Thesis

Health care is critical in any society. Managing patient’s data goes a long way in ensuring good treatment measures are taken. Health care information therefore must be collected correctly and stored in a manner which abides by the principled of confidentiality, integrity and accessibility (Kaushal et al., 2009). Data regarding a patient should be kept confidential as much as possible and only retrieved when needed. A good health records management system should be able to confidentially store patient’s data. Each patient should have an account within the system where their data is stored. Access to this data should be given on privileges basis and only to individuals who will use it for treatment of the patient. The patient’s data in a good health information management system should be of high integrity. Data should be collected from the source (the patient) and recorded during the collection process. Having an intermediary stage where data is recorded in in a secondary avenue before being transferred to the primary system could lead to errors thus compromising its integrity. A good health information management system should also ensure ease retrieval of data wherever needed. A doctor or medical practitioner shouldn’t should not find it hard to get data on a patient when in the process of treatment. Comment by Author 2: What is this? Be specific what you mean with that. Comment by Author 2: I rather you use the correct term for this. Rather use the HIPPA, etc. The terms you learned with this degree. Make it relative to the subject of EMR. Comment by Author 2: Make sure you use quotations if you copied the original author prior to citing. Just in case you copied anything and pasted it. Comment by Author 2: What does this mean? please identify and don't assume the reader knows what you mean. Comment by Author 2: Now, that is where you include a paragraph or two on what your overall research is investigating and researching. Then, I would include a paragraph or two to explain what previous research has proved to date about the same issue you are researching. Then, should have a paragraph to provide a good background about the data and why is it important. Rethink to add more value of information so your reader learn this knowledge.

Medical records refer to the documentation of a patient’s medical/health history and care over a period of time within a particular health care provider’s geographical coverage (Jha (a) et al., 2009). Being a requirement for all health care providers to build and maintain patient’s health data, these providers open an electronic file for each new client and input all data regarding the client whenever visiting the provider. Such data will include recording observations and administration of drugs and therapies, orders for the administration of drugs and therapies, test results, x-rays and other health reports. These records should be complete and as accurate as possible to ensure and medical practitioner within the provider can have a 360-degree view about the patient.

Electronic Medical Records (EMR) also referred to as eElectronic h Health r Records (EHR) or simply health charts ensure digital collection, storage, and retrieval of patients patients’ medical records. The EMR gives a real-time information concerning a patient’s interaction with a specific health care provider. With the holistic approach offered by EMR, practitioners can prescribe offer and provide the best medical care attention to a patient as perby simply retrieving real-time data the data at their disposal needed to making timely medical decisions. Comment by Author 2: Don't use terminology that leaves the reader wonder what you mean. Rephrase.

This is medical information held about an individual patient. Access to a particular patient’s health history greatly determines the type of medical attention such a patient getsneeded. With reliable, timely and conclusive access to this data will help in understanding the patient’s illness, underlying medical conditions, already undertaken medical tests, any ongoing medication or impending medical procedure to the client (Parente & McCullough, 2009). Comment by Author 2: Sentence structure is incorrect or weak. Don't start with "This is". You need to be specific in every way possible. If you are referring to data, then say Data is ..., etc. Comment by Author 2: You have redundancy all over the intro. When you talk about data, I would prefer to utilize well a good literature review to talk about what did data offer the healthcare field and also, the previously discussed challenges or opportunities. You have to be consistent. Meaning, you have to stay focused on your topic. If you are talking about barriers, then stick to this all around, for instance, make sue that you bring this up as you talk about anything. Comment by Author 2: very broad term. Why don't use something like healthcare information? That is more appropriate to your study as well. Comment by Author 2: Good. These are the things you need to discuss here. That is how someone can tell you did a good literature review. Make sure to use te literature and cite. This is a confirmation that your research is reliable.

The primary Research found that various barriers to EMR implementation exist in acute care and physician practice settings including the are implementation costs, the uncertainty about the return on investment (ROI), the concerns about maintenance costs, and the lack of physicians’ acceptance of use (Barbara & Ken 2010). While an EMR might offer an inclusive approach in addressing medical information challenges, its implementation greatly determines its level of success. The sponsors of an EMR implementation must be aware of these barriers and come up with clear guidelines on how to overcome them to ensure full realization of the EMR benefits.

In this paper, the i will seek to give a guide on how to effectively implement an EMR in a health care provider. To understand this, the various challenges to the implementation will be analyzed from which elaborate ways will be formulated to address the barriers. The findings from the research can be used by small to large health care providers when rolling out epic EMR.

i. Identify the various barriers to implementation of an Electronic Medical Records (EMR).

ii. Formulate conclusive solutions to address the identified barriers to EMR implementation.

iii. Give a guide on effective EMR implementation across health care facilities.

