Free Electronic Medical System Dissertation Example

Abstract

This study analyzes the benefits and challenges of implementing an electronic medical system in both hospital and clinic environments. The overall research problem addressed in this study is determining how to effectively manage and communicate expectations associated with perceived benefits and challenges derived from a new install of an electronic medical record. The purpose of this study is to analyze perceptions associated with both the benefits and challenges derived from installing an electronic medical record system. This problem is relevant to many such as those who are directly engaged in the healthcare industry. An electronic medical system directly impacts how care professionals document care provided for patients. Those who are members of the patient population within a community are also directly impacted due to the integration of electronic medical records across care settings and increased requirements for patients to take a more active role in their personal health management. If the problem of effectively managing and communicating expectations associated with perceived benefits and challenges of a new electronic medical record install are not addressed there is potential for decreased levels of early adoption, slower rates of patient engagement and slower rate of return for both patient and industry participants. The theoretical framework applied personally by Vernita B. Thornton, researcher, included literary review and analysis of survey information. The survey directly measures questions related to perceptions from both industry and non-industry professionals. The Chi Square method was used to determine the distribution of data within a category type. The survey results display the majority of participants perceive and maintain an expectation of outcomes indicative of receiving benefits from the implementation of an electronic medical record system.

Dedication

This study is made possible by the support of many individuals who have helped me develop in my chosen profession of Data Reporting. Among my supporters, my family, Steven L. Thornton and Steven L. Thornton, II are most deserving. They have, over the course of my career and this project, provided me with immeasurable support, both by allowing me time to work on the task at hand and by making tremendous financial sacrifices required to support the expense associated with my goal of completing my doctoral studies.

Acknowledgements

This research is the result of my overall interest in healthcare and direct exposure to the implementation process of electronic medical record system. The road traveled to get to my doctoral studies developed from a deep-rooted interest in medicine and a desire to help others help themselves. My grandmother, Erline Baker, always stresses the importance of taking care of ourselves by taking advantage of homegrown and preventative measures. My grandmother has recipes for the best soups and herbs, which work like medicine, so I have always had an interest in the process of helping to heal. Other people whom I would like to acknowledge are my mother, Bernice Baker and my mother in law, Brenda Hayes, who are always encouraging me and are happy to watch my beloved Steven II, when I need a few hours of alone time to gather my thoughts to work on my studies.

I would also like to acknowledge my aunt, Ula Mae Golden, who sadly passed away in the early 1990s due to a long and painful battle with colon cancer. During her battles with cancer, I would always be nearby with a desire to help alleviate her pain. I take great pride in knowing, although no longer with us, she is aware of all of the advancements in cancer care and research supported by data. Ula and I were always very close and I am sure that she would be very proud to know that I am working towards helping others have a better chance for a more successful medical outcome.

Growing up in a very frugal family, it was often easy to forget that we were not exactly financially middle-class. I had to make very practical financial decisions and these lessons have served me well in life. Growing up, I maintained a very strong interest in attending medical school, even though I knew that it was not the most practical financial option for my family and me. As my talent for numbers, data, and communications were well recognized, I took advantage of the educational opportunities provided to me by the University of Memphis and graduated with a focus in Finance. I immediately started on my career path at one of our most respected local banks in the corporate headquarters.

I resounded myself to being a banker, and I was recognized as a highly skilled professional in my community. As I write this acknowledgement, I must thank all of those who mentored me in this phase of my career, especially Bank Trainer, Lisa who was responsible for teaching me to be humble when delivering data. Data may not always convey good news but it should be respectfully communicated and relevant. This lesson is very relevant today, as I work in the healthcare industry, as we are often tasked with developing data to address major challenges in our community, such as studies to identify and improve outcomes for those with chronic diseases. Our reporting tools may be evolving and generate results in a more polished format, but the focus must be on the mission that is developing tools to improve patient care and patient safety.

As I continued to grow in my banking role, I was transferred to a suburban banking market, where I would have daily interactions with physicians, clinics, and hospital entities. Each day, I worked to provide the best data analysis for these clients, as in my mind, they were heroes, who were saving lives. One day, while working to assist one of our Metro Vice Presidents with a hospital transaction, I realized that I could bring my skills and talents to the healthcare industry. I was confident that I could be a part of helping people get better every day, not by performing surgery, but by providing supporting data that makes the surgical equipment a reality in a care setting. Soon after, I landed at one of the largest multi-specialty clinics in our community, where I was assigned to the Family Medicine division. This was a wonderful experience, as I was taught by Patti how to run practice. As I was still very young at the time, she exposed me to every aspect of running practice, including credentialing physicians, payer negotiations, budgeting, and even the tough decisions related to staffing a practice. I was prepared for my eventual placement with my current employer.

I am so blessed to work for, in my opinion, one of the best healthcare organizations in the country. Over the years, I have learned more than I can ever express and must acknowledge all of my Directors who were true mentors. Initially, I worked in research, providing data to support initiatives. I must acknowledge Tom and Barbra, who allowed me to grow and develop my skills. They both allowed me to have autonomy, whereby I could use my resources to get the work done, while producing accurate and timely results for our end users. They both taught me to be patient with the data, reminding me that we often need to look at information from different perspectives to drive true value from the information presented.

Currently, I am working with a team whose goal is to implement an Electronic Medical Record system. I must acknowledge, Beverly, our Vice President of Clinical and Revenue Transformation. The only word I can say to provide acknowledgement is simply WOW! Each day, I am so thankful for this experience and involvement in the deployment of a system that will revolutionize our ability to provide the best care for our patients. It is a privilege and honor to work in this capacity with a fearless leader. Each day, I am learning to think deeper and desire to work efficiently and smarter to better understand the needs of our patients and system end users.

Finally, I would like to acknowledge and express my appreciation for my Committee Chair and Professor, Dr. Antonio Santonastasi for his continued patience. Dr. Santonastasi’s patience and guidance is tremendously appreciated, as I work to complete my doctoral studies, work a full time position with tremendous responsibility to patients and stakeholders, while at same time balancing my commitments as a wife and mother.

A medical record is an account of medical history for an individual. Since the early days of medicine, providers have maintained paper notes, which summarize health related activities. However, medical records have tremendously evolved over time. The chronological medical record has evolved from sparse and illegible notes to more complex elements that are required to be documented in order to support medical necessity of procedure, adherence to appropriate medical protocol for treatment of a condition and documentation for appropriate reimbursement. Medical records eventually evolved to a more complex filling system with information for each patient maintained in folders. The folder system was often organized by name, and eventually medical record numbers were added as more people gained access to care requiring additional levels of identification and verification.

In a perfect world, medical records would encompass a timeline of activity from birth to death. However, in our very mobile society it is often very difficult for anyone to maintain a complete medical history which is all encompassing and complete. As a result, the interest in portable medical records spawned. As a result, it became necessary to make advancements in the area of medical record documentation. Since the introduction of Medicare and Medicaid, more people have access to care and, as a result, the government continues to expend incredible amounts of resources to pay for this care. Therefore, it has become necessary over time to utilize information from medical records to confirm what care provided and the necessity of the care provided. Additionally important is the ability to confirm patients are receiving quality care, which is also safe care.

The complex building blocks necessary to report against federally defined or program methods will highly depend on organizations success in implementing an electronic health record system. The reporting of discrete data will be critical, as we go further into an era of pay for performance and reimbursement based primarily upon quality outcomes. Quality measures, Core Measures, and Meaningful Use reporting will all be at the forefront of reporting requirements that will drive patient care outcomes and safety. Failure to comply with reporting requirements directly effects patient care, as many individuals who need medical services would no longer is eligible to utilize their provider of choice due to provider non-compliance with reporting metrics.

Successfully reporting the required elements can only be accomplished with the utilization of an electronic health record system. Electronic health records make it easier for providers and facilities to demonstrate improvement and gain high marks for continued improvement through data and reporting. Organizations that are unable to report on their performance, and are thus unable to reflect improvements, will eventually be removed from programs, such as Medicare. Consequently, the reimbursement from all other financiers will be greatly reduced, if organizations do not take full advantage of integrated data.

