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Electronic Health Record In The Healthcare Organisation

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Question:

Discuss about the Implementation of Electronic Health Record(EHR) in the Healthcare Organisation.
 
 

Answer:

Introduction

The requirement of creation and promotion of an efficient healthcare system is unarguable. The efficiency can be attained when the healthcare organisations are attaining the maximum benefits from the healthcare system. In the healthcare organisations, the efficiency can be achieved by the efficient use of technology (Eurohealth, 2012). The electronic health record (EHR) system has the potential to transform the healthcare system. Over the last few years, technology has intervened in the every major industry and most of the organisations have implemented heavy computerisation to increase the efficiency of the organisation. However, despite these technological advances in the society, there is no provision to maintain the health records of the patients electronically. Moreover, most of the patients are prescribed through hand written records and only a few patients are able to electronically contact their physician or set an appointment with the doctor. The Electronic Health Care Record (EHR) has the potential to transform the healthcare system of an organisation from paper-based system to computerised system which is capable of delivering high quality care to the patients. However, a simple EHR system provides only partial benefits to the society and the healthcare organisations; it is important that the Electronic Health Care Record system is implemented in a strategic manner. The EHR can be defined as the longitudinal record of the patient’s health which is stored electronically. The information is generated in the encounters between the patient and the doctor. The electronic health record also contains information related to the patients’ demographics, progress, medications, vital statistics, past medical history and the medical reports. One of the primary benefits of the EHR is the avoidance of the poor penmanship and associated difficulties in understanding the reports. There are three vital components of Electronic Health Record (EHR) which can improve the health care quality and reduce the system costs. These are: clinical decision support system tools, computerised physician order entry (CPOE) system and health information exchange (HIE) system. The clinical decision support system assists the physicians in decision-making regarding the patient care. It can be used to obtain latest information of the drugs or check previous records to identify a patent’s allergy to a specific drug. The CDS system can reduce the instances of medical errors which will assist the physicians in delivering effective healthcare (Menachemi and Collum, 2011). The aim of this article is to recommend the implementation of EHR in small patient setting. The Kotter’s change model has been applied for the implementation of EHR in the organisation. The intention, attitude and the beliefs of the healthcare personnel and the physicians are critical in acceptance and adoption of any new technology. Also, the perceived usefulness and the perceived easiness of use influence the adoption of new technological system. Therefore, it is important that social and the behavioural factors are considered in the EHR planning. In the present article, the case-study method has been used to describe the application of Kotter’s change management model in the implementation of cost efficiency among the physicians (Martin, & Voynov, 2014).

Reaching Consensus

It is important to reach a consensus in the change management process to reduce the resistance to the change. It promotes acceptance of the change process and ownership of the collaborative decision. It will motivate the people to work towards the common aim. The consensus will build support and among the stakeholders and they will be more acceptable of the change process (Voehl & Harrington, 2016).  A business organisation can build resistance by clearly defining the mission statement for the group, defining roles and responsibilities of the members, maintaining the group mission, establishing positive and open communication and creating s system of continuous review and feedback.

The hospital can use consensus decision making to reach agreement between different group members in a group.  The consensus decision-making can be used to find solutions which are actively supported by all group members. The consensus decision making allows the management to take into consideration the opinions, ideas and the concerns of all the members. When the management listens to the viewpoint of all the group members, they can bring proposals which can work for everyone. It can result in innovative and creative solutions which can inspire the people and group as a whole (Ledgerwood & White, 2006). In the context of the present organisation, the proposed role of Electronic Health Record (HER) will be determined with the help of consensus decision making.

The Electronic Health Records (EHR) will be used to support decision making by discussing the benefits of the system as conducted in Lagoon Hospital in Nigeria.

Lagoon Hospital has implemented an innovative consensus management approach to implement the electronic system to maintain the medical records of the patients. An electric medical record system has been introduced as a part of the innovation process in the hospital. The organisation has creates a mission to consistently deliver quality healthcare which exceeds the expectations of the customers. The Lagoon Hospital is the first hospital in the Sub-Saharan Africa which has earned the accreditation from Joint Commission International (JCI) which shows its excellency in clinical practices related to patient care and safety (Hygeia, 2017).

