Introduction
Electronic health records (EHR) are a widespread and practical application of information technology in healthcare. They contain data about the patient in digital format while protecting the privacy of the person. Information in this form can be effectively used by providers to treat one patient and be transmitted between them to ensure the best recovery. Choosing the right EHR and its capabilities for the organization will increase efficiency, reduce costs and help to achieve its goals.
Analysis: Organizational Overview: Organization
Selecting the necessary system for the organization depends on its size, goals, and stakeholders and can take a long time. The studied case presents the medium-size healthcare organization Alpha, which includes 150 beds, and 5 for intensive care. Key specializations include pediatrics, cardiology, women’s health, outpatient surgery, and orthopedic surgery. Its auxiliary service lines contain 13 clinics, which, in addition to mentioned specializations, also have family practice, internal medicine, neurological, and eye care clinics. Part of Alpha’s activity is also devoted to outpatient rehabilitation services and a community wellness program.
The organization is interested in ensuring that the new system will allow employees to transmit data through all service lines efficiently. The new system should also solve the problem of entering information and provide a convenient scheduling system. The main stakeholders are the staff – doctors, and nurses, as they will use the system the most. Other stakeholders include administration, managers, information technologies (IT) and health information management (HIM) department, billing department, and the EHR provider.
Design: Applications: Health Informatics
EHR is a collection of several systems that work together. Several components should be included in the EHR for Alpha. In particular, registration – administration, discharge, transfer (R-ADT) system, continuity of care record (CCR), and a personal health record (PHR) are needed to contain patient data. Computerized provider order entry (CPOE) systems, patient monitoring systems, document management systems (DMS), clinical messaging, scheduling systems, and electronic mediation administration records (EMAR) also support personnel activities (Sayles & Kavanaugh-Burke, 2018). Population health and patient-provider portal are necessary to provide patient support.
Design: Applications: Requirements
It is possible to set the following requirements for EHR:
- Health data – information should be collected and presented thoroughly and in a standardized form.
- Communication – the system should provide convenient and fast communication between suppliers.
- Patient support – the system should provide tools to communicate with patients. They should also be able to see personal information, like test results, and general information, like guides or health recommendations.
- Order Management – the system should enable providers to work with prescriptions and orders (Green, 2021).
- Population health – the system should support communication with society and provide it with reports and relevant information.
- Privacy and security – patient data, and providers’ communication must remain confidential and protected from intruders.
Design: Applications: Scope
The necessary components will help to solve the tasks assigned to the Alpha organization. For example, DMS will streamline paper patient records using scanning. CCR and PHR contain patient information, and authorized users can access it. In this case, doctors will have complete and accurate information collected by other specialists, which will reveal a more detailed history of the patient. R-ADT and CPOE systems are needed to collect data in a standardized form using document templates, which will then be used in the treatment and by the billing department. CPOE is created to enter orders by suppliers but also contains a reminder function important for regular patient screening and integrated clinical decision support capabilities.
EMAR simplifies the discharge of medicines, and scheduling systems are convenient for appointments. Patient monitoring systems can be effectively used for intensive care and cardiology. Patient-provider portals help customers communicate with doctors and learn the necessary information, like test results or clinical guides. Finally, population health is helpful for the community wellness program, as it is designed for reporting at the public level. For example, it can provide information about the prevalence of a virus or disease.
Design: Applications: Data
Secondary information is data collected by someone else, not its current user. In the case of EHR implementation, Alpha should consult with other health institutions that use the proposed systems from the particular vendor (Sayles & Kavanaugh-Burke, 2018). Organizations can be found with the help of an EHR provider, cold calls, and corporate offices (Sayles & Kavanaugh-Burke, 2018). In this case, Alpha will determine the real advantages and disadvantages and evaluate the results of other organizations. When the choice is made and the system is installed, Alpha employees must also go through training. They will also receive secondary information about the peculiarity of using the systems. Training is carried out not only before installing new systems but can also be ongoing or additional after some changes.
Design: Applications: Health Information Exchange
People’s health depends on many factors, so it is crucial to consider all aspects that impact them. Health Information Exchange (HIE) provides different health organizations with information that their colleagues gathered about a particular patient, excluding the possibility of error if the patient does not remember accurate data. HIE involves storing customer data obtained from various institutions and EHR systems (Price, 2020). If the EHR system is connected to the HIE, its users can receive and send information there. Thus, the chance of error is reduced, and treatment becomes more effective.