The level of reporting required is now extremely extensive and can only be maintained by fully implementing electronic medical records. If an entity is unable to participate in pay or programs, such as Medicare, it will have far-reaching, potentially detrimental, consequences for patients. Patients could lose the familiar continuum of care, as well as trusted relationships with their providers, if those providers fail to transform and adjust to an industry that strives to adopt continued technological advances, so that a paper chart will eventually become obsolete. In addition, failure to sustain reporting will subject organizations to considerable fines and penalties, which will lead to staff reductions, as a means to cover the losses generated from an inability to generate accurate and timely reports.

When an organization decides to implement an electronic medical record system, it faces the need to address perceptions associated with both the benefits and challenges of installing a system. The primary benefit is the additional information that can benefit the patients and aid in better managing their care. However, the challenges are clearly the cost of the applications, adoption of the technology and data security concerns. The newly enacted rules and federal regulations related to reporting bring the need for accurate, complete, and computerized medical data to crossroads within our society. At this point, federal regulations require organizations to implement both data transformation and integration processes, which are reflective of needed quality and improvement changes associated with process workflows.

The benefit that is derived from this research will support patients, healthcare providers and the community at large. Those individuals who participated within the study are all in some manner actively utilizing medical care for their own personal wellness or for the wellness of their family. Therefore, there is a benefit to those who are actively engaged in the industry as well as benefit to those who are beneficiaries of medical care. Therefore, the perceived benefit or challenge derived depends upon many factors. The varying degrees of acceptances of changes to reimbursement programs and the acceptance of technology are only two of the many possible influences on the degree of benefit or challenge derived from an electronic medical record implementation.

As a result of the reporting mandates, the healthcare industry is highly engaged in its ability to collect and report data made available through the electronic medical records, which will result in overall improved patient outcomes and enhanced patient satisfaction measures. However, implementation of sophisticated electronic health record systems introduces considerable challenges, which include large capital expenditures inclusive of significant financial and human capital outlays. These substantial investments of both money and time occur early in the project and continue for significant periods prior to fully optimizing any newly installed electronic health record system.

Problem Statement

One significant problem encountered with the implementation of an electronic medical record revolves around managing perceptions associated with both the benefits and challenges that will be derived from installing a system. One of the more significant problems is managing the perceptions related to potential discomfort associated with learning a new tool. All organizations implementing an electronic record must learn how to manage and address potential challenges often described as concerns by those not directly involved or committed to the process of change and transformation. As processes and workflow segments change, all the affected parties will experience a period of discomfort with the change. Consequently, if their concern with challenges associated with implementation is not managed this energy will prohibit or delay users’ opportunity to optimize.

Implementing an electronic medical record system is a huge undertaking as it affects patients, medical, and office staff, and touches nearly every segment of any integrated health system. The organization under study made the decision to implement a completely new electronic medical record system from necessity, when existing vendors announced they would not be aligned to facilitate reporting requirements as mandated by the government. Organizations wishing to continue receiving full government funding and avoid penalties must meet stated governmental deadlines, which require the ability to report data associated with various measures related to patient quality and organizational efficiency. As a result, leaders of the studied organization made a bold, challenging, and exciting decision to select one of the best vendors for Electronic Medical Records in the country with an undeniable reputation for creating systems reflective of near seamless integration. In order to meet the deadlines recommended by the government, the studied organization chose a very aggressive timeline for implementation.

Across the country, it is typical for staff not directly involved in the implementation process to experience high degrees of anxiety that slows their rate of adoption and acceptance. However, empirical evidence also suggests that, once organizations fully adopt an electronic medical record system, the problems they anticipated prove to be less problematic than expected when appropriate mitigation practices are in place. Moreover, most report that the well-trained implementation teams are able to address most issues within very reasonable timeframes. The largest challenges of implementing an electronic medical record system are the associated cost and the time required installing. In addition, successful implementation of a record system requires a very strong project management team, which is not easily deterred or sidetracked. The challenges and concerns generally dissipate once an electronic system is actually implemented, and the system adoption begins. These effects are often visible months prior to full implementation, as an organization works to continually inform the employees of all the changes and actively sharing the information pertaining to the system being installed.

Purpose of the Study

The purpose of this study is to analyze perceptions associated with both the benefits and challenges derived from installing an electronic health record system. In order to address the research question guiding this study, the researcher is performing an extensive literature review, encompassing professional journals and industry websites. In addition, a survey was conducted to identify perceptions of industry and non-industry professionals (who may at any point also be potential patients within an integrated health system) related to the implementation of electronic records.

The study considers the perceptions associated with both the benefits and challenges that will be derived from installing an electronic health record application for use across an integrated system. Several benefits and challenges are evaluated, with specific consideration given to costs associated with implementation; training and concerns related to the protection of private health information. Other considerations addressed within the study include ability to access the internet and overall comfort with technology.
The literature review and research findings confirm that both industry and non-industry individuals are becoming more familiar electronic health records. Both segments of the population are very likely to use available information. The available data indicates that both individuals and industry sectors will actively utilize the data yielded by an electronic medical record system to make better healthcare decisions and engage in preventative care measures.

Significance of the Study

This study is significant to healthcare industry professionals, inclusive of boards of directors, executives, medical providers, and appropriate medical extenders who document within patient’s records. A patient’s extended care team will also find this study to be significant as all professionals servicing medical facilities, such as suppliers of pharmacy, ancillary services and durable medical services, will benefit from the introduction of this system. Most importantly, patients and their family members serving as proxy or decision-makers will benefit from more efficient record-keeping, in particular those in long-term care, and patients receiving medical care for chronic, urgent, or preventative care needs.

Conceptual Framework

Generally, whenever a decision related to the implementation of technology is announced, irrespective of the setting, it brings opinions and perceptions. Often challenges are reported as the new technology will be too complex to learn and thus hindering the ability to perform current task. These perceived challenges reduce the ability to appreciate the beneficial changes in the workflow and improved efficiencies created with the implementation of technology. In addition, the negative energy minimizes the value of learning additional skills for the benefit of the organization and most importantly for the benefit of patients served. The perceptions that the challenges will surpass the benefits gained are generally highlighted by negative energy of those not willing to openly and fully engage in the process of change. The goal of this study is to provide insight into the managing perceptions associated with both the benefits and challenges that will be derived from installing an electronic health record system.

Research Questions

The research question that guided this study was:

How can we identify, effectively manage and communicate realistic expectations associated with perceived benefits and challenges derived from a new install of an electronic medical record?

Assumptions, Limitations, and Delimitations

The assumption made at the outset of this study is that both healthcare industry participants and non-industry participants have a general familiarity with the ongoing national healthcare debate in the United States. In addition, the study participants are expected to have an opinion about their personal medical information being made available in electronic format. Limitations of the study may arise as not all responders would have direct person-to-person contact with the researcher as the survey would be delivered by electronic portal, supplemented by cover letter only. Moreover, it is assumed that the questions are drafted in a manner that would not require any additional explanation. Finally, as the survey would be available for two weeks only, this may limit the number of responses. This decision is taken in order not to be disruptive to industry professionals. Accordingly, non-industry professionals are also required to provide their responses within two weeks, to ensure consistent access to the study population.

