Healthcare industry transformation and electronic medical records implementation

¶ … ERM

There have been a great many changes in the healthcare industry in the past two decades, largely due to the globalization of the workforce and changing demographic patterns, and technological advances. It was interesting to think about the vast changes occuring in and to look at the ways in which technology, privacy laws, and stakeholder expectations have changed. The industry changed in terms of a reliance on hospital-based care to more emergency clinics, outpatient and nursing home services, and managed care. More hosptitals merged, and many doctor's have banded together to form larger, more cost-effective, speciality groups. One of the largest and most obvious changes has been in cost of healthcare. In 1990 the avereage cost of care per person was $2,800, rising in 2000 to $4,700, and then in 2010 exceeding $7,500. In 1990, 14.1% of Americans had no insurance and in 2010, and additional 50 million people, or 16.3%. Certainly these issues are concerns, but there have been incredible innovations that have changed the lives of all those involved in the healthcare industry. For example, doctors can turn their I-phones into an EKG monitor and transmit data in real time to a cardiologist, will cost less than $100, and will change the way patients interact with their physicins (Chideya, 2012).

We must also realize that the healthcare system is its own ecosystem, and as such, has different levels of dependence from a number of different departments and stakeholders. When implementing a system of medical records that is so vastly different than the norm, every single aspect of the healthcare ecosystem is involved. Many in the industry heartely support the idea of ERM systems, but are also concerned about change, the workload, accuracy, privacy, and a host of other issues that are changed when a new system is introduced. For an ERM system to be viable, it must be able to travel with the patient every step of the way in their healthcare -- from regular checkups, to eye-exams, dental-exams, tests, insurance, pscyhology, and more. It must be holistic to be valuable, for looking at only a piece of the patient's life or medical history brings us back to the previous paradigm and manner of doing things in an outmoded and rather inefficient manner. Note on Figure Y that there is a circular pattern between the patient, the provider, the community, and any other aspect of their lifestyle. Technology is a tool, and as a tool it has the potential for great good, or great error. As technology evolves, though, so do the aspects of functionality it may provide. In the holistic healthcare ecosystem, EMR should, in theory, be accessible anywhere at anytime to any patient, medical professional, or professional that has an interest in the patient and consent from the patient to view records; or, in the case of an emergency procedure, to save a life. Thus, EMR planning and implementation must be done based on strategic healthcare initiatives, not technological tactics (Knickrehm and Ficery, 2011).

Any implementation of an ideal Electronic Medical Record system would require not just a technology side within the clinic or office, but an important exteral reach to the outside providers, services and other interested parties in terms of Internet and telecommunications components. An example of this would be Tele-health, which esssentially focuses on the manner in which medical information is shared (exchanged) using electronic communication between interested parties and patients, with the overall goal of providing better, more up-to-date, medical care (Wasson, 2012; Telehealth, 2012). 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, 2011).

Tele-medicine is a global phenomenon that has benefits for individuals in all walks of life. It helps expand access to care, education, new research and technology, in particular in populations that tend to be more isolated or communities (or regions) that cannot afford to support full time clinics and have had to rely on travelling medical care. This also applies to homebound patients or patients who are chronic and can more easily (and less expensively) use email or video conferencing with specialists in any location worldwide -- benefits that would not normally be available to most populations. In addition, test results, lab studies, etc. can be available quicker, and can more easily be discussed with the patient on a more interactive basis. For the individual, so much information is now available that is vastly superior than anything they could access even a decade ago (Web.md, the Mayo Clinic, scholarly articles, support groups, etc.). An informed patient can then be more of a participant in their own health care paradigm, ask more pertinent questions, and above all, provide more details to their healthcare provider while taking more responsibility for their own participation in their personal situation (Gray).

A Robust Configuration Management Database is very much needed for this any adequate ERM implementation. The various issues inside the center can be noted by this system and suitable solutions can be formulated. It is necessary to feed all the information about the IM/it department of the center into this system and so it can work efficiently. For example, this system is used to provide complete accurate information about the people, processes and technologies that compromise the it environment. It also helps to map the performance of all the systems in this center. If there is an infrastructure problem in the center, then the center can easily find out the affected databases, servers and users. It is also very useful in implementing certain changes in the center. The use and accuracy of any EMR program may be enhanced in terms of robustness and reliability with a CMBD (Catalog and Confirmation Management) process. This technique controls hardware and software assets far better, helps diagnose issues, improves the efficiency of such issues as network management, sharing of disparate information from alternative sources, most especially in the legal and regulatory sectors. It is especially effective in helping to reduce redundancy and duplication of effort (Aeritae, 2010; Messineo, 2009).

