Essay On EHR: Benefits, Risks & Recommendations For GPs In Australia.

The requirements for a doctor’s practice

• What is the business context of a doctor’s practice:

o what is the nature of the business market,

o what challenges do they face,

o what constraints are they under,

o what special regulatory, social and ethical circumstances do they operate in?

• What are areas of breakdown or problems in the practice?
• What processes and services do they perform?
• Who are the key stakeholders, their needs and requirements?

• Who is a Vendor offering software solutions?
• What is their background?
• What functions do they offer?
• What is their architecture?
• What equipment do you need?
• What risks are there in implementation?
• What are the costs and benefits of the solutions?
• How will you proceed with the implementation project (roles and responsibilities?)

The case study that is evaluated provides an idea of the potential value and the benefits offered by the electronic health records. However, there are a number of issues associated with the use and maintenance of electronic health records (Parsons et al., 2012). Although the concept of electronic health record is not new, the use of electronic health record system has considerably increased over the years. The case study gives an idea of the healthcare services provided by the healthcare services to the Australian society. The use of electronic health record systems certainly benefits the aged population of Australia. The case study evaluates the target that is set up to establish a demographic or a target group to the potential patients who can be benefitted with the use of the electronic health record system (Sittig & Singh, 2012). The capability of the electronic health record system is to trade the patient’s data electronically so that it can provide the opportunity to the general practitioner a secure and effective ways of administering the patients’ data.

The purpose of the report is to evaluate the process of analysing the data that is collected on basis of the case study. The data which was collected was in respect to an electronic health record and the doctors’ practices in Australia. The report provides a number of key recommendations on basis of the use of the electronic health record system. These recommendations will addresses the risks involved in using an electronic health record system. In the data collection part, the business context of a doctor’s practise is analysed in the report. The investments that is done so far is analysed in the report including the financial benefits associated with the use and installation of the electronic health record system. The risks associated with the implementation and use of an electronic health record system by a general practitioner is further discussed in the report. There are a number of benefits of implementing an EHR and the process by which the benefits of implementing this project can be realized is evaluated in this report. However, there are a number of ethical and social implications associated with the adoption of an electronic health record system. These ethical and social implications are needed to be addressed in order to make this project a success. The relevant ethical and social principles associated with the use electronic health records by the doctors within Australia are evaluated in this report. The risks in relation to the identified ethical and social principles are evaluated in the report. These risks are mainly associated with the patients and the staffs and therefore the measures to address these risks are needed to be identified. The analysis provides an idea that role of general practitioners is very important in Australian society; however, there are a number of issues that are faced by the GPs that can be addressed by the implementation of the electronic health record.

Primary Recommendation 1-> The popularity and the need of general practitioners can be increased by making use of the electronic health record system.

Key Recommendations

Secondary Recommendations-> 1. The use of an electronic health record system can target the patients of rural areas and the aged citizen as it is difficult for them to visit a doctor. This will increase the demand of the general practitioner which is considerably low since the patients nowadays prefer to visit a specialist in the first place.

2. The use of an electronic health record system is expected to improve the process of keeping a track of the patients’ data. Since the data of the patients’ can be easily tracked and accessed, it is expected to be adopted by a number of people.
3. In order to increase the number of general practitioner workforce, it is recommended that the general practitioners make use of the electronic health record system.

Primary Recommendations 2-> The General practitioners find it difficult to practise in the remote areas as the technology availability is low. It is therefore recommended for the general practitioners to implement an electronic health record system, the data from which can be easily accessed with the help of a mobile device as well (DesRoches et al., 2013).

Secondary Recommendations -> 1. The mobile application that is to be developed should incorporate the option easy appointment booking. It is recommended for the application to involve an option of setting up a direct connection with the practitioner so that the patients can avail the medical services in times of need. This is expected to increase the market opportunity for the general practitioners.

Secondary Recommendations -> 2. The security features of the electronic health record system should be strong enough so that the patients’ data that is stored in the system is kept secured.

Secondary Recommendations -> 3. It is recommended that the electronic health record system is to be designed in such a way that the patients’ can control who can access the data that is stored in the system.

Primary Recommendations 3->  The collected data about the market presence suggests that the GPs ration is decreasing day by day in comparison to the other clinical professions, for which the adoption of the electronic health record system by the general practitioners of Australia is recommended. However, in order to ensure the success of the project, it is essential to analyse the target market or the target group of patients who will be availing this services. It is therefore recommended to further analyse the potential benefits and the target customers of an electronic health record system.