Definition of Terms

All definitions below were researched from the Centers for Medicare and Medicaid Services website known as CMS.gov.
Abstract. A paper copy of record
Accreditation. An examination hospital policies, procedures and entity operations
Advance Beneficiary Notice. A Medicare notice for a service expected to be denied for payment.
AHIMA. American Health Information Management Association
Ambulatory Care. Outpatient services which do not require an overnight hospital visit
Ancillary Service. Services such as x-ray, drug, laboratory, or therapy
Attending Physician. Physician who is primary responsibility for patient care (CMS.gov, 2014)
Benchmark. A performance measure
Beneficiary. A person with Medicare or Medicaid insurance (CMS.gov, 2014)
Centers for Medicare and Medicaid Service. A government agency
Clinical Performance Measure. This is a method or instrument to estimate or monitor the quality of care
CPOE. Computerized Physician Order Entry
Cross Walking. A matching of old to new
Current Procedural Terminology. A medical list of codes used physician and other services (CMS.gov, 2014)
Data Dictionary. A document or system that characterizes the data content within tables within a database.
Data Mapping. A matching of old to new
Diagnosis Code. Codes describing what are thought to be the problem or reason for visit
Diagnosis Related Group. A system which groups patients according to diagnosis, type of treatment, age, and other criteria (CMS.gov, 2014).
Eligibility for Medicare Part A. This hospital insurance primarily for those who are 65 or older
Eligibility for Medicare Part B. This is available coverage to individuals receiving who are also eligible for Medicare Part A (CMS.gov, 2014).
Freedom of Information. The public’s right to know (CMS.gov, 2014).
Health Care Quality Improvement Program. HCQIP is a program, which supports the mission of CMS to assure health care security for beneficiaries.
Health Employer Data and Information Set. A set of standard performance measures
Health Insurance Portability and Accountability Act. A law which ensures insurance coverage
Hospitalist. A doctor who primarily takes care of patients when they are in the hospital (CMS.gov, 2014).
International Classification of Disease.A medical code set maintained by the World Health
Organization (WHO) (CMS.gov, 2014).
Medicaid. Medical coverage for the poor or those in poverty
Medicare. Medical coverage mostly for those aged 65 and older (CMS.gov, 2014)

Conclusion

This chapter presented the problems associated with the perception that the challenges to implementing an electronic health record are greater than the benefits. This dissertation includes an abstract, table of contents, required chapters presenting the study content, references, and an appendix. This chapter introduced the background and defined the purpose of the study. Chapter two will provide a review of the pertinent literature, focusing on sources published by noted experts in the industry. It is followed by the actual study design in Chapter three. Chapter four provides a discussion of the survey findings, and chapter five presents the conclusions of the study and recommendations for further research in this field.

Chapter 2: Literature Review

This chapter will present a critique of previous scholarly research conducted by a variety of experts in the healthcare industry, with specific insights into the implementation of electronic health records. A tremendous number of studies and research reports were considered, inclusive of scholarly journals, articles, and governmental websites. The literature review will thus provide an overview of the problem and will highlight plans for further study.

Historical Overview of the Problem

Historically, within the healthcare industry, many disparate processes and systems have been in use. Consequently, patient’s medical history consists of a variety of charts and inputs from a large number of differing systems. Moreover, this information was traditionally not stored in a single location for access by providers or patients. These disconnected services and actives result in poor use of available information and inefficient resource utilization, which increases the opportunity for patient safety issues to occur. In recognition of these issues, many organizations are striving to implement and use one integrated medical record system. One such organization, which has successfully deployed one of the industries leading electronic health record systems, is Johns Hopkins University. To date, this organization has implemented an electronic medical record system to more than 600 ambulatory care settings (John Hopkins, 2013). Similarly, Mayo Clinic has also implemented what is considered one of the largest electronic medical record systems in the world, inclusive of physician notes, laboratory results, and radiology imaging—all in one integrated electronic chart (Mayo, 2013). Although these very large organizations were the pioneers in medical record integration, the successful results did not occur without overcoming tremendous challenges. It is recognized that these and similar challenges evoke concern and heighten perceptions that the challenges outweigh the benefit of implementing an electronic medical record system.

Presently, many electronic medical record programs are in use. The difference between electronic medical records of the past and systems available today is that many changes and improvements have been incorporated since the passing of health reform. Most vendors are now offering a higher degree of record integration. Prior to the reform, the integration was typically available only within organizations proprietary internal systems. However, major electronic medical record providers now allow an opportunity to connect with other participating providers within the community, extending their services nationwide, and even worldwide. The participating providers who decide to either purchase an electronic record system or purchase a modified version of the system from others within their market will provide tremendous benefit to the patients they serve. The ability to have an integrated record system that allows physician offices to share records with each other and hospitals will result in cost saving for both the patients and the providers, while improving efficiency in care, leading to better outcomes.

The success of implementing an electronic medical record system greatly depends upon the adoption of the mission. There is a tremendous amount of emotion that comes with the integration of a major product, such as electronic medical record system. This emotional challenge stems mostly from a desire not to change, thus limiting the potential to recognize the actual need for a fully integrated electronic medical record system. Recent commentary in the New York Times, contributed by Milt Freudenheim, reveals that hospitals have received over $6.5 billion USD in incentive payments, while individual providers have received far more. Despite the obvious benefits, the contribution providers are reporting that the technology slows down their ability to practice, as they are burdened with an unfamiliar system and struggle to access patient information (Freudenheim, 2013). This inability to see beyond immediate drawbacks and general perceptions associated with change can cloud the user’s perspective, leaving many unable to appreciate the benefits and challenges. The providers reporting difficulty using unfamiliar technology may have not taken full advantage of available training, which would allow them to operate within the new computer system more effectively. The challenge associated with the amount of cost, time and effort of taking on a large task of record integration makes some focus on the negative and results in them sometimes unconsciously working against the tide of improvement. To this end, Sarah Kliff from the Washington Post recently reported that, while the use of health IT has increased the quality and efficiency of patient care, the level of improvement is below that initially projected and is marginal (Kliff, 2013). Those who are actively engaged within the healthcare industry are fully aware of the unnecessary redundancy and waste, which can occur when a patient with multiple chronic conditions is being treated by a wide number of specialties. Thus, electronic record implementation will help promote patient safety, while providing long-term cost savings for both the patient and the providers.

There are many areas specific to healthcare workflows that currently require duplication of service and efforts. In addition, the lack of integrated information opens the door for potential errors, especially in the problem areas such as medication reconciliations. Improved electronic medical systems allow patients to login and view their results, as well as communicate interactively with their physicians and care providers. The newly developed medical record options will allow those who work with electronic medical data to share this information for the benefit of the patient. In addition, an electronic medical record will give patients increased access to their personal medical record information. This, in turn, will improve patients ability to take control of their healthcare.

As a result of accessible medical record, patients will be able to connect to their provider wherever more information is required, or changes in their health plan needed. While, initially, both providers and patients may be unfamiliar with the new service, once they become accustomed to it, vast majority of patients will take advantage of the additional resource. An interactive electronic record system will also help reduce the number of patients who are classified as noncompliant, as having improved access to their data will make the patients active contributors to their medical care. Access to information and data makes the reporting, patient follow-up, and compliance more efficient for all involved. Integration also encourages retention to prescribed medical programs. Advanced software systems, which are now able to provide this degree of information and integration, are very costly to install, as to expenditure on the technology, hardware and human capital necessary to for a successful and timely implementation is considerable. However, for those working within the medical industry, striving to encourage patients to be compliant and responsible for their care, the benefits and lives saved surpass the cost and time associated with implementation.

Critique of Previous Scholarly Research

In this chapter, the pertinent literature on the topic of electronic health records is presented. The information is segmented into sections dedicated specifically to benefits or challenges pertaining to the implementation of electronic medical record system. The currently available data related to electronic health records is extremely vast, owing to the evolution of electronic health records and their widespread usage. According to 2009 edition of Markets and Markets, the Allscripts Misys Healthcare Solution was formed in October 2008. Over the next few years, the company continued to expand its electronic medical offerings and its practice management divisions. Today, their largest competitors are other well-known EMR providers, such as McKesson and Epic (Markets and Markets, 2009).

According to the same report, physician offices and practices are now incorporating practice management, claims management, electronic prescribing, document management, and patient access applications (Market and Market, 2009). In 2008, approximately 44,000 of physicians and clinics were utilizing an Allscripts product solution (Market and Market, 2009). Markets and Markets (2009) reports that the dynamic change within the healthcare industry have resulted in increased utilization of electronic claim processing systems, electronic payment processing, intranet, and internet applications.

The healthcare industry must incorporate integrative efforts within their work, as a result of business and clinical areas needing to work together. Healthcare providers are showing increased interest in revenue cycle management systems that are integrated with other hospital applications (Market and Markets, 2009). Application providers, such as Allscripts, McKesson, and Epic, are just a small sample of vendors providing integrated data for the healthcare industry. There are many other vendors in the marketplace that would all be considered major contributors to the industry.

