Mckesson EHR and Its Implementation in Hospital Setting

Advance Information Management and the Application of Technology

In this modern age, the incorporation of information technology (IT) with the health care system is important. With the need of quality care within the industry, there is great significance in many institutions about the execution of electronic health record (EHRs) and information support systems. The use of registries and IT support systems will enable the community hospital to monitor and track patients and improve patient safety and quality of care (Chin and Sakuda, 2012). The advantage of making use of computerized management systems is limited not only to reduced book-keeping and accounts for patients and physicians but is linked to continued access to reasonably priced healthcare, enhanced quality of care, prevention of medical blunders, reduction in health care expenses, improved administrative efficacies, and engagement of patients in their own health care (Chin and Sakuda, 2012).The following proposal will seek to investigate and recommend a new computerized system of management that will bring the community hospital to be in passivity with significant use regulation.

Project Committee

The following project committee will be responsible for the implementation of the new electronic system of management that will bring the hospital in passivity with meaningful use legislation. They are the interdisciplinary team members to be on the project committee, with their title, position and role to be played in the execution of the project. In addition, it also explains the required skill sets in making the project become productive and successful.

1. Electronic System Implementation Manager

The main role of the implementation manager is ensuring that the project is dynamic and in progress. This shows how significant the manager is as the project can, in his absence, come to a standstill. The project manager is accountable for:

i. Monitoring the work strategy to make sure that the project is on agenda

ii. Sustaining a list of retailer and practice problems that ought to be determined iii. Planning execution-associated occasions, for instance hardware distributions

iv. Assigning everyday jobs to the other members of the enactment team.

In addition, the manager will be liable for communicating any information and keeping the members informed (Health IT, 2013).

2. Lead Nurse

The lead nurse is a significant member of the team and plays a vital role together with other nurses. This is because the lead nurse acts as a leader who has an understanding of the clinical work procedures and processes. In addition, the lead nurse plays a critical role in inspiring and invigorating the medical staff to embrace the change in terms of using electronic equipment. In addition, the lead nurse is responsible for initiating consensus and consent among the nursing personnel (Health IT, 2013).

3. Lead on Information Technology

This member of the project team will have the responsibility of positioning and operating the software and hardware of the management system. The lead on information technology will be a link between the technology and the individuals using it and understand the issues and problems faced by them regarding the functioning and operation of the software and hardware (Health IT, 2013).

4. Physician Leader / Titleholder

It is imperative to take note that the implementation of the electronic information system may not commence without appointing a physician leader. The role played by this member of the project team is a point of reference between the system managers and the physicians to clearly indicate the expectations form the electronic information system, which they shall operate. This member will be responsible for ensuring that all the other physicians in the healthcare institution are up-to-date on the development and advancement of the system (Health IT, 2013).

5. Electronic System Builder

The electronic system or information system builder is responsible for creating and modifying any electronic health records system application areas. These include different aspects such as the formation of templates and drop-down boxes. This member of the project will play an important role as he or she will be knowledgeable regarding the functioning of electronic system in all aspects in comparison to any other individual in the implementation. In addition, this project team member will serve the purpose of frequently communicating with the electronic and information system management, and might participate in training any new personnel on how to use the system (Health IT, 2013).

6. Meaningful Use Leader

This particular member will have the sole responsibility for training personnel within the project team and the healthcare institution, regarding the use of the system successfully and thereby attain meaningful use (Health IT, 2013).

Real-life Computerized Management Systems

The following section will analyze two real-life computerized management systems and look at benefits and drawbacks of the systems as well as the manner in which the systems will impact patient care and documentation. These two computerized management systems are PRIMIS (Patient Relevant Interactive Management Information System) and McKesson Hospital Information System.

