electronic Medical Record System: Successes, Failures, Lessons, Cengage Read More