Solving Workflow Chalenges in Health Sector

Synchronizing the Patients' Medical Information between Institutions

With the advancement of information technology into the medical field, the healthcare industry is continuously becoming reliant on the salient contributions that the IT brings into the field and it has shown exemplary reception of the IT. One of the latest contributions of the It in the medical field globally is the electronic health records (EHR) which has been globally received as a solution to various challenges that the medics have been facing including the scheduling challenges, information storage, making orders for the hospital, retrieval of patient information, allocation of rooms for patients, admitting and discharging patients and having a well scheduled rounds and medication for the patients (Menachemi N. & Collum H.R., 2011).

However, the introduction of the electronic health records came with a number of challenges that still need to be solved so that the systems can effectively help the health care facilities. The large volumes of data stored through the EHR can only be very meaningful and useful if the relevant information can be easily shared cross the relevant medical institutions when need arises and in the process not compromising on the integrity or confidentiality of the information. There have been significant challenges among the institutions that use the electronic medical records system in terms of the inability to synchronize or interface the patients' medical information from one institution to another. The institutions hold large volumes of information that are pertinent in treatment of patients whenever they may be in the U.S., particularly those with chronic diseases or conditions that need specialized treatment in which the medication history is very important, yet passing of information from one institution to another has become a big challenge. There is need hence to have an alternative system or system adjustment that would ensure these challenges are overcome and the sharing of information is not just enabled across institutions but also made efficient and timely, upon request. As a project manager, there are steps that shall be forwarded and explained in order to ensure the bureaucratic and structural barriers that exist in the current information sharing platform are overcome and a more efficient system is instituted, taking lessons from the existing system to solve the challenges experienced by the current electronic medical records system (EMRS).

The case study will first analyze the current EMRS and find the weak points that make it impossible to have an effective system. The effect of these faults will be highlighted, other systems used in other developed nations will be discussed and an alternative system suitable for the U.S. situation will be highlighted and discussed in details. The implementation plan will be discussed and the necessary personnel and the accompanying training that they will need in order to effectively implement the new EMRS within the health care facilities and the relevant institutions. The significance of this intervention will go a long way in solving workflow challenges that institutions may be facing occasioned by the introduction of the EMRS hence creating backlog of assignments within the facilities and institutions or inefficiencies and poor service which may lead to lack of safety for the patients. There is need to have a data exchange system that not only functions effectively within the respective states but also has the ability to deliver data of Americans who may choose to move from the North to the south for vacations and may need medical attention while there.

The current EMRS used in institutions

The system that is currently being used in the EHR is still widely seen to be a stumbling block in the process of data exchange between stakeholder groups. From the perspective of the provider, the most important service or provision of the electronic record is the ability to avail the information when it is needed and to the person who needs it. The current electronic system however lacks in this since the health information exchange is faced with several challenges some of which are technical and yet others regional nature of the healthcare system and the laws which leave the country with a fragmented healthcare market.

A typical EMRS consists of the central data storage and access point being the center of focus for the users, and the stakeholders who rely on the data collected and stored at the central data bank being at the periphery. The stakeholders in this case include the hospital administration, hospital medical departments, doctors, patient, laboratory, pharmacy, hospital medical department and the insurers as well.

Source: IBM.com (2010)

The EMR system above which is the predominant system used in the management of patient information was actually meant for patient's billing and insurance data management. However, with time, the rate of exchange of data fro one department to another increased and the systems were consequently developed for clinical use hence the above EMR system that is being used currently in many hospitals. This is a system that is seen to be significantly better than the previous file system and hand written records that used to be piled in the hospitals. The EMR is versatile, easier to access, enhances communication, has data accuracy and can also be considered to be long-term cost reduction measure for the institutions that have adopted it.

The EMR system databank stores specific details on the patient and these include the patient registration which includes the problem list and encounters, it also has the care plans for the patient and related orders for the patient. The EMR system stores the service instances like the procedures and any legal documents that may arise. It also has schedules for attending to the patient and supplies and equipment that the department may make orders for. The data also includes the surgical procedures, outpatient procedures, invasive diagnosis study, the bedside procedures, imaging, physiologic tracings, special studies, practitioner notes, provider discrete observations, identifying information, health history, physical exams. It also had data on physical exams for instance on general status, vital signs, skin, head, ears, throat, nose and the other parts (Carte J.H., 2016). These form part of the vital information that is stored in the central data bank in the EMR.

System challenges

The institute of medicine in 2003 recognized the centrality of the EMR and the role that it can play in the transformation of the health care. This prompted this agency to give out 8 key functions that are targeted at safety, care efficiency and quality that the EMR needs to support. These were the physician access to the information which may include the allergies, lab results, diagnoses, and medication among others. Secondly is the EMR needs to enhance access to previous and new results among the providers in a multiple care situation. Thirdly was that it needed to computerize the provider entry system. EMR also needed to prevent drug interaction through establishing of computerized decision-support system and in the process improve compliance with the best practices in the medical field. Set a secure system around the electronic communication among the providers and the patients. Enhance patient access to the disease management tools, health records and health information resources. Initiate a computerized administration process for instance used I scheduling, and lastly have a standards-based electronic data storage reporting to relevant departments for the sake of patient safety and disease surveillance efforts.

