Planning a Quality Health Information System

There has been a digital transformation of medical practice, which has been exemplified by Electronic Medical Record (EMR) and Computerized Provider Order Entry (CPOE). EMR is a digital form of the conventional paper-based records for patients (Centers for Medicare & Medicaid Services, 2012). It represents medical records within a facility like a clinic or a doctor’s office (Patient Safety Network, 2016). There exist a number of types of digitized health records containing the same information, such as, the Electronic Health Record (EHR) and the Personal Health Record (PHR). While PHR refers to health documentation that is maintained by the patient that it pertains, EHR is usually an official health record belonging to an individual and that is often shared among a number of agencies and facilities. CPOE, on the other hand, refers to a system that is used by clinicians to electronically place orders that are directly transmitted to the recipients.

About a decade ago, most orders from clinicians were often handwritten. According to Patient Safety Network (2016), the 2009 federal HITECH Act as well as the Meaningful Use program spurred the increasing usage of CPOE in both outpatient and inpatient settings. Although in the case of Cedars-Sinai Medical Center, it managed to suspend the use of millions of dollar investment in a computerized system for placing orders, the successful implementation of CPOE or EMR requires patience, time, teamwork, and money (Silow-Carroll, Edwards, & Rodin, 2012). This paper uses Cedars-Sinai Medical Center as a case study to provide evidence for how CPOE and EMR can optimize patient safety, improve efficiency and quality outcomes, reduce the risk for errors, standardize processes, accommodate regulatory standards expectations and enhance patient satisfaction.

 

 

The Case of Cedars-Sinai Medical Center

Cedars-Sinai Medical Center based in Los Angeles invested $34 million for the installation of a computer system in 2002 (Patient Safety Monitor, 2017). The hospital made use of the system, but it frustrated a number of staff members who discovered many issues and instead, rebelled against the use of the system. The hospital had to be forced to shelve the system after only three months. The nurses and doctors cited issues such as time consumption, inadequate training and that the center had abruptly implemented the system without allowing enough time of trying the system with at least one ward before launching the system in the entire system. According to Patient Safety Monitor (2017), the administrators at the hospital admitted that there were some flaws with the system, but claimed that the many conflicts that were witnessed were based on cultural issues. By 2005, the officials were waiting for improvements in the technology and younger doctors who were at least more familiar with the technology to be recruited before giving the system another try. By that time, the hospital largely relied on the extra number of staff to countercheck its procedures.

According to the former President George W. Bush, while most industries in the United States are using information technology to enhance their businesses and make them more efficient, cost-effective and more productive, the healthcare sector is lagging behind (Patient Safety Monitor, 2017). The failures experienced at Cedars-Sinai showed how it was difficult to make a transition from paper-based system to the electronic methods of storing and retrieving patients’ records. These challenges prompted the national coordinator for health information technology David J. Bailer to conclude that the implementation of the electronic health record was risky and had a chance of 30% failure. Patient safety was compromised with the introduction of CPOE and EMR. However, it was reported that a veteran doctor in Cedars-Sinai Medical Center had a tendency of mixing up dosages for years. Each time the doctor wrote the wrong dose, a nurse corrected it, and the computer barked at the doctor (Connolly, 2005). While the technology was appropriate for correcting human errors, it was claimed to be slow and clunky and only about 2000 doctors at Cedars-Sinai were involved in the development of the system.

Functionality of CPOE and EMR Systems

Quality Outcomes, Patient Safety and Satisfaction and the Reduction in Medical Errors

CPOE and EMR systems are critical to improving the safety of patients. Healthcare centers and hospitals are increasingly implementing the systems following the enactment of the American Recovery and Reinvestment Act, 2009 (Sittig & Singh, 2013). According to Sittig and Singh (2013), the numbers of EMR vendors increased to 1000 from 60 since 2008. While recent evidence has pointed to the unexpected and substantial risk in the use of CPOE and EMR, such concerns are often compounded by the speed of system development and adoption. This implies that the risks presented by the systems should be considered alongside their benefits to patient safety (Sittig & Singh, 2013). Failures in systems, either man-made or natural are inevitable.  With proper planning and implementation, CPOE and EMR have witnessed a wide adoption for the promotion of patient safety, improvement of quality and the modernization of healthcare (Khanna & Yen, 2014). Computer systems used in health care are known for their point-of-care, real-time and patient-centric source of information for doctors.