1. PRIMIS (Patient Relevant Interactive Management Information System)

PRIMIS is an online menu driven software management information system designed and systematized to support different central registry and management functions of hospitals. The system was created by the Hospital Systems Study group and has been deployed in numerous hospitals in Saskatchewan in Canada (Wig, 1982). The main advantage of this system is that it facilitates the central registry for obtaining and accessing the demographic information of in-patients and out-patients. In addition, the system enables the proper patient documentation in terms of their history and medication. However, one of the perceived disadvantages of the management information system is its synchronization issue with other systems such as the pharmacy system (Wig, 1982).

2. McKesson Hospital Information System

In particular, McKesson hospital information system offers the healthcare institution with a database that offers the operation of health records electronically and increase patient safety. In addition, this management information system is beneficial as it incorporates the financial, clinical, physician applications of the hospital. In addition, the system provides solutions to the inadequacies and intricacies perceived in the hospital operational systems. On the other hand, the downside to this management information system is that it is quite costly to implement and execute (McKesson Corporation, 2015).

Proposed System and How Adoption of Meaningful Use will benefit the Organization

The recommended system between the two is McKennen Hospital Information System. This is because the system will improve patient care and documentation. To start with, the information system will facilitate the management and integration of clinical, financial and operational information in different departments of the community hospital. This recommended system will impact patient care and documentation. The community hospital will then be able to record and maintain patient data and information electronically. This implies minimal manual errors and avoiding data loss. In addition, through the electronic system, there is the possibility of backing up the data and information. Consequently, this will increase patient care as the system will get rid of any inefficiency within the clinical practice. In addition, the software vendor has invested plenty of funds in technology R&D for the forthcoming periods on future-centered initiatives to assist and enable healthcare institutions to use healthcare IT in a more strategic manner not only for enhanced business but also for improved care and better connectivity (McKesson Corporation, 2015).

The recommended system will ensure that there is the protection of patient privacy. This is because the electronic system will bring about security checks in which patient information and data will not be able to be accessed without any authority and approved access. In addition, the recommended system meets Health Insurance Portability and Accountability Act (HIPAA) requirements (Nass et al., 2009). Since the system takes into consideration the privacy rule which is integral to HIPAA requirements, the acceptability of this system is higher. The lack of accessibility by personnel without authorization implies that the patient data and information will be safeguarded from unauthorized or unwanted parties (from the point-of-view of patient's privacy and preference) (Nass et al., 2009). In addition, it is imperative to ensure that there are forms, which grant authorization not only from the patient but also from the authorized personnel. This decreases the level of variability and, at the same time, enhances the informed nature of approval (Nass et al., 2009).

Another aspect taken into consideration with the recommended information system includes the security standards. In relation to the HIPAA standards and requirements, the system will ensure that there is satisfactory data storage integrity, backup and recovery. McKesson makes available hospital information technology within the community hospital, as well as certified EHRs, that take into account the fluctuating requirements of healthcare organizations (McKesson, 2015). In particular, with the change in the health care act, the management information system will ensure that security measures are taken with the sensitive patient data and information (Ness et al., 2009). This also includes the right of granting patients their designated information in the hospital information to access their medical and billing records.

How the McKesson system will meet meaningful use in the particular setting

Meaningful Use ordains how healthcare providers and clinics should employ certified EHR (Electronic Health Record) software for fulfilling American government-mandated goals that took effect in the year 2010. This program lies at the heart of the progressive, timed, launch of the first Stage; lately, the Center for Medicare & Medicaid Services has announced completion of the second Stage (which outlines rules). These objectives are aimed at improving:

patient safety

General public health

Authorized health information sharing, and Patients' access of health information (HMS, 2015).

According to CIO of McKesson Specialty Health, Jeffrey Kao, the company's certified Meaningful Use products help healthcare providers deliver to patients the most superior care by way of increased patient involvement, clinical decision assistance and care coordination. Kao states that by including the most recent interoperability standards in their next generation offering of healthcare technology, the company can bring about improvements in information interchange with other EHR systems possessing and requiring details on patient care, including systems at allied hospitals and practices. For supporting users with increased first and second stage requirements, necessitating digital engagement of patients, McKesson (iKnowMed Generation 2 and iKnowMed EHR users) leverages the patient portal, My Care Plus, which, at present, provides to over 75,000 registered patients secure, online accessibility of their medical records. My Care Plus affords patients easy information-sharing with healthcare providers, family members, and caregivers, in addition to lab result viewing, secure message transmission to physicians, and access to condition- and medication- specific educational resources (Mckesson, 2014).