Design: Applications: Security
Patient information, especially in electronic form, requires serious protection from the organization. Kruse et al. (2017) identify three areas of security for protection against external and internal threats:
- Administrative: risk analysis and assessment, Chief Information Security Officer, security evaluation.
- Physical: physical access control, assigned security responsibility, workstation security.
- Technical: firewalls, encryption, access control, virus checking, authentication, audit trails.
The most effective and discussed methods are firewalls and encryption. Firewalls monitor inbound and outbound traffic and block malicious traffic. When encryption occurs, the data text is converted for storage to an unreadable form. Once the provider accesses data, it is converted to the original format.
Design: Applications: Disaster and Recovery Planning
A disaster and recovery plan is needed to protect patient data in critical situations, such as natural disasters, power outages, and other similar events. Such a plan usually involves data backup, actions procedures, and disaster recovery (Snell, 2018). Alpha can create a backup network or cloud storage for patient data. Backups help access and restore information when conventional methods are unavailable, even during cyber-attacks (Snell, 2018). Thus, the prepared plan allows for providing care to patients continuously.
Design: Applications: Computer-Assisted Coding
Computer-assisted coding (CAC) improves the performance of healthcare facilities by improving the quality of reports and meeting the requirements of its customers. Using CAC, data from EHR is transferred to transcription and financial systems (“Computer-assisted coding software,” n.d.). CAC uses natural language processing (NLP) to “analyze and interpret unstructured healthcare data using specialized algorithms, extracting the facts that support the codes assigned” (“Computer-assisted coding software,” n.d., para. 3). Thus, with the help of CAC, the management of medical documents is simplified by embedding the correct codes into them.
Design: Applications: Capabilities
The CAC capabilities required for EHR efficiency are as follows:
- Performance – fast coding speeds up processes such as search of duplicates, document sorting, and other tasks (“Computer-assisted coding software,” n.d.).
- Transparency – codes must be associated with relevant data in patient records.
- Consistency between different code assets provides accuracy and confidence in data (“Computer-assisted coding software,” n.d.).
- Correctness – affects the correctness and effectiveness of results and improves compliance.
Design: EHR Selection: EHR
An electronic health record system refers to the digital version representation of a patient’s paper chart. They are used in hospitals in retrieving and storing patient records and health information. They also aid in communicating with patients online and reminding the health care workers of scheduled activities and lab results. There are two types of health record systems: physician-hosted and remotely hosted. Any organization requires a relevant system that will enable the smooth flow of various activities.
The method depends on the organization’s stakeholders, its goals, and size. The healthcare organization in discussion is Alpha, and its size is medium. Its main aim is to consider the transformation from its outmoded blend of paper documentation and electronic scheduling systems to a stronger EHR that will contain all its service lines. It should also be user-friendly adequately not to separate its committed staff. It has 150 beds, where five are designated for intensive care needs. The emergency department is defined as a level 3 trauma center. The assigned care areas are outpatient surgery, orthopedic surgery, women’s health, pediatrics, and cardiology. The auxiliary service lines consist of 5 family practice clinics, two internal medicine clinics, one cardiology clinic, one orthopedic and sports medicine clinic, one eye care clinic, one women’s clinic, and one pediatric clinic. Additionally, Alpha provides outpatient improvement services and social welfare activities. The Epic systems are the certified EHR chosen in the hospital as it suits the organization’s needs. This is because it is cost-effective in terms of maintenance and stores patients’ data securely. It also operates with a wide range of features like electronic connectivity and communication, order management, and template-based data entry. It has a patient portal and a variety of cloud host systems.
Design: EHR Selection: CMS Regulations
The system satisfies the CMS regulations in a variety of ways. It protects the rights of the patients. For example, when a patient discloses information to the doctor, it is stored and not easily assessable by outsiders. The portals also allow patients to easily access information (“How to select an EHR vendor,” 2021). For example, when they want to know their medical history, they can log in to the portal and get it there. They can also monitor the trend of their diseases without forgetting some information. And in case of any dangerous direction, they can get recommendations on what to do to regain their health.
Design: EHR Selection: Type of EHR
To establish a suitable EHR system, one must decide on where to store data efficiently. The Physician-hosted system is the one chosen because of its efficiency over the remotely hosted systems. It best suits the organization since they are cheap and do not require overhead costs such as software (Adler, 2021). They have higher security of data hence protecting the privacy of patients. They have better performances as they are located within the site and do not require the internet to access information.
Design: EHR Selection: Patient-Centered Technology
The EHR selected can easily be used to support patient-centered technology. It does through the communication between patients and doctors online using portals. The patients become aware of how to retrieve their records, hence improving self-monitoring. It reduces medication errors that might be made during the treatment process leading to severe complications. Patient-centered care is also increased, causing them to be more responsible for their health.