Secondary Recommendations -> 1. In order to increase the target customers of the electronic health record system and to increase the adoption of the electronic health record system that will be managed by the general practitioners, it is recommended that the interface of the health record system should be user friendly. This is essential since the main target patients of the general practitioners are aged people. It might be difficult for them to get accustomed to the modern technology and therefore, it is recommended that the system to be developed is kept as simple as possible.

Secondary Recommendations -> 2. For increasing the target group of patients who will be using the electronic health record system that will be maintained by the general practitioners, it is recommended that proper advertising is done. The benefits of using an electronic health record system can be advertised as much as possible so that there is an increase in the reach of the customers.

Strategic Context

Primary Recommendations 4->  It is further recommended that the electronic health record system should incorporate the remedies of some common diseases so that he patients can easily access those data in times of need and in cases when establishing the connection with a doctor becomes difficult due to technology, connection or time issue.

Secondary Recommendations -> 1. It is recommended that the electronic health record application that is needed to be developed should incorporate an offline operation as well. This offline operation can make the remedies of the most common diseases available to the patients even when there is a connectivity problem.

Secondary Recommendations -> 2. It is recommended that the system should incorporate the feature of direct voice call with the general practitioner so that it increases the demand of the electronic health record system and as the electronic health record system will be managed by the general practitioners, it will in turn increase the demand of the general practitioners as well.

The above discussed points give a clear idea of the key recommendations that are identified on basis of the gaps, challenges and the risks that are evaluated on the value report of that is associated with the use of electronic healthcare records and its use in increasing the demand of the general practitioners in Australia. The strategic context associated with the business background and the business environment is discussed in the following section.

This section of the report will analyse the business background associated with the decision of making use of an electronic health record system in increasing the popularity and reach of general practitioners in Australia (Jensen, Jensen & Brunak, 2012). For that, identification of the mission statement and the proper analysis of the strength, weakness, opportunity and the threats associated with the project and the recommended solution is needed to be evaluated.

A business case is to be prepared that is associated with the use of electronic health record system within a doctor’s practise, in this case the general practitioners of Australia are considered. The main aim of implementing and using such system is to increase the efficiency of providing medical services to the patients. The use of an electronic health record system will mostly optimize the clinical experiences by arranging and organizing the data in such a way that it becomes easier for the patients to adapt to the system. Furthermore, the use of electronic health record system ensures that the data will be securely stored in the database and can be accessed by the person who is permitted to access the data (Lau et al., 2012). The general practitioners in this case are permitted to access the data so that they can suggest suitable solutions to the patients. The aim of the project is to therefore enhance the process by which the general practitioners of Australia provide health services to the patients. The electronic health record system is chosen for this purpose since with the help of the electronic heath record system, the data of the patients can be securely traded in order to increase the opportunity for the general practitioners for serving a large number of patients’ in Australia (Pearce & Bainbridge, 2014). This will considerably increase the reach of general practitioners and will improve the opportunities for them.

The decision of using an electronic health record system is expected to improve the revenue that is collected from the health record system. There are a number of advantages associated with the use of the electronic health record system, which includes the reduction is the decreases printed material, free appointment booking and establishment of 24*7 connection with the general physicians. This is expected to increase the business value of the general physicians as well. The choice of EHR is therefore appropriate to consider.

The use of electronic health record is expected to increase the acceptance of the general physicians in Australia by enhancing the process by which they provide medical facilities to the clients (General Practice Facts, 2018). The system is expected to improve the current medical practices in Australia by acknowledging the gaps associated with the current medical practises. In order to understand the business background and the effectiveness of the decision, a SWOT analysis is performed.

The strengths, weakness, opportunities and the threats associated with this project is needed to be evaluated in order to understand whether the proposed methodology will actually provide a solution to the identified problem. The strength, weakness, opportunities and the threats associated with the use of an electronic health record system to store and trade the patients’ data in order to improve the condition of the general practitioners of Australia is discussed in the following sections.  

Strength

The strength of the proposed process and the methodology is that the condition of the general practitioners can be considerably increased in Australia. The electronic data keeping and easy accessibility of the data by the physicians will help them serving a large number of patients and will further ensure that the patients are securely administered. Although the target patients of the general practitioners is the aged people, the use of the electronic health record system can further increase the reach of the patients that consult the general practitioners for their treatment (IBISWorld, 2018). The data and the researchers prove that nowadays patients are more prone to consult specialist in the first place instead of visiting a general practitioner.

Weakness

Although this project aims at increasing the opportunity for the general practitioners by increasing the patient’s reach, the weakness of this project is that the patients are quite reluctant to visit a general practitioner as they prefer to consult a specialist (Fernández-Alemán et al, 2013). Therefore the audience of this project is quite less and therefore it would take time for the project to reach the market size as it is expecting.

