Critical Issues in EHR Implementation

EHRs have the potential of being the core tool in the delivery of healthcare, integration of all patients' information into one record which can be accessed by authorized professionals at any time ( Payne, 2016) . The purpose of this paper is to discuss the critical aspects of EHRs including the people involved in its implementation, the ethical, professional, and regulatory standards, the order sets as a part of new records, and critical information needed to be obtained. 

Essential Information Contained in the Databases 

Data on various aspects is required to ensure that the quality of health care is improved. They include Demographic data which consists of the patients’ facts such as age, race, and gender, and ethnicity, the status of marriage, name, and address of residence, among others. This information is crucial in improving care since some treatments depend on things such as the age of the patient and some conditions best understood by the doctors if they have information on the patient’s race ( Lin et al., 2018) . 

Administrative information: The information contains facts on health insurance like membership and eligibility and the required deductibles and copayments for particular benefits packages concerning the kind of services being offered, such as outpatient procedures and diagnostic tests. The information helps the health providers to be able to advise the patients accordingly in a way that they acquire the appropriate treatment with the health insurance cover that they have improving their care. 

Health status and risks: This is information reflecting the lifestyle and behavior of the patient, such as whether the patient uses drug substances. The report also includes the fact about the family of the patient, such as a history of cancer in the patient's family. This is to help identify if the patient can be at risk of getting such diseases that are hereditary hence allowing the physician to take the precautionary measure to improve the health care of the patient ( Lin et al., 2018) . 

Health status includes the information on the patients themselves, such as the functioning of their brain, their perception of their future and past health, among others. The medical history of the patient and the current management constitute the health status of a patient. Medical history consists of previous hospital admissions, pregnancies, surgical procedures, and the like. Ongoing administration medically includes health screenings, allergies, therapeutically procedures, among others. The information helps in ensuring that the patient is provided necessary care depending on their medical history ( Lin et al., 2018) . 

Role of Informatics 

Health informatics in the world today has become health care’s new currency. The informatics usually ensures that the information of patients that is collected, which include the test results, medical history, treatments as well as the demographic data is accessible, secure, accurate, and integrated. It is through health informatics that information taken from the patient is easily stored and analyzed at deeper levels despite its wideness generating health intelligence ( Crawford, 2014) . Informatics transform the data into useful and meaningful information for a variety of health care purposes. 

Systems and Staff Involved 

The implementation of Electronic Health Records (EHRs) requires that the people involved should be part of it. All the health professionals, including the doctors, nurses, lab technicians, administrative staff, the clinical staff, and surgeons, should be involved in its implementation. This allows them to have a sense of ownership, avoiding pitfalls and makes the process of implementation successful for health professionals ( Palvia, Jacks, & Brown, 2015) . 

The administrative staff is involved in registering the patients as they come to the hospital, so they need to be aware of what to capture. The lab technicians need to share information around the hospital to the doctors and nurses on the medical tests of the patient ( Palvia, Jacks, & Brown, 2015) . The implementation process should also include the systems being used for the EHRs process, and they need to be updated as well as the systems technicians. The technicians should be brought to speed on the new system making implementation successful. 

Professional, Regulatory, and Ethical Standards 

Electronic records are prone to compromise, especially today where the internet use is on the Patients information. Therefore, it is supposed to be protected from access by any other person besides the health providers and staff. The use of user ID and passwords should be incorporated in the system to serve as regulatory standards so that it is only the user who can log in to the system ( Alvandi. 2015) . 

Physical and logical restriction standards such as the use of audit trail, antivirus and spyware installation should be incorporated to ensure that the integrity of data is maintained which is compromised through data tampering, incorrect entry, and impairment of the soft and hardware. Professionals should ensure they do not tamper with data, and they should make sure that data entry is correct. These are the professional and regulatory standards ( Alvandi. 2015). 

It is ethical to ensure that the information of patients is private and confidential through providing that information is only used for the intended reasons. The patients’ information should only stay within the accessibility by the people involved with the patient and not any other outsider. This, therefore, requires that confidentiality and privacy standards are involved in the implementation process for security purposes ( Alvandi. 2015) . 

Communicating Change and Transition Plan 

In the healthcare setting, it is the role of the management to describe any form of change that is set to come to the organization. According to Burke (2017), management has to be clear about any type of change. For example, an organization is planning to make changes in the recording of patients' information from traditional approaches to the EHR. It is, therefore, the responsibility of the management to communicate honestly and accurate information to the entire healthcare team. The second step is to speak with managers whose workers will be affected most by the change. Like in the example above the nurses are to be affected most. Prior communication with the manager will help them make psychological preparation and create a plan to help the employees adopt during the transition. During the change process, the management must keep the channels of communication open to ensure participation ( Burke, 2017). 

During the change period, the organization undergoes a transition process that must be well contemplated by the team leading the change. A transition plan is necessary to help the employee adapt to the change ( Burke, 2017) . For example, a transition plan can look like 

Structure	Process	Outcomes
Change management strategy guided by a model or theory Communication strategy  Having an able and dedicated team to implement the transition.  Staff education and training plan	Involving all stakeholders  Teaching the staff the change plan –ensuring it is understood  Engaging the staff and collecting feedback on the proposed transition plan  Ensuring that the employees attend the education, training and orientation processes  Monitoring communication strategy effectiveness.	Engaging staff in progressive change over a while  Managing challenges such as staff stress through continuous education, counseling, and communication  Ensuring patient safety and management during the transition.