The goal of healthcare reform is improving the quality of care while decreasing cost. The recent reform act, known as HITECH, supports reimbursement payments based upon performance, efficiency, and quality, as paper records are converted into electronic records, as a part of an integrated healthcare system. However, the implementation of electronic health record system may be challenging for smaller physician practices and very often difficult to justify, as these smaller practices often do not see a direct correlation to revenue (Colpas, 2013). While the recent health reform put the need for electronic medical records into focus, these systems have been in use for more than 30 years (Colpas, 2013).

The major complexity associated with implementing systems is the need to connect systems considered unrelated. The implementation of an EMR system may require a significant number of interfaces and additional data extracts, in order to provide all entities with the data elements needed to comply with the reform expectations. There are many concerns related to medical records which include physicians highlighting the reduced direct patient contact, as electronic tools may increase physician efficiency to the point where very little interaction with the patient will be required. Other concerns involve security issue, in particular those related to protecting patient information and determining who is ultimately responsible for breaches in the system. Initiatives, such as Meaningful Use goals, are important in maintaining trust is the system and are thus critical milestones that must be achieved by both hospitals and physician practices. The opportunities to bring together electronic health records, which require integration of all aspects of the patient care, will be essential for the future of patient care and quality.

Study reports electronic medical records, when used properly, will improve quality and patient safety. Once the systems are correctly built to mirror workflows, it is generally considered that they will not cause harm, but rather assist in the care being provided (Colpas, 2013). One major advantage of electronic health system is a tremendous amount of additional data that can be useful in the course of care planning. The implementation of electronic health systems will provide organizations with a wealth of data; however, at present, programs are not in place to address the best methods to utilize the information made available. According to the author, successful implementation and data utilization process will involve some degree of a data warehousing system. This system will allow the data from the EMR and the legacy systems to be merged, allowing analysis and care (Colpas, 2013).
One important drawback related to the implementation of an EMR is high cost of implementation (Colpas, 2013). Empirical evidence suggests that hospitals in particular are most disappointed with initial results of the EMR implementation, as they are often unable to produce immediate analytics that display an improvement in healthcare. Thus, it is essential to extract, group, and combine data from a variety of different sources—all correlating to some degree to the data provided by the new EMR system—to be able to provide evidence of the overall usefulness (Colpas, 2013).

Once the systems are implemented, organizations will continue to report positive findings and many are expected to expand the staff working in the area of data and reporting. It is thought that EMR systems are essential to healthcare organizations, as they maintain data that will aid providers and patients in managing chronic conditions and identifying risks, mitigation of which can help patients improve their quality of life. As organizations move towards implementation of electronic systems, they face data security issues, in particular those related to mobile devices, which may make unauthorized access to digital records easier. According to the Department of Health and Human Services fined one hospital $1 million for losing the medical records of 192 patients (Colpas, 2013). Even if fines are avoided, organizations must have sufficient funding for maintaining an EMR. There are considerable ongoing maintenance fees, hardware and software considerations such as ensuring the data are secure.

According to a 2013 EHR IMPACT study the term interoperability is found to be a key factor in the acceptance of electronic health record (EHR) systems (Duftschmid et al., 2013). The study findings highlight that most currently available systems focus on transforming the data into a format that can be exchanged and presented in an extract view. The main benefit of the extracted data is that it provides an optimum opportunity to integrate all the required information needed to provide integrated care (Duftschmid et al., 2013).

The referenced study above focused on a dual model. A dual model brings together the two types of models referenced in the study. Identifying and determining the design of a system and its build are essential steps to move in direction of integration (Duftschmid et al., 2013). It is evident HL7 logic utilizes the concept of templates which maintains a familiar pattern as observed in the referenced study. The template and component concepts are utilized in most of the currently available electronic medical record systems.

It is very important for organizations and users to recognize that systems will require ongoing updates and additional build to utilize the optimized development efforts. EHR content introduced or existing build is modified (Duftschmid et al., 2013). This is a very important consideration for the analyst working to build and implement the electronic health record system. Once the system is implemented, there will be a continuous number of updates and service packs, which may significantly affect the system functions. Therefore, having the core system hardcoded ensures longevity and stability of the system. Modifications of existing and additional system build can include special updates and patches which do not require one to reprogram the entire system (Duftschmid et al., 2013).

During the transfer and load processes data is mapped into tables. These tables are used to generate forms and produce record documentation. The data is stored and the extractor processes transforms it into documents, lists, and usable views, which can be used to provide integrated patient care. In order to generate the data, the system uses underlying databases, SQL queries, and other data query design tools related to data warehousing (Duftschmid et al., 2013).

According to the 2009 edition of Markets and Markets related to medical device markets, the healthcare market is moving towards an integrated information system, bridging relationships between providers, payers, and patients while utilizing more affordable technology solutions. The growth in the need for medical care due to the increasing and aging population, in addition to increasing number of individuals suffering from chronic conditions, also increases the potential for medical errors. Thus, the ability to incorporate technology and electronic medical records provides a significant opportunity to improve patient outcomes cost-effectively and efficiently.

Medical technology can assist in many aspects of healthcare, including offering complete automation and decision support capabilities (Market and Markets, 2009). Other applications which are generally offered by EMR vendors include remote patient monitoring, telemedicine, clinical data repository, intelligent networks, and automatic care alert systems. All of these and other add-on products are generally added during the optimization phases directly after the completion of an implementation (Market & Markets, 2009).
According to the Market and Market (2009) report, the industry reflects the continued shift towards increased IT applications to support improved opportunities for resource utilization. These efforts are primarily aimed at reducing patient length of stay and cost for both the patient and the provider. It will be critical that, as a healthcare IT industry continues to evolve, systems continue to use innovation while encouraging communication of various teams to support integration. In addition it will be critical for ongoing optimization in the areas of data security and remote service offerings (Market & Market, 2009).

Over the past decade, the U.S. government has become more involved and active in protecting patient privacy and rights, in particular those related to confidentiality of their medical records. According to Markets and Markets (2009), government has already begun to recognize the growing need for data security by enacting laws to protect patients.

The United States continues to lag behind the universal implementation of electronic health records. For example, according to Market and Market report (2009), the Chinese government provided $124 billion package for healthcare reforms. It is reported the funding supported full implementation of a countywide electronic health record system. In comparison, while our government is working in the same direction, it is only offering a reported $20 billion for the implementation of an electronic record system. As a result, organizations will be responsible for taking steps forward to make up the difference in their cash outlays by performing far above average on various quality measures (Market & Markets, 2009).

Market and Markets (2009) presents a very well defined summary of the direction we are taking with respect to electronic medical records. The industry, which includes providers, payers, patients, and all supporting resources or suppliers, is moving toward integration, which comes with both benefits and challenges. The report indicates that all parties must work together to understand the needs and expectations of the market participants in order to maximize the benefits the efforts to integrate various systems can yield (Market & Markets, 2009).

Inferences for Forthcoming Study

This specific study explores perceptions related to electronic medical records in order to determine the degree to which they affect the actual benefits and challenges of implementing an electronic medical record system in an organization. Future studies will consider how, once an actual electronic medical record system installed and optimized, an outline of specific care improvement benefits that are reportable. Forthcoming studies may also consider results of perceptions of personal data security and privacy. The framework of any forthcoming studies will be based on the survey and data collection methodology utilized in the study described here.

Benefits of Electronic Health Records

There are many benefits associated with implementing electronic health records within organizations. The most frequently cited benefits relate to quality, improved patient engagement, and improved operational efficiencies that yield savings for organizations and providers. Within healthcare industry as a whole, the benefit of electronic health record system is that it would potentially create new jobs. According to Market and Markets (2009), healthcare IT providers generate more than 60% of their revenue through license fees, which requires the incorporation of knowledge transferred to the patient and the providers caring for the patients (2009). The number of opportunities within the market are expected to grow, as electronic health records will become commonplace and will continue to undergo development (Market & Markets, 2009).

