Chapter on "Movement Toward Electronic Medical Records"

Chapter 10 pages (2826 words) Sources: 12

[EXCERPT] . . . .

Legal Barriers

Electronic Medical Records contain information that is private and confidential. The possibility of these records creating legal issues is high. This is one of the high barriers in the implementation of the EMRs. EMR gives flexibility of sharing information and this can lead to leaking of such information thereby raising privacy or security concerns. Medical practitioners are not sure whether this technology is a secure medium of storage of vital information. They fear that the system can be accessed by unauthorized personnel thereby creating grounds for litigations. Simon, et al. (2007), explain that to physicians, this issue is of utmost importance than the patients theselves, they believe that the system is prone to security and confidentiality issues.

Organizational Barriers

Organizational characteristics of individual practices determine the implementation of EMR.

According to Simon, et al. (2007) Organizational size is a determinant of the adoption of this technique. It seems that medical practitioners in large organizations are more likely to adopt the EMR than those in smaller ones. Larger health organizations are more likely to have extensive support in the application of the system. Conversely, these organizations need time to select and acquire this system and in addition, convert and enter information.

These organizations can however easily solve problems with interconnectivity as opposed to smaller ones because they possess stronger resources including expertise in management, support staff as well as the most important, financial resources. On the other hand Reardon and Davidson (2007), state that most smaller practices are IT enabled and do not have barriers associated with the implementation. On the same line, the affiliation of a practice to a hospital determines the implementation of EMR. It appears that employed medical practitioners are more likely to use EMR than those who own the their establishments (Burt & Sisk, 2005).

Change Process Barriers

EMR can bring change in the process of performing work that has taken a long time to establish. This can make medical practitioners unwilling to make the change. This makes the process a hindrance to the implementation efforts. Some of the issues that arise during the change process include lack of support from the organizational culture. There is need for cultural change in order for the implementation of EMR to occur and this change is slow (Randeree, 2007). There is need for change in aspects of the organization that can forester an electronic information system. The culture has to be friendly in order for there to be meaningful transformation from paper-based to an electronic record system. In addition, lack of incentives is a critical factor in the implementation of EMR. Unless the medical practitioners identify ways in which they will personally benefit from the system, they might not be motivated to adopt it. On the same note, lack of participation is also an important factor in the implementation of the EMR. The implementation of the EMR is most likely to be successful only when the entire organization participates in it. Nonetheless, lack of leadership is a major impediment in the adoption of the EMR system. Team leads or project managers have a critical role to play in either the success or the failure of adopting the EMR system. The leaders need to motivate the member of the organization of the importance and the benefits of the system. Failure to do this will be detrimental to the implementation plan (Miller & Sim, 2004).

Vendors of Electronic Medical Record

According to Hamilton, (2009) the following are the leading top ten healthcare Information Technology vendors in the United States of America. (Appendix 1)

Cost of Electronic Medical Record System

The cost of Electronic Medical Record system is not straight forward. It is not practical to stop by an electronic shop for an EMR system and choosing from a variety including prices. According to Valancy (2002 ), the vendors of EMR do not conform to a set price making it a challenge to compare various vendor proposals. Some prices are low with higer support cost while other are high cost. In most cases the ongoing costs are not included in the pricing (Appendix 2)

How Medical Record System Are Implemented

There need to be a proper implementation plan to avoid implementation gap after the installation of the stystem. Implementation that is not well managed is most likely to fall short of Expectations. First, the organization appoints someone to take charge of the implementation and act as a logistic manager. This person keeps the operations as well as the vendor on track.

Second, the organization through the logistics manager needs to monitor the cost of the project and check if they are within the original estimates. Making changes in the original budget can be detrimental to the implementation process.

Third, it is a good practice to redesign the workflow incase the implementation fall back.

It is advisable to reopen operations with procedures in place such as patients prescription renewal.

Forth, it is advisable to conduct intensive training sessions for all the practitioners planning to use the system. This is intended to foster self-reliance and the logistics manager needs to make followup sessions.

Fifth, the organization through the logistics manager develops a plan to move essential data from the paper records the new electronic system. This involves manually entering paper records into the new system.

Sixth, consultations with all the practitioners on a common documentation format. Here they can adopt a template which simplifies documentation and saves time.

What Happened to Existing Paper Record System

After moving from the paper-based record system to the electronic system, the organization will most likely want to reclaim space and reduce costs associated with managing paper records. The organization need to have an appropriate migration strategy that focuses on the planning and implementation of archiving and records destruction as a policy so that they can take advantage of the opportunity to reduce costs.

Refferences

Burt, C.W., & Sisk, J.E. (2005). Which Physicians and Practices Are Using Electronic Medical Records? . Health Affairs.

Daily Koss. (2009, April 24). Why EMR can actually reduce healthcare. Retrieved September 28, 2012, from http://www.dailykos.com/story/2009/04/24/724033/-Why-EMR-can-actually-reduce-healthcare-costs

DoBias, M. (2003). Illegible? Scribble? The (hand)writing is on the Wall. Inside the Joint Commission Online.

Dray, P. (2002). Deja vu. Health Management Technology.

Fung, B. (2012, August 29). No, Chris Christie, U.S. Health Care Is Not the 'World's Greatest'. The Atlantic.

Gabriel, B.A. (2008, July 15). Technology: Do EMRs Make You a Better Doctor. Retrieved October 2, 2012, from www.physicianspractice.com.

Gill, J.M. (2009). EMRs for Improving Quality of Care: Promise and Pitfalls. Family Medicine.

Hamilton, D. (2009, February 3). The Top Ten Electronic Medical Record Vendors. Retrieved September 28, 2012, from ww.cbsnews.com: http://www.cbsnews.com/8301-505123_162-33640350/the-top-ten-electronic-medical-record-vendors/

Miller, R.H., & Sim, I. (2004). Physicians' Use of Electronic Medical Records: Barriers and Solutions. . Health Affairs .

Randeree, E. (2007). Exploring Physician Adoption of EMRs: A Multi-Case Analysis. Journal of Medical System, 489-496.

Reardon, J.L., & Davidson, E. (2007). An Organisational Learning Perspective on the Assimilation of Electronic Medical Records among Small Physician Practices. European Journal of Information Systems.

Reynolds, G. (2009). Information Technology for Managers. Connecticut: Cengage Learning.

Simon, S.R., Kalshal, R., Cleary, P.D., Jenter, C.A., Volk, L.A., Oray, E.J., et al. (2007). Physicians and Electronic Health Records "A Statewide Survey. Archives of Internal Medicine.

Valancy, J. (2002, April 9). How Much Will That EMR System Really Cost? Retrieved Sptember 28, 2012, from www.aafp.org.

Valdes, I., Kibbe, D.C., Tolleson, G., Kunik, M.E., & Petersen, L.A. (2004). Barriers to Proliferation of Electronic Medical Records. Informatics in Primary Care .

Appendix i

Top Ten Vendors

Company

Location

Installations

Installation %

Meditech

Westwood, MA

1,185

26.6%

McKesson Provider Tech

Alpharetta, GA

14.1%

Cerner

Kansas City, MO

12.6%

Siemens Medical

Malvern, PA

9.5%

Self-developed

8.0%

CPSI

Mobile, AL

7.9%

Epic Systems

Madison, WI

6.0%

Eclipsys

Boca Raton, FL

5.5%

Healthcare Mgmt Systems

Nashville, TN

5.3%

Healthland

Glenwood, MN

3,8%

Figure1 by Hamilton (2009)

Appendix ii

Hardware Pricing

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