 


The management of Lagoon Hospitals obtained consensus from different officers by highlighting the benefits of the electronic system to them. The benefits of the electronic health record system were discussed with different employees. It was discussed that the implementation of the electronic record system will allow the staff to create an updated record of the medical and critical information such as medical history, future appointments, and medication and allergy histories. It can increase the efficiency of the healthcare professionals by creating structured information source, supporting inter-operability across the system and supporting effective decision-making by easing the process of accessing and interrogating the medical data. The waiting time of the organisation is also reduced and the errors created due to illegitimacy of handwriting are also mitigated. The appointment system will be better managed and more space is created in the hospital which creates conducive environment in the organisation (Gbenga-Mustapha, 2013).

The strategic alignment process can be used to determine the stages of the change management process. In the change management process, the major challenge for the organisation is to obtain consensus and reduce the resistance of the staff members. Therefore, in the first stage urgency can be created in the organisation to reduce the current operational efficiencies in the organisation. In the subsequent stages, the employees of the organisation should be acknowledged with the benefits of the Electronic Health Record so that the resistance for the system is reduced (Jones & Recardo, 2013).

Change Management

The implementation of the EHR system will bring certain changes in the operations of the organisation. All the system will be automated and the healthcare professionals and the physicians will be required to learn new processes and technology. There will significant changes in the organisation processes which will cause temporary loss in organisation’s productivity. The implementation of electronic health record will require significant investment in purchasing and installing hardware and software, converting the paper charts to electronic ones and training the users to operate the new systems. The management also has to constantly pay for the software maintenance and support. Moreover, the employees are also needed to be constantly trained to operate the system (Menachemi and Collum, 2011).

There are certain factors which forces the implementation of EHR in a healthcare organisation. The incentives, culture of the organisation and access to resources are the critical factors which are associated with building the pressure for the change process. The leadership and the organisation culture are also significant in the implementation process. The success rate of the implementation of clinical information system is one in three which shows high rate of failures of these systems. The inappropriateness in the selection of change management model also contributes to the failure of the system. The organisation should use creative change management approaches to create an efficient change management system (Kotter, 2012).

Setting:

The administration of Northshore Medical Group followed the Kotter’s eight-phase approach for the change. It is a multidisciplinary physician group located in Chicago, Illinois. It is accredited by Joint Commission and cares for about 60 patients in a day. The hospital also performs six to eight surgeries in a week.

Creating a Sense of Urgency:

It could be scrutinised that the Director of the Medical Centre was initially indifferent regarding the benefits of EHR. However, the practice managers and the billers were concerned regarding several issues such as lack of physical space for storing the medical records, the consumption of physical space for storing medical records and wastage of time an efforts in finding the lost medical records. These problems enhance the perception regarding the perceived usefulness of EHRs for the management and the administration. All these situations triggered the practice manager and the biller to create urgency for the use of Electronic Health Records (Kotter & Cohen, 2012). The Later, an announcement was made by the manager of the Northshore Medical Centre for the implementation of EHR. The employees were divided into three groups, physicians, allied healthcare staff and the administrative staff. The physicians do not have a significant role in the change management process; however, they have to experience their use and determine whether the organisation should implement EHR or not. After the evaluation process, the physicians were indifferent to the use of EHR. Moreover, the allied health staffs, which comprise of the lab physicians and medical assistants in the age group 40s or 50s strongly, opposed the implementation of the system due to the highly challenging learning curve. The administrative staff which refers to the billers, receptionists and the administrators were more acceptable to the change as they were willing to try something which assists them in the management of thousands of medical records (Edwards, 2009).

 

Forming Coalition:

After the creation of a sense of urgency, the next stage is to create a powerful coalition to guide the change. The guiding coalition was established of the manager and the biller. This coalition was responsible for implementation of EHR system with minimal disruption by identifying the facilitating and the restraining forces. The coalition was responsible for all aspects of the EHR implementation which includes clinical, operational and financial factors. An example wherein the guiding coalition assisted in the implementation of EHR process in the organisation is where the members of the guiding coalition actively participated in the EHR training organised by the vendor. It increased by the perceived ease of use of the organisation (Cameron & Green, 2015).