The study intends to address the following questions;

i. Does EMR improve service delivery in health care providers?

ii. What are the key components of epic EMR?

iii. What type of patient’s information is captured in EMR?

iv. What challenges does health care facilities face in implementing EMR?

The information from this research will be crucial to health care providers as they will be able to have a clear understanding of epic EMR. As the paper will point out the various barriers to EMR implementation and offer possible solutions, health care providers will have a guide kit on what to do whenever implementing an EMR. Regulatory bodies will understand the kind of patient’s information is collected and help in enacting various regulations deemed necessary to protect this information.

In this second chapter, relevant literature information related and consistent with the objectives of the study was reviewed. Important issues and practical problems were brought out and critically examined so as to determine the current situation. This section was vital as it determined the information that links this study with past studies and what future studies would still need to be explored so as to improve knowledge.

For an EMR platform achieve its overall objectives, the following key features have to be incorporated in its design.

i. Patient portal (My Chart). This forms the initial point of contact between service provider and the patients. Any new patient should be registered by capturing personal details, contact information and even address data. Having geographical location of patients is key I planning for scheduling. For existing patient, by keying in a search criteria such as phone number or email, one should be able to retrieve all data about the specific patient. This greatly gives the medical practitioner a 360-degree view about the patient thus allowing for conscious decision making in addition to greatly saving time (Mostashari et al., 2009).

ii. Patient Scheduling (Cadence). Ability to register patients, schedule them and even choose a purpose for visit is necessary for an EMR platform. Members should be able to key in patient’s data in real-time, enable appointment booking and even reason for appointment. With embedded notification option, the EMR should be able to send reminders to patients on their upcoming appointments.

iii. Patient history recordings. A good EMR should keep all patient’s information and make it easily accessible. This information should be synchronous in that one can have a view of the patient in terms of allergies, previous procedures, treated ailments, any lab tests and even payment information. Externally available patient clinical records should also form part of the patient history recordings.

iv. E-Prescribing. This allows for electronic printing and transmission of patient’s prescription from the doctor’s room to pharmacy, or even transmission on laboratory test results to the doctor’s room. The E-Prescribing feature gives automatic and instant notifications on drugs and any allergies as stored in the system database regarding the specific patient (Barbara & Ken, 2010).

v. Medical Billing Dashboards (Professional / Hospital Billing). Billing forms part of medical care process. A system which will be able to correctly and accurately accumulate and project all charges across the various treatment processes such as consultancy fee, lab fees and pharmacy fees is effective. A chart comparison of the various processes charges makes it more desirable.

vi. Order Entry (CPOE). This allows medical practitioner to enter, save and transmit a patient’s order compromising of prescription, medical tests and any other service offered. These orders are transferred electronically making it fast and very effective. Also reduces the error of mix-up in patient orders.

vii. Lab integration (Willow). Lab tests forms part of medical attention. Doctors will need to have access to lab tests results to give the right prescription. An EMR should therefore have a directly link to the laboratory whereas results are updated, the doctor can view them without having to go through paperwork filled by laboratory team.

viii. Documents management (HMS). Any system should have a systematic way to manage various documents. Am EMR is no an exception. Documents should be easily managed and shared through the EMR without having to physically move the documents from on place to another. The platform should offer charting features for quick clarification whether needed amongst the medical team.

ix. Centralized Communication (Command Center). Customer experience in key in care delivery. A good EMR should have an easy patient-doctor interaction. This should be management at a central point to ensure no unattended queries and also to enhance accountability.

Despite the many adorable features of an EMR, adoption has been slow than expected. This rate is even worse for small and medium health care providers. Some of the challenges associated with the slow adoption of EMR within health care providers are discussed below (Sameer & Krista, 2010).

i. High capital costs and insufficient returns on investment. Good Electronic Medical Records systems are not cheap to acquire. Other overhead costs such as training, support costs and integration technicalities drives the cost even higher. Many small heath care providers have only a limited number of clients thus unable to foot for the initial costs on EMR. Even when they are able to acquire an EMR platform, the returns might never realize the initial investments within the estimated financial period thus making it a less viable investment.

ii. Underestimation of the change management required. More than often organizations fail to plan enough for deployment of an EMR platform as a result of overlooking the change management required. Though it’s just a system, an effective EMR touches every process in an health care provider. Whenever change is underestimated then some functionalities of the EMR might be overlooked thus fail to realize the full epic EMR potential.

