By: Janelle Chevalier (3-7)

Cara McMahon (8-18)

Marcus Selvidge (2 &19-22)

Amanda Wright (23-27)

New Age Technology in Healthcare

EHR have become almost a necessity in the healthcare industry. Since the invention of computers occurred, industries have been devising plans to save money, time, and increase productivity. EHR although very expensive to set up have a true benefit for the patients we care for. Before EHR, patients information was scattered in paper charts and files, many times difficult and time consuming finding pieces of the puzzle. Now most of the information is at the click of your mouse. As technology improves, it is likely we will see EHR’s become more advanced to meet patients needs. This presentation breaks down the specific portions of the EHR in the healthcare industry.

Introduction

It combines hardware and software

It is used as a telecommunication network

Used to collect, create, and distribute useful information

It is used within an organization for effectiveness and efficiency

What is a Computer Information System (CIS)

When choosing a system you want to do extensive research on an Information System Vendor.

Cooperation usually see a need for having a CIS and management would be the one to push for this system

When choosing a system management should get staff involved to get feedback. This would help the success of the CIS (Winder 09).

When choosing a vendor you want to make sure that vendor will not only meet your needs now but also in the future.

 

Choosing, Revising, and Implementing CIS Systems

Health Information and Data Includes patient data to make clinical decisions

Medical and Nursing diagnosis

Medication lists, Allergies, and test results

Results Management  Manages results of all types electronically, including labs and radiology

procedure reports current and historical

Order Entry Management

This is where clinician enters orders which include medication, care orders, labs, microbiology, pathology, radiology, nursing, supply orders, ancillary services and consultations.

 

Eight Components of Electronic Health Records

Decision Support Computer alerts to help improve the diagnosis and care of

the patient for example screening for correct drug selection, dose, and interaction

Electronic Communication and Connectivity Online communication among healthcare teams This includes email, web messaging, integrated

health records, and telemedicine

Patient Support Includes patient education, home telemonitoring, telehealth

systems, and patient education

 

Eight Components Cont.

Administrative Processes

Includes electronic scheduling, billing, and claims management

Keeps a schedule for inpatient and outpatient visit

Procedures, electronic insurance eligibility validation, claim authorization and prior approval.

Reporting and Population Health Management

This is the Data collection tools

It supports public and private reporting requirements including data represented in a standardized terminology and machine-readable format.

Finally the EHR system “MUST” follow appropriate privacy and security standards when it comes to HIPPA regulations. Only persons who should have access to the EHR are the people who are providing care for that patient.

Eight Components cont.

According to the American National Standard E.H.R components are made to mimic traditional paper charts. The structure must include information on the:

1. Patient- such as registration

2. Provider- who is taking care of the patient

3. Problems- current and past problems

4. Encounters- such as notes

5. Orders- such as medication orders

6. Services- such as nursing interventions

7. Observations- free text information about the patient

EHR Structure Components

The E.H.R is structured to where individuals can look up information differently. The information can be looked up through different perspectives such as:

Chronological data

Episode

Problem

Topic

Perspectives of the EHR

According to the American National Standard there are two specific ways for recording data in the E.H.R.

1. Free text- such as dictations, codes, and number values ( i.e. vital signs)

2. Structured data- such as multiple choice information ( i.e. choosing within normal limits for a patient with normal lung sounds)

Data Entry

“In order to incorporate EBP into the practice of clinical nursing the information needs to be embedded in the E.H.R so that it is part of the work flow.” ( McGonigle & Mastrian, 2009, p.209)

There is uncertainty of how often the E.H.R must be updated with EBP but the incorporation alone has been a big step in comparison to how things were after the year of 1999

Evidence Based Practice in the EHR

Today EBP is widely accepted as best practice and promotes a high level of patient safety

Up until 1999 EBP practice was pushed away due to high cost

It was discovered by the Institute of Medicine in 1999 that, “48,000 to 98,000 deaths occurred from medical mistakes” ( Gugerty, 2006, p.23)

After that year EBP was widely accepted and is incorporated into E.H.R system products

EBP History

Below are a list of some E.H.R vendors: Practice Fusion- www.practicefusion.com

Mxsecure- www.mxsecure.com

MD care- www.mdcareplus.com

GE Centricity

Next Gen

eClinicalWorks

Greenway

Aprima

Pulse

Athena

Waiting Room Solutions

EHR Companies

It is important that organizations make several plans in case of a disaster resulting in a power outage.

Normally a healthcare organization has ways to properly back up patient information but in case of an unexpected disaster those files will be lost forever.

The best solution for health care organizations is to make sure that they have off site back up storage available.

“ A practice hosted E.H.R. cannot provide the level of record recovery without special planning and strategy because the practice hosted system resides in the practice.” (Strafford, 2010)

A highly recommended offsite back up company can be found at www.amazingcharts.com

The average cost from Amazingcharts.com for offsite back up is $250/year.