Studies have reported the relationships of EMR and CPOE in reducing adverse drug events (ADEs) and medical errors. These studies, such as the one that was conducted at Brigham and Women’s Hospital, have concluded that such systems do reduce medical errors. Errors related to transcription were found to be reduced or completely eliminated with the introduction of the systems (Silow-Carroll et al., 2012). At Brigham and Women’s hospital, there were serious life-threatening errors in earlier years before the installation and implementation of a decision support system. Errors such as those for potassium orders were common and were only intercepted by pharmacists or nurses before administering the drugs before the introduction of CPOE and EMRs (Silow-Carroll et al., 2012).

Accommodation of Regulatory standards, Standardization of Processes and Improvement of Efficiency

Studies have shown that CPOE and EMR offer a number of benefits in the efficiency of processing orders and the availability of radiology and laboratory results. In one study, CPOE greatly reduced the time it took to receive results for both radiology and laboratory orders. In addition, the systems have been seen to decrease the time between pharmacies ordering and the time of administering the medication (Charles, Willis, & Coustasse, 2014). At the same time, because of prompt availability of results and quicker processing of orders, the patients’ hospital stay was reduced. A host of other clinical efficiencies can be attributed to the use of CPOE. For instance, the Ohio State University hospital witnessed a great improvement in the count of patients whose levels of potassium normalized within only 24 hours (Charles et al., 2014).

Quality Outcomes

The interest to adopt CPOE and EMR in the improvement of quality care in health centers is increasing. Proper installation and implementation of the systems can significantly improve the process of medication ordering, thus leading to reduced cases of errors (Charles et al., 2014). In a study that was conducted in 3364 hospitals, the researchers concluded that hospitals that enter every order into their CPOE systems tend to be successful in terms of performance compared to their counterparts on patient outcomes. The systems are often designed to streamline the process of ordering through the standardization of the process, elimination of the issues with bad handwriting and making the order to be easily traceable.

Challenges that the University Health System might Experience

As Silow-Carroll, Edwards, & Rodin (2012) opine, research study respondents highlight potent challenges accruing from attempts to switch to EHR systems as well as its optimized application. Through commitment, innovation, trial and error and more so, creativity, health providers have successfully overcome these arising transitional shortcomings. These included: attainment of staff and physician concessions; training challenges; lagging performance improvements; challenges in the utility of EHR in performance reporting; timing and cost; and support for appropriate EHR application (Silow-Carroll, Edwards, & Rodin, 2012). It is critical to adequately comprehend these shortcomings in an effort to improve the Universities experiences in transitioning to CPOE and EMR Systems based systems.

Training Challenges

Healthcare institutions face incredibly significant challenges, mainly logistical in nature, in attempts to offer training to entire staff and community clinicians on the effective utility of EHRs (Silow-Carroll, Edwards, & Rodin, 2012). Overcoming this particular challenge requires expanding capacities of IT personnel to constructively liaise with chosen EHR vendors through work engagements aimed at customizing the system. This will require addition IT oriented clinicians to serve as a bridge linking technology to healthcare provision practices. Healthcare settings involve remotely placed operations necessitating for coordinated training and implementation of the integrated system with central facilities (Silow-Carroll, Edwards, & Rodin, 2012). As such, training needs should be embraced as an ongoing necessity to ensure new recruits are well versed with system operations as well as enable all personnel to adapt appropriately to arising system changes.

Staff and Physician Concessions

Research studies have indicated that the greatest shortcoming in the successful deployment of this system is attributable to the inability to attain desired staff and physician concessions (Silow-Carroll, Edwards, & Rodin, 2012). It’s useful to note that a very small proportion of hospital staff resist transitioning to EHR systems. However, physicians and specialist staff normally present weighty concerns relative to anticipated changes in their operations. Such anxieties are further appraised by prevailing ambiguities associated to the anticipated benefits and the novel clinical rules perceived as additional burdens.

Performance Improvement

Previous studies indicate that healthcare settings highlighted challenges in optimizing the application of EHR systems towards enhancing efficiency and quality healthcare delivery. Shortcomings noted in early phases of implementation indicated that streamlining processes and ensuring sustainable quality parameters while customizing and designing EHR systems to ensure standardization were common (Silow-Carroll, Edwards, & Rodin, 2012). It was critical to ensure clinical staff was not in any way alienated during attempts to maximize performance improvement capacities.

