Evaluating Electronic Medical Records, Research Paper Example

For centuries, healthcare systems have been using Paper-based records. Evidence show that the current systems are not sufficient to give high quality, safe, cost effective and efficient healthcare and thus computerization especially the adoption of EMR is the only way to ensure effective health care. The interoperable, paperless, multi-discipline, multi-specialty and multi-provider medical records has been the target for many years by healthcare professionals, researchers and administrators and are now about to become a reality in most western countries where it is  gradually replacing the papers used for documentation of  patient details ( Coiera E. 2003)  .

The Electronic medical record system is the key to computerization of any health care information system because other technological innovations like decision support systems cannot be incorporated into routine clinical practices without EMR. The storage of clinical information electronically will potentiate the computerized tools to significantly help clinicians in enhancing the medical care quality as well as increase medical practice efficiency. Such tools may include alert systems for detecting contraindications on prescribed medication, reminder systems for identifying patients whose preventative care interventions are due as well as coding systems to facilitate the choice of the right patient encounter billing codes. Electronic medical records have many advantages over the paper based records .Such include the potential for structuring, automating as well as streamlining workflow in the health care centers. EMR enables the integration of a wide range of individual care activities such as monitoring, decision supports, electronic prescribing, ordering from the laboratory, and display of results .In addition trail for data and information becomes possible with EMR .The trail can be analyzed easily for the purpose of medical audits, epidemiological monitoring, quality assurance and disease surveillance (Coiera E. 2003)

With the much anticipated from the implementation of EMR, there is need to evaluate   implementation process and its satisfaction. Such evaluation will include monitoring the physicians’ capability to effectively use the EMR. Evaluation however challenging is an essential part of the development process of clinical information systems such as the electronic medical records (EMR) systems. EMR systems deal with the storage, processing and distribution of information required for delivering health care to patients. Such systems are considered as complex systems and so is their evaluation. When evaluating these systems it is believed that multiple perspectives and comparative element should be employed in addition to integration of quantitative and qualitative methods (Coiera E. 2003).  The evaluation should also rely much on the reaction of humans to the system. Such multi-perspective approach requires more than any realistic amount of the available resources and therefore methods requiring fewer resources are considered. One such quantitative method is the Task-oriented self-reporting on the use and performance of the EMR (Coiera E. 2003).

Analyze possible outcome measurement strategies related to organizational change.

Task oriented questionnaires can be used as a quantitative method in the evaluation of EMR systems from the physicians view .The questionnaire to physicians in almost all specialties and gives a coverage of essential parts of their work .The questionnaire may used to compare and investigate how physician use a certain EMR system as well the performance with the system across time.  It can also be important in comparing patterns in use and performance EMR systems in different hospitals and vendors. The questionnaires require the physicians to give their experiences of using the EMR (Poissant L & Tamblyn R.2005).

Describe how the effectiveness of your organizational change will be determined once it is implemented.

With computerization of physician practices on the rise, Stakeholders are pushing for demonstration of the value of implementing Electronic Medical Record (EMR) and therefore there is  need for development of survey tools for measuring processes in the medical office, including physician tasks as well as administrative duties before and after the implementation of EMR( Keshavjee K. 2001).

Work processes in the medical office as well as efficiencies of the front office can be evaluated by consulting groups that manage medical practice and a target group of physicians. Measures considered in the evaluation include: number of verbal orders that are not signed, number of procedures requested by the physician through the physician order entry system as well as number of transcription lines dictated.

Data collection tools are employed to capture these measures before and after implementation of EMR. Variables hypothesized as likely to improve with the implementation of EMR as well as those not expected to change should be included as controls. The same process is then measured prior to the implementation of EMR and six months after EMR implementation.

Measures considered when evaluating the administrative efficiencies include: time taken to pull charts for filing consult notes and lab results and for visits during the day, time spent on writing in the chart and time spent on billing.

Measures to be considered in evaluating the Physicians on clinical practices include: time spent reviewing results from the lab and on reviewing consult notes, time spent in writing prescriptions and on writing in the chart. Physicians will also be asked to give their opinion on  whether they felt that the day of their work was longer , whether they felt that there was extra work to do,  whether more time was spend on the charting and how they considered the quality of the chart( Keshavjee K. 2001).