Create a Vision for Change

Norhshore Medical Center, LLC would become leaner by the implementation of EHR. The vision of the organisation is that EHR is not the end goal of the change management process but the means to end. The aim of the organisation is to increase the leanness and the quality of the organisation by successful EHR implementation process (Kotter, 2008).

Giving Voice to Vision

The vision of the change management process was established by the practice manager and the biller. The manager and the biller communicated regarding the vision with each member of the team. The EHR implementation was not a simple project in the organisation but will create a major shift in the organisation culture. The management communicated immediate changes with the physicians such as enhanced diagnostic and monitoring tools for improved patient care, increased revenue, decreased manual mistakes and the overall liability (Kotter & Rathgeber, 2013). The administrative staff was also communicated with the immediate benefits of the change process such as less missed appointments, prevention of double booking of the beds and less time to find missing records, time efficiency in data entry, data management and transparency in the organisation.  It also creates possibility of several people working with the same patient at a single time (European Commission Information Society and Media, 2009).

Empowering Broad-Based Action

The practice manager and the biller also ensured that there is full participation of the most resistant group of the organisation, the allied health staff who do not perceive any immediate benefits with the implementation of the system in comparison to the physicians and the staff. The learning of the complete EHR system is a complex process and requires the time. The manager and the biller were focused on the group learning. They monitored the entire learning process and focused on how learning can be improved (Kotter, 2008). The following learning approaches were taken, individual and group training, setting up dummy patients for the practical implementation and making the teams watch training videos in group so that they can support each other. The managers also make provisions so that the individuals as well as the groups are recognised for their individual efforts and achieving specific milestones.

 

Generating Short Term Wins

In the Northshore Medical Centre, the EHR implementation was conducted during the time period from 1st October, 2013 to 31st December, 2013. During this time period, several milestones were created to mark the progress of the project. The particular milestone was set to create an active allergy list of the patients. In this particular milestone, the physicians had to feed any known allergic reaction to the health records. It is important part of the patient care as an adverse outcome can be prevented resulting from known allergic reactions. Using this approach increased the usefulness perception of the healthcare professionals (Kotter, 2014). It also created the perception that the adoption of EHR system is a strategic vision and change in necessary in the organisation. 

Consolidation of Change

The early achievements and issues were consolidated in the management meetings. It provided the motivation to achieve more challenging milestones in the organisation. With the HER, the patients can give educational printout about the diagnosis and the post-procedural instructions related to the appointment and the procedure. The initial goals were easy which increased the perceived competence and confidence of the people which will be impacted by the change.

Anchor new Approaches in the Organisation Culture

The implementation of EHR at Northshore can increase the operational efficiency and increase the capital revenue generation. After five months of the implementation of the EHR system, the medical record system was completely transformed from the paper-based record keeping to electronic-record keeping. The implementation of EHR system will change the operations of administrative staff as instead of hunting down the medical charts, they have to notify when a task is needed. The attitude of the staff was also changed and the medical staff that was initially resistant to the change created a positive attitude. They more often enquired about the additional functionality of EHR process (Cameron & Green, 2015).

Planning Development

The Electronic Health Record system has the capability to increase the safety and the quality of care provided to the patients. However, the major challenge with the use of EHR is its proper use by the physicians. The integration of EHR system can impact positively in the operations of the organisation. The EHR system can increase the time efficiency of the nurses as the use of computer will reduce the documentation time. The documentation of admission information can be conducted easily. With EHR, the personal digital assistant can be used which can reduce the manual error and increase time efficiency of the nurses. The major challenges in the use of EHR system are lack of adequate knowledge by the nurses or lack of confidence to operate the device.

The physicians can also increase their time efficiency with the use of EHR system. The use of bedside or point-of-care computer system can reduce the documentation time of the physicians. Moreover, the use of central station desktops is less time consuming than thee point-of-care computer system. The integration of EHR system also directly impacts on the patient care, user satisfaction, information accuracy, and completeness of data entered and the nature of workflow. However, time efficiency is the only possible impact which can be assessed. The implementation of EHR can also positively impact on the shift times and working periods. The physicians’ schedule can be developed accurately with the use of EHR system. The time efficiencies can be enhanced regarding the patient encounters (Poissant et al., 2005). It could be reflected that Electronic Health Record will positively impact on the quality of healthcare provided to the patients. It can reduce the time devoted to the care of each patient which can increase the efficiency of the patients. Moreover, it will also reduce the cases of negligence on the healthcare entity due to negligence. The competing healthcare organisations which are using Electronic Health Records are becoming more efficient in the patient care and have become resourceful to deal with more patients daily. The customers have become more satisfied with the services provided by the hospitals. The physicians and the administrative staff have become more time-efficient and the integration of EHR system has reduced the burnout of these employees.

