TERM PAPER HSA
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HSA4191TermPaperExample2018.docx1
Within the EHR
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[Student Name Removed]
Abstract— This research paper was conducted to demonstrate the usefulness, positives, negatives and challenges associated with implementing the Electronic Health Record in a small private family practice group. Further use of research in this paper includes pieces on project implementation, government security accordance and system recommendations.
INTRODUCTION
Health information technology (HIT) has been revolutionized by the development of the electronic health record (EHR) and its expansion. The generalization of its use includes the transformation of paper patient charts and protected health information (PHI) into electronic forms and from there the options to revolutionize HIT began. The development of the EHR has brought a multitude of advantages and challenges with its implementation in the HIT world. Although the functions of EHR have allowed for both public and private sectors to utilize its possibilities, the private sector will be focused on in this situation. The ability for an electronic system to safely document, record, save, integrate and share with other instantly has allowed HIT to expand rapidly to all corners of the world.
EHR functionalities
In health information technologies, electronic health records have been identified by the Institute of Medicine as having eight core components which include the following [1]: recording patient health information and data, result management, physician order management, decision support, electronic communication and connectivity, patient support, administrative process and reporting, reporting requirements, and population health. Table 1 allows a visual representation of the core components along with other variable options available through the EHR [2]:
As seen, the electronic health record is much more than digitized patient records. As the EHR has the ability to provide functions ranging from patient care through supportive administration functions and even the function of informational infrastructure guidance in order to better aid the staff of the practice in clinical and clerical office services.
Integration of Practice Management System
Practice management systems (PMS) have multiple levels of integration with electronic health record systems yet there are difficulties at each level. Levels of integration can range from full system communication sharing all data entered in to each system or select data pending on the organizations need for level of integration from one system to another [3]. To distinguish the two systems, practice management systems provide more clerical functions of a physician’s office such as patient billing profiles, insurance verification, appointment scheduling and sending appointment reminders [3]. Co-coordination between the two systems have become increasingly more difficult due to the evolution and development of multiple EHR products. As organizations develop new electronic health record systems and PMS software the possibilities and extent of integration has become challenging yet still possible.
One such successful integrations of PMS and EHR was conducted with the organization A ViSolve Inc. A ViSolve Inc. was able to drastically decrease duplication of data, reduced physician effort in clerical work and decrease manual data entry [4]. A ViSolve Inc. was able to create interoperability with the purchasing organizations PMS and EHR systems to ensure that each were able to have seamless communication [4]. In this case, results from the integration allowed for improvements in speed and quality of care within the practice, improved accuracy between data sharing in the two systems, increased productivity from the clerical point of view, and a positive shift in physician hours spent towards providing more quality of care rather than in data entry [4].
Challenges in implementing The ehr
Small private practices have had a larger struggle in implementing the EHR due to differentiating factors that larger public systems may not have had. Table 2 contains the mean values from a previous study representing the ratings of challenges to implementing the HER. In this sample of medical group practices both large and small throughout the nation they named and rated challenges and barriers to implementing the EHR on a scale from one to five with five being the most important [5]:
· Cost and Return on investment – Amongst the highest mean ratings from Table 2 were the lack of resources available to invest in an EHR along with the lack of return investments status post implementation [5]. The loss of revenue caused from this challenge/barrier includes the transition period from paper to the EHR. This transition period represents the possibility for an unseen loss of revenue during the EHR implementation which can be substantial if incorrectly managed. In addition, assuming the medical practice has the necessary means to support this loss of income the possibility of not being able to recover from the transition or recover any amounts of monetary gain from the system has also established a challenge for implementation [5]. Sometime implementing the EHR does not always prove to be beneficial as small practices can become overwhelmed by licensing fees and annual fees associated with implementation making the investment too risky.
· Physician ability and willingness – Also referred to as the people barrier, physicians, clinical staff and other providers must have the willingness to alter their clinical practice to accommodate changes [5]. If an effort is not attempted to perform a successful transition into the EHR, then ultimately the project will fail costing an exponential amount of money and maybe even the medical groups practice. Coinciding with this if the clinical staff does not have the capacity to adapt quickly to the EHR then the illusion of loss on investments as mentioned in the first barrier to implementing EHR will also follow. Technical skills will need to be developed at an alarming rate which can be come another liability to the small practice if not enough training is available.
advantages in using the ehr
Table 3 lists the benefits and advantages of implementing the EHR into private practices based off the same study previously used in the challenge/barriers portion of the paper. This too, contains a mean rating of the advantages provided by the EHR [6]:
· Access to information – Both PHI and clerical information can now be more easily accessed by individuals who require the necessary means to view data. In this process, workflow improvement is also a key factor in EHR implementation [6]. Improvement in workflow can now benefit provider efficiency and in turn increase the quality of care for patient in the practice. Providers will now have instant medical information at the click of a button streamlining the process for conduction searches on past medical history, allergy lists, medication lists, and lab/radiology results.