Features of the system and how they will meet the guidelines of the three stages of meaningful use

Meaningful use has three stages;

Stage 1 criteria place emphasis on patient information's electronic recording. Providers have to fulfill fifteen Core objectives and five out of ten Menu goals.

The basis of Stage 2 is the fundamental EHR functionality that was developed in Stage 1 through promotion of objectives devised for fostering increasingly complex and diverse EHR utilization. Several objectives of Stage 2, for instance, revolve around electronic patient-provider information interchange, including ability of establishing secure messaging service for patients and making health records available online.

The provider, in implementing EHR, should present information with regard to clinical measures of quality.

Integration of McKesson's Quippe technology enables ready access to patient management features and clinical decision assistance. End-to-end Medicomp MEDCIN Engine integration is also profitable. The system enables care documentation by the use of handwriting, gestures, and various annotation options (Mckesson, 2015). The above feature covers the first stage and a part of the second stage of meaningful use criteria. Constructed using the most up-to-date standards of interoperability, iKnowMed Generation 2 facilitates information sharing across the continuum of patient care -- between professionals, ambulatory services, clinics, and other systems of healthcare technology. This covers meaningful use Stage 2, enabling interoperability between the McKesson EHR system and other systems. McKesson's solutions developed for independent practitioners ensures that healthcare providers get to concentrate lesser on charting and get to devote more time to doing what's most important for patients. Bright Note Technology's dynamic processing ensures that healthcare providers can utilize their favored style of input for recording patient information onto a single note, synchronized straight away across the whole patient chart (McKesson, 2010).

How the system will improve patient care and documentation

The Paragon hospital information system by McKesson incorporates clinical applications featuring workflows that automatically include documentation as non-intrusive elements of patient visits, instead of after-the-fact recording tasks. As Paragon is wholly-integrated across every application and constructed around one single patient databank, data recorded at any place within the system can instantaneously be accessed all through the system. This instantaneous access facilitates improved treatment-related decision-making by clinicians as well as increases patient safety. Paragon offers a wide-ranging set of multidisciplinary medical software solutions accompanied by anyplace, anytime Web access to comprehensive patient records. Moreover, McKesson's Paragon Clinician Mobile application affords clinicians access to patient-specific medical information, including list of patients, order list, drug list, I&O's, vitals, and outcomes. This feature aids clinicians in carrying out more effective rounding as well as remaining informed with regard to incoming patient information without constantly being bound to a computer. McKesson's EHR system allows;

Doctor Documentation

The integrated product supports charge capture and care communication via the natural workflow of the physician

Drug Administration

Provides a point-of-care program that supports drug/therapy safety while intuitively documenting the process of administration

Care Plans

Computerizes workflow for planning patient care and facilitates reduction of time needed for creating and documenting patient care strategies

Clinical Assessment

Allows collection and evaluation of patient assessments, I&O and vitals by caregivers, in addition to automation of therapy assessments and flow sheets (McKesson, 2015)

How the system will impact the quality and delivery of nursing care and patient outcomes

Disparate technologies and paper-based patient medical records will be replaced by these advanced systems, which will also tackle the challenge of duplicate information entries with communications competences devised for improved care coordination and automating of outmoded manual processes. The installed McKesson EHR system will allow effective personnel scheduling. Clinicians equipped with these novel systems will have 24/7 secure, easy access to comprehensive patient records. Examination room observations in clinical practices will automatically be updated in patient charts. Patients will have access to their respective EHRs, and can re-register, request for prescription refills, track medication and keep in touch with their doctors through a secure web-based connection. These systems are meant for providing safety nets to all patients, doctors, nursing professionals, and pharmacists, with unparalleled access to data and sharing abilities, promoting secure, superior-quality patient care (McKesson, 2010).