Despite thee above being the ideal intended purposes of the EMRS, they have not been fully realized, with the situation spiraling towards more inefficiency particularly in the face of the gradual changes that are coming into the health care system with the implementation of the affordable care system recently introduced. In order for the providers and the payers to effectively serve the patients in the new health care system, there is need for more interaction among the stakeholders in the health care sector. This can only be facilitated using a more interactive system that can be based on the existing system with significant improvements.

The current system seem to direct all the concerned stakeholders to a central depository where they go to get the information that they need. This information may not be as comprehensive as the doctor or the hospital may need and there would be little recourse to this. They will have to notify the relevant person and wait for the information to be made available on the common database. There is no room for the doctor to directly go for the information from the source or even to pass the information to athird party, but to just input it into the common data base and then the third party to access it from the common pool. This proves to be time consuming and inconveniencing since there could be an emergency that needs faster relaying of information and yet the person to make the information available may not see the urgency as he will be communicating with a database not another human being. This raises a serious challenge of interoperability where interaction is not between two stakeholders directly to expedite the care for the patient, but between an individual and a machine or even worse when the patient has to deliver the information on their own from one doctor to another, killing the intention of interoperability of the system which would significantly increase the efficiency (Pennic F., 2015). The challenge of the current systems gets even worse when these inefficient systems are unable to exchange patient information from one system to another in different states since they are unable to interface. The current EMRS gives room for technical variations in the EHR from different vendors hence hindering a lot of positive developments and profits that could come from the system towards making a more efficient health care system.

Proposed system innovation

Bearing the challenges that the current system faces, there is need to have a new system where the interoperability is taken into account. The new system first needs to have a central cloud system with a proper backup where all the data can be stored at and a proper backup that goes with it. This will ensure that the data from across the nation is accessible from the central server from a reliable vendor. The duty of custody of data will hence be removed from the individual EHR vendors and instead they will be given the requisite authority to link their individual system with the central server.

There will then be linking of the various vendors to each other in a manner that the personnel using one HER vendor will be able to communicate with another personnel on a different vendor. This will establish a common communication platform that will be essential for the stakeholders from different hospitals and related institutions to communicate to each other and get information in real time or as fast as possible to help expedite patient handling.

The new system will also give each responsible stakeholder in the related departments of the concerned institutions the ability to update the information once they have acquired the information from the authorities that are permitted to give the information like the patients or the guardians. For this to effectively work, there will be a cell or online file allocated to each individual patient, this will be traceable through the unique number that it will be allocated. This number will be the one that the concerned personnel, from various vendors will use to update and upload any information concerning the patient and the treatment procedures that they might have undergone. This will centralize information and make more information available and also make the vendors or the EMRS interoperable since all of them will be able to contribute to the information pool about the patient.

The patient will also not be left out as other authorized bodies access his information. The individual patient will be able to access his online file and view all the information with the particular doctors or insurer who updated the information clearly indicated. This will enable the patient follow up on his medication in good time and also know the dosage that he should be taking and the other medical and health measures that he might need to be taking and may have forgotten.

This structure will result in an open medical records system that will help avert the exorbitant costs of transferring information from one vendor to another. The information highway will be fed into each vendor's local server hence the ease and free access of information. The open nature of the system does not necessarily mean unsafe and prone to be mismanaged. The individuals who will be accessing the system will need authorization and the security details will be changed regularly. There will also be strict guidelines that will need to be followed by the individuals as they use the system.

The EMR system will also have a standardized gateway which will essentially be the clearing point for the vendors intending to use the EMR. This means there will be a standard interface which will make it possible for various EMR to interact with the others and give an effective means of users to access data and use it for the medical process. The access of the systems will be tightly controlled with the patient being a significant player in the customization of the online files concerning them. The patients will even have the option of instructing their doctors to flag their accounts or files momentarily to stop any access or updates on their files in the circumstance that they feel their data integrity might have been breached or may be at risk if access is continued (Cirella N., 2007). With the heightened security, the doctor will focus more on the delivery of information and taking care of the patient rather than worrying all the time about implementation of the security policies.

The proposed interface for the EMRS that is highly interactive

The changes will be continuous, however, the initial phase that will see that beginning of the system having data access and sharing possible between vendors is expected to take one year. This will include first 1 month of floating the idea to the stakeholders, 2 months after that of sourcing for IT personnel and system designers, 3 months of the team working to come up with a preliminary structure. 1 month of having the preliminary structure reviewed by the various stakeholders, 1 month of making the necessary adjustments of the developed system. Two months of test run among randomly selected institutions, then the final 2 months will see parallel running of the new program and the old one to see if there are gaps that will require filling (Authenticity Consulting, 2016). This will incur an estimated budget of $200,000 and it is worth noting that there would be running costs after the successful implementation. This amount will be for logistics, hiring expertise and also buying the needed equipment to be used in the process.