MMHA 6600 Health Information Technology to Address the Continuum of Care

EMR In A Long Term Care Setting: Problems and Opportunities

Problems/RisksA sizable amount of capital is needed during the initial investment, which many organizations may not have. There could be a potential for unauthorized access to sensitive patient information due to a lack of proper security barriers. Patient records may not be updated in real-time thus having inaccurate information. The electronic medical record may not be available/accessible due to a system failure.A large malpractice liability because of unexpected events during data entry, errors during transitioning from paper to digital format, and loss of data with possible permanent destruction (Thakkar & Davis, 2006).Staff overreliance on an EMR causing a decrease not only in the quality of care but the proper rapport in order to gain a patients trust.A patient may prematurely access information about their condition in which they may not fully understand causing them undue stress.

EMR In A Long Term Care Setting: Problems and Opportunities

Opportunities The ability to access (update and modify) patient information, in real-time, from remote sites including personal laptop and/or mobile device. Emerging encryption methods allow for an increase in privacy and safe-keeping of sensitive patient information from unauthorized access.A centralized record-keeping system that allows all facets of a patient medical history to be recorded and updated in order to provide a tailored and comprehensive medical approach.The quality and efficiency of medical care increases because patient information is easily accessible and notes are written in accordance American Medical Association standards so they are easy to read by any medical professional. There is a more efficient use of space because many organizations utilize cloud-based technology allowing for more patient rooms in order to better serve the community. An electronic medical record allows medical providers to identify patients who are due for preventive visits and screenings.The interoperability within various medical specialties allow for an increase in medical acuity because all providers are able to coordinate medical care while reducing errors.

Legal And/Or Regulatory Concerns

Digital medical records could put the organization at risk, especially during implementation, for medical malpractice claims due to possible errors in data migration.Sophisticated digital “footprints” can implicate a provider who inadvertently review, or fail to review, essential information in the EMR (Richards, 2012).Medical providers could incur legal implications if they import, whether it was a mistake or not, clinical findings beyond their scope of practice along with electronically signing the document. Clinicians who miss critical details that affects treatment options could be found liable for negligence since it can be argued that all information to make a sound clinical judgment was “right in front” of the person (Sittig & Singh, 2011). Information “overload” could implicate physicians because it could cause them to overlook pertinent findings about a case despite having full and clear access to information, thus making them vulnerable to a medical malpractice suit. The rationale for compiling and amassing a great deal of sensitive patient data bring about the ethical and legal dilemma of “appropriateness of access” along with privacy controls utilizing complex encryption methods to prevent system breeches (Kierkegaard, 2011).

Acquisition And Systematic Evaluation Of An Electronic Medical Record

The acquisition and systematic evaluation of an EMR requires a great deal of investigation to ensure that functionality meets and/or exceeds the organization needs (CMS, 2016). The first step in EMR evaluation requires an organization to address its needs, goals, technical capability, and financial readiness.The second step would require the organization to develop a plan “of attack.” This would require careful interpretation of information gathered such so as to outline a timeline in which each phase of the implementation process will be executed. This requires successful completion of each step of the initial process.The third step would involve the initial phase of implementation with the desired EMR company that best fits with the target goals and interoperability capability the organization needs. This can be done via a monolithic system only, best-of-breed systems, or a hybrid between monolithic and best-of-breed systems. The fourth step would be to conduct initial training sessions with staff to ensure they are slowly exposed to the EMR and learn the various functions so they are comfortable with its applications. In addition, allow for “hands on training” with a beta version to visualize how a typical system would work. The fifth and sixth sixth are combined because this step requires that all facets be in compliance with ICD-10 and meaningful use regulations as well as continued product improvement to ensure the quality and safety of the organization is not compromised so patient data/satisfaction is not compromised either. His allows for proper evaluation methods of potential vendors.

Acquisition And Systematic Evaluation Of An Electronic Medical Record: SWOT Analysis

Strengths A significant amount of patient data can be safely stored and accessed within a moments notice. This includes all medications, radiological images, labs, etc.The ability to access (update and modify) patient information, in real-time, from remote sites including personal laptop and/or mobile device. The interoperability within various medical specialties allow for an increase in medical acuity because all providers are able to coordinate medical care while reducing errorsWeaknessVulnerable to unauthorized access and breeches of confidential data if proper encryption methods are not utilized. High implementation cost up-front Subject to corruption and total system malfunction that may prevent access to essential patient information. Opportunities The quality of communication has improved due to the ability of information to be accessed by all authorized users from various specialties.Complied demographic data allows for predication of the most common manifestations within the community to be determined along with proposed treatment options to be developed.The overall cost of care is reduced due to a digitized format requiring less personnel to swift through paper-based systems along with improved quality of medical care due to increased efficiency. Threats Poses a potential safety and quality threat to sensitive patient information because of ill-defined security protocols safeguarding access to patient information.Clinicians who miss critical details that affects treatment options could be found liable for negligence since it can be argued that all information to make a sound clinical judgment was “right in front” of the personProper funding for the type of system necessary for widespread implementation along with staff resistance to change causing a possible boycott and sabotage of organizational change.

Planning For Implementation Of Technology

Planning for the eventual implementation is a rather difficult metric to establish since there are so many unknown variables. The following provides the initial steps for the initial planning stage:Establishment of project team leaders in order to direct, acquire information, interpret information, identify organizational needs, and to predict possible barriers along with proposed solutions. Establish Project activities and phases in which various benchmarks are quantifiably measured based of progress. The three areas (phases) assessed are: readiness, deployment, and adoption/maintenance.Communication of change along with proper planning for the proposed change with all members of staff.Data migration along with concurrent training sessions in order to identify EMR reporting requirements that not only fulfill legal precedence but also that of the organization in order to satisfy the requirements necessary to ensure efficiency.Establish a deployment schedule of implementation that includes contingencies in the event a specific or total system failure.

