Electronic Health Record Essay

In the proposed scenario, a Clinical guard Specia amount (CNS) with a Post-Masters Nursing Informatics Certificate has decided that the cytosine bed infirmary that she croaks in would benefit from transitioning from make-up charting to apply an electronic health record (EHR) administration. She has d sensation initial clinical look for and has a solid foundation of best- forbearing-practice reasons that support this flip. She has in every bailiwick researched and studied the cultivation on the governments web localises healthIT.gov, and CMS.gov pertaining to the Ameri set up Recovery and Reinvestment Act and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. HITECH is a stimulus package approved by the US government allowing $19 billion dollars to be divided between hospitals and doctors who demonstrate deport in mindingful uptake of electronic medical records(ARRA HITECH Solutions, 2015). She k at a generation that the best way to select and institute an EHR is to fall in a team of members with various specialties pertaining to the goals outlined in the stages of HITECH. Stage 1- selective information capture and sharing, Stage 2- Advance clinical edgees and Stage 3- Improved outcomes. all(prenominal) of these stages has its own immoralingful intake criteria. As seen in the plat to theleft.The CNS begins by choosing the members of her team from various disciplines in the hospital. Because this leave behind mean corporate wide changes and adoption. Her list implys the following, from the IT department, a Clinical Nursing Informatacist- chosen for a specialty in how checks interact with computer softw are and what is maked for nurses to efficaciously flush for affected roles, and the Director of Clinical Informatics- chosen for an overall knowledge fundament of the hospitals informatics resources and involvements including what software and laboredware is currently avail satisfactory, wha t has worked or failed in the past tense and what changes impart need to happen to keep the hospital compliant with long-suffering retirement and safety regulations.She ordain also need a bodily Project Manager to organize and disseminate selective information to the various off-site entities link up to the facilities that will need to be on board with this change crosswise the corporation. A Chief Medical Information policeman will be key in providing the perspective of the physicians and their particular ineluctably and goals, and to be a liaison for the staff physicians when the EHR rollout occurs. A Chief Information Officer will buzz off knowledge about the hospitals day to day functions that will need to integrate into the new EHR along with how those systems currently function.A Chief Nursing Information Officer will admit their finger on the pulse of each nurse building block and be aware of the assorted user interface requirements that will be involve by va riant departments for the the specific token of flow and care given. Lastly, a Chief Financial Officer will be adapted-bodied to puff the team on topics concerning governmental funding and current assets along with dowry to create and maintain a budget as requisite with the eruditeness of new software and hardware, he will also be able to work with each departments budget makers when the time comes for allocating educational activity hours and equipment purchases. Along the way the team will need to bring in sub-specialists to give information and feedback as they hone the new system, simply for now the assembled team will be responsible for researching, choosing and implementing the best EHR for their hospital.A.2 a-e) Choose 2 real-life computerized management systems and analyze them by comparing their advantages and disadvantages, recommend the best choice to suitable the MU requirements, describe how the features of the recommended system meet the guidelines outlined in the lead stages of meaty use, describe the impact on smell of uncomplaining care, enfranchisement and outcomes.The team is aware that currently they pay a computerized system that they use for coverage and track labs, radiology and scheduling, but all documentation is paper based. They consider the price point involved with adding modules to the existing McKesson software vs purchasing and implementing an entirely new EHR called epic. epos appears to be user friendly and able to seamlessly connect all of the facilities under the umbrella of their corporation. They make a list of some(prenominal) of the pros and cons associated with each system.McKesson has the upside of being a system they film already worked with and it has different programs that can be pieced together to meet some of the meaningful use (MU) criteria for compliance. They already drive a working relationship with this vendor and some flummox with the product. Once the discussion gets going, the tea m realizes that on that point are many more bad points than good with McKesson. In their experience, the software modules are connected in a piecemeal fashion that makes it serious for programs to interface. Quite frequently info is just lost and not retrievable. in that location are different information entry systems for the different types of departments i.e. OR, ER, labor &delivery, Med/Surge, radiology, and pharmacy. The different systems do not allow for across the board data glean and that makes it difficult and time consuming to track reportable nursing and CMS indicators. The aesthetics of McKesson are something that is frequently complained about by the staff, due to lack of characteristic color transition and eye fatigue.Lastly, the group is very reluctant to enshroud on building their EHR base with McKesson because the PCPs in the area will not be able to attack hospital records, and office enforce information will not be addressable to the hospital based sta ff. cod to the need for increased man hours in servicing McKesson, lack of decided data sampling, and the poor continuity of care related to PCPs not having openingion to hospital data and vice versa, the team decides to read heroic instead. Epic has the overmaster side of being a system that will require a large initial outlay of funds. The hospital will render to purchase software, and related hardware. They will have to expand the IT and biomedical design departments to support and maintain the new system and equipment (something that would have been necessary to a smaller degree with McKesson).They will have to address some retrofitting needs related to wiring and computer instillation and lastly readiness will be a very big issue. Despite the potential down sides, the team comes up with a long list of reasons that heroic poem is the proficient system to choose. To begin with big is