Opportunities

One of the significant opportunity that this project might provide to the general practitioners or the doctors who are operating is Australia is a secure platform of maintaining, managing and trading the records of the  patients. The success in the use of the electronic health records system can provide the general practitioners an opportunity to serve more patients in Australia (Andrews, Gajanayake & Sahama, 2014). The use of electronic health record system is not new but adoption of the same by the general practitioners of Australia is expected to increase thus increasing the number of patients who will be consulting the general practitioners over specialist.

Threats

Along with a number of strengths and opportunities that can be obtained with the use of electronic health record system by the general practitioners of Australia, there are a number of threats associated with the use of an electronic health record system. There are certain data security risks associated with the storage of the data in an electronic health record system. Apart from this, the electronic health record systems are needed to be continuously monitored in order to eliminate the chance of any error in processing the patients’ data as it can risk the lives of the patients.

The investment on an electronic health record should be made as the need for this project. A cloud based solution for the electronic health record system is proposed. It is assessed that the initial installation cost of the system would be $39800 and the annual maintenance cost would be $16400.  In order to analyse the financial benefits of the system, the NPV and ROI is analysed. The NPV and the ROI are calculated on basis of the initial instalment cost and the annual cost of the project (Schwalbe, 2015). It is assumed that the cashflow is year 0 to year 3 is $50000, $50000 and $100000 respectively. With these assumptions the estimated NPV for the project is 86,388 and the payback will occur in year 1. A discounted rate of 8% is assumed for the project. The detailed NVP and the ROI as calculated is represented below-

Figure 1: Representing the NVP and the ROI for this project

(Source: created by author using MS Excel)

The payback of the project will occur in year one and therefore it is expected that the project will be beneficial to be implemented. From the figure 1, it is clear that the breakeven in occurring in between year 1 and year2. Therefore, the implementation of the project according to the financial analysis is justified. The picture below represents the payback for the project which is found out to occur in between year 1 and year 2.

Figure 2: Representing the payback for the project

(Source: created by author using MS excel)

Apart from the financial benefits, the non financial benefits of the project are needed to be analysed. The non financial benefit of the project is that the condition of the general practitioners in Australia is expected to increase. The key performance indicator for the success of the project is the increase in adoption of the electronic health record system in Australia.

There are however, certain risks associated with the implementation of the system. Since the system will be implemented in a cloud based solution, there are certain data security risks associated with the system (Bowman, 2013). Apart from the data security risks, there are chances for the project to face certain implementation risks, which include non availability of the investors, increase in the subscription charge of the cloud and the project delays.

This organizational change includes the process by which a change in the organizations strategies, processes and the procedures are made. In order to make this investment of the project a success, it is essential to bring about certain changes in the process in which the general practitioners in Australia operates. There are a number of ways in which the organizational change can be brought about. It is evaluated that the general practitioners need to gain proper technological knowledge about operation of the electronic health record system so that it can be used as a medium of providing medical services to the patients.

The use of heath record system is not new in Australia as the similar other project are being undertaken by the Australian government. Therefore, this project can be easily implemented. The digital opportunity of implementing the system is that the success of the project can increase the adoption of the digital health record systems in future.

For assuring the management that the benefits claimed can be actually realized by ensuring the proper feasibility study of the project is undertaken. The NPV and the ROI is a proof that the project can be actually realized.

The implementation of the project should ensure proper project governance. For this, a project supervisor is to be chosen who will keep a track of the project progress. Implementation of the project in a controlled environment will ensure that the project is implemented within a scheduled time. The implementation of the project in a controlled environment will assure the management that the benefits that are claimed can be actually achieved.

The benefit map of the project is represented below-

Figure 3: Representing the benefit Map

(Source: created by Author using MS Vision)

There are certain risks that are evaluated in the value document and as a risk management approach, a proper risk assessment is to be made at the beginning of the project which will assess the risk on basis of the probability of its occurrence and the severity of the risk. A proper risk management will ensure that the project will be implemented in a scheduled time and the benefits claimed can be obtained.

The target measures will be calculated on basis  of the increase in the number of patients of the general practitioner after making use of the electronic health record system and the data from the electronic health record system to treat the patients. The KPIs are to be evaluated as well as an important source of target measures (Sinha et al., 2012).