Planning For Implementation Of Technology… Continued

Stake holders during the planning process involve those who are directly affected such as the CEO, CIO, CFO, Health Care administrators, and the various medical professionals including physicians and nurses. External stakeholders such as those within the community who have a vested interest, patients, and indirect investors all benefit from information outlining the steps taken in order to fully implement change. Some of the risk factors include unintended delays, financial constraints, developer issues, staff non-compliance, and inefficient assessment of organizational needs. Mitigation and risk plans shall be in place by capitalizing on the experience of other organizations that have undergone the same change. Preventative measures detailing potential pitfalls with proposed remedies to prevent/limit negative outcomes will greatly enhance the collateral damage that may occur. All of these measures will help justify the financial impact that the organization will incur and limit/prevent excess expenditures (

Implementation Of Technology

The implementation process requires that all aspects during the planning process have been executed to ensure a working model. Thus, implementation has several levels in order to ensure success:Identifying necessary hardware to complete data migration from older digital files to paper-based system to ensure completeness Identification of local/state reporting requirements to ensure compliance.Continued partnerships with developers to design templates and EMR configurations that allow access to authorized users Staff preparation through mock simulation utilizing a “live” version to ensure proper feedback and reduce anxiety.Full vendor assistance to address system failures and coordinate EMR implementation activities regarding training and updates.Based on the proposed implementation methods above, change management strategies have been developed in order to allocate the proper amount of resources to emerging changes that require attention. Change management strategies also allows for the development of privacy and security measures. Since information could be subjected to unauthorized access several security measures have to be taken to ensure a stable system that could withstand a cyber attack (Gunter & Terry, 2005).

Implementation Of Technology

Privacy and security concerns can be addressed as follows (not a comprehensive list, but a starting point):Digital audit trail that leaves identify markers such as components that were accessed/changed, who had access to files, and time stamps of said events.Conduct monthly risk analysis to ensure proper encryption methods are up to industry standards and protecting sensitive information. Conduct monthly training programs that elucidate the importance of safely securing patient information along proposed methods to mitigate any potential lapses in security protocols. Work with vendors to develop new security measures to ensure sensitive information is not easily accessible by unauthorized users as well as complex encryption methods to deter a cyber attack.System monitoring with creation of user capabilities that limit or grants entry to system features.

Implementation Of Technology Continued

Data migration, sharing, and integration is of great concern due to functionality and interoperability. Strategies should include: Profile the data to be migrated Understand data intricacies and format for interoperabilitySelect a migration schedule that best suits business needs Test migration and sharing capability with a backup to ensure data is not cleared before merging Perform end-validation to ensure functionality The utilization of such measures along with cloud-based solutions allow for a reduced-cost technology platforms. Cloud-based technology allows for cost reduction and safer methods of privacy protection and end-to-end encryption methods

Implementation Of Technology Continued

Support and Sustainability

Ongoing support along with financial and technical sustainability is essential for an electronic medical record to function appropriately. A financial sustainability plan should include the following evaluation methods:Current utilization of resources.Comprehensive list of any/all items needed and used for the project.Required resources for ongoing utilization and for project upgrades. The amount of funding currently needed to keep the ongoing operation. Who will be contacted when more resources and/or funding is required to keep the operation going.The end-user technical support is of great importance because this guides how each person will be able to utilize the system. Thus, it is imperative to develop a method that simplifies this process along with integrating changes in system architecture with the potential to fit with emerging industry technologies. The following slide will provide an example of how this can be achieved.

Support and Sustainability

EMR Competitive Advantage

An electronic medical record system proves to not only be efficient but provides a competitive advantage over archaic paper-based record-keeping methodologies (Richards, 2012). Some of the advantages include:Faster scheduling and automatic follow-up services with patients Marketing of services through consultsIntegrating billing service where all billing is done within the application without needing a third-party service.Compliance measures automatically created by the developers to ensure local/federal regulations are automatically met

Conclusion

The added cost that Bethany Place will incur will be significant, however, this initial cost is low compared to the rate efficiency gained. The increased efficiency translated to an expedited medical care allowing for my patients to be seen, thus increasing revenue. While certain issues may arise the explanations provided within the presentation provide reliable solutions.

References

Richards, R.J. (2012). Electronic medical records: tools for competitive advantage. International Journal of Quality and Service Sciences, 120-136 (4). DOI:10.1108/17566691211232873Sittig, D. F., & Singh, H. (2011). Legal, Ethical, and Financial Dilemmas in Electronic Health Record Adoption and Use. Pediatrics, 127(4), e1042–e1047. http://doi.org/10.1542/peds.2010-2184Thakkar, M., & Davis, D. C. (2006). Risks, Barriers, and Benefits of EHR Systems: A Comparative Study Based on Size of Hospital. Perspectives in Health Information Management / AHIMA, American Health Information Management Association, 3, 5.Centers for Medicare and Medicaid Services. (2016). Electronic health records. Accessed on 02/09/16 from https://www.cms.gov/Medicare/E-health/EHealthRecords/index.htmlKierkegaard, P.(2011). “Electronic health record: Wiring Europe’s healthcare”. Computer Law & Security Review. 27 (5), 503–515. DOI:10.1016/j.clsr.2011.07.013Gunter, T.D., & Terry, N.P. (2005). The emergence of national electronic health record architectures in the United States and Australia: models, costs, and questions“. Journal of Medical Internet Research, 7 (1).DOI:10.2196/jmir.7.1.e3