Performance Reporting Using EHR

According to Silow-Carroll, Edwards, & Rodin (2012), healthcare settings pointed out frustrations caused by EHR shortcomings in facilitating reporting more so, the low capacity for generating reports on meaningful use. It was pointed out that arose numerous free test fields as well as occurring mismatches in formats for data storage and reporting requirements calling for users to employ manual translation and data abstraction. In addition, the system may interpret data entry delays as a non compliance in accordance to core measure standards which is ultimately unacceptable.

Time and Cost Challenges

Integrating the EHR system comprehensively proved to be a long processes and thus, inherently expensive to implement (Silow-Carroll, Edwards, & Rodin, 2012). This required institutions to formulate coping strategies aimed at managing, containing and recouping costs; appropriately staffing; coordinated and well timed rollouts and consistently updating systems.

Promoting Proper EHR Application

The institution will have to contend with challenges stemming from attempts to promote proper and optimized system use among EHR users within clinical settings (Silow-Carroll, Edwards, & Rodin, 2012). For instance, clinicians with busy schedules may habitually employ shortcut mechanisms like cut and paste on chart notes, outdated problem itemization or incomplete entries. It is thus imperative that system developers continually work towards system assessments and subsequent developments that conform to clinical staff workflow, automate tasks and minimize administrative work.

Leadership Strategies to Overcome Challenges

Incorporating quality reporting and tracking into HER systems proved to be the only avenue towards enhancing its alignment to external reporting needs. This can only be attained through including personnel well versed in system accreditation and quality improvement throughout the selection and design formulation of the EHR system (Silow-Carroll, Edwards, & Rodin, 2012). This will promote adherence to best practices in ensuring data is consistently accessible and suitable for reporting, improvement and analysis. It is therefore imperative that the institutions manifest a share vision with its leaders towards transforming the reporting system. Leaders are instrumental in setting priorities and boundaries that assist staff in focusing on conforming to EHR standards as well as reporting requirements (Silow-Carroll, Edwards, & Rodin, 2012). The leaders are in a prime position to initiate and sustain effective collaborations amongst compliance/accreditation professionals, quality assurance/control teams and clinical staff.

Key Staff to be Included in the Multidisciplinary Team

Commercial EHR merchant often offer trainers for EHR to equip staff in healthcare institutions with skills and knowledge towards optimized use of the system (Silow-Carroll, Edwards, & Rodin, 2012). For the hospital administrators, it is critical that IT personnel within the institution ensures that such training is extended to administrative and clinical personnel as well as affiliated community based physicians. These are key staff which the institution should actively ensure receive required training and as such, they should be regularly be tested for proficiency in EHR system application.

Conclusion

With the implementation of the CPOE and EMR systems organizations can fully optimize patient safety and satisfaction, reduce risks for errors, improve patient outcomes, accommodate regulatory standards expectations, improve efficiency, and standardize processes. While the Cedars-Sinai Hospital and other cases have presented a negative image toward the implementation of computerized systems in health care settings, much has been done to improve the systems and more doctors are today efficient in working with the computer systems. It requires proper installation and implementation of the CPOE and EMR systems to achieve the desired objectives. The implementation of the systems also requires time and should it should take a while before all doctors get used to the working of the systems. Overall, the systems can help resolve cases of efficiency and patient safety, thus improving patient outcomes.

References

Centers for Medicare & Medicaid Services. (2012).Electronic health records. Centers for Medicare & Medicaid Services. Retrieved 30^th January 2017, from https://www.cms.gov/Medicare/E-Health/EHealthRecords/index.html?redirect=/ehealthrecords

Charles, K., Willis, W. K., & Coustasse, A. (2014). Does Computerized Physician Order Entry Reduce Medical Errors? In Proceedings of the Business and Health Administration Association Annual Conference 2014, Chicago, IL.

Khanna, R., & Yen, T. (2014). Computerized physician order entry: Promise, perils, and experience. Neurohospitalist, 4(1), 26-33

Patient Safety Network (2016). Computerized provider order entry. Retrieved 30^th January 2017, from https://psnet.ahrq.gov/primers/primer/6/computerized-provider-order-entry

Silow-Carroll, S., Edwards, J. N., & Rodin, D. (2012). Using electronic health records to improve quality and efficiency: the experiences of leading hospitals. Issue Brief (The Commonwealth Fund), 17, 1-40.

Sittig, D.F., & Singh, H. (2013). Electronic health records and national patient safety goals. The New England Journal of Medicine, 367(19), 1854-1860.

  Do you need high quality Custom Essay Writing Services?