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The Need for Implementing an EHR System, Case Study Example

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Case Study

Abstract

Hospitals with an up-to-date health care delivery system can run more efficiently and provide the best possible patient care.  In addition to hospitals implementing an EHR system, it has been suggested that there should be specific functions that the system regulates, such as documentation, test results, imaging results, physician order records, and any conclusions or diagnoses.  The need for this type of health care delivery system has become apparent from several different case studies in regard to patients admitted to hospitals and lack of coordination with their primary care physicians in regard to appointment follow-ups and discharge summaries after patient hospital discharge and physicians missing the recommended tests for different diseases due to the lack of a software system for tracking and administering the correct care. All hospitals should evaluate these plans and find solutions to the most effective approach of implementing a health care delivery system.  Implementing an EHR delivery system would provide providers with the means to work together even if the providers are not part of the same medical group or health plan, as well as offer incentives to the hospital from the insurance health plans per 2009 American Recovery and Reinvestment Act .  Implementing an EHR would allow patients to receive the best possible care, as well as the best valued care.

 

Health Care Delivery Systems have been re-organized and developed in order to provide a higher performance for delivery of care to patients, such as information changes to the flow to both provider and patient, increased coordination, the development of electronic health record (EHR) systems and access to the correct type of care.  The following paper focuses on the implementation of the electronic health record system in hospitals.  This report suggests that hospitals with an up-to-date health care delivery system can run more efficiently and provide the best possible patient care.  In addition to hospitals implementing an EHR system, it has been suggested that there should be specific functions that the system regulates, such as documentation, test results, imaging results, physician order records, and any conclusions or diagnoses.

The need for this type of health care delivery system has become apparent from several different case studies in regard to patients admitted to hospitals and lack of coordination with their primary care physicians in regard to appointment follow-ups and discharge summaries after patient hospital discharge.  The lack of communication between the hospitals and primary care physicians has resulted in patients being readmitted to the hospital for worsening symptoms after their in-stay hospital visits.  (Shih et al., 2008)  In fact, it has been found that 17.6 % of hospitalizations have resulted in readmission within 30 days, with around 75% of the cases preventable.  (MedPac, 2007)   In addition, to lack of communication between hospitals and physicians, physicians have been missing the recommended tests for different diseases due to the lack of a software system for tracking and administering the correct care needed.  Electronic Health Care systems contain disease registries and care reminders providing physicians with the necessary steps and any updated changes to regular care for specific diagnoses, such as diabetes, for instance.

Due to the lack of coordination and subsequent readmissions of patients and decreased amount of recommended testing of patients, in 2009 the American Recovery and Reinvestment Act was signed authorizing Medicare and Medicaid Services to offer incentive programs to physicians and hospitals who successfully implemented EHR systems.  (CMS, 2010)  Implementing such a system, therefore, would not only provide incentives from the patient’s insurance company and decrease costs, but increase the organization of their patient’s records and thereby increasing the quality of care.  Most importantly, the patient’s information would be readily available to any provider through this system.  This is extremely important and a major problem in our health care system.  It is crucial that a provider have access to a complete medical history in order to perform the most effective care to the patient.  In addition, the information being available in real time, no faxing, calling etc. increases the quality of care to the patient as well.  Furthermore, the system provides support systems helping physicians with preventative care decisions and management, such as reminders for routine services and disease registries.

In order to be considered “successful” and be rewarded incentives, the “meaningful use” of the EHR system has been regulated to certified EHR technology.  The technology has proven to increase quality, efficiency and safety, and decrease adverse health effects. (CMS, 2010)  Some hospitals have implemented EHR systems successfully, such Kaiser Permanente and Geisinger Health System.  (Shih et al., 2007)  Although these two health care companies have implemented this system, there is a difference between the two companies.  Kaiser Permanente provides services only to patients who are members of Kaiser Permanente Health plan and is referred to as a closed system; whereas, the Geisinger Health Care provides services to patients within and outside of their health plan and is referred to as an open system.  The two different companies have the basic idea of implementing a more efficient health care technology system; however, it seems to be even more efficient and productive for our society to provide an open type of system.  For example, Geisinger Health care assigns nurse care managers to patients at high risk for complications.  The nurse coordinates with the primary care physicians and develops a plan for the patient with the necessary follow-up.  With the assistance of the EHR system, timely follow-up are given.  (Shih et al., 2007)

All hospitals should evaluate these plans and find solutions to the most effective approach of implementing a health care delivery system.  It is suggested that there are some useful approaches hospitals can use in order to go forward with this plan and integrate the approach into their organization.  The approach should consist of committing financial resources, involving the current staff, require training for all staff, streamline processes, create checklists within the system for compliance issues, analyze data from the system, create a quality team, and follow the initial schedule of implementation.  (Silow-Carroll et al., 2012)

