The 21 st century has experienced technological advancements which have made improvements and controlled many aspects of life including healthcare. Electronic Health Records (EHRs ) can be expressed as a longitudinal record of patient health data collected from their daily encounters in the health care systems (Palvia, Jacks & Brown, 2015). An electronic health record has information about a patient’s health status along with their past records. The information incorporates their demographics, medications, progress notes, crucial signs, immunizations, health issues, past medical history, radiology information and laboratory information ( Bushelle-Edghill, Brown & Dong, 2017 ).EHRs are on the rise due to easy loss of paper records. Many healthcare systems are using shifting to the use of EHRs which is improving and increasing quality healthcare.
EHRs have different forms and the term relates a broad range of electronic information systems widely used in healthcare. They are used in health organizations as interoperating systems on regional level and in affiliated health units. EHRs are used in healthcare units including pharmacies, hospitals, general practitioner surgeries as well as other health care providers ( Bushelle-Edghill, Brown & Dong, 2017 ). EHRs are widely used in the world because it enhances patient safety. By implementing EHRs different initiative are needed to enhance integration driven by financial stimulations and government regulations.
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Implementation of EHRs in healthcare systems is a complex process that involves a multiple technological and organizational factors. This includes organizational structure, technical infrastructure, human abilities, culture, management and financial resources. Palvia, Jacks & Brown (2015) argue that the process of implementing EHRs in healthcare is more challenging because of the complexity of data entry problems, medical data, privacy concerns and lack of information on its benefits. However, the challenges push for stronger initiatives which are driven by the promise of availability of patient data and enhanced integration, the need to improve cost effectiveness and efficiency, changing of the patient doctor relationship to that of care and the need of dealing with a more rapidly changing and complex environment.
Envisioning the Future
Implementing EHRs will benefit the patients by strengthening the quality of care and the association between healthcare practitioners and patients. This will be done through the ready access to up to and accurate patient data. After the implementation of EHRs in the healthcare system, the health practitioners will be able to communicate more clearly and quickly with the patients, spend less amount of time paging through charts and transmit important information. The EHRs will give the hospital an opportunity of accessing national records such as the National Cholesterol Education Program Risk Calculators to use for patients (Bullard, 2016). To enhance patient safety, several recommendations on using EHRs will be used including industry and clinical end user recommendations, health information technology and human factors health information technology. The strategies will be useful in enhancing quality and safety care while adopting the EHRs.
EHRs implementation requires all healthcare providers and hospitals the section of skilled providers who are committed to providing a system that fits the needs of the healthcare institution. Selecting the best healthcare providers will ensure that the system matches the specific needs of the patients (Palvia, Jacks & Brown, 2015). It is also important to deal with providers who have proven themselves constructive in the healthcare system. The providers will be entitled to identify the hospitals workflows be committed to a long-term relationship with the system and be ready to adapt with the patients accordingly. For health providers to work with EHRs system, they will be trained on using information technology including adequate typing skills and computer use (Bullard, 2016). The knowledge and previous experience with EHRs will reduce uncertainty and disturbance for the providers. This will also improve the ability of providers to access patient records immediately while on call, thus saving time.
There will be several changes to be expected during the implementation of EHRs especially on the staff. The original division of workforce will change with new profession tasks emerging and others disappearing ( Bushelle-Edghill, Brown & Dong, 2017 ). The new job roles will either leverage the captured clinical data or support frequent integration of EHRs with medical workflows. The clinical technicians will act as knowledge resources on the EHRs by ensuring effective solutions to problems at the original technical points. They will help in leading the shift from initial to automated practices while integrating the principles of change management. The medical scribes will navigate the EHRs, locate information for review, respond to different messages directed by clinicians and enter new information into the EHRs (Patterson, Anders & Moffatt-Bruce, 2017) . The healthcare improvements specialists will leverage the information present in the EHRs and deliver quality improvements projects for clinical and service activities. With the implementation of EHRs data scientists will need excellent communication skills and proficiencies in both statistical analysis and computer programming (Palvia, Jacks & Brown, 2015). All the hospital staff will work collaboratively to integrate EHRs with clinical practices and ensure quality care.
