A Plan for Conversion, Integration, and Implementation of Electronic Health Records (EHR) in a Residential Care Facility
Description of Institute
The objective of this study is to examine the implementation of a new information technology data-management plan at a residential care facility for individuals with mental illness/mental retardation. This facility also provides day treatment and respite care. This will include a two-person practice for a Nurse Practitioner and a Psychiatrist. The institute at focus in this study is a residential care facility for individuals with mental illness and mental retardation.
The mission of the residential care facility is to provide day treatment and respite care in addition to care for mentally ill and mentally retarded individuals in the best possible setting with the most effective treatment available.
The term 'assisted living" is defined by the Assisted Living Facilities Association of America as any group residential program "that is not licensed as a nursing home and that provides personal care and support services to people who need help with daily living activities as a result of physical or cognitive disability." (Institute of Medicine [IOM], 2003) Placing residents in an environment that is more home-like has been demonstrated to "foster a greater degree of self-sufficiency among residents, lower costs, and a higher sense of self-esteem." (Institute of Medicine [IOM], 2003) Assisted living facilities while not offering the full freedom associated with independent living are still not as restrictive as is the nursing home environment. Residential living facilities serve to bridge the gap between independent living and nursing home care. The residential care facility is designed to promote "individualized attention and opportunities to address residents' individual needs and personal desires." (Institute of Medicine [IOM], 2003) The business model is such that addresses the physical, emotional, and spiritual welfare of the residents. The team will make provision of assistance with medications, dressing, grooming, bathing, and dining and all other activities associated with daily living. The program will provide a level of care that ensures the best quality of life through anticipation of and exceeding the needs of residents.
IV. Governance Structure -- Organizational Chart with All Stakeholders
The following figure illustrates the governance structure of the residential care facility.
Figure 1 -- Governance Structure
V. Change Transformation Framework
Implementation of the EHR system will be based upon the 'Change Transformation Framework' shown in the illustration labeled Figure 2.
Figure 2 -- Change Transformation Framework
Assessment of Transformation Planning Transformation Implementation
Target Analysis Plan for Stakeholder engagement Activities to motivate stakeholders and Readiness Analysis Plans for Sponsor Engagement sponsors
Needs assessment of: Plan for Development/Implementation
Planning for Communication Implementation of Communication Adoption of Communication
Learning Development for Transformation
Education and Developmental Planning Implementation of Training Deployment of Development
As shown in the above figure transformation to EHR system use involves several phases including:
(1) Transformation assessment
(2) Transformation planning;
(3) Transformation implementation
(4) Transformation communications; and (5) Transformation learning development.
VI. Project for Implementation
Practice Fusions HER (Electronic Health Record) was developed from the real workflows of physician's practices. The free, web-based EHR system is a fully-feature system that enables the physician and/or the facility to effectively manage the practice. The system can be utilized for appointment-scheduling, completion of a medical chart, sending of prescriptions with the e-prescribing feature and even billing for services. The EHR is reported as being easy to use enabling the physician and/or facility to sign up for the service and to immediately begin charting.
VI. Overall IT Plan and Planning Time Horizons and Organizational Budgeting
The typical implementation of the Practice Fusion EHR is approximately 1 year's time. While the Practice Fusion EHR upfront cost is relatively low, training of employees and the addition of certain employees will represent some expenses to the organization's budget.
VII. Sponsorship Team and Implementation Team
The objective of the plan is to facilitate the desired outcome for the residential care facility including an increase in integration and interoperability amongst multiple facilities, to make provision of multiple methods for information presentation, facilitation of identification and location of patients and to introduce the standardization of accessibility protocols, to provide support for data integrity and confidentiality and to make provision for systems operation and maintenance in the determination of system and data accuracy.
The stakeholders that are responsible for making contribution to the implementation of EHR at the residential care facility will be inclusive of customers, various levels of management, outside experts and business and IT leaders. The customers, or the EHRs end users include health care consumers and clinicians will make provision of the necessary inputs in regards to policies, procedures, requirements, and usability of the system. The management team will have the responsibility for roll-out of the system and to ensure that staff members are sufficiently bought in and able to contribute to the system implementation. The industry consultants and vendors will make provision of the needed outside perspective for the organization and will provide the necessary tools for EHR implementation.
VIII. Strategy for Capturing Current Workflow
The identified strategy for capturing the current workflow includes those stated as follows:
(1) Identification of stakeholders;
(2) Conduct a structured team interview;
(3) Observe the process;
(4) obtain copies of paper forms and tag them to a step;
(5) Get copies of the policies and procedures in place;
(6) Obtain a copy of the management and control reports;
(7) Present findings to the stakeholders.
The following illustration identifies key stakeholders, key EMR capabilities, and the systems that support and interact with EMR.
IT infrastructure, telephony and internet access are reported as "just some of the resources in which companies invest large amounts of money but only use by 10% to 45%. his low utilization rate of resources, coupled with the unperceived duplication of these, significantly increases operating costs (OPEX), which imposes a heavy burden on businesses." (Panotech, 2012) Panotech protect will protect the organization's IT system through its unique infrastructure design and development for the residential care facility that will be "cost-effective, scalable, and manageable." (Panotech, 2012) Panotech provides IT management and maintenance services as well as disaster recovery services.
I. Process for Request for Proposal for System Chosen and Reason for Selection
The process chosen for request for proposal for the chosen system and the reason for selection involves a comparison of the vendors who offer EHR/EMR systems. The facility is currently using an electronic patient care charting system, a physician ordering system, and a pharmacy ordering system. The following objectives are recommended:
(1) Creation of a mission statement for implementation of full EHR
(2) Project management team development and implementation.
(3) Key stakeholder involvement from each user group to inform IT.
(4) Make certain executive management and ongoing support for the project exists;
(5) Selection of vendor;
(6) Written benchmarks to measure success and in testing effectiveness.
Necessary as well is demonstrating to early adopters how success has been realized through the use of EHR. Also important is the integration of a wish list in the discussions on functionality and introduction of new product releases. Partial implementation of EHR has occurred at the residential facility and there is an expectation for resistance in the creation, adoption, and implantation of the full EHR system. It will be of key importance that current employees are surveyed concerning their feelings in regards to implementation of a full EHR system in the residential care facility. The survey has been constructed and includes the following stated questions:
In an effort to prepare the residential care facility for implementation of the electronic health care records and an interoperable system of electronic health records, the team has prepared a readiness assessment to identify questions that need to be answered as strategies are developed for appropriate implementation appropriate. The assessment tool is used for the purpose of gathering data that the implementation will use throughout the implementation process to ensure the successful roll out of the EHR.
What is the most positive aspect of the system in your opinion?
How do you perceive the system will affect your work/responsibilities?
What are your primary concerns about the new system in terms of your use of the system?
Please state two methods that can be used to reduce your concerns about use of the system?
IV. Business Case for Implementation of the New System and Strategy for Choice of Vendor
The strategy used for the choice of vendor for the EHR system involves a comparison of vendors that provide such systems. There was an extensive list of vendors compared with the top chosen being those listed as follows which make provision of electronic health record solutions for the health care industry which have been screed for the their system's capacity for interfacing with other systems and solutions: