EMR Organizational change plan

Introducing electronic medical records (EMR)

Along with expanding health coverage to more Americans, one of the goals of recent federal policy has been the widespread adoption of electronic medical records (EMR) by healthcare providers across the nation. "The federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records" (Abelson, Creswell, & Palmer 2012). Having EMRs can be used by providers to gain swift access to comprehensive information about a patient's health history. Some patients forget their history of diagnoses or the medications they are on; sometimes patients must be treated when they are in a mental or physical state where they cannot be forthcoming with information and their friends and families are not nearby. Also, there is the problem of patients attempting to obtain more pharmaceuticals or drugs which they should not be taking. "Electronic medical record systems lie at the center of any computerized health information system. Without them other modern technologies such as decision support systems cannot be effectively integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty, multi-discipline computerized medical record" is the goal of the future (Electronic Medical Records, 2011, Open Clinical).

Need for proposed change

With complete and accurate EMRs, a physician or nurse can obtain a patient's full health history swiftly, with fewer fears about medication errors. "Having immediate access to key information - such as patients' diagnoses, allergies, lab test results, and medications - would improve caregivers' ability to make sound clinical decisions in a timely manner" (Electronic Medical Records, 2011, Open Clinical). It would also facilitate coordination between disparate members of a patient's treatment team, or when a patient was being treated at a hospital far away, such as when he or she is on vacation -- or when a doctor is away and cannot attend to his or her regular patients.

Working at an organization with a data-driven focus that demands an evidence-based approach to treatment makes it all the more vital to adopt EMRs. "Online, real-time EMR database has proven to be extremely useful in improving patient care through such features as physician-online order entry, barcode scanning of patient wristbands to identify patients prior to treatment and surgery, and real-time patient information. It will prove even more useful as providers, health plans and health policymakers develop mechanisms to identify and use information largely hidden in the database" (Ellis & Loree 2010). Success rates for particular treatments at the organization can be tracked; information about typical patient profiles can ensure better use of organizational resources. There is "a value proposition of implementing business analytics for improving operational efficiency and customer segmentation and target marketing"(Ellis & Loree 2010).

When "EMR data can be analyzed...Relevant questions that can be answered include: How does the timing of events impact the clinical outcome? To what extent does day of week and time of day (shift) impact timing of clinical events? Should we increase staffing on certain shifts or on weekends in certain clinical areas to expedite patient discharges, improve quality and, thereby, reduce cost?" (Ellis & Loree 2010). There is also a substantial social value to using EMRs. Through electronic data, the CDC was able to track the spread of recent potentially deadly outbreaks such as the H1N1 virus (Vaughn 2009). Patients themselves can also more easily track their data from home, reducing the administrative costs of having to solicit such information directly from providers. "Computerized administrative tools, such as scheduling systems, would greatly improve hospitals' and clinics' efficiency and provide more timely service to patients" (Electronic Medical Records, 2011, Open Clinical).

Organizational and individual barriers to proposed change.

Why has there been such resistance to EMRs, then? Implementation of EMRs is often scattered and quality of training can be varied. "Even within a single town, a single group practice, and among...

The reasons may include an individual's basic computer and typing skills, time spent learning the new EMR, quality of training, willingness to adapt, and flexibility and ease of use of specific templates and tools in the EMR" (Smith 2011). This can create a bad impression of EMRs at organizations that have not yet adopted them.
Additionally, there are also fears about security breaches, by patients and also by providers who fear being held liable for such breaches. "Many Americans are nervous about the security of their personal health information in a digital interoperable healthcare system -- and for good reason. It seems like there is a new headline every week about a data breach involving personally identifiable patient information" (Vaughn 2009: 1). Healthcare organizations are concerned about being liable for vital patient information being lost to hackers who do not even physically have to enter a building to obtain the information.

These are the primary reasons that "computerized information systems have not achieved the same degree of penetration in healthcare as that seen in other sectors such as finance, transport and the manufacturing and retail industries" (Electronic Medical Records, 2011, Open Clinical). Other commonly-cited reasons for barriers to organizational change in health care include "departmentally siloed information" and "limited cross-functional interaction" (Ellis & Loree 2010). This is the case at our organization to some degree. For example, there is often little sharing between different departments, even though patients are being treated exclusively at the same hospital. The proximity of one or two floors does not mean that doctors and other providers truly operate as a 'treatment team.' But EMR could facilitate this, ensuring that everyone had the same, core based of information but people can be very protective of their areas of specialty.

Factors that might influence proposed change

Some of the barriers to implementation are common to any type of change, namely the fear of having to learn new standard operating procedures. Physicians may prefer to simply note things on paper and are not consistent about entering data into a computer. When there is a paper and a consumper system simultaneously in use, even if the paper files are supposed to be used as back-up, this can cause conflusion if half the staff uses the old system while the other half uses the new system.

Summarize factors influencing organizational readiness for your proposed chane

Perhaps the greatest obstacle at present to implementing the desired change is that of cost. Training in a new system can be costly, and the record-keeping systems themselves can be expensive to install and use. However, there is substantial administrative pressure to adopt the system of EMR, firstly becase of the desire to make medicine more evidence-based and data-driven, and also because hospitals that adopt EMR can actually bill more for services because of enhanced accuracy about the treatment patients are actually receiving. Organizations that have adopted EMR have stated that their current expenses "reflected more accurate billing for services" particularly for Medicare patients for whom reimbursement from the government has historically tended to be lower (Abelson, Creswell, & Palmer 2012). "Hospitals that received government incentives to adopt electronic records showed a 47% rise in Medicare payments at higher levels from 2006 to 2010, the latest year for which data are available, compared with a 32% rise in hospitals that have not received any government incentives" (Abelson, Creswell, & Palmer 2012).

Theoretical model relating to proposed change

There is, however, a great deal of resistance on an emotional level. Physicians and other providers complain that it is much easier to simply scrawl notes in a file and dislike having to take the time to enter data. "Kurt Lewin theorized a three-stage model of change that is known as the unfreezing-change-refreeze model that requires prior learning to be rejected and replaced" (Change theory by Kurt Lewin, 2012, Current Nursing). The first, critical step is convincing people that change is necessary and is going…