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This 1996 Act was part of a Civil Rights concern that as information became more electronically disseminated, it would lead to misuse of that information (U.S. Department of Health and Human Services, 2010). Certainly, one of the benefits of electronic information is that on one hand it is available to a larger number of people, but it is also verifiable on who views that information at what time. This protection, though, is part of the ethics of individual rights. It has, however, affected scholarly research and the ability to perform retrospective, chart-based research and evaluations. One study, in fact, said that HIPAA managed rules led to a 73% decrease in patient accrual, triple the time recruiting patients, and tripling (at least) of mean recruiting costs (Wold and Bennett, 2005). However, despite the few incidents in which the regulation of this information is detrimental, most civil rights advocates praise the legislation -- believing that each individual should control access to not only their bodies, but information about their bodies and conditions as well.
Too much security and a lockdown of information, and the benefits of immediate access to information and patient benefit will be lost. Too little security and there is an increased potential of fraud. Patients however, have far more trust that healthcare providers will keep their information save, secure, and private for particular use than they do with banks, governmental institutions, employers, or even credit card companies (Shinkman, 2012).
One of the selling points for ERM is that data tends to be more accurate because it is entered only once. This, of course, forces the person doing the initial entry to be even more aware of the issues surrounding the data, but also has some issues relating to privacy concerns. Accuracy of the information is completely dependent upon two major paradigms: the initial set up of the system and the quality and expertise (training) of input personnel. Adopting a four-part program will solve the initial concerns about accuracy, and focusing on appropriate training (see below) will alleviate some of the worry on the second issue. However, a continuous and rigorous training program will be necessary when there are new hires; people have been out of the office for vacations, etc., when there are system upgrades, and the like. Part 1 ensures initial data accuracy for the system; Part 2, the training, Part 3, network implementation and testing of accuracy of information; and Part 4, Ensuring appropriate equipment so that there are no hardware or software issues that cause inaccuracies, down-time, calculation mistakes, etc.
Part 1 - Conversion of existing patient records -- Preloading is one of the most essential steps to convert medical records (patient histories) into the new system. This creates a standard record with minimal information, but that can be added to once the structure is complete. We will begin by entering the patient's name and vital demographic information (point of contact, insurance information, etc.). Then move to past medical history, problem list, medication history, and allergy history. It is important to use ICD-9 codes as much as possible, and for this reason, it might be advisable to hire temporary help to load data; individuals with nursing experience and/or insurance data entry so they are familiar with the correct codes and terminology. Each chart on the active list (can be 12-24 months) should be completely preloaded prior to using for charting (live use). It is important to hire the right people for this crucial step -- anyone not comfortable with technology will have a difficult time.
Part 2 - Once the preloading is done, it will be time to customize the HER based on the provider of the hardware/software. This should be done with an implementation team consisting of the Medical Office Manager, 1-2 nurses, and the data entry staff, a physician if at all possible, or the MOM trains the physician later. The provider source customization training should take 1-2 days, and would be most effective if the office was shut down for a day -- preloading finished and QC'd (Quality Control) by Thursday, training on Friday and Saturday, live on Monday. If not possible, then training in a conference room on Friday with minimal interruptions. If the training is offsite, then as many of the implementation team as possible should attend. It may take a full day to customize some of the options per office, and any technical support should be there to ensure that modems, printers, etc. are all working. This might need to be done on a Sunday, if the office wishes to go live Monday. Finally, if at all possible, the first few days of going live should be done with reduced schedules so that the patient load will allow for a learning curve.
Part 3 - Network Implementation -- at each step, we must ensure we are protecting patient privacy and meeting HIPAA and ARRA mandates as well as all insurance and local/state regulations. Implementing a new network can be problematical, depending on whether it is wireless. Network implementation planning should be in partnership with the selected vendor or their representatives and will consist of a 10 stage entry process to include: 1) Identification of needs/goals/equipment; 2) Produce timetable and milestones/responsibilities; 3) Diagram equipment and workstation flow (topology diagrams); 4)Order equipment, test equipment; 5) Cabling plan and implementation; 6) Confirm power sources, wiring and surge protection; 7) Install and load basic firmware; 8) Test firmware and all ancillary devices and basic applications; 9)Customize Network for office; 10)Load and test software, begin moving into transition plan and pre-loading applications.
Part 4 - Equipment for transition -- the software we use will be a complex database program specifically designed for a small medical office. We will ensure that it includes branching logic that supports alerts and reminders, and allows for subscriptions to drug formulary services and regulatory bodies. In today's marketplace, it is not necessary to spend thousands of dollars per machine for staff. Instead, lightweight notebooks with wireless capabilities can be used in exam rooms, desks, offices, or off site if necessary. We are committed to using our HER system (hardware, software, human resources, and processes) to: collect and use data from multiple sources; use by doctors, nurses and office staff as primary point of information for patient care; and to provide important an robust decision making support for a model of evidence-based health care. Basic equipment should include: 1) at least 1 server and workstation; 2) wireless routers and boosters, depending on location; 3) monitor/keyboard workstations; 4) Laptops, 5) scanners; 6) Digital Scanners; 7) Tablet computers; 8) Desktop computers and monitors; 9) backup server or offsite data protection or both; 10) Backup power sources and surge protectors (Ten Steps, 2012; Walker, et.al., eds., 2005).
Finally, a check and accuracy plan should be in place to ensure data integrity. This is often done by having two people check every Xth record, or randomly pulling insurance files for review. Besides the issue of privacy, because so many healthcare providers are using ERM systems, the public is becoming even more aware of their use. "The CDC's National Center for Health Statistics estimates that more than half of office-based physicians have adopted a basic HER, while more than 10% have adopted a fully functional system." Research done in this area shows that the majority of patients and physicians have a positive perception of electronic documentation. Most also agree that ERM systems will help improve patient care, more efficiency in the work environment, and therefore an eventual cost benefit for all stakeholders. In addition, because of the amount of real-time data, access to as much historical data as possible, physicians believe the ERM implementation will improve diagnoses. (Study: Patients Believe, 2011).
Cultivation of Customers
The clinical side of Tele-health is called telemedicine, defined by the American Telemedicine Organization as "the use of medical information exchanged from one site to another via electronic communications to improve patients' health status." Specific examples of telemedicine include video consultations, remote patient data monitoring, nursing call centers and searching for or saving personal health information online (Gray; Carter, 2001). In addition, E-power technology allows the patients to act in charge for his healthcare management on a daily basis. This provides better satisfaction for the patients, as they know their body conditions. They can make their own decisions with discussing their physicians. The E-power technology also helps the patients to boost their fitness. There are certain products for helping the patients in tracking their own health conditions. If there are any symptoms for the defects they will alert the patient about the exact conditions. There are also certain devices that can track and record the heartbeats and other biometrics of the patients (Turisco, 2009). Situations like chronic blood pressure issues, effects of new medications, or even vital signs are more accessible to physicians…[continue]
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