Implementation of an Electronic Health
Record SystemBy: Na’Shea Merritt
Future Compliance Requirements
The principle objective of this presentation is to discuss the necessary requirements for the Top Notch
Clinic transitioning from a paper-based health care system to an electronic health record (EHR). The
alarming cost of health care alone with frequent medical errors have greatly encouraged the government to
focus on ways to alleviate these problems. The Health Information Technology for Economic and Clinical
Health (HITECH) Act, a part of the American Recovery and Reinvestment Act (ARRA), was the nation’s
first federal commitment supporting the adoption of EHRs. When functioning properly the EHR system
proves more beneficial than paper records by offering increased practice efficiency, patient participation,
and cost savings. The quality of care and accuracy of diagnosis also improve with EHR offering better
health outcomes (HealtIt.gov, 2014).
Obstacles During Implementation
The obstacles will be in learning a new system and how it works. The greatest obstacle in transitioning from paper
to EHR is in the cost. The system costs takes into account the design, development, interfaces to other systems, and
periodic upgrades. The initial purchase of software along with annual maintenance fees are consistent with license fees of
commercially available systems. Induced costs are inclusive to the transition from paper to electronic taking into account
the brief decline in physician productivity due to transitioning. It is with assumption that the initial productivity loss will
be twenty percent the first month using average annual provider revenue with an ensuing return to baseline productivity
levels after the third month (Wang et al, 2003).
Plan of TransitionTransition from paper charts to an EHR is a
complex journey. The adoption of EHR system takes
years to fully evolve (AHIMA, 2010).
Building an effective EHR implementation
team or committee is essential to the transitional
process because everyone plays a role in selection,
implementation, and continuous monitoring. Staff
training will prove beneficial but will take time in
adjusting to a such an advance system.
To aid in a smooth transitioning process
collaborative efforts and decision-making from the
Top-Notch Clinic stakeholders must be ensured.
Stakeholders Position
The key stakeholder is the primary physician which makes all the final decisions for the clinic. It is based upon his
past experience and expertise that he carry out each decision. He takes what has worked great in previous health care
settings and use that to his advantage. Basing his decision on what will profit this facility most.
The employees input is always welcome because the stakeholder realize that each individual can offer valuable
information from their aspect of the clinic. Each employee provide skills, knowledge, commitment, and a different
perspective in the process of implementation. Everyone plays a role in selection, implementation, and continuous
monitoring.
Top EHR Systems
Aspects of IT System
eClinicalWorks V10 is ICD-10 compliant and enables integrated voice to text options with five hundred plus enhancements. This version is faster and more intuitive in completing clinical documentation. Immediately upon using eClinicalWorks V10 the Progress Note options will draw attention with its voice to dictate clinical findings, help with eClinicalWorks Scribe tab, and the structured text. Also, the Orders tab is easily navigated for placing order for the patient. This allows for effortlessly ordering before the patient leaves the office. Medications, labs, procedures, and immunizations can be quickly searched (eClinicalWorks, 2014).
eClinicalTouch eClinicalMobile eClinicalWorks RCM Healow & Healow
Messenger
Estimated Cost of Implementation
Upon examining the costs of the EHR it is important to categorize the costs into two groups including:
system costs and induced costs. The system costs are inclusive of software/hardware, training, implementation,
ongoing maintenance, and support. It is with assumption that the hardware will be replaced every three years. The
system costs takes into account the design, development, interfaces to other systems, and periodic upgrades.
The costs estimated range is $2500 and $3500 per provider for initial purchase of software along with
annual maintenance fees (Wang et al, 2003). These fees are consistent with license fees of commercially available
systems. Induced costs are inclusive to the transition from paper to electronic taking into account the brief decline
in physician productivity due to transitioning. It is with assumption that the initial productivity loss will be twenty
percent the first month using average annual provider revenue with an ensuing return to baseline productivity
levels after the third month (Wang et al, 2003).
Funding
According to Health Information and Management Systems Society (2010), there are three prominent funding options.
1. Installing the EHR application along with the database server in the clinic. Top-Notch Clinic will have to
purchase the software license, hardware, professional services, implementation consultants, network infrastructure, and
device deployment. The database physically resides within the clinic with an internal data center.
2. Deploying the application service provider (ASP) version of the EHR. This consists of the same help with
project management through the same purchases needed in the first option. However, the clinic will not be obligated to
purchase hardware nor software from vendor (HIMSS, 2010). The Top-Notch Clinic can have all features of EHR
without being held responsible for internal data center, it is remotely managed by vendor for a monthly fee. This process
is known as Software as a Service (SaaS).
3. Partnering with a hospital or either an Independent Physician (IPA). This option allows for a hospital to pay
eighty-five percent of EHR costs for an independent provider. The IPAs normally support price discounts on either
purchase or SaaS model for memberships (HIMSS, 2010).
Funding Cont’d
The transition from paper to eClinicalWorks V10 can
be funded with an HITECT Act grant. In 2009, an estimated
twenty-seven billion in incentives were authorized through a
federal stimulus for critical access hospitals (CAHs),
hospitals, and providers to transition to EHRs (Gottlieb &
Millsaps, 2011). Some of HITECH funding is specifically for
supporting infrastructure such as: state Health Information
Exchanges (HIEs).
HIEs were established to enable data sharing and
provide discounted opportunities. Sixty-two Regional
Extension Centers (RECs) have been formed around the
world to serve physician practices (HIMSS, 2010).
These centers assist in selection, implementation, and
meaningful use. The Top-Notch Clinic qualifies for this
funding as it mainly targets small primary care facilities.
Ongoing Barriers
When contracting for a cloud-based EMR such as eClinicalWorks V10 system privacy and security is addressed by
Health Insurance Portability and Accountability Act (HIPAA) and Patient Protection and Affordable Care Act (PPACA) rules
and regulations. Contract terms comply with the HIPAA business associate requirements (McWay, 2014). Data centers with
high level encryption methods and security rendering unreadable data to aid in achieving HIPAA compliance (CareCloud,
2014). According to American Academy of Orthopaedic Surgeons (AAOS), quality reporting was made priority in 2007 and
since then PPACA has expanded the Physician Quality Reporting Incentive (PQRI). This introduced a penalty structure for
any failure to report replacing the current positive reward structure in 2015 (Mather, Hettrich, & Nunley, 2011). A breach of
confidentiality should only be done with an ethical or legal exception such as a person being at high risk for serious harm or
legal obligation to report infectious disease. (DeBord, Burke, Dudzinski, 2013). Otherwise the breach in confidentiality may
result in costly fines.
Conclusion
A transition from a paper-based system to eClinicalWorks V10 is deemed necessary for the Top-Notch Clinic. The benefits of eClinicalWorks V10 (eClinicalMobile, eClinicalTouch, eClinicalWorks RCM, Healow, and Healow Messenger) all are effective ways to aid in performance measurements. The qualities offered through this system excels far beyond what most EHR systems use and can give the clinic a promising future with an advantage over other organizations. This will prove to be a costly endeavor initially but definitely worthwhile.
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