Outsourcing Process

With the advancements in technology, the paper-based medical records are becoming obsolete. The Electronic Health Record system will allow seamless flow of information which is readily available and easy to use. However, several Electronic Health Record (EHR) systems are challenged by the lack of effective use. Moreover, the issue of selection of the most-appropriate EHR system is also a complex task. Therefore, outsourcing EHR is the best option for the healthcare organisations. In the outsourcing process, the healthcare organisations can outsource the services of data migration of Electronic Medical Records, use it a SaaS service and up-gradation of the existing EHR system. With the outsourcing activities, the healthcare organisations can increase the doctor-patient engagement in a digitally-interactive manner. The processing of the medical records of the patients, using EHR system as service and privacy and security management are approaches which can be outsources from other companies (Amatayakul & Lazarus, 2005). All the services should be outsourced from one company so that all the services are streamlined. The services provided to the patients are entered into the system by the administrative staff. The calculation of the total cost endured by the patient can be outsourced. Moreover, the health care organisations can also produce adequate supporting documents which can speed up the reimbursement process of the organisations (Walker et al., 2006). There should be constant communication and collaboration between the administrative staff and the outsourcing personnel. Training should be provided so that the physicians remain updated with the current operational processes. The outsourcing agency should provide real-time updates to the software. Moreover, all the processing should be conducted regularly and the information should be updated in real-time (Hammaker & Knadig, 2017).

 

Privacy Considerations and Increasing Awareness

The Data Protection Act (DPA) control how the personal information of an individual can be used by the business organisations or the government. In the EHR system, the data protection Act is relevant as the personal information of the patients is attained by the healthcare organisations and outsourced to the other companies. According to the data protection principles, the personal data of the individuals can be obtained for lawful purposes and should not be excessive or more than required. Moreover, the personal information of the individuals can only be outsourced to the countries which give adequate protection to the rights of personal data usage. Accordingly, the company should outsource the information processing to the companies which give adequate data protection rights. The unauthorised use of information by the healthcare personnel can adversely impact on the security of the people.  Certain methods can be used such as limited accessibility and password protection to protect the information.

Increasing Awareness for Business Growth and Information Investment

The Electronic Health Record (EHR) system can open numerous business opportunities for the healthcare organization. The electronic health record can support the clinical care by assisting in clinical research. The EHRs have significant use in the routine clinical care of the organisation. It can also be used for secondary purposes such as clinical research, design and execution of clinical trials for new medicines. The EHR system should be used to exchange the information internationally as it ensures consistent and complete recording of clinical information (Coorevits et al., 2013). The healthcare organizations can also customize the services to increase the business efficiency.  The healthcare organizations can customize electronic health record templates to increase the proficiency of the system. The companies can also implement strategies to enhance the training and development of the employees (Gardner, & Pearce, 2013). The Electronic Health Records are commonly used by a large number developing countries to increase the quality of health care and as they are cost-effective. However, technology can introduce certain hazards such as safety of information in the organization. The malicious elements have found it easier to breach the security of the system with the technological methods. The use of Electronic Health Records can create certain privacy issues which raises ethical concerns for the governments. Several governments have made laws to safeguard the privacy of the people whose data in stored in these electronic systems (Ozair et al., 2015).  The information generated through Electronic Health Records can be used in the clinical research and mediating insurance and compensation issues. The patient’s past records can be used to efficiently provide treatment. It can be used to detect past allergies and reactions to certain chemicals. The information can be used by the organizations effectively by proper management of the system. The administrative staff should be given training to properly manage the system. The electronic health record system should be password protected so that the unauthorized candidates cannot access the personal information of the patients (Ticher, 2008).