Order Sets 

Research done on the Order set application within the EHRs has indicated the reduction of human error and an improvement in overall outcomes of the patient through adherence to evidence-based guidelines. However, when incorrectly applied order sets can result in limitations. It is, therefore, the role of the involved parties to ensure the order sets are successfully set in place by providing that that the orders sets form part of the new record (Elsevier, 2015). 

According to Elsevier (2015), the EHR team can, therefore, can ensure successful implementation of order sets by establishing a formal governance body and structure for the Order sets application and to ensure that the structure is tied to the objectives of the organization. EHR should provide the planning on how to track the flow of work of the order sets. This way, it will be easy for the team to ensure that all order sets have been put in place. The EHR team should also develop and apply a style guide for the order sets whose role is to ensure ease of use and consistency. The team can also implement approaches that encourage and streamline the involvement of the clinician. 

Measuring the success of EHR 

The success of any change or strategy in an organization can only be determined if there is evidence to indicate the changes experienced. EHR implementation in a health facility also can be measured and evaluated while evaluating the changes it has brought in the organization. Different factors are considered when measuring the success of EHR depending on the target or the aim of the party taking the measurements ( Wright et al ., 2015) 

Wright et al. (2015), identify tools such as return on investment (ROI) to measure the financial success of implementing the EHR. EHR ROI can provide information on financial returns relative to the cost of investment. EHR success can also be measured by evaluating its impact on care coordination. It can be done by carrying out research on how EHR has helped improve the process of care coordination compared to the previous method. The success of EHR also can be measured through patient engagement evaluation. Patient engagement can be measured by tracking the number of contacts a patient makes with the care providers and evaluating whether the EHR is applicable in accessing the medical records. 

Interprofessional Team Collaboration in Healthcare 

The concept of interprofessional collaboration in healthcare provision has been emphasized in the past few decades to improve the unitive process of care provision. Different theoretical approaches can be used for collaboration of interprofessional teams participating in patient-centered and providing evidence-based care. 

The theory of bureaucratic theory by Ray suggests that both the thesis of caring and antithesis of bureaucracy when reconciled and collaborated can result in unitive force which leads to bureaucratic. It is models that indicate that collaboration of different teams in the healthcare can result in better care that meets the needs of the patients while still adhering to bureaucracy. A different theoretical model that can be used interprofessional team collaboration is the transformative learning theory. It is an approach that is most applied in a learning environment where the students are presented with a disorienting dilemma to challenge their thinking. The theory can help be used to force different teams to work together to realize the potential of unity in providing evidence-based and patient-centered care ( Hebert, 2014) . 

Leadership skills are essential when engaging an interprofessional team collaboration. Skills such as the management of productive meetings, adherence to decision-making guidelines, and teamwork creation can result in improving the provision of evidence-based and patient-centered care. 

References 

Alvandi. M. (2015). Optimizing the Effect of Electronic Health Records for Healthcare Professionals and Consumers. Retrieved from https://www.ajmc.com/journals/ajac/2015/2015-vol3-n3/optimizing-the-effect-of-electronic-health-records-for-healthcare-professionals-and-consumers?p=1 

Burke, W. W. (2017). Organization change: Theory and practice . Sage Publications. 

Crawford, M. (2014). Making data smart: Practical informatics is helping transform data into health intelligence, and now moving into day-to-day HIM work. Journal of AHIMA , 85 (2), 24-27. 

Elsevier, (2015).THE FOUR ESSENTIAL STEPS TO EFFECTIVE ORDER SET MANAGEMENT AND THEIR IMPLEMENTATION AT the UNIVERSITY OF KENTUCKY HEALTHCARE. Retrieved from https://www.elsevier.com/__data/assets/pdf_file/0005/810365/2951_EL-CL-UKHealthCare-CaseStudy-MOS210pod-Web.pdf 

Hebert, J. S. (2014). Advancing interprofessional collaboration in nursing education. Athens Journal of Health , 2 (4), 239-259. 

Lin, K. J., Singer, D. E., Glynn, R. J., Murphy, S. N., Lii, J., & Schneeweiss, S. (2018). Identifying patients with high data completeness to improve the validity of comparative effectiveness research in electronic health records data. Clinical Pharmacology & Therapeutics , 103 (5), 899-905. 

Palvia, P., Jacks, T., & Brown, W. S. (2015). Critical Issues in EHR Implementation: Provider and Vendor Perspectives. CAIS , 36 , 36. 

Payne, T. H. (2016). The electronic health record as a catalyst for quality improvement in patient care. Heart , 102 (22), 1782-1787. 

Wright, A., McCoy, A. B., Hickman, T. T. T., Hilaire, D. S., Borbolla, D., Bowes III, W. A., ... & Bates, D. W. (2015). Problem list completeness in electronic health records: a multi-site study and assessment of success factors. International journal of medical informatics , 84 (10), 784-790.