· Prescription capabilities – Administering and refilling drug prescriptions can now be conducted electronically which can substantially increase the process of interactions with pharmacies in the area. Filing claims with insurance agencies for prescriptions is now more efficient as software within the EHR and PMS systems are able to verify coverages electronically. EHR implementation can further track medication prescriptions which is another added benefit to private family practice groups seeing how government regulations are becoming stricter with the current opioid epidemic in the country.
· Medical Errors – EHR implementation utilizes real time documentation and is continuously updated with each patient visit providing the most up-to-date information for each encounter. This provides physicians with more accurate data when conducting medical procedures, diagnosis, and viewing diagnostic results allowing less medical mistakes to occur.
· Reduced Expenses – A key factor for private medical groups in hopes of achieving as much income as possible is to control expenses. The Center for Medicaid and Medicare insurance reimbursement rates decrease year after year and private insurers are following with the reimbursements rates to hospitals and private practices alike [7]. Implementation of the EHR allows private practices to marginalize expenses by avoid duplications and mistakes which ultimately maximizes their profits.
Project Planning and Management
EHR implementation and the management of this project can be successfully done through a five-step process as outlined by Claudine Beron the Vice Chair of the Health Information and Managements Systems Society [8]: initiate, plan, execute, control and closing phases.
The initiation phase will consist of educating the staff about the project while gathering their understandings of their skill set of information technology and identifying missing skills and key pieces required to continue to the next phase of the process [8]. The planning phase will rely heavily on the project team selected to be responsible for the success of the rest of the process. Here, the team will need to manage a detailed schedule including time and cost of activities, project risks and communication pathways for issues should they arise [8]. The planning phase will also develop a budget for the resources required as well as vendor selection of the EHR, confirmation of software and hardware installation and the verification of staff training schedules [8].
The following two stages occur almost simultaneously as execution and control of the project are underway. Top objectives in this part of project management include conducting and managing ongoing activities such a training and installation, measuring project milestones by performing quality assurance checks, and identifying any risks that would likely trigger a contingency plan prior to when they are necessary [8]. Control of the project management monitors risks and logs issues that arise, tracks performance and completion percentage, measures the reporting of timesheets, tacks vendor and subcontractor reports and documents cost control [8].
The closing phase prompts the end of the project management process and includes closing out financial obligations, signing out vendor and subcontractor documents, finishing final reports to executives and shareholders and conducting a project review to determine the lessons learned through implementation of the EHR system [8].
Technology Security Considerations
To prevent breaches in EHR systems, vendors and organizations have designed their software’s and hardware’s to make the as impeccable as possible in order to prevent breaches in PHI and HIPAA violations. The tradeoff for security however is access and one of the key function the EHR is to provide easy access to information posing a difficult situation for vendors and EHR developers. Considerations for technology security include publishing standards and definitions of what constitutes as a violation and can include the creation of a system of levels that provide warnings and negative reinforcements to prevent the violation of said standards [9]. Ensuring internal compliance from all employees via signed agreements partnered with continuous training and education on these systems can also improve secure conditions [9]. From the software perspective, audit recording systems and encryption software can help track and lock accessible PHI to prevent further HIPAA violations from unwanted breaches [9].
0. Final Recommendations base upon Data
Through extensive data analysis this practice should acquire an EHR system that best suites smaller medical groups seeing as there are only three physicians on staff. Based off the data collected from Medical Group Management Association and the Health Services Research Division at the University of Minnesota the average upfront cost for one physician of a smaller private practice will be over $33,000 with annual maintenance fees of over $1,500 per month [5].
In this case of the given $150,000 for upfront expenditures approximately $120,000 would be expected to be spent at $40,000 per physician leaving a remainder of $30,000. This small family practice could expect to consume most of its annual budget leaving room for approximately $1,650 per physician per month with only a $60,000 allowance. An adequate recommendation for an EHR system would most likely fall under operators of the EHR systems eClinicalWorks or Allscripts as they cater more to smaller practices holding over 20% of the small practice market share combined compared to the other nine top competitors [10]. Specifically noted to avoid are EHR giants such as Cerner and Epic whom mostly provide services to large medical and hospital groups [10].