iii. Lack of alignment between clinical process and workflow to the EMR system. When effectively implement, an electronic Medical Records system should take over all processes in a facility dictating the workflow. If not properly aligned to existing processes and workflows, people might feel that the EMR isn’t effective thus a barrier to adoption.

iv. Concern that systems will become obsolete. EMR costs are high thus a fear in investing. With technology changing very fast, some facilities might feel in no time the technology will be irrelevant thus loosing the system as a whole.

v. Lack of skilled resources for implementation and support. EMR will need trained staff from deployment to its support. Many facilities lack enough staff with technical knowledge on supporting systems thus fail to adopt. They might consider hiring new staff to support the EMR platform as an extra expense and decide against adoption altogether.

vi. Concern regarding negative unintended consequences of technology. Organizations are always in fear of negative consequences brought about by new technology and systems. Health care providers are always concerned on whether staff will become reluctant and less careful as they believe an effective EMR makes their work easier thus compromising the work standards.

The paper has outlined the various challenges associated with adoption of epic EMR. Through this section, a series of options and measures will be outlined to address the noted barriers.

i. Preparing for change. Change is never always welcomed. In most cases, people would prefer the norm way of doing things. EMR adoption will definitely have a great change in how processes flow within the healthcare facility. Fear of job losses due to digitization is a real concern amongst many staff. The management and drivers of the EMR adoption should engage all stakeholders well and in advance to seek for acceptance and support in the implementation. EMR is purely about streamlining processes and improving on efficiency thus shouldn’t be shunned away.

ii. Investing in skilled resources to implement, support and train other users. Implementation is only successful if its deployment is done in correct way, with enough support and training. Having few new staff to support the EMR depending on the size of the facility is far outweighed by the benefits an effectively implement epic EMR. Such resources should train the medical practitioners on different modules in the EMR and general use.

iii. Planning for alignment and integration should be properly done to ensure all processes and workflows are captured in the EMR. The implementation team need to understand all the current processes and workflows which them will be matched with the EMR processes and workflows. Any merging of processes whenever necessary should be documented so as not to reach dead ends (Sameer & Krista, 2010).

iv. Though initial costs to acquire epic EMR might be high, when property implemented the revenue realized would easily justify the investment. It is therefore necessary for facilities to shift focus from the initial costs and rather focus on effective implementation which will bring high returns to cover for the initial costs which are one off costs.

While Cedars-Sinai has a good reputation in medical innovation, their EMR implementation was a failure which is often used as Cautionary to anyone intending to acquire an EMR platform. While the hospital invested $34 million on EMR system in 2002, the system was later scrapped as a result of ineffectiveness and poor implementation (Sameer & Krista, 2010). The system was meant to improve health care by providing end to end EMR services. Much of the failure was associated with the introduction of many decisions support mechanisms way after the actual deployment. Pre implementation planning was poorly done thus such important support functionalities had been left out. Much of the drugs and prescription module had been left out. Insufficient training and lack of system testing also attributed to the failed implementation at Cedars-Sinai facility. More critically, a phased approach wasn’t used as always recommended for such systems which hugely turned out to be a costly mistake.

Veterans Administration (VA) implemented a national EMR system called Vista in 1999 which was a success. The success was majorly attributed to its comprehensive roll out plan for the system. Careful planning and collaboration with IT personnel, subject matter experts and end users was critical to the success as it led to creation of a workable system. The system’s 24/7 technical support and timely feedback sessions were highlights of the success story. Buy-in was achieved at all levels throughout the organization prior to implementation (Sameer & Krista, 2010).

This chapter explains the approach i used to gain information on the research problem and includes the research design, study population and sample size, sampling design and procedure, data collection methods, measurement of variables. Procedures used of data collection, data processing, analysis and presentation and anticipated problems to the study.

A research philosophy is a belief about the way in which data about a phenomenon should be gathered, analyzed and used (Saunders et al., 2019). In this study ontology research philosophy will be used. Being a hypothetical-deductive investigation, subjectivism approach will be used to determine how effectively can Electronic Medical Records system (EMR) can be adopted by healthcare providers. The study will also formulate various ways which can be employed to promote EMR adoption across the health sector.