The ethical and the social implications of the system is associated with the secure storage and maintenance of the patients’ data. The ethical and the social issues associated with the use of the electronic health record are as follows (Hazin et al., 2013)-

1. One of the significant ethical and the social issues associated with the use of electronic health record system is that the privacy and the confidentiality of the data is to be maintained. The confidential information of the patients cannot be compromised.
2. The system needs to be protected from the data security breaches that are associated with the use of the electronic health record system (Nguyen, Bellucci & Nguyen, 2014).
3. The inaccuracy in the data can risk the life of the patients and therefore, it is one of the major social implications associated with the use of the HER.
4. There are certain issues associated with the implementation of an HER which includes taking the permission of the patients in trading the acquired information (Jensen, Jensen & Brunak, 2012).

The potential risks and threats to patients and the staffs are as follows-

1. Data inaccuracy is one of the major social implication and the inaccuracy in data can risk the life of a patient due to improper treatment, which is a major risk associated with the use of the system.
2. In case of a data breach, the patients’ data can be acquired by an attacker thus risking the confidentiality of the patients’ data.
3. The risk associated with the staffs is that if they fail to properly ensure security in the system, there is high chance of job loss.

These risks can be mitigated by ensuring proper security system, security governance and access control in electronic health record system so that the information can only be accessed by the authorized personnel.

There are certain limitations associated with the use an implementation of the system, which are as follows-

1. The success of the system is subjected to the adoption of the health record system by the masses.
2. The system can be a success only if the health record system is able to offer something new in comparison to the existing health record systems.
3. Understanding the techniques and technical aspects of health record system is necessary for the general physicians.
4. It is very difficult to target the customers who refer to specialist for suggestion on their health condition.

References 

Andrews, L., Gajanayake, R., & Sahama, T. (2014). The Australian general public's perceptions of having a personally controlled electronic health record (PCEHR). International journal of medical informatics, 83(12), 889-900.

Bowman, S. (2013). Impact of electronic health record systems on information integrity: quality and safety implications. Perspectives in Health Information Management, 10(Fall).

DesRoches, C. M., Charles, D., Furukawa, M. F., Joshi, M. S., Kralovec, P., Mostashari, F., ... & Jha, A. K. (2013). Adoption of electronic health records grows rapidly, but fewer than half of US hospitals had at least a basic system in 2012. Health Affairs, 32(8), 1478-1485.

Fernández-Alemán, J. L., Señor, I. C., Lozoya, P. Á. O., & Toval, A. (2013). Security and privacy in electronic health records: A systematic literature review. Journal of biomedical informatics, 46(3), 541-562.

General Practice Facts. (2018). Retrieved from https://ama.com.au/article/general-practice-facts

General Practice Medical Services – Australia Industry Report | IBISWorld. (2018). Retrieved from https://www.ibisworld.com.au/industry-trends/market-research-reports/health-care-social-assistance/general-practice-medical-services.html

Hazin, R., Brothers, K. B., Malin, B. A., Koenig, B. A., Sanderson, S. C., Rothstein, M. A., ... & Kullo, I. J. (2013). Ethical, legal, and social implications of incorporating genomic information into electronic health records. Genetics in Medicine, 15(10), 810.

Jensen, P. B., Jensen, L. J., & Brunak, S. (2012). Mining electronic health records: towards better research applications and clinical care. Nature Reviews Genetics, 13(6), 395.

Jensen, P. B., Jensen, L. J., & Brunak, S. (2012). Mining electronic health records: towards better research applications and clinical care. Nature Reviews Genetics, 13(6), 395.

Lau, F., Price, M., Boyd, J., Partridge, C., Bell, H., & Raworth, R. (2012). Impact of electronic medical record on physician practice in office settings: a systematic review. BMC medical informatics and decision making, 12(1), 10.

Nguyen, L., Bellucci, E., & Nguyen, L. T. (2014). Electronic health records implementation: an evaluation of information system impact and contingency factors. International journal of medical informatics, 83(11), 779-796.

Parsons, A., McCullough, C., Wang, J., & Shih, S. (2012). Validity of electronic health record-derived quality measurement for performance monitoring. Journal of the American Medical Informatics Association, 19(4), 604-609.

Pearce, C., & Bainbridge, M. (2014). A personally controlled electronic health record for Australia. Journal of the American Medical Informatics Association, 21(4), 707-713.

Schwalbe, K. (2015). Information technology project management. Cengage Learning.

Sinha, P. K., Sunder, G., Bendale, P., Mantri, M., & Dande, A. (2012). Electronic health record: standards, coding systems, frameworks, and infrastructures. John Wiley & Sons.

Sittig, D. F., & Singh, H. (2012). Electronic health records and national patient-safety goals.