Further recommendations would suggest to use a remotely hosted EHR system, specifically a cloud system while avoiding more expensive remotely hosted options such as a subsidized or dedicated host system. Cloud based systems require minimal if no installation during implementation, are relatively cheaper monthly with an average of $1,100 per month and have an outsourced IT department creating the perfect environment for a small private family practice [11]. This practice may also benefit from a physician-hosted system however a recommendation for this type is withheld because according to the National Center for Biotechnology Innovation; vendors of this type of system can withhold data from practices should any issues arise and being a more expensive system, it would be best to avoid this option [11].
Conclusion
The research conducted on this paper has certainly shed more light as to what the Electronic Health Record has become. The EHR is certainly much more than digital paper charts as its functions and implication reach far beyond what its original intentions were for.
Presented in the paper were several challenges, advantages, and special considerations that make taking the step toward implementing the EHR a risky but rewarding behavior for any healthcare organizations. Tables two and three both list the negatives and positives, accordingly, of implementing the HER. Specifically, mentioning physician resistance and staff capabilities as well as management costs are major cons that were easily outmatch by key advantages of EHR: improved access to information, reduced medical errors, reduced expenses in the long run and most importantly improved quality of care.
Following HIPPA and governing acts of HIT are a constant reminder that the EHR will only be able to go as far as the government allows in order to keep PHI protect and safe from breaches. Although not the safest system possible, the cloud system would be the most recommended for a small private family practice. It’s accessibility, low cost, and easy installation suite the practice the best out of its competitors.
As for learning exercises throughout the course, modules six and seven provide solid background information specifically for the paper. HIT service management and electronic health records were core objectives for this course and were certainly helpful while conducting this research.
References
[1] IOM cites core functions to improve EHR systems. (2003). Healthcare Benchmarks And Quality Improvement. Volume 10. Number 10, pp. 118-119.
[2] P. Sinha, G. Sunder; P. Bendale, M. Mantri; A. Dande. (2013). “Electronic Health Record: Standards, Coding Systems, Frameworks, and Infrastructures.” The Institute of Electrical and Electronics Engineers, Inc. Published by John Wiley & Sons, Inc.
[3] D. Gans, B. Dowd, T. Hammons, J. Kralewski, (2005). “Medical Groups’ Adoption of Electronic Health Records and Information Systems,” HEALTH AFFAIRS ~ Volume 24, Number 5 p.1323.
[4] A ViSolve Inc., “Interoperability Service: PMS and EHR A ViSolve, Inc. Case Study” Retrieved July 27th, 2018 from http://www.visolve.com/uploads/resources/vicareplus/PMS%20and%20EHR%20Integration.pdf
[5] D. Gans, B. Dowd, T. Hammons, J. Kralewski.(2005). “Medical Groups’ Adoption of Electronic Health Records and Information Systems,” HEALTH AFFAIRS ~ Volume 24, Number 5, pp.1328 – 1330.
[6] D. Gans, B. Dowd, T. Hammons, J. Kralewski, (2005). “Medical Groups’ Adoption of Electronic Health Records and Information Systems,” HEALTH AFFAIRS ~ Volume 24, Number 5, pp.1327 – 1328.
[7] Center for Medicare and Medicaid Services. (2016). “Comparing Reimbursement Rates.” Retrieved on July 29th, 2018 from https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/LTSS-TA-Center/info/understand-the-reimbursement-process.html
[8] C. Beron (2013). “Readings: Implementation of Electronic Health Records” Retrieved July 28th, 2018 from http://openonlinecourses.com/ehr/ImplementationOfInformationSystems.asp
[9] J. Hauenstein, & C. Sarrico, (2011). “Can EHRs and HIEs get along with HIPAA security requirements?” Healthcare Financial Management: Journal Of The Healthcare Financial Management Association. Volume 65. Number 2, pp. 86-90.
[10] Medical Economics. “Top 10 Most popular EHR systems for small practices” Retrieved on July 29th, 2018 from http://www.medicaleconomics.com/modern-medicine-feature-articles/top-10-most-popular-ehr-systems-small-practices
[11] D. Neal. (2011). “Choosing and Electronic Health Records System: Professional Liability Considerations” Innovations in Clinical Neuroscience. 2011 Jun; Volume 8. Number 6, pp. 43–45.