The design of electronic health records must involve the human factor in its development. The HCI, or Human Computer Interaction method, for example, considers this concept in the development of health technology (Arbuckle et al., 2011). The goal is to achieve a high degree of user acceptance by ensuring that the products maintain usability and result in end user satisfaction. The authors conducted a study, whereby they reviewed clinical decision support systems designed to aid in compliance with colorectal cancer screenings. The study focused on many areas, including coordination of results, coordination between providers, data collection efforts, and both provider and patient education specific to colon cancer screenings. Each focus area within the study was an identified barrier that could be overcome by the incorporation of healthcare technology, inclusive of a clinical decision support system, which is an embedded segment of most any electronic health record system on the market today. The participants in the study conducted by Arbuckle and colleagues were healthcare providers from the VA Hospital systems. All the participants were experienced and would thus understand the benefit of having information displayed in one place. The study participants were 12 Primary Care Practitioners (PCP) who were representative of the VA system, and included doctors and other providers, such as nurse practitioners. The authors concluded that electronic health systems would be well received by physicians, provided that the usability component is considered in the design of the system. According to the study findings, providers were most focused on the need for simplicity, efficiency, error recovery, and recognition (Arbuckle et al., 2011).

According to Stonehenge International government agencies such as the Department of Defense (DOD) and the Department of Veterans Affairs (VA) were required to share information. They are required to maintain an electronic connection and communicate patient information in a secure manner. It was reported by Stonehenge information related to pharmacy was most commonly communicated between these entities.

These efforts to increase the amount of shared data are ongoing and include identifying various options such as a standard formulary to aid in expanding electronic communications. In an effort to integrate with the required federal standards it is necessary for the involvement of many departments. The process of working together is considered to be the necessary factor to ensure best patient care while utilizing an integrated system (Stonehenge, 2008).

According to Fernendanz, Schreiner, Bezarro, Yu, and Black (2011), the utilization of tools that store, track and retrieve information will become a standard necessity within all practices. When implementing a computer-based system that maintains considerable interoperability, it is imperative that organizations work to ensure that key factors, such as training requirements, are addressed. Moreover, metrics that will be populated into the system must be well defined (Fernendaz et al., 2011). The transition from paper charts to electronic storage of medical data has been under slow development for more than a decade. However, the newly imposed governmental regulations have brought an additional level urgency to implementation.

It is reported that translational research requires both a trended amount of data which will include data such as personal data and test results (Hinchcliff et al, 2012). The author states that most healthcare organizations will have some degree of electronic health record systems to collect and analysis data. However, the systems must provide critical information in the correct and easy to use format while enabling integrated patient care. Therefore, another major benefit of implementing an electronic medical record is that it provides an opportunity to generate medical information in expected format. While, in some systems, this may take form of a decision protocol, in others, it may require grouping related data into sets. Uniform data distribution allows entities to track various elements and extract required information easily and efficiently. In addition, the ability to maintain data in a standard format can assist in analyses, as well as aid in managing elements, such as staffing. It allows opportunity to provide evidence-based data to better support initiatives and produce consistent documentation, which can be used to support the elimination of programs where optimization is not a viable option.

Electronic health records provide an avenue for the review of information on the patients record. The systems allow interested parties to view information in total and also at the patient detail level. Currently today many of the best electronic medical record systems are challenged to provide data from across the system in a total or summarized view for analysis (Hinchcliff et al., 2012). As a means to collect this type of data organizations rely heavily on tools known as data warehouse. A data warehouse is a large database which is used for reporting. The data warehouse is used to combine data and information by integrating information from a variety of sources. Information is often integrated into the data warehouse by the use of data interfaces. Data warehouses are often used to calculate data that contain query or information which has been pulled and converted into readable computer language for reporting (Hinchcliff et al., 2012).

Most electronic record systems have a process called extraction, transfer, and load, which brings data from the source system into the data warehouse system, facilitating the development of queries and reports. Developers define a base population data warehouse. They next will add criteria and parameters which result in the expected data output. In academic medical centers, recent surveys show that products such Microsoft SQL Server are used for data warehousing at rates greater than 50% (Hinchcliff et al., 2012). According to the findings of the Hinchcliff et al. (2012) study, assuming query is correctly designed, a 99.5% accuracy rate can be achieved when using data warehouse information, which is comparable to manual abstractions (which reflect approximately six errors per 1000 records, primarily due to data entry error).

Adoption of electronic medical record systems requires a considerable amount of training and review to ensure that the end users are well prepared to manage the problems encountered in order to ensure patient safety (Holmes et al, 2012). These issues should be recorded in a so-called problem list, containing key items within the medical chart. Thus, one of the main goals of an electronic medical record is a shared problem list, which is visible by all who are directly involved in the care of the patient. The problem list for patients aids providers in selecting the appropriate protocol to ensure that patients are receiving the most appropriate treatment. The problem list and its management are critical training areas and may pose a challenge during early adoption of electronic medical record system.

A key challenge usage of the problem list may yield to inconsistencies in how providers enter data into the system. The inconsistencies not only put patients at risk, but also make collecting and reporting data for population studies and wellness programs difficult. The major issue with the problem list is that managing providers have a difficult time enforcing consistency related to input into the system. The main issue with the problem list is missing and incomplete data. This has become more important under the new legislation, as the requirements to comply with federal regulations will require the providers to comply or face considerable penalties (Holmes et al., 2012). Further challenges arise, as organizations move towards adoption of electronic medical records, as they need to determine what problems should be included in an electronic problem list and how to determine when a sufficient number of problems are listed. Finally, consistent rules must be in place to determine data that is no longer relevant or too old for inclusion within an electronic medical record active problem list. Additionally, when implementing electronic medical records, providers must determine how to manage sensitive problems or sensitive notes on a shared electronic medical record. Often, patients with sensitive problems, in particular those related to mental illness, HIV, or AIDS, have considerable concern for their privacy, which sometimes surpasses the need for their medical safety (Holmes et al., 2012).

The passage of the Hi-tech act requires the entire medical community to review the problem list and determine the gaps in its quality between providers. Once the problem list is available for sharing and distribution, it is imperative to address the deficiencies it suffers from in the past (Holmes et al., 2012). Additional studies conducted indicate that most general providers are interested in interoperability with at minimum other local providers (Kidd & Kvist, 2006). The study conducted by Kidd indicated that many general providers are adverse to adoption of technology. However, since 2006, there has been a tremendous shift in the attitudes of the provider community as they started to appreciate the importance of integrated electronic medical information.

Additional benefits of the problem list and information sharing are the ability to maintain email communication between patients and providers. The benefit to patients is evident; doctors often see email communications as an additional challenge in the doctor-patient relationship. One key concern is that email communications become a part of legal documentation, and physicians are concerned about delays in their ability to respond to email communications, which will bring added risk to the provider (Kidd & Kvist, 2006).

Incorporating innovative technology is a daunting task to many ophthalmologists or specialty providers (Misch, 2012). Very often, specialty practices encounter some challenges when working to interface one or two pieces of diagnostic equipment into larger medical record systems. However, the benefit reported is that, once the specialty practices are fully engaged with an electronic record system, they are able to see on average potentially twice as many patients because the enhancements offered by electronic systems save both time and money (Misch, 2012).

Contributors from the Family Practice News report that the use of a certified electronic health record system improved drug therapy. Improvements in follow-up monitoring of patients with chronic conditions, such as those with type 2 diabetes, hypertension, or other conditions that require maintenance to control the a health condition were observed (Moon, 2012).
Major benefits of the electronic system are that patients who were previously listed to have significant problem list issues reported the greatest improvement. These primary measurements for chronic diseases tracked by governmental quality programs have generated a reported $44,000 per physician for meaningful use reporting opportunities (Moon, 2012).
According to Mulrhein, Zimmerman, and Chaffee (2013), computerized physician order entry (CPOE) was first implemented in 1971, but widespread adoption had been initially slow. However, a survey conducted in 2010 revealed that approximately 34% of hospitals in the United States had implemented CPOE using the vendor system. A major challenge associated with CPOE is the introduction of patient risk or even death related to unintended consequences associated with data input into a CPOE system (Mulhren et al., 2013). As the use of commercial CPOE systems increased in the early years of the 21st century, so did reports of unintended consequences and even patient deaths associated with CPOE (Mulrhein et al., 2013). As a result, organizations, such as Leapfrog, set standards for CPOE and various order sets, with the aim of supporting positive patient outcomes.