Report findings

Electronic Health Records (EHR) is a system in which the patients’ records are stored electronically rather than on papers. It is an efficient system and the healthcare organizations require it to reduce the manual errors, due to the illegitimacy of the writings and to reduce the consumption of the physical space. However, before the implementation of changes, the employees always resist it. It is important to bring a consensus for the change so that appropriate efforts are made for the success of the change. The management of the organization can obtain consensus from the employees by promoting the benefits of the Electronic Health Record (EHR) system with the employees. The company can also define a clear mission statement; establish open communication, transparency and feedback in the organization. After obtaining the consensus, the company should plan change by selecting appropriate change management model. The Kotter’s model has been selected for implementing the organization change. It has been successfully used by the Northshore Hospital in Chicago to implement the Electronic Health Record (EHR) system. In this model, the change is implemented in eight phases. In the initial phase, urgency is created in the organization for the change. The management broadcast the importance of the change in the organization and motivate the employees in embracing the change. The management actively participates in the change process so that the change can be accepted easily. The Electronic Health Record (EHR) can be used to increase the efficiency of the nurses as well as the physicians. It will reduce the average reporting time of the physicians. With the enhanced services, the customers will also be satisfied with the services. In electronic Health Record system, the companies can use outsourcing to be more cost-effective. However, it is important to collaborate and communicate with the outsourcing agency for smooth functioning of the system. The companies should also be considerate of the privacy of the users and the patients while outsourcing the work. Since the patients’ information is sensitive and comes under the Data Protection Act, the healthcare organization should outsource the work from the agencies which have the same data protection laws as that in the Mauritius. In addition to it, the healthcare organization should also increase the awareness regarding the business benefits of the Electronic Health Record system as it will open new business opportunities for the organization. The information obtained with the Electronic Health Record (EHR) can be used by the organization in clinical researches and eefficient management of thee insurance claims. 

 

References

Amatayakul, M.K., & Lazarus, S.S. (2005). Electronic Health Records: Transforming Your Medical Practice. Medical Group Management Assn.

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Coorevits, P. et al. (2013). Electronic health records: new opportunities for clinical research. Journal of International Medicine 274(6), 547-560.

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EHR system at NorthShore University HealthSystem, Evanston, IL (Chicago), USA. Retrieved 6 April, 2017 from https://www.ehr-impact.eu/cases/documents/EHRI_case11_NorthShore_USA.pdf

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Gardner, C.L., & Pearce, P.A. (2013). Customization of Electronic Medical Record Templates to

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Hammaker, D.K., & Knadig, T.M. (2017). Health Care Management and the Law. Jones & Bartlett Learning.

Hygeia. (2017). Lagoon Hospitals Implement Electronic Medical Records (EMR) – 1st In Nigeria. Retrieved 6 April, 2017 from https://www.hygeiagroup.com/index.php/lagoon-hospitals-implement-electronic-medical-records-emr-1st-in-nigeria/#sthash.koJYt0Sh.dpuf

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Jones, D.J., & Recardo, R.J. (2013). Leading and Implementing Business Change. Routledge.

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Kotter, J.P. (2008). A Sense of Urgency. Harvard Business Press.

Kotter, J.P. (2008). Force For Change: How Leadership Differs from Management. Simon and Schuster.

Kotter, J.P. (2012). Leading Change. Harvard Business Press.

Kotter, J.P. (2014). Accelerate: Building Strategic Agility for a Faster-Moving World. Harvard Business Review Press.

Kotter, J.P., & Cohen, D.S. (2012). The Heart of Change: Real-Life Stories of How People Change Their Organizations. Harvard Business Press.

Ledgerwood, J., & White, V. (2006). Transforming Microfinance Institutions: Providing Full Financial Services to the Poor. World Bank Publications.

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Menachemi, N., & Collum, T.H. (2011). Benefits and drawbacks of electronic health record systems. Risk Manag Healthc Policy 4, 47-55.

Ozair, F.F., et al. (2015). Ethical issues in electronic health records: A general overview. Perspect Clin Res 6(2), 73-76.

Poissant, L., Pereira, J., Tamblyn, R., & Kawasumi, Y. (2005). The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review. J Am Med Inform Assoc 12(5), 505-516.

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Walker, J.M. e al. (2006). Implementing an Electronic Health Record System: Health informatics. Springer Science & Business Media.

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