In order to commit financially to the implementation of a health delivery system, resources should be applied to required type of software, IT experts or staffing, training and equipment needed for the system to develop.  In addition, in order for the resources to be allocated specifically towards the implementation, the staff leaders at the hospital should be aware and willing to place goals and set standard meetings on a weekly basis.   Furthermore, the staff leaders should involve the administrative team and the physicians, as well as holding them accountable for meeting deadlines for the implementation of the system. In order to assist the team with meeting the deadlines and increase the willingness of the implementation, efforts from the leaders should be focused on helping the team with the new system, such as promoting the system through the use of announcements, meetings, newsletters and emails, with specific emphasis on the benefits of the system.

It has also proven important for hospitals to involve their own staff in the implementation process.  By doing so, the staff takes part in the design of the program and has a sense of ownership, as well as the ability of the staff to train and provide input on what works or doesn’t work.   A good example of staff assisted EHR was observed in the Geisinger Health System implementation process.  Geisinger brought in the top candidates from their organization to help establish the system.  Geisinger broke down the implementation team into three teams consisting of a physician optimization team, a nursing team and an IT team.   (Silow-Carroll et al., 2012)

Once the system is in place, it does not necessarily mean that the system is following all compliance and meeting the “meaningful use” for the incentives through the American Recovery and Reinvestment Act of 2009.  There are some suggested steps that seem useful and productive that can establish compliance, such as creating checklists in templates and putting data in specific fields.  The EHR system can be utilized to create a checklist in order to create data on patients that would need additional services or to ensure that the patient’s care is meeting compliance issues, such as standards of care.  Basically, the EHR can automatically report patients that need follow-ups or additional types of services.  This is another instance where the staff could help facilitate in the design of the EHR program, especially the quality trained staff.

It is important for the data fields to be specific in order for the hospital to monitor and report using the EHR system.  Again, this is where weekly meetings and follow-ups become important as well.  In addition, creating specific and discrete data fields helps physicians document all patient information.  Hospitals use EHR data to gain insight into their goals of the program and compliance issues through exporting the data from the system and having analysis teams run trends and performance reports.  (Silow-Carroll et al., 2012)  This is useful because it allows the hospitals to run higher level analysis and help report their results and meet the “meaningfulness” for the requirements of the incentive program.   For instance, in order to meet compliance for the incentive program, reporting has to occur every 90 days during the first year of implementation.  In addition, 80% of the patients must have their records in the system.  (CMS, 2012)

Previous hospital experiences have illustrated the need to for the hospital to stay on schedule and within the budget.  It seems practical to research hospitals that have successfully implemented the EHR program and evaluate their method for remaining on schedule, as well as budget spending.  (Silow-Carroll et al., 2012)

Implementing an EHR delivery system would provide providers with the means to work together even if the providers are not part of the same medical group or health plan.  This would allow patients to receive the best possible care, as well as the best valued care.  In addition, patients would have access to the care and information they need, even after hours since there are different points of entry to the system.  This type of system would allow offering same-day appointments for urgency and allowing patients to have access to clinics that are 24-hours.  Patient’s information would therefore be available to all providers in real time through this type of system.  This would be ideal since all lab results and other tests would be available real time, instead of just the physician who order the tests or performed the surgery.  Although this sounds ideal, there are some problems that still need to be addressed, such as working hospitals working with solo providers and getting them on board, as well as training providers and outside staff.

Overall, implementing a Health Care Delivery System can be beneficial to the hospital, health plan, physician and patient.  An EHR can deliver both quality and care to all parties involved, and most importantly decrease adverse effects in patients. Again, all hospitals should begin implementing this system in order for the entire health care network to be connected and ensure all patients receive the necessary treatment.

 

References

CMS. (2010).  Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1

Requirements Overview. Retrieved on July 16, 2013 from: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf

MedPAC Report to Congress. (2007).  “Promoting Greater Efficiency in Medicare,” Chapter 5.

Shih, A., Davis, K., Schoenbaum, S.C., Gauthier, A., Nuzum, R., McCarthy,D. (2008).

Organizing the U.S. health care Delivery System for high Performance.  The Common Wealth Fund.  47pgs.  Available at: http://www.commonwealthfund.org/usr_doc/Shih_organizingushltcaredeliverysys_1155.pdf

Silow-Carroll, S., Edwards, JS., Rodin, D.  (2012).  Using Electronic Health Records to Improve

Quality and Efficiency: The Experiences of Leading Hospitals.  The Common Wealth Fund.  39pgs.  Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1608_SilowCarroll_using_EHRs_improve_quality.pdf

 

 

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