all one system. It allows for seamless interdepartmental interfacing. The PCPs in th e area already use a version of EPIC and this will allow for easy data exchange and a patients information will follow them easily. The EPIC system has a medication reconciliation form that is easily viewable to all care givers and pharmacies in the area, keeping track of each patients reported medication demigod and frequency. EPIC has a my chart feature that allows patients see labs, after visit summaries , and to interact with physicians about scheduling, medications and lab results. EPIC hasmany built in safe guards, including password protection, continuous backup and recovery programs so no data is lost, and the vendor provides continuing support as needed. EPIC comes in 3 pre-bundled, customizable templates, each already set up to meet the meaty utilise (MU) criteria without having to alter the program.The team can look at the troika available options and determine if one fits them perfectly, or find the closest one and alter it to fit their specific needs. Some examples of how EPIC will meet the Stage 1 MU criteria are computerized physician direct entry, checking for drug interactions and allergies automatically, tracking demographics, keeping current diagnosis, medication and allergy lists, allowing patients to have electronic gateway to discharge summaries, and it gives patients electronic access to physicians. Once the hospital has utilise EPIC for at least two years, some examples of how EPIC will dish meet the Stage 2 MU criteria are ongoing patient data entry and discreet sampling for report generation. The team will tarry to develop the software that demonstrates interoperability in sharing of lab results with other providers and systems. pledge risk judicial decision will be ongoing and built into the system.smoking status will be tracked on all patients 13 and older and the EPIC software is designed to guide the facility from conflux the Stage 1 criteria to meeting the Stage 2 criteria. Stage 3 MU objectives are projected to impro ve outcomes. The team is waiting on the final examination ruling for what the Stage 3 guidelines will be and in the mean time they have a projected goal of focusing on primary prevention measures and up overall population health. This will let in recommended vaccination reminders, smoking cessation assistance, healthy lifestyle and meal homework recommendations, and yearly checkup reminders generated by primary physicians that will crossover to hospital patient charts. Some of the better benefits of EPIC include point and get through tabs in the assessment fields, this allows for separate sampling of information. EPIC utilizes a reporting workbench that will harvest requested, reportable dataand assemble it into a user friendly template. This will benefit the hospital by step-down former man-hours required to find and collect data for clinical quality measures, public health reporting, and CMS indicators.Discrete data sampling from EPIC will make the hospital a benefit to the c ommunity as come up by allowing it to track trends and provide information to community health nurses. EPIC comes with the ability to establish hard stops and reminders that allow real-time users to be aware of needs for care coordination and patient specific follow-ups or recommended test related to treating chronic conditions. It will also allow for symptom driven order entry fields to be immediately available in emergent situations where time taken to look for those things could mean a worse outcome. This is especially cardinal when people present with symptoms of stroke or warmness attack. Another EPIC benefit is the different levels of bedside specific PHI protection related to sensitive care. EPIC has a break the glass functionality pertaining to all intimate assault and psychiatric admits.This function lonesome(prenominal) allows relevant staff to light and view these patients charts, any others are shown a pop-up pattern and a keep an eye on is sent to start an inv estigation of any other person who logs in to theses charts. The team is impressed with the information provided by EPIC concerning scanning patients and medications at the bedside and the reduction in medication errors this causes. The scanners will integrate with the medication dispensing machines already in use at the hospital. One of the major benefits of EPIC is the order entry build. Each physician, with a minimal amount of training, can custom-make the order entry process to reflect their needs. Medication orders are at once linked to a pharmacist to double check for allergies, and correct dosing information, and whence the medication becomes available, via PYXIS machines on the unit for the RN to administer at the bedside. The bedside dosing requires the patient and medication to be scanned, further eliminating potential errors, and provides a pop-up warning if an emergency override is required during any of thesesteps. While the team acknowledges that training and time t o become familiar with the new charting and bedside routine changes will ab initio impact patient care in a negative way, they have a plan in mind to keep the patients educated on the new system changes and the anticipated better care available to the patients across the board from instituting an EHR system. Having the patients ask questions and give real time feedback will suspensor the team tweek their training and bedside routines to give better, more organized care that results in trackable outcomes. This is just an overview of some of the many functions EPIC has that persuaded the team to choose it as the new EHR system for the hospital. (EPIC and McKesson related information was culled from the authors own experience with the systems and personal interviews with multiple members of the informatics department at St Francis Hospital, Indianapolis campus).A.3 a) Use of Quality Improvement DataEPIC has point and click assessment tabs and a ensampleized documentation format that links related data. This allows for separate data sampling related to things like CMS indicators. The hospital will be able to track compliance with things like door to EKG times in the emergency department, Foley catheter use and resultant CAUTIs, and the time from when a patient presents with stroke symptoms until a cat scan is done and/or whether the patient receives antithrombolytics as a result. The hospital will also be able to generate reports on errors that occur the via the Risk Monitor Pro accompanying tracking software. This will allow them to continue researching and improving processes.A. 3 b) certification Standards and MethodsEPIC has 24 hour monitoring of staff use opus logged in, and the records they access. This is cardinal because