Goals and Needs
Clinical Goals
The main goal of implementing EHRs is to support the decision making by clinicians and provide them with easier cross-coverage. The clinical goals will follow the SMART goal process such that the EHRs will be able to empower clinicians to specifically use information technology to manage and quality care is provided to the patients. This will enable the healthcare system to improve the current levels of care and enhance coordination among the physicians and other health practitioners (Bullard, 2016). Despite the expected challenges in achieving this goal, different mechanisms will enable the system to attain its objectives. The effort is relevant since it will provide the system with areas of focus for sustained improvements in clinical processes and organizational infrastructure during the adoption of EHRs. To achieve this goal the implementation should take a period of six months.
Revenue Goals
The implementation of EHRs specifically needs approximately 10,000 dollars per year to maintain and support practice management system and limited network. The application of cost containment strategies will be used with the goals of reducing expenses, improving efficiency, and increasing quality care (Weech-Maldonado, Davlyatov & Lord, 2018) . The EHRs have a potential of improving effectiveness and efficiency of health providers if adequate funding is provided during and after the implementation. The process may be costly but the cost benefits will lead to substantial savings. Further, financial needs are relevant to ensure a submission of quality measures and enough funds facilities needed during implementation. The revenue will be including the costs of hardware and software, maintenance, implementation and training which should be collected within a period of three months.
Goals around Work Environment
EHRs should promote and allow effective work environment in the healthcare system. The work environment should have all communication facilities with the patients, imaging facilities, labs, specialist offices and MCOs that have been accomplished electronically (Safdari, Ghazisaeidi & Jebraeily, 2015) . This will help in enhancing documentation and efficiency. EHRs should require minimal training and be user friendly to new health practitioners. Health care systems have many resources schedules that need to be handled and checked frequently. EHRs should sustain multi resource scheduling more efficiently and easily. To achieve this goal within a 6 month period, improvements should be made on record requests, patients check-ins, management of referrals, appointment scheduling and prescription management.
Approach
Implementation of EHRs needs a multi-disciplinary approach to organize the new system, design practice workflows, ensure security and privacy compliance, manage the adoption process and train the health care team. An effective EHRs implementation will ensure that the practice adapts more easily into the new system (Safdari, Ghazisaeidi & Jebraeily, 2015) . Creating an implementation team will be the first and most important practice. The team will consist of nurses, physicians, medical assistants, receptionists, administrative and compliance staff.
Due to misfortunes associated with paper records, the healthcare system will stop using the old methods of transferring and storing data. The jobs required for dispensing medical documentation and records will be obsolete. For instance, the need for employing medical clerks will reduce. The manual data collection, storage, indexing and retrieval methods will not be needed (Bullard, 2016). Workers will be trained to take new roles in an electronic environment. This will help in making the implementation process much easier and more efficiently.
The current and past medical records of patients as well as medications will be retained during the implementation process. This will ensure no confusion occurs during documentation. The practitioners will also ensure that the newly prescribed medicine do not conflict the current medications ( Bushelle-Edghill, Brown & Dong, 2017) . Previous guidelines used by health care providers will be retained and improved to ensure safety and more access to complete patient information. By improving the continuity of care, providers will be able to exchange information with patients and other providers. This means that the old information and documentations will be retained.
Steps in the planning Phase
The first step during the EHRs implementation planning is analyzing and mapping out the processes and practices of the current workflow. An EHR which does not integrate into the workflows of medical practitioners may affect the financial return and productivity on the investment (Palvia, Jacks & Brown, 2015) . To address this concern it is crucial to comprehend and understand different workflows in the current office practice. This includes events that occur in an actual patient appointment, appointment of schedules, workflows after patient visits, questions and how unscheduled patient visits are handled ( Bushelle-Edghill, Brown & Dong, 2017) . Assessing the workflows will determine the potential impacts of EHRs implementation in the medical practice. Before the new system is introduced, the workflows redesigns should be completed to problems in the new information system from occurring.
The EHR needs to be configured to deal with any issue that may arise during the implementation process. This will be done by working with the health IT vendor to make sure that the EHRs meet the suitable safety measures (Bullard, 2016). An HIPAA risk assessment will be conducted to protect the systems and practice computers. The EHR needs a list of build elements including; treatment regimens, demographics, patient history settings, medication management settings, computerized order entry and billing. An EHR vendor will be employed to manage, monitor the process and make sure that all the elements are in place.