The implementation of regulations and the overall healthcare acts have now resulting in electronic health record (EHR) and computerized physician order entry (CPOE) as the new normal within the industry (Mulherin et al, 2013). The increased use of the EHR and CPOE has created an opportunity for organizations to certify and create standards for these technologies. There are many well-documented benefits associated with CPOE most notable are reduced medication errors, compliance with protocols and formularies, and improved organizational efficiencies. While a reduction in medication errors is often assumed to correlate with reduced avoidable drug events this is not always the case. Often studies lack sufficient information to confirm a significant reduction in avoidable drug events or mortality (Mulherin et al., 2013).

Another concern is the lack of external validity in the body of literature regarding CPOE implementation outcomes. A significant majority of early reports of positive results when using CPOE came from four distinct institutions, namely Brigham and Women’s Hospital in Boston, LDS Hospital in Salt Lake City, Vanderbilt University Hospital in Nashville, and Registries of Institute in Indianapolis. These early leaders in CPOE are all large academic medical facilities, using "homegrown" systems that were developed and customized over many years to meet institution-specific needs. Extensive time and resources are required to create and maintain homegrown systems, making commercially available products the only practical option for many institutions. As a result, the benefits observed within these four institutions may not be comparable to those at institutions using vendor-based systems (Mulherin et al., 2013).
Providers are not the only entities who must work to operate effectively utilizing electronic medical records. Payers must also work to incorporate the changing technology into their workflows (Shin, 2012). Recent study, conducted by the American Hospital Association, reported limited relationships between practitioners and payers. A study with a focus on the effect of coding points on the increased use of electronic medical records, the utilization of evaluation and management codes at levels 4 and 5 increased due to the availability of more comprehensive information provided by the integrated records (Zupko & Legrand, 2010). As a result, the government can easily establish significant increases in coding levels by providers. Additional review of practices, conducted in the form of cloning visits, cloning notes, and auto entry, are all elements performed by the government, with the aim of mitigating the factors known to increase patient risk. However, when these tools are used correctly, they increase efficiency for both the patient and the provider (Zupko & Legrand, 2010).
The relationship between electronic health records and the display in reporting improvement of patient outcomes measures reporting continues to be an area of ongoing development within the industry (Wiggley, 2011). In this study, the author reviewed a specific set of patient outcomes in an acute hospital setting. The data was sourced from eight hospitals, of which four maintained EHR system components and the remaining four had no electronic health record component. Findings revealed that there were no significant differences in the patient outcomes in the areas of mortality, length of stay, and complications in patients who presented for diagnosis of heart attack (Wiggley, 2011). However, the study was somewhat inconclusive, as various other factors could affect the findings. Thus, the recommendation is to repeat the study. It was noted that there is considerable evidence indicating that the implementation of electronic health records improves quality measures performance indicators (West, 2010).

Challenges of Electronic Health Records

According to 2012 edition of the American Journal of Emergency Medicine, the goal of any electronic medical record system is to support the daily work needs of the staff (Claret et al., 2012). Contributors to this publication indicated tremendous improvement in what is titled “the before and after observational effects of the first medical contact.” According to the report, the introduction of an EMR system improves the overall speed at which providers are able to take care of patients upon arrival.

The study revealed that the EMR system shortened the time previously required to assess the patient and to determine his/her medical history. In certain situations, as the medical history would be assessable in the EMR system, only update questions would be necessary. In most cases, the study participants reported that, having been engaged with an electronic medical record system, they would not be willing to return to the prior handwritten noting processes. The EMRs systems resulted in a shorter “door to first medical contact” time and fewer patients in the triage areas. In most cases, those polled reported an improvement; however, some issues were revealed, such as those related to workflow design, which resulted in the need to reorganize to take better advantage of the available medical record systems being tested in the study (Claret et al., 2012). According to Markets and Markets (2009) report, the continued focus of the healthcare IT is on linking technologies in order to help providers work together. This integration allows access to interconnected data of a patient, related to items, such as diagnostic images and tests located within PACS or RIS, which are both radiology imaging storage tools. In addition, doctors working together with the benefit of Computer Order entry can utilize various smart order data sets, which provide an additional indication of expected protocols and aid in effectively combining treatment plans (Markets & Markets, 2009).
The healthcare industry is reported as one of the most human resource intensive areas of the service and public sector industry. It was reported that in 2006 there were approximately six million workers within the health care industry (Dubois, McKee, & Nolte, 2006). It is reported that approximately 70% of all healthcare budgets in westernized nations is directly related to salaries and benefits (Dubois et al., 2006). Due to the innovations in healthcare, which have lead to increased longevity for patients with chronic diseases, it is important to be able to better to manage all of the information related to their care.

It is considered important to maintain the ability to extract data to determine trends in healthcare (Dubois et al., 2006). Generally speaking, the change in trends are directly related to technological developments, improved patient education, changing expectations of patients, and mobilization factors reflective of a desire and ability to access the care that best meets their medical needs. The ability to have data systems in place allows trending, which helps organizations plan for immediate and long-term workforce needs. The ability to trend data is an important factor, as trending is crucial to understanding resource needs, population composition, and identifying services that will be most needed by the population being served (Dubois et al., 2006).

It is reported that demographic trends present one of the most basic challenges to optimizing an electronic health information systems. The demographic trends provide insight
into the future healthcare needs and services, which will have a significant impact on the ability to supply future care. The systems in place can track current patients and their needs. The systems also provide indication of the health status of the community. This indication includes o key demographics, such as birth and mortality rates (Dubois et al., 2006).
Health systems across the world are affected by aging nursing population as they have not effectively utilized systems presently in place to further encourage more educational interest in the areas of healthcare (Dubois et al., 2006). Globally, healthcare systems struggle to implement more robust electronic health systems due to a decline in the number of younger nurses. A study conducted in the UK indicated that, between 1988 and 1998, the number of nurses under the age of 30 decreased by 30%. This may be explained by the fact that, globally, the educational requirements to complete a nursing program are becoming increasingly advanced. A similar trend has been noted across the globe, where there has been a tremendous decrease in number of physicians aged 40 and under. It was concluded in the study that perceptions associated with change has hindered the introduction of electronic record systems, which will be better positioned to support patient care (Dubois et al., 2006).

More women working within the medical profession has important consequences for workforce planning, with a direct correlation to patient needs. Further, as the traditional gender roles are changing, with more men seeking an improved work-life balance, there may be an additional facet to consider in regard to staff planning ensuring that the appropriate staff are available to take care of patients. While, an electronic record and practice management system may be able to report on the staffing needs, access to trend and demographic information may pose a challenge.

The traditional view that healthcare costs increase due to increasing population age is now seen as too simplistic, as it fails to consider other factors that add to the increasing cost associated with providing care. One of the main sources of expenditure will continue to be technology associated with integrating the record systems and improving practice performance. The technical advancements associated with electronic records, as well as incorporating technology to provide services, are greatly changing the required skill and labor pool needed within the healthcare industry. Cited findings of one study, noted that pharmacy staff can be reduced by 6.3% with the implementation of electronic communications (Dubois et al., 2006).
Introduction of EHR systems has changed many existing roles and does reduce or call into question traditional roles associated with clerical functions. An electronic record system cannot completely eliminate this function, which remains a major category within the healthcare industry (Dubois et al., 2006). Another key benefit of an electronic record system is it can consider the increasing number of cases where the primary and secondary care settings are not clearly segregated. The mobility of patient and the ability to utilize referrals provides a tremendous opportunity for data sharing to include images, test results, and even telematics, whereby entities can work together remotely for the benefit of the patient, streaming images to other specialty organizations.

Data management is one of the driving forces of the clinical decision process. All healthcare and data professionals are now forced to make the best possible use of all available data (Dubois et al., 2006). Effective utilizing and benefiting from electronic medical record systems require healthcare providers to participate directly in their development, maintenance, and interpretation. According to Dubois et al. (2006), approximately 80% of general practitioners in Europe were already using some degree of computer technology in their practices.
The changing arena of healthcare industry is very vivid in the way that health professionals interact. Today, the change creates an environment consisting of a very challenging energy as a variety of different groups work to better understand available data. The need for management to control cost by providing more efficient opportunities for service is a tremendous challenge within the industry (Dubois et al., 2006).