EHR Safety

“In 2003 nationwide survey by computing technology association found human error was most likely because of problems with security breaches.” ( McGonigle & Mastrian, 2009, p. 187)

8% of the breaches were from technical problems and 63% were from human error. (McGonigle & Mastrian, 2009, p.187)

McGonigle and Mastrian give several suggestions to protecting the E.H.R such as:

Decreasing physical factors i.e. removing USB devices

Firewalls

Proxy Servers

Spyware

Antivirus software/hardware

Limiting internet access to employees

Viruses, Worms, & Hackers

The user must first agree to terms related to HIPAA

The Privacy Rights Clearinghouse states that those who have access to the E.H.R are healthcare providers, government agencies, medication information bureau and insurance companies (2011)

Accessed is gained according to the Privacy Rights Clearing house when the patient gives consent to let others see them

McGonigle and Mastrian state that group titles also allow for appropriate access (2009, p. 186)

Access to the EHR

Using network securing devices such as, “ encryption, passwords, firewalls, retinal recognition” ( McGonigle & Mastrian, 2009, p.175)

Dedicated phone lines

Nurses acting as privacy offers ensuring that policies and procedures are consistent with HIPAA regulations

Avoiding “shoulder surfing”. ( McGonigle & Mastrian, 2009, p. 175

HIPAA Considerations

McGonigle and Mastrian state that, “ the patient’s rights must be protected in the face of a healthcare provider’s duty to his or her employer and society at large when initiating care and assigning finite healthcare resources.” ( 2009, p. 160)

It is also the healthcare providers duty to use ethical frameworks when making ethical decisions.

Ethical Considerations

According to a study published by the Partners Healthcare System in Boston, average annual savings from utilization of electronic records are $86,400 per year for a single health care provider.

Direct Costs may include:

Initial set-up fee’s

Recurring software costs for license renewals and updates

Repair costs to damaged equipment

Training expenses for new employees

Reduced labor costs because electronic technology is generally faster

(Ingram 2011)

Budgeting for EHR

When purchasing an EHR for a facility, you can generally expect an expensive up front cost initially for hardware, software, training, and installation fees. However, over time you can expect to see capital gains increase once system has been in place.

Strategies for purchasing an EHR for your facility

Begin the search with the “right”-size vendors

Beware of vendors of high-end systems that are offering “community hospital pricing

Share the costs with end users, and involve clinicians in the selection process

Consider all of the costs

Be sure to factor in the costs of additional internal staff that will be required to operate the EHR system. This may include IT staff, Nurse Informaticist, and a Chief medical information officer (CMIO).

Don’t rush into an EHR purchase

Don’t ignore an incumbent vendor

Don’t replace the hospital’s entire revenue cycle applications

(Swab & Ciotti 2010)

Purchasing EHR

Pay careful attention to your tech support to uncover what is covered in your package. Meaning are there tech support 24/7 for help or does the EHR tech support mainly provide Q & A answers by searching through a database.

To ensure you know exactly how things are done use these tips:

Research the support team through web searches, twitter, articles, or even calling other customers they follow to determine if they are satisfied.

Determine how available they are for help: 24/7, calling, email? How long does it take on average to get a reply?

Is the support offered locally or internationally? What language do they speak compared to your employees, because this may make things increasing difficult to get a problem solved.

(Zieger 2011)

Technical Support

Once an EHR is initiated by a health care facility, there will be portions throughout that may need changed slightly or re-developed/updated. Of course all of your staff have already been trained to use each part of the EHR in place. Below are several ways that are helpful to update the users of the system without spending countless hours and dollars.

Short video clips

Short handouts that can be passed around during staff meetings

Short demonstrations with small groups

It’s important to note that when new updates or changes are made, make sure users are informed early so that less time is required to go over each one. The more updates that are to be taught, the longer it will take.

Continuing Education

“The Health Information Technology Act (2009) requires all healthcare facilities to fully adopt EHRs by 2014. This will change how nurses practice, underscoring the importance of teaching students about informatics and the other topics and skills they need to provide high-quality care.”

Many hospitals are implementing and educating their nurses differently. With researching many hospitals and how they are bring EHR into their hospital, I have found that it takes many different steps, and teaching to get every single nurse of all generations on the same understanding

The article from America Nurse Today, has implemented teaching students in the nursing programs before graduation about EHR. This was called AES, or Academic Education Solution.

“Integrating AES across nursing curricula provides an appropriate environment for teaching students about EBP, standardized nursing language, and the IOM’s core competencies, while giving them the experience of an informatics-intensive healthcare environment.”

This type of education was broken down into two semesters. The first semester the students were taught about documentation on wound care and medication administration. Once the students were taught the information, they were made to perform check offs in front of one of the faculty at their school.

In the second semester  included students learned more about the EHR, and used the system to take care of pretend patients, with the guidance of their instructors.

“Students must learn how to identify, find, use, and evaluate information to successfully apply evidence-based principles for delivery of culturally competent and safe care. Access to such data as patients’ current vital signs, medication history, and alerts for drug incompatibility can dramatically increase the quality of nursing care. Clear, concise, readily accessible information stimulates critical thinking, resulting in better clinical decisions grounded in evidence-based care.”