Another important step is establishing a chart abstraction plan that will ensure the transformation of information from paper to electronic charts. This can be done by assigning the existing staff to id the process. Temporary or additional staff can be hired to upload the past medical family and medication histories as well as upload the demographics before the patients’ visits (Patterson, Anders & Moffatt-Bruce, 2017) . A checklist of items to be entered in to the HER will be prepared to ensure that the most critical information are not missed during transfer. There is need to understand the specific elements that should be migrated from the old system to the new one including the provider schedule information and patient demographics.
The implementation team will ensure that obstacles and concerns about privacy and security are addresses. This will be done through a re-evaluation and re-visitation of HIPAA regulations. EHRs implementation can be risky especially with the patients’ records if the healthcare system is not able to provide the necessary security for protecting the patient records (Palvia, Jacks & Brown, 2015) . Any security concerns will be dealt with under the HIPAA regulations to avoid legal trouble and leakage of patient medical records.
Meaningful Use
In February 2009, the Health Information Technology for Economic and Clinical Health (HITECH) act was implanted. The main goal was to ensure substantial financial resources are available to expand the usage of EHRs and promote the improvements in healthcare efficiency for all American citizens (Patterson, Anders & Moffatt-Bruce, 2017) . The efforts were laid by the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information and Technology. Health care providers were required to use certified EHRs in meaningful use to receive the incentive payments. This involves the use of EHRs in improving safety, quality and efficiency; improve care coordination and public health; engaging the patients and family in their health; reducing health disparities; and maintaining security and privacy for patient health information.
The incentive programs have three stages with their own objectives standards and measures. Stage 1 of meaningful use specifies the criteria that healthcare professionals and hospitals are entitled to meet for them to qualify for the incentives (Ballard, 2016). The rules define 10 menu set and 15 core objectives that focuses on providers sharing and capturing patient information. Stage 2 is the onset of meaningful use that concentrates on more rigorous health information exchange and advanced clinical processes. The objectives of stage 2 specify that patients are expected to be provided with secure access to online health information. It will also build on the needs for Stage 1 with more rigorous expectations for additional HER functionalities. Several core measures are related to recording, entering, and ordering of medicines (Patterson, Anders & Moffatt-Bruce, 2017) . To ensure effective use during the implementation process, the statutory requirements of HITECH should be adhered to which include the use of certified EHRs technology, in a meaningful manner, a manner that provides an opportunity for electronic exchange of data and to submit clinical quality measures.
Conclusion
EHRs implementation involves an evaluation of effective strategies and tactics that will help in understanding the specific needs and of the of the team and the overall process. The clinical, revenue and work environment goals will prepare the team on the anticipated measures during the implementation process. The goals follow the SMART process, which are the guides to HER implementation and motivate the staff on the necessary changes. The implementation plan depends on change management process, training and effective technology. Segmenting the tasks into three categories of what to start with, stopped and sustained is the first effective step during the planning process. The implementation planning phase involves analyzing practices, mapping the workflows, creating a contingency and project plan, establishing a chart abstraction plan and identifying the security and privacy concerns. The two stages of achieving meaningful use are also important to set the baseline for data sharing. This plan impacts an individual’s thoughts on the benefits of implementing EHRs in the healthcare system. It also provides a comprehensive on the anticipated concerns and how healthcare providers can tackle the issues efficiently. The success of this implementation plan is meeting the goals and provide quality care to the patients through EHRs.
References
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Bushelle-Edghill, J., Brown, J. L., & Dong, S. (2017). An examination of EHR implementation impacts on patient-flow. Health Policy and Technology , 6 (1), 114-120.
Palvia, P., Jacks, T., & Brown, W. S. (2015). Critical Issues in EHR Implementation: Provider and Vendor Perspectives. CAIS , 36 , 36.
Patterson, E. S., Anders, S., & Moffatt-Bruce, S. (2017, June). Clustering and prioritizing patient safety issues during EHR implementation and upgrades in hospital settings. In Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care (Vol. 6, No. 1, pp. 125-131). Sage India: New Delhi, India: SAGE Publications.
Safdari, R., Ghazisaeidi, M., & Jebraeily, M. (2015). Electronic health records: critical success factors in implementation. Acta Informatica Medica , 23 (2), 102.
Weech-Maldonado, R., Davlyatov, G., & Lord, J. (2018). EHR Implementation Among Nursing Homes: Is It Associated With Better Financial Performance?. Innovation in Aging , 2 (suppl_1), 599-600.