Design: EHR Selection: Peripherals
One user interface design recommended to be included in the HER system is the voice user interface to allow patients to interact with the machines. This will increase data security by allowing voice passwords. This will allow flexibility of the equipment to both the healthcare providers and the patients (“How do I select a vendor? | HealthIT.gov”, 2021). Efficiency will be increased and, therefore, better cooperation among the stakeholders. Generally, it will create a conducive emotional and physically comfortable environment.
Implementation: Data Entry
Data entry is done directly into the database using a keyboard. Form design creation enables the patients to input and submits their data online through the created websites. Screen design calls for the use of a practical layout and attractive colors to make the information appealing. To ensure the data is completed, it must be saved, and the documents given must be scanned. Finally, reports must be generated, and also backing up the information is essential for easy retrieval if it gets lost. Data analyzed in graph form on the screen can be used to give quick trends, for example, when taking pressure records of a patient.
Implementation: Testing
Testing helps in identifying problems likely to be associated with the system and making necessary adjustments. The appropriate approach for testing used is integration testing. It involves the working of the hardware, including the input devices such as the mouse and keyboards. The printer should be able to print out clear documents and reports. The papers must be appropriately scanned, and barcodes must also be scanned with ease. The rooms set aside for setting the devices must comply with the manufacturer’s recommendations, be clean, ventilated, and secure installed sockets.
Implementation: Education and Training
The training process is crucial in ensuring that the working staff is aware of operating the various machines. Instructors should be conversant with what they are demonstrating and should be confident when doing the exercise. He must know how to control the learners, especially the adults who might be curious about operating the computers to avoid damage. They can also learn from one another by sharing what each of them knows. If possible, they must be motivated to learn since some people lack interest in technology developments.
Planning for Training
For the training process to be a success, it must follow a detailed procedure that begins with the preparedness of the trainer. He should develop objectives, develop the training, and implement it. A schedule should be created, giving room for everyone to avoid discrimination. The learning objectives must be attained at the end of the program to make the training a success. A training location is chosen to be either online or face to face in a computer room if available. The resources needed must be collected before the day, and the plan of training must be sent to the learners to make them aware of the topic. During the training, the instructor must prepare the class by setting up the necessary software and ensuring the room is comfortable for both participants. The evaluation is done to determine whether the set objectives were attained, and finally, the documentation training is done for future references.
Conclusion
In summary, EHR, as a digital version of patients’ paper charts, can be viewed as a practical application of information technology within the field of healthcare, providing medical professionals with instant access to patient records. It incorporates several systems, including administration, discharge, transfer, and patient monitoring, among many, that allow medical facilities to track patient flow within them and update and retrieve client data. In the discussed case study, the healthcare organization Alpha is recommended to become part of the HIE network to prevent misinformation errors from occurring (Price, 2020). Alpha is advised to ensure the security of patient information by establishing physical access control and a network security system. In addition, disaster and recovery plans should be established to safeguard data in case of power outages. Overall, several network structures should be utilized within the EHR system to protect patient information and easy access to vital data for healthcare professionals.
Furthermore, patients, as recipients of healthcare services, should also be encouraged to use EHR. Patient-centered EHR systems that allow easy retrieval of patient information for clients can increase self-monitoring and, consequentially, better health outcomes. In addition, EHR can be designed for patients with different ailments, including visually impaired persons, allowing them to access through voice commands and ensuring that the healthcare system does not marginalize any patients.
It should also be noted that EHR implementation requires medical facilities to comply with specific technical conditions. Thus, the Alpha organization will be necessary to assign a room for peripheral hardware equipment to safely house printers, scanners, and barcode scanners for documentation. All hardware will require continuous monitoring and upgrades if needed. Moreover, administrative and medical personnel will need to be trained by experienced instructors to be able to use EHRs. Overall, implementing the HER system, its maintenance, and staff training can present a financial burden for the Alpha organization. Nevertheless, the prevention of medical and medication errors and associated health outcomes by far outweigh the implementation costs.
References
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Kruse, C. S., Smith, B., Vanderlinden, H., & Nealand, A. (2017). Security techniques for the Electronic Health Records. Journal of Medical Systems, 41(8), 127.
Price, L. (2020). Why Health Information Exchange is important for EHR use. Patagonia Health. Web.
Sayles, N.B., & Kavanaugh-Burke, K. (2018). Introduction to information systems for health information technology (3rd ed.). Ahima.
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