hundreds of staff members will be using the system and thither has to be accountability if utilizationees were to look up their own records, or the records of friends or family. Thisinformation can be tracked and the employee inte rviewed and disciplined if needed. EPIC also comes equipped with incident reporting software called Risk Monitor Pro. whole staff members are encouraged to use this format to report any incident that might warrant further investigation. It covers every location, type of employee, type of equipment, patient, visitor or vendor. Risk Monitor Pro forms are used to report potential or perceived injuries, faulty equipment, sentinel events and things that have the potential to cause harm or damage.This information can be followed up on by the risk management team, so that process improvement is an ongoing process. The team works with members from the IT department and plans for primary data storage with a redundant back up storage unit that simultaneously updates so if the primary server fails there is no outlet of information. They have also planned for a second, off site data storage center that can be used in case of emergency to ensure continuity of services, and keep things up and r unning magic spell the primary system is off line for upgrades. Lastly back up tapes will be kept at a third site in case both of these areas are compromised, and the system can be rebooted and running again within 72 hours.A. 3 c) Explain how the system will protect patient privacy and meet HIPAA requirements EPIC will protect patient privacy in a number of ways. overthrow User access is limited to only being able to access the information needed to do their jobs. Making the accessible information different for nurses, physicians, registration clerks, radiology technicians, committee members etc.Personnel will only be granted access once they have completed tribute training and have signed documentation stating that they understand the legal risks and responsibilities when accessing saved health information (PHI). Individuals outside the hospital will have access to EPIC as well, for example nursing home physicians. They will have a read only access granted, but will require mul tiple patient identifiers to access the information. Also, as mentioned earlier, EPIC will employ security relatedchart hard stops like divide the Glass.A. 3 d) Explain how the recommended system meets HIPAA requirements EPIC helps to meet HIPAA requirements with machine-controlled enforcing of access policies, and pro-active alerting that links directly to the risk management department, requiring hygienic password policies, and automatic logout at end user work stations. EPIC allows providers to protect the integrity of data and recover original data in the case of it being altered or damaged. EPIC users are required to have appropriate training to be able to access the system, and can be locked out in the case of termination. Portable devices carry encryption software that does not allow for third party data bloodline or access. EPIC can also quickly generate reports with discrete sampling related to various forms of access. The majority of compliance will be the responsibilit y of the staff with written policies, documented sanction programs and investigation that is on-going, lucid and documented.A. 3 e) Describe how adopting the system will reduce costs to the administration Instituting this new system will initially generate more costs, but in the long run will save the hospital cash in many ways. Meeting the ARRA/HITECH Act requirements will help to stir up those cost with financial incentives and avoiding fines and penalties. Having readily available test results will subside the costs and labor associated with repeating lost or illegible results. With higher-up organization and data summary tools, the cost for labor associated with studying charts separately and generating reports will be exponentially lower.The need for transcriptionists will be greatly reduced by utilizing dictation software. Facilities for storage of paper charting cost capital for upkeep and staffing. An electronic database should make billing and insurance claims easie r to process and thereby generate revenue faster. The time it takes for physicians to spend going over intricate medical histories with patients is greatly reduced byhaving that information readily available in a database. According to a recent study, when hospitals rely on advanced electronic health records they can save up to 10 percent per patient admission (Advanced EHR Cuts Hospital Costs By 10% Per Admission, 2014).4. A) Explain why active nursing involvement in the planning, selection, and implementation of the systems is important to the success of the implementation process and meeting meaningful use requirementsActive nursing involvement is important to the success of implementing any process that affects care given at the bedside. For the system to be optimized for use, nursing suggestions and feedback are critical. EPIC knows this and has a team of nurses on staff to work with the facilityin developing end-user interface. Nurses from the hospital include the advocates, CNSs, NPs, LPNs, managers, and bedside care givers, each with a specific focus and experiences that are valuable when helping to decide how charting should work. Any thing that pulls a nurses fear away from the patient, or is distracting or difficult to work with decreases the perceived level of care and increases the potential for errors.The health care goals of meaningful use include improving efficiency, safety and quality while decreasing discrepancies, involving patients and their families in their care, improving public health outcomes, improving care coordination, and advancing security and privacy of PHI (Gregory & Klepfer, 2010). All of these things are the foundation of every interaction a nurse has with a patient. This is why nursing is one of the most trusted professions, gibe to the Gallup pole website, nurses come out on top at 80% when people were asked to rate the honesty and ethical standards of people in different given fields (Honesty/Ethics in Professions Gall up Historical Trends, n.d.).Because standard nursing care already meets the goals outlined for meaningful use, the most important thing the averagenurse can do is to work hard to be competent utilizing the selected EHR software. Advanced users and nurse leaders are important to help guide the EHR selection process in the direction that will improve the bedside interactions and user interface. Clinical nurse specialists have advanced educations and bring the nursing philosophy to the selection and implementation process. All of these roles are bouncy to the success of any EHR implementation.