The research design is the overall strategy that is used to integrate the different components of a study in a coherent and logical way, thereby, ensuring effective address of the research problem; it constitutes the blueprint for the collection, measurement, and analysis of data (Creswell, 2012). This study’s is to hypothetically investigate how EMR platform can be effectively adopted by healthcare providers. The study will first analysis the various barriers to adoption and therefore formulate various ways in which such barriers can be addressed. Questionnaires survey will be used to collect primary data. Literature analysis with be the key source of secondary data though the research. Journals and other publications will be studied to supplement the literature analysis.

The study population will comprise of healthcare providers within the United States (US). The questionnaires will be distributed to staff in Trinity Health Hospital and St Peters Hospital Albany New York. Both hospitals have implemented epic EMR thus the paper will analyze firsthand knowledge on epic EMR training and experience. Literature will be reviewed for other healthcare providers within the US for so as to get a broader view on epic EMR implementation.

Sample size is a research term used for defining the number of individuals/entities included in a research study to represent a population. This subgroup is carefully selected so as to be representative of the whole population with the relevant characteristics. Sampling is a procedure, process or technique of choosing a sub-group from a population to participate in the study (Smith, 2013).

i. The sampling plan describes the sampling unit, sampling frame, sampling procedures and the sample size for the study. The sampling frame describes the list of all population units from which the sample was selected (Cooper & Schindler, 2012). Factors considered in determining the sample size included; Confidence level: the measure of how certain you are that your sample accurately reflects the population, within its margin of error. Common standards used in research are 90%, 95%, and 99% (Cooper & Schindler, 2012).

ii. Margin of error: the percentage that describes how closely the answer your sample gave is to the “true value” is in your population. The smaller the margin of error is, the closer you are to having the exact answer at a given confidence level (Cooper & Schindler, 2012).

The Trinity Health Hospital and St Peters Hospital Albany staff will form the sample size for primary data. Both hospitals have a total of one hundred and fifty seven (157) staff. The paper aims at having all of them fill the survey questionnaire. By use of literature analysis and publications as a source of secondary data, a sample size may not be clearly determined. However, enough of secondary data will be reviewed to enable formulation of a rich opinion.

Questionnaires will be used to collect primary data. Secondary data will be collected by use of literature analysis and reviews of relevant journals and publications touching both on EMR and systems adoption within hospitals and healthcare facilities. When necessary, randomized interviews will be conducted but the I intend to rely on questionnaires, literature and publications to deduce an opinion.

This is systematic application of statistical and logical techniques to describe the data scope, modularize the data structure, condense the data representation, illustrate via images, tables, and graphs, and evaluate statistical inclinations, probability data, and derive meaningful conclusions. The research sought to identify the challenges faced by healthcare facilities in EMR adoption and specifically epic. From the identified challenges, the research then deduced various ways in which these barriers can be overcome. Data was collected through questionnaires. Secondary data was collected by reviewing literature, journals and related publications. In analyzing the data, the I tried to find answers to the research questions formulated at the beginning of the research.

Upon data analysis, it was clear Electronic Medical Records (EMR) platforms are such an important system within healthcare facilities. From storing patients data, relaying lab tests results and showing patient’s history, EMR greatly improve on overall efficiency within a healthcare facility. Initial capital investment for EMR platform, lack of alignment with existing clinical process and workflow and lack of skilled resources to implement and support the EMR platform greatly hindered the adoption and use of EMR mostly in small and medium healthcare facilities. With many afraid they may not realize the full return on investment when purchasing an EMR, such facilities resulted to manual processes.

Lack of skilled resources to effectively implement and support EMR was noted to be a challenge in effectively adopting epic EMR. Not many of the small and medium healthcare facilities have a well-established information technology (IT) department. Majority they rely on consultants for the basic technical issues. EMR would require dedicated IT resource to implement and give any needed support. As integration will mean moving almost all facility processes to the system, such resource should always on standby thus relying on a consultant is never a viable option. An extra cost of hiring and maintaining an IT resource therefore has to be incurred.

Aligning the epic EMR with the existing clinical process and workflow was noted to be a major challenge. In most cases, the healthcare staff didn’t understand how integrating processes to the EMR will be like. They therefore resulted to working with the existing workflows thus sidelining the EMR. This easily rendered the epic EMR absolute as deployment has been done but it isn’t being used.

