Of equal importance is the need to optimize the cost effectiveness of this quality of care by reducing length of hospital stay and reducing instances of readmissions for the same or related complaints. Individual department such as pharmacy, radiology and laboratory each have computerized systems specifically aimed at task completion within the department taking no thought of the dissemination of that information across the spectrum of not only medical departments but also to administrative and clerical departments.
With the advent of care possesses such as computer physician order entry(CPOE) and electronic medication administration record systems(EMARs) aimed at both quality and cost effectiveness the necessity exist to provide all needed information including medical records, radiological imagery such as CT scans, MRIs, and laboratory results at the immediate disposal of the practitioner. Administrative departments such as billing, medical records, medical supplies, and social services requiring real time updates on care administered, supplies expended in administering this care and follow up required in order to complete the continuum of care.
There is therefore the need to integrate all these various clinical and administrative processes into a single efficient hospital based system of delivery of care. Electronic Health Record systems (EHRs) are not only designed to provide such services but also information to patients and stores and manages data collected on patients. The American Recovery and Reinvestment Act (ARRA) of 2009 provided $34 billion via Medicare and Medicaid for the implementation and use of EHRs.
Two such systems EpicCare and HCS eMR respectively define themselves as follows. The EpicCare Inpatient Clinical System spans all hospital departments and specialties, giving providers the tools they need to deliver safe, high-quality care. EpicCares role-based navigators simplify relevant information access for physicians, nurses, therapists, dietitians and any other provider in the hospital setting HCS eMR meaningful use software is a Workflow Driven / Focused solution focused on high User Adoption. HCS eMR works for your hospital because it:
Builds on existing processes such as Medication Reconciliation ¢ Integrates with existing technology to streamline processes ¢ Leverages sophisticated rules and timely alerts to drive success ¢ Can be implemented quickly and is fully adopted ¢ Is economical Organizational and individual barriers to proposed change Several potential barriers exist to the implementation of an integrated electronic health records system (EHRs), these include structural, financial/business, technical/professional, and cultural. Structural
Memorial Hospital Pembroke is not a standalone hospital rather it is one of five hospitals in the Memorial Hospital System (MHS) formerly known as the South Broward Hospital district of Florida, as such much consideration has to be given to the eventual implementation across the system not only to Pembroke itself. Diversity in buyers and payers of supplies and services across the system would impact heavily on integration. There are also different providers of information technology in various departments that would have to be modified to enable integration via a central system of informatics.
Financial and business The infrastructural implementation of EHR systems requires initial high dollar investment which in the current economic environment may require budgetary restraints on other services and supplies. Although the intent is clear and the potential promising, there is limited evidence of the economic benefits of EHR systems in healthcare mainly because it is in its infancy, the hospital board of governors may require extensive due diligence studies prior agreeing to any such change. Cultural The cost-benefits across the continuum of providers e. g. octors, nurses and recipients e. g. patients of healthcare have yet to be realized and as such much caution and resistance is to be anticipated.
Clinicians inclusive of nurses envision health informatics particularly EHRs as being time consuming and takes away from, autonomy, actual time spent with patients, also old habits are hard to break, and question what personal benefits are to be gain from this intrusive system. Not to be ignored is the additional scrutiny as all processes will be documented at time of process and provides a permanent record, errors cannot be deleted.
Departments who previously had autonomy on how information is transferred and disseminated from the individual department to other practitioners may show reluctance to opening up to the scrutiny of others. Patients also will be required to accommodate intrusion, as with the availability of previously restricted information at the bedside from computers on wheels (COWs) more time may be spent at the bedside by practitioners instead of doing time consuming reviews and making notes prior to patients rounds.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) which provides federally regulated protection of patients health information held by healthcare professionals, is another possible barrier that impact the implementation of the proposed change, and care has to be taken to limit the unnecessary access of patients data. Factors influencing proposed change
Important factors that may affect whether implementation of an EHR at Memorial Pembroke is employed include, how receptive management and staff are to the change, the existence of available EHR systems providers versus in-house creation of a system, Cost of purchasing, implementing and maintaining a system and if funding is available, real benefits to be attained, are they measurable, and structural, cultural and financial readiness of the organization for the change. Receptiveness of management and staff
If the existing system works for staff or is perceived to work then many questions arise among the participants why does there need to be this intrusive change. Can the proposed benefits to be realized justify the overhaul and inconvenience to come and am I going to be remunerated for my efforts? Available EHR systems There are many systems already on the market including EPICare inpatient-core; HCS eMR and ChartAcess which are ready for implementation have a system of support and maintenance.
Although these are expensive systems, to build an in-house system replicating these would be time consuming and require extensive developmental processes that would certainly result in delay in implementing such a system. Cost May be divided into acquisition and maintenance, acquisition cost include cost of software, training, installation, paper to electronic conversion and implementation productivity loss, which may not be measurable. Maintenance cost includes upgrades, replacement of hardware and internal and external support cost.
Acquisition cost will be significant and may impact on the ability of the organization to meet other budgetary demands. Maintenance cost are spread out over time and may not be as impacting, also the possibility exist that cost savings from the use of the EHRs employed may offset maintenance cost. Factors influencing organizational readiness There are certain basic requirements of readiness which Memorial Pembroke must meet in order to be ready for health IT without which failure is almost assured.
These are Organizational culture, Management and leadership, Operational and Technical readiness. Organizational culture defined as an assessment of how the organization perceives EHR, general staff and physicians perceptions and patient involvement. Does Memorial Pembroke view EHR as a liability or as an asset, is the staff open to what is better for the patient or are they more concerned about turf protection, are nurses prepared to record even the most minor detail if it means a better overall picture of the state of the patient.
Management and leadership does the organization have the management that appreciates the importance of the change to the overall goals of the organization and is there a readiness to apply necessary resources to include human resources, financial resources and information and to manage these resources not only for current but also future EHR needs. Is there an executive team, a strategic plan, quality improvement and care management, and sound financial management?
Operational readiness takes into consideration, protocols, operational procedures, staffing needs for the implementation, training plans and programs, preparedness of project managers and IT staff for the implementation. Technical readiness considers the organizations technical environment and information technology capabilities to deal with and absorb the change. Is there adequate server capacity, a rational process of procurement also potential for growth and development of the department? In short can they handle it? Theoretical model related to proposed change
The model best related to this organizational change which seeks to enhance the institution as a whole in the furtherance of improved quality of care for patients as also to optimize the organizations ability to be effective in the administrative process and other peripheral processes involved in this change is organizational development. Organizational change targets the entire organization and creates a climate of open discussion with valued feedback which helps to reinforce or modify to the change. It depends on the utilization of process consultants to facilitate interventions and to manage the change.
Internal and external resources to support change Within the organization several resources may be found which may facilitate or enhance the change to be implemented, these include competent senior management who portray a sense of confidence and facilitate dialogue with staff thus enabling them to be active participants, a strong human resource department that arranges and implement training programs aimed at preparing staff for the change. A vibrant IT department with competent personnel knowledgeable in IT systems that can facilitate incorporation of new technology to its network.
Staff that are trainable and who understand the dynamism of the organization and of change and are willing to adapt in order to meet organizational goals. Externally advantage has to be taken of a proven provider of EHRs that has the experience and support infrastructure that will facilitate attainment of the organizational goals. Independent consultants who are experienced in the change to be implemented, and who are able to monitor and manage the change at each stage of implementation. Research data that provide information aimed at making informed decisions, provided by research specialist and not ad hoc pieces of information.