* (Meyer, Sternberger, & Toscos, 2011)

Educating Student Nurses on EHR

There are a number of barriers that prevent the integration of EHRs into health professional education. Three main barriers are:

A shortage of faculty who are familiar with differing types of EHRs

A shortage of health informatics professionals who can implement such systems

A shortage of opportunities to access multiple differing types of EHRs within the context of a health professional student academic program

 

* (Borycki, Joe, Armstrong, Bellwood, & Campbell, 2011)

Educating Nurses on EHR

Gain acceptance

Involve them in the selection process

Have staff nurses be a part of the process of choosing the EHR program

Provide training

Training should include hands on training

Must provide support

* (Wilson, 1999-2011)

Steps to Educating Nurses

EPIC is a EHR that was started in Spring of 2009. For this nurses and health care providers were assigned to take certain classes at different times. These classes included the basic knowledge of the EPIC system, and then the more in depth charting used my nurses and physicians. The classes were usually in about 4-5 hour blocks that were in about 8-9 different days.  The classes were taught by informatics people who worked on computers and who had extensive training in the program. These people were sometimes from different states, where the hospitals that they worked at had already implemented EPIC. After the classes were taught to the nurses, the hospital provided SUPER USERS (people who had more training on EPIC, who were present on the first few weeks of the beginning of EHR, to allow help to those who needed it). The hospital  does go through several updates per year, where the nurses are required to go to more EPIC training to better understand the updates for the system.

 

EPIC at St. John’s

Electronic Health Record is defined as “a computerized system where patient records are created, used, exchanged, stored and retrieved.” (What is an Electronic Health Record or EHR)? Having an Electronic Health Record in place at a hospital can allow not only the hospital but the health care providers a better chance for greater patient care. Although some of the older generation nurses do argue about how EHR is taking away from actual hands on patient care. EHR, is allowing all health care providers for each patient to work together to make the best of that patients’ care. As we have learned throughout working in a hospital with EHR, and throughout this slideshow, technology shouldn’t be thought as a burden but as a way to know our patient, and every part of our patients’ history. 

 

Conclusion

McGongile, D. & Mastrain, K. (2009). Nursing informatics and the foundation of knowledge. Jones & Bartlett: Sudbury, MA.

NIH National Center for Research Resources . (2006). Electronic health records overview. Retrieved from: http://www.ncrr.nih.gov/publications/informatics/ehr.pdf.

Wikipedia. (2011). Information systems. Retrieved from: http://en.wikipedia.org/wiki/Information_systems.

Winden K. (1990). A step-to-step approach to choosing an information systems. Retrieved from:  http://www.k2healthtech.com/content/docs/Provider_Article.pdf.

 American National Standard (2000) Standard guide for content and structure of the electronic health record. Retrieved from www.musc.edu/infoservices/lanvision/Regulations_Policies_Guidelines/ASTMEMRGuide.pdf

Gugerty, B. (2006) The holy grail: Cost-effective healthcare evidence transparently and consistently used by clinicians. Retrieved from http://www.himss.org/content/files/him/20-3/07_column_holygrail.pdf

Privacy Rights Clearinghouse (2011) Fact sheet 8: Medical records privacy. Retrieved from https://www.privacyrights.org/fs/fs8-med.htm

John (2006) Overwhelming list of emr companies. Retrieved from http://www.emrandhipaa.com/administrator/2006/02/21/overwhelming-list-of-emr-companies/

McGonigle, D., & Mastrian, K. ( 2009) Nursing informatics and the foundation of knowledge. Sudbury, MA. Jones and Bartlett Publishers.

References

Ingram D 2011 Cost benefit analysis of electronic medical records Ingram, D. (2011). Cost benefit analysis of electronic medical records. Retrieved November 2, 2011, from http://www.ehow.com/about_5453630_cost-analysis-electronic-medical-records.html

Swab J Ciotti V 20100501 What to consider when purchasing an EHR system Swab, J., & Ciotti, V. (2010, May 1). What to consider when purchasing an EHR system. Retrieved November 2, 2011, from http://www.hfma.org/Templates/InteriorMaster.aspx?=20452

Zieger A 20111011 Check out your EHR vendor's tech support team before you buy Zieger, A. (2011, October 11). Check out your EHR vendor's tech support team before you buy. Retrieved November 2, 2011, from http://www.ehroutlook.com/installation/208.html

Borycki, E., Joe, R., Armstrong, B., Bellwood, P., & Campbell, R. (2011). Educating Health Professionals about the Electronic Health Record (EHR): Removing the. Knowledge Management & E-Learning: An International Journal, 56.

Meyer, L., Sternberger, C., & Toscos, T. (2011, May). American Nurse Today. Retrieved October 31, 2011, from How to implement the electronic health record in undergraduate nursing education : http://www.americannursetoday.com/article.aspx?id=7830&fid=7770

What is an Electronic Health Record (or EHR)? (n.d.). Retrieved 31 2011, October , from Medappz: http://www.medappz.com/whatehr.htm

Wilson, J. (1999-2011). How to Prepare Nurses for EHR. Retrieved October 31, 2011, from eHOW.

References