Immediate Access to Patient Information

A clear benefit to EMR systems is their portability: healthcare personnel can easily carry a laptop or tablet to the examination room, pull up details of tests, vital signs, drugs, histories, x-rays, and more. Special software can provide potential interactions, as well as a more thorough history of what was prescribed when, and at what dose, something not all patients remember clearly. This system also alerts the physicians and the nurses if there is a difference in the details, or if healthcare has been given in different locations. . This technology helps the nurses to detect the faults made by the doctor in the treatment of the patient (Tutela, 2009).

Electronic medical records allow for easier retrieval of patient information and are typically integrated into billing systems and scheduling, thus providing clients an incentive for coming back to the particular office or clinic. A health care professional within the hospital can also access continuing education and attend seminars online, and contact specialists for disease information outside his area of expertise. They also have more control over the continued management of health intervention and knowledge of patient progress. In an interview with educators who served as telemedicine case managers for adults with diabetes, "the nurses and dietitians calling these patients reported satisfaction with both the feasibility and effectiveness of telemedicine" (Gray; Gomez, et.al., 1996). Advantages specifically named were "more frequent contact with patients, greater relaxation and information due to the ability to interact with the patients in their own homes, increased ability to reach the underserved, more timely and accurate medical monitoring, and improved management of data"(Sandberg, et.al. 2009).

More and more, increased access to information and the ease of using technology has increased collaboration between doctor and patient. This has, however, encouraged a more patient-driven medical system. Patients are less content to let the doctor prescribe or order tests without knowing more about their own condition, the medications they must take, and even costs of procedures. Nursing theory is also pushing that the patient take more responsibility for their health and healthcare, rather than being passive participants and allowing others to make decisions that will impact their lives. This change has given rise to the term "e-patient," describing someone who actively seeks out health information and communication online. Advantages include emotional support and information sharing, access to physician question and answer forums, online records to capture progress and goals and access to clinical trial databases. A sense of empowerment is the common thread running through these patient portals that connect patients to providers and to each other (Gray).

Of course, immediate and robust access to patient information brings up issues of privacy and confidentiality as well. HIPAA, or the Health Information Privacy Act, is designed to protect the individual and sets national standards of compliance on who may view patient information, and at what level of detail. 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).

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 on an almost real-time basis, saving the patient the need to travel into the office, particularly when not feeling well. Remote diagnosis, while not ideal, is certainly better than not being able to diagnosis the patient due to extreme weather, natural disasters, geography, and more (Telemedicine Benefits, 2011).

Conclusions

In conclusion, there are many unapplied technological (computer, telecommunication, etc.) techniques that are now available to the medical professional. . It is the duty of the health centers to implement various techniques for the better treatment of the patients. IM/it developments have created more benefits for the patients as well as the physicians and nurses in the healthcare centers and the trend toward efficiency and expectations from stakeholders continues. These trends have also resulted in changes that could revolutionize healthcare -- Electronic Medical Records (EMR). Computers have evolved with enough memory, and now the Internet is fast enough, to allow computerized medical records created in one organization to be shared with others. This is very advantages to the patient, who may have had procedures in Texas but injured in Colorado, and unable to speak to let doctors know of allergies or other conditions. Costs drastically decrease, and the potential of transcription errors over time are diminished. While EMR adoption rates have largely been focused in the major urban areas and the very larger providers, as long as HIPAA rules are followed, the technology is certainly with the grasp of almost every physicans's office. Additionally, real-time event monitoring for critical care patients (e.g. heart, etc.) gives the physican added tools and the ability to more quickly assess a situation and refer to emergency care or a specialist (Garets and Davis, 2005).

Recent studies have shown that there a number of key findings regarding the use and implementation of ERMs within the modern healthcare system:

42% of physicians now use an ERM solution to document patient care and 33% use ERM during every patient encounter.

62% of physicans and 81% of patients have a positive perception of documenting patient care electronically

More than 60% of physicans believe the best benefit to using EHR is the real-time access to patient information; or at least quicker access to lab or test results.

Both physicians (62%) and patients (78%) believe HER will improve the quality of healthcare, although both groups do have concerns about the security and privacy of data.

When appropriate, both groups believe EMRs allow for the secure and seamless sharing of information with other healthcare providers, pharmacies, and payers (Study: Patients).

Implementing even the simplest EMR system is tremendously complex, requiring a number of people, processes, dialog, and pre- and post-implementation plans (See Fig. X).

Technology has so vastly changed the entire way healthcare is provided, how doctors work together, and how the political and cultural aspects of healthcare are impacted because of managed care, that it seems the industry has completely evolved from the vast cottage industry of providers to coordinated delivery systems that are focused on being secure, error-free, and managing populations in a diverse and broad environment. Computerization of the medical industry is an on-going reality that continues to grow in speed and complexity. There is certainly increased fiscal restraint in the industry and a greater demand by all stakeholders to see value in the system, which especially includes any new implementation in EMR.