Ways the quality improvement data collected from the new EHR system can be gathered and tracked

First, organizations need to configure their systems to ensure collection of data elements in the exact same way with time. This approach guarantees reliable, accurate data for quality improvement, enabling avoidance of needless team efforts on system reconfiguration and manual activities. Thus, a successful, dependable data collection approach includes proven techniques, tools, frameworks, and processes, and usually entails automating, if possible, some sections of the process of data collection. Secondly, a quality improvement team must, at the very least, come up with a well-drafted plan detailing steps to collect individual data elements. Effective quality improvement teams recommend implementation of a comprehensive data collection strategy before actual data collection, or plan development while calculation of baseline is underway. A sound data collection strategy covers the details listed below for individual measures (U.S. Department of Health and Human Services, 2011):

• Measure name

• Denominator aspect with exclusions and inclusions

• Source of data for denominator, including specific queries that should be run, or report factors to be entered

• Numerator aspect with exclusions and inclusions

• Source of data for numerator, including specific queries that should be run, particular sampling parameters, or manual steps

• If different people are assigned to the task, determine who gathers discrete data elements and performs measure calculation

• Incorporate a calendar for reporting measure-performance; for instance, calculation of Breast Cancer Screening standard on every month's second Tuesday is apt if the quality improvement team in Breast Cancer Screening analyzes performance information on every month's second Friday (U.S. Department of Health and Human Services, 2011).

How and where the data will be stored, backed up, and recovered

EHR information is collected on the personal server of physicians. Apart from purchasing software, servers, and other hardware, physician responsibilities include maintenance, data backup and security. While information continues to be under physicians' control, vendors can incorporate disabling codes into software they sell (Neal, 2011). EHR systems have indisputable benefits. However, when taking into consideration the shift from paper-based patient charts to EHRs, how data backup will be done should also be decided for protecting data. An excellent backup option is information storage on the dedicated servers of vendors. Though physicians might have less control in storage terms, the information is saved in known, definite physical locations on servers. For EHR protection, record security maintenance, and compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations, EHR backup is essential on a daily basis. HIPAA backup rules specifically demand a plan for off-site backup/recovery in the event a disaster strikes. Ready backup availability on servers of vendors will ensure easy recovery and secure restoration, if a disaster occurs.

Measures to protect patient privacy

Unauthorized/inappropriate access of users to EHR information gives rise to significant liability risks linked to patient confidentiality infringements. Furthermore, portable gadgets are especially susceptible to theft, loss, and improper access, thus necessitating breach notification. Staff training is crucial for preventing inappropriate access. Additionally, physicians must make sure that adequate security protections exist on software and hardware (portable devices included); one example is auto lock-out feature after a definite interval of inactivity (Neal, 2011). Measures employed by banking and other industries, including patient information encryption, access controls, and auditing can also help ensure that only authorized people can view patient data.

How the HIPAA regulations will be met

HIPPA guidelines will be fulfilled by the following steps;

Lead Practice Culture, Choose Team Members, and Learn

Assign security officer(s).

Review HIPAA security conditions with EHR developer/vendor.

Consider utilizing the services of a competent professional for aiding in security risk evaluation.

Apply tools for previewing security risk evaluation.

Refresh knowledge with regard to HIPAA guidelines.

Foster a health facility culture of safeguarding patient information and privacy.

Document the Process, Actions, and Findings

Recording of risk assessment data and HIPAA-related procedures, policies, activities, and reports is necessary under HIPAA's Security Rule.

Conduct Security Risk Assessment

The process of risk assessment evaluates potential vulnerabilities and threats associated with EHR integrity and confidentiality. This assessment's findings will help physicians in driving their risk mitigation plan.

Develop Action Plan

By applying risk assessment results, organize a discussion and come up with a strategy for risk mitigation. This plan must revolve around high-priority vulnerabilities and threats. It is imperative that the security strategy be doable and affordable. Make the most of HIPAA-provided flexibility.