Each day employers are working to better adapt to different modes of working, based on flexible contracts and transferred staff to alternative employers (Dubois et al., 2006). This presents a major problem with the coordination of utilization of electronic health record system. Therefore, as organizations consider cost and challenges of an electronic record and practice management system, they must realize that they may have to finance staff certified in the appropriate electronic technology. Job stability and lifelong placement at a healthcare organization are no longer the norms as people may work a series of non-standard working arrangements. As the industry is generally in need of additional labor there are often opportunities for ongoing part-time employment, short-term contracts, on-call work, multiple employments, independent contracting, and many other forms of employment (Dubois et al., 2006).

A major challenge with electronic health records is an increase of the amount of work within the industry. The work involves many considerations such as a substantial learning curve. As a result of go-live and implementation activities staff work very long and often unpredictable hours. These experiences often lead to work stress injuries due to repeating physical motion and other issues such as overall employee disengagement. (Dubois et al., 2006).According to an article published in Review of Optometry (2012) systems across the country work to utilize medical records to support their efforts of displaying meaningful use of resources. Organizations are now working to adhere to additional requirements. These additional requirements now introduce additional clinical quality measures and additional reporting requirements for those working in the health care environment. (ROO, 2012).In response to a federal advisory board, the final certification rule also adds a requirement that all personally identifiable health data must be encrypted when not being actively in use for care or analysis (ROO, 2012).

According to Review of Optometry (2012), meaningful use criteria are divided into objectives. Today each provider must now work to achieve 17 core measures for meaningful. Providers could select five out of the ten available. Under Stage 2, the core objectives must be either completed or exempted.
Electronic health records systems will be an important tool in aiding all providers to report on data. Practices that attest for the 2013 payment year will avoid the 2015 penalty payment. Those that do not attest for the next year will experience a reduction in Medicare reimbursements as of 2015.Providers will be focused on reaching a successful attestation to avoid penalties (ROO, 2012).

Stage 2 includes a special provision for eligible professionals demonstrating meaningful use for the first time in 2014. Providers attesting no later than October 1st, 2014 would avoid the 2015 penalty (ROO, 2012). As a result EHR vendors were required to make many changes to ensure their systems allows users of their applications to attest. This required adding new features related to changes in workflow and other optimization efforts.

The item known as the problem list was created in 1960. The problem list was created by Lawrence Weed. He created the list as a part of his recommendations for a problem-oriented medical record (Holmes et al., 2012). Recognized as a simple listing this tool is a commonly expected section of the paper medical record and is now used in EHRs (Holmes et al., 2012). The problem lists as a list of clinical information. The information should be clinically relevant to physical and diagnostic concerns and past procedures. The problem list includes summarized view regarding patients most pressing issues and medical history related to chronic diseases. The problem list allows practitioners sense of the patient and ensure that significant issues that affect treatment decisions are not hidden within the medical note (Holmes et al., 2012).

Historically review of the problem list on paper was reported as inconsistent (Holmes et al., 2012). Practitioners have developed their own style of managing and organizing the problem list. While these differences are likely frequent they will be problematic within an electronic medical record. Therefore, it is important that guidelines are developed and maintained within an electronic system (Holmes et al., 2012).

The creation and management of problem list is a uniform process within the healthcare environment, primarily due to the growing utilization of electronic health records. The movement to the EHR in the United States brings the possibility to consistent, standard and shared information all aimed to improve patient outcomes. To comply with meaningful use guidelines, practitioners must maintain an up-to-date problem list of current and active diagnoses, based on clinical coding standards designed to classify diseases, symptoms, and other factors relevant to the patient (Holmes et al., 2012). In order to be compliant, a large majority of of all unique patients must have at least one entry. If no specific complaints it will be important for providers to adequately document this into the medical record systems.

Oversight of how to best manage problem areas for patients is communicated by a wide range of organizations, such as American Health Information Management Association. This organization released best practices for problem lists in 2008. However, this guidance for how practitioners should approach, manage, and organize the problem list is largely limited to high-level definitions. From the policy perspective, practitioners are left to their own personal judgment when creating and maintaining the problem list (Holmes et al., 2012).
In 2012 it was reported that education and training specific to how to optimize information located within the problem list greatly varies. Most practitioners interviewed as a part of this study found the education they received was highly variable as it related to fully utilizing data associated with problem list (Holmes et al., 2012). As many healthcare organizations in the United States created their own policies towards the problem list, it is unclear how effective they are at producing valuable problem lists or how widespread their adoption is across the United States. Therefore, while policies offer high-level rules, specific guidance to the practitioner on how to construct and maintain an accurate problem list is noticeably absent, and leaving room for errors and variation in practice (Holmes et al., 2012).

Developing and following a define set of rules or smart electronic features are noted as most effective and accurate manner to work with electronic problem list. Research is limited in the study of patterns or variances among providers of what they enter within the problem list. This issue must be addressed, as it would help the medical community move forward in developing such mechanisms.

The purpose of the study conducted by Holmes et al. (2012) was to develop a better understanding of how practitioners think about and use the problem list. In addition, the author worked to highlight opportunities to review variances in practitioner input with focus on various demographic factors of the physician such as their years of experience, age, and specialty. Such research will assist in the pursuit of developing policies and tools that can create a common approach to the problem list (Holmes et al., 2012).

Those participating in the aforementioned study revealed that the medical community needs to work towards standardization and optimization. This effort can be achieved through the development of policies revolving around the full utilization of a problem list. They recommended that tools be built into the EHR; aiding practitioners comply with those policies. Finally, the study findings reported a minimal relationship between opinions towards the problem list and participant characteristics, such as age, medical experience, or opinion on the importance of the problem list. For the completeness measure, the only significant factor with the support of a decent sample size was that residents felt that the problem list should include less information than suggested by non-residents. These differences could be due to the changes to recent training or less experience in the medical field (Holmes et al., 2012).
This study showed practitioners, in general, do differ in their judgment towards the problem list. However in most situations the majority of the participants would adopt a common approach to completion. Further, practitioners indicated that they do to maintain a degree of freedom in what they can enter into the system and most were not in favor of a large number of restrictions within their electronic workspace. The creation of a policy to help guide a common approach as well as provision of tools that would encourage upkeep would be helpful in creating accurate problem lists over time (Holmes et al., 2012). Therefore, the implementation of electronic health record system provides a significant opportunity to help practitioners with this barrier to detailing patient needs.

According to Gilmer et al. (2012), diabetes is a common and costly chronic disease. In 2007, more than 17.9 million U.S. residents suffered from this condition (Gilmer et al., 2012). Research cited by Gilmer indicates that approximately 32.8% of the entire US population is at risk of maintaining this status. In this context, an added benefit of electronic health records is that patients and doctors can work together to establish preventative or health maintenance needs. Thus, an electronic medical record and online access to medical information provides a tremendous opportunity to reduce the risk for developing preventable chronic disease.

Today there are sophisticated electronic medical records are characterized by unique aspects related to what is defined as integrated clinical decision support (Gilmer et al., 2012). According to the authors, such systems have the potential to improve care and resource utilization for millions of persons who are actively enrolled in health plans. Moreover, those who are associated with providers who maintain electronic medical records have ability to benefit from the data to aid patients in making healthy decisions, which will result in improved outcomes. These systems are often able to produce reports and dashboards, allowing ready access for areas requiring additional monitoring. This benefits both the patient and the physician working with various populations, aiming to improve their health status.

Despite the tremendous benefit that can be generated from a wellness opportunity, creating the detailed reports with the ability to track patient progression and the efforts to maintain current data can be costly. The systems that allow this level of patient connectivity are expensive to install (Gilmer et al., 2012). Moreover, significant costs are associated with training of both staff and patients, as both groups must be educated on how to use the patient portal. The cost of training staff includes not only the employees undergoing training, but also expenses associated with providing sufficient workforce in order to continue operations while training is in progress.

The aging population maintains a large number of complex health conditions. These conditions include common chronic situations such as obesity, high blood pressure and heart conditions. As a result of the heath status of this population they are historically a large receiver of healthcare services (Ludwick & Doucette, 2009). In many situations, increasing patient information an integrated fashion will be extremely beneficial to both patients and providers. The major benefits identified include improved patient safety, as well as increased office and staff efficiency. Although initial decrease in physician productivity is expected, during the early days of the system utilization, staff quickly recovers, as they become more proficient with the system (Ludwick & Doucette, 2009).