With proper implementation and support, EMR is a game changer in any healthcare facility operations. Some of the wins realized from acquisition and implementation of an EMR are as discussed below.

i. Less paper/storage. An EMR will greatly reduce the paper and physical storage needed for medical records greatly as data will be captured electronically and storage in digital format which doesn’t need physical space. Up to $1.3 billion could be saved yearly by moving from paper use in maintaining medical records (Girosi et al., 2005).

ii. Reduced redundancy an operational efficiency. EMR greatly reduces redundancy in record-keeping as a record need to be stored once but assessed from different places. Operations are well streamlined thus improving on efficiency from EMR's capabilities in storage, processing and information retrieval in computerized methods which are far faster than paper based (Vreeman et al., 2006).

iii. Great data accuracy. EMR system ensures great accuracy in billing, prescription and service authorization. An error can as well be easily corrected from search function as compared to manual search.

iv. Improved patient control and transparency. EMR system facilities communication between facility departments. Clinical personnel have a 360-degree view of patient thus more time devoted to planning and appropriate care (Vreeman et al., 2006).

v. Better reporting capabilities. Through an EMR system, clinical personnel can better analyze and review patient outcomes. With multiple outputs formats, reports can be customized for better understanding of the patient, payers and other parties who might need to use such information (Vreeman et al., 2006).

Data is a big asset to any organization. However, many entities lack clear systems which can store data and interrelate to give it meaning. Hospitals and other healthcare facilities have large pools of data concerning patients. By sorting and grouping this data, various processes and practices will be greatly shorted while at the same time improving on accuracy. This leads to cost cuts and increased revenues as a result of improve in efficiency and effectiveness. Epic EMR is such a system which can make healthcare facilities realize these benefits. Once it’s implementation and deployment has been properly done, these facilities stand a big chance in realizing its full potential and the benefits thereof.

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Epic Implementation Survey Questions:

1. What do you like about Epic?

2. What is your job role MD, RN, Medical Billing?

3. What department do you work?

4. How could we make it easier for you to adjust to Epic?

5. One a scale of 1-10, 1 being poorly satisfied, 10 being extremely satisfied, how satisfied are you with your training?

6. How was your trainer's knowledge of Epic: Poor, Fair, Good, Very Good, or Excellent?

7. On a scale of 1-10, 1 being poorly satisfied, 10 being extremely satisfied, how satisfied were you with your trainer’s teaching skills?

8. On a scale of 1-10, 1 being poorly satisfied, 10 being extremely satisfied, how satisfied were you with your trainer’s communication skills?

9. On a scale of 1-10, 1 being poorly satisfied, 10 being extremely satisfied, how satisfied were you with your trainer’s people skills?

10. Was your trainer kind and understanding when it comes to teaching you something you didn’t comprehend?

11. How much time did your trainer spend teaching you the new system?

12. Overall, how much do you feel you have learned from your trainer?

After the questionnaire was distributed, 157 participants both staff from Trinity Health Hospital and St Peters Hospital Albany took part. The response was analyzed as follows.

1. Why do you like epic?

Responses included because of the systems; effectiveness (24%), easy to use (27%), fast (9%), no paperwork (28%), secure (7%) and others (5%).

2. What is your job role?

Two (2) participants where in MD positions, 34 physicians/doctors, 57 nurses, 18 from accounts and billing, 14 from pharmacy, 8 receptions, 14 from the laboratory and 10 other hospital units.

3. What department do you work?

4. How can we make it easier for you to adjust in epic?

Respondents gave the following recommendations; 52% needed more training, 23% more technical support, 15% needed manual printouts while 10% gave other recommendations.

5. Training satisfaction levels.

More than half of respondents (85) rated satisfaction levels as 5 and above up to 10 while 72 respondents were not satisfied.

6. How was the trainer knowledge on epic?

7. Trainer’s teaching skills.

Majority of respondents through the trainer needed to improve on teaching skills with only 27% of respondents saying were satisfied to extremely satisfied.

8. Trainer’s communication skills.

Response was fairly distributed with satisfied to extremely satisfied having 51% while 49% gave a scale of 5 and below.

9. Trainer’s people skills

63% of respondents rated the trainer’s people skills between 6 to 10, satisfied to very satisfied. 37% of respondents felt the trainer needed to improve on people skills.

10. Teaching something not comprehended.

The respondents were evenly distributed in their responses. 35% said the trainer as understanding, 33% were neutral while 32% felt the trainer wasn’t understanding when teaching something they didn’t comprehend.

11. Time teaching new system

The training took 3 days which was the response from all participants.

12. How much learning from trainer?

While majority of respondents (57%) agreed the learnt much of the system from trainer, 43% learned little or nothing new.

13. Did the Tip sheet help during Go-Live?

While majority of respondents (70%) agreed the Tip sheet help, 30% learned little or nothing new.

Department Distribution

Physicians Nursing Billing Finance Customer Service Pharmacy 34 57 12 6 8 14

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