Questionnaires will be used to capture reported estimates from individuals  on the amount of time spent on all work in the office as well as outside office for example extra time spend in completing charting outside the hospital.  In such case separate questionnaires are given in person to physicians as well as their staff. In addition, should be given some time to observe each practice in order to do direct measures of time-on-task and then give comments on the issues concerning the workflow ( Keshavjee K. 2001).

Determine how you will measure quality, cost, and satisfaction outcomes to evaluate your EMR change.

The 2004 DeLone and McLean model for evaluating the success of new developments in technology can be adapted in measuring the effectiveness of EMR implementation. This

Model includes extra metrics like the quality of Service aimed at addressing customers demand for services from the relevant service providers as well as the net.

Benefits to tackle issues like what is considered a benefit, who benefits and the level of analysis in which the benefit is realized. The Model gives a framework suitable to match the various metrics with the six dimensions:  Quality of the system, Quality of the service, Quality of information, Use and satisfaction of the user Satisfaction as well as net benefits (DeLone H. & McLean R. 2004).

From the figure it’s clear that the quality of the system, quality of the service, quality of information affect the use as well as user satisfaction both individually and jointly. In addition the degree of use can have negative or positive impacts on the satisfaction of the user affect the degree .Its also depicted that use and satisfaction of the user are direct antecedents of net benefits (DeLone H. & McLean R. 2004).

Service quality involves evaluation of overall service delivered by the service provider as well as third party. The quality of Service is important in developing clients trust. Reliability and timely services will be considered in evaluating EMR effectiveness.

Success of usage can be evaluated using measures like the number of tasks performed, usage per day, frequency of use is it daily or hourly .Reduction of the time spend on processing  is an anticipated benefit of  implementing  EMR. Reduction in time spend in several processes both by the physicians and the administrative staff like time spent reviewing results from the lab and on reviewing consult notes, time spent in writing prescriptions and on writing in the chart by physicians as well as time spend by administrative staff on tasks like pulling charts for filing consult notes and lab results and charts for visits during the day and time spent on writing in the chart and on billing. Other considerations when evaluating success of usage include efficiency of performing the operation using the EMR which can be depicted in reduced errors and staff savings as well as the change in average turnaround time compared against the Pre-determined goals.

User satisfaction is a multidimensional attitude towards the various aspects of the EMR. Such dimensions include interface between man and the machine, quality of output, user constructs like accuracy, timeliness, content, ease of use and the feelings created by participation in the use as well as level of understanding. User satisfaction can also have impact on the use because the satisfied users will tend to increase usage. In evaluating user satisfaction measures like percentage of average turnaround time that responses take compared with the pre-determined goals as well as customer satisfaction should be put in consideration.

Net benefits form the most vital measures of success, because they depict both the negative and positive impacts of implementing EMR on the whole health care structure. Such benefits can include reduction in cost and ease access to information and return on investment. Evaluation of the net benefits is dependent on service quality of information or the content (DeLone H. & McLean R. 2004).

Conclusion

Health care providers in many parts of the world have seen the need to have improvements on their service outcomes in the face of challenges like lack of interoperability and the increasing costs .healthcare systems, hospitals, clinics as well as physician practices are adopting EMR with the aim of improving health care services they offer .Implementation of EMR however  has met many barriers including: technical matters like ease of use and functionality, doubts on its usefulness clinically, issues on training and resistance by the relevant users .There is therefore need to demonstrate  the value of implementation to stakeholders who include the physicians as well as patients .

References

Coiera E. (2003) The Guide to Health Informatics (2nd Edition).  London: Arnold.

DeLone H. & McLean R. (2004) Information Systems Success: The Quest for the Dependent Variable. Washington D.C.: Georgia State University press.

Keshavjee K. (2001). Measuring the success of electronic medical record implementation using electronic and survey data. Hamilton: McMaster University press.

Poissant L & Tamblyn R.( 2005) .The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc. 12(5):505-16.