A challenge related to electronic system adoption stems from the considerable effort necessary to retrofit exam rooms to accommodate the additional computer hardware required by electronic medical record system implementation (Ludwick & Doucette, 2009). Very often, organizations must perform gap analysis, whereby they visit all locations and make assessments in order to determine the best method to install the necessary equipment. In a study approximately 19 examination rooms were viewed, representing 51% of the total 37 rooms in these offices. As this was a relatively small practice, it is expected that adoption of larger systems would pose a considerable challenge related to both time and resources (Ludwick & Doucette, 2009).

A significant benefit to EHR process is the consideration of many different systems currently available within the market place. One software vendor, which is frequently cited as popular with variety of providers, is Epic. According to the Journal of Health Management submission by O’Brien, the Epic system can cost in excess of $35 million (O’Brien, 2006). The physicians surveyed as a part of this study concluded that the Epic system improved their efficiency in 90% of the cases (O’Brien, 2006).

According to the author, a major challenge of implementing an electronic system is to ensure the process does not cause significant disruption to operations (O’Brien, 2006). Moreover, while training the staff will, care must be taken to ensure that qualified staff remains on duty, to avoid patient issues. Obrien further reports that the implementation of electronic medical records needs to be well aligned and organized. Failure to take such measures will affect the schedule of physicians, leading to problems with patient visits. Frustration with a poorly implemented system will typically result in physicians sending their patients elsewhere, which will have tremendous impact on the bottom line of an organization (O’Brien, 2006).

Additional challenges related to implementing an electronic medical record system relate to training requirements. In a referenced case study nearly 1700 employees, as well as hundreds of physicians, required training of the system functionality and workflow migration (O’Brien, 2006). The staff training was generally well received. However, the physicians were required to be trained and certified, which presented many challenges and was particularly difficult for physicians nearing retirement, who were less adept at using modern technology. Thus, the study findings indicated that the most efficient and effective training includes functionality as well as workflow education (O’Brien, 2006). Despite the challenges related to time needed to train and certify, within one year of the implementation, the majority of those surveyed were very pleased with their improved abilities and tools to complete their jobs in more efficient and productive manner (O’Brien, 2006).

Another challenge related to electronic health records is the ability to share data or interface with other systems. Research was presented in Family Practice News. The research reported that more than 70% of the physicians polled said that their electronic health record system was unable to communicate electronically with other systems (Schneider, 2012). Lack of understanding pertaining to the information can be gained, in addition to the large cost of creating an interface connection, is a considerable barrier to the electronic health record system adoption. Most participants in the Schneider survey indicated that they perceived information related to relevant laboratory and imaging tests essential to the patient care provision.
Fatigue is yet another challenge associated with electronic records. According to Stantz (2012), the Office of Inspector General is aggressively reviewing use of what is termed identical notes. As a result, it is recommended that providers become proficient in order to effectively utilize the system and avoid using shortcuts that can adversely affect patient safety. It is important for providers to not only review notes within an electronic chart, but to also make a concerted effort to update the record to ensure the most current information is always available. Updates should be made, if required, upon the end of each patient visit, and only the appropriate provider should document a history of a present illness (Stantz, 2012). In addition to the need for proper care when updating patient records, it is also important that electronic templates or favorites are used with extreme care. According to research conducted by Stantz (2012), the electronic record can be corrupted with incorrect application of templates that list medication and diagnosis without a complete review of visit reason and the overall problem list.

Summary

In summary, this chapter presented compelling information on the knowledge related to both the benefits and challenges of implementing an electronic medical record system. The reviewed literature identified many challenges, in particular those related to the cost, demands on staff, and time required implementing. It is evident that there are equally compelling benefits associated with moving forward with implementation. One of the most relevant benefits of adoption of electronic medical records is the opportunity to improve access to information for the benefit of the patients and their families. The subsequent chapter will describe the methodology adopted in the present study, as well as the study population, the survey method, and the data analysis methods.

Chapter 3: Research Method

Worldwide, electronic health records have been in use for over a decade. The purpose of this study is to consider the benefits and challenges of implementing electronic heath records. There have historically been many variations and product releases of electronic health record programs, each claiming to be better than the next. The rapid pace at which vendors release the products generates some degree of concern that an electronic system may be less safe and not as effective as promised, potentially compromising private information. However, vendors entering the market claim that their products are the perfect solution for hospitals, practices, or individual providers. As these products must rapidly adjust to changes in the healthcare and governmental relations environment, existing electronic health solutions are constantly evolving. Early adopters of electronic health record systems may find their current systems are not well aligned to meet the constant changes and requirement as mandated by the government and various regulatory agencies.

Systems that are appropriately aligned are also extremely expensive. The required diligence, manpower, and focus necessary to ensure a successful launch, along with the most important element of data transformation are all well documented as exceedingly difficult to accomplish. It is necessary to overcome challenges associated with electronic medical record system implementation. The electronic medical record will ensure the organization, its affiliated providers and, most importantly, the patients all maintain the most accurate information.

Methodology

The purpose of the study is to identify and analyze managing perceptions associated with both the benefits and challenges that will be derived from installing an electronic medical record system. This is a mixed research study. The quantitative section is generated by the utilization of a self-made survey obtaining participant opinions related to the need to install an electronic medical record system. The qualitative section is generated from the interview response located in appendix. Responses generated from the ten survey questions provide data to be analyzed in subsequent chapters.

The challenges of implementation will include the cost of actually purchasing a robust electronic medical system, as well as implementation issues, training requirements, and increased pressure to remain compliant with HIPPA privacy and security regulations. The benefits addressed will encompass improved integration of patient care, improved communications, reduction in out of pocket cost to the patient, and improved community outreach opportunities related to care coordination. The various perceptions and opinions of those not directly involved in electronic medical record implementation are widely available, as in addition to scientific and professional publications, such views are shared on websites and in various blogs. The general, the online message is one of doom upon implementing an electronic medical record system, despite successful implementation by most of the largest and most respected integrated health systems in the nation.

Data for consideration in this study is identified through personal experience, provided by direct involvement in electronic medical record implementation and online research. This information will be supplemented by an online survey, which will comprise questions related to perceptions of challenges and benefits of integrated health systems. The survey data will be subsequently analyzed and the results will be presented in a summary format. The questions were presented as this facilitates simple tabulation of results. In response to the research question presented in the study a degree information was received. The objective would be to retain these opinions and compare them against those obtained in forthcoming studies. The aim to ascertain whether the views shared in this study remain unchanged after a period of optimization.

This study aims to answer the research question of how we can identify, effectively manage, and communicate realistic expectations associated with perceived benefits and challenges derived from a newly-installed electronic medical record (EMR). The most appropriate means for data collection for this research is a survey, and the method for data analysis is the chi-square statistic.

Sample

The survey method was utilized to collect primary data from the health-care industry population. These are individuals who are involved in the healthcare industry. The sample comes from two kinds of respondents; the industry participants and the non-industry participants. A total of 50 individuals answered the questionnaires; 30 from the health-care industry and 20 from the non- health care industry sector. They were randomly chosen and each filled out the questionnaire by clicking on the Survey Monkey link

Variables

This research makes use of categorical variables. The variables of the study, represented in each of the ten questions in the survey, are as follows: (a) industry participant; (b) non-industry participant; (c) familiar with EMR; (d) observed PHC use of the electronic device; (e) proactive; (f) has access to the internet; (g) comfortable with technology; (h) reduced interest; (i) willing to pay; and (j) believes EMR is secure.

Survey design

The survey questionnaire was designed using a Survey Monkey template. The formulated questions resulted from a preliminary research about what influences acceptance of newly-installed mechanisms, such as EMR. Issues of security, privacy, and access to ones personal medical records were also considered. The final document contains ten closed-ended questions that are answerable by ‘Yes’ or Number There are also spaces for additional information that the respondent may want to share. Respondents have to answer the questions online at the Survey Monkey site in chronological order.

The pros and cons of EMR are built into the questions. For example, question number5 inquires if one had access to medical records in an electronic format would you be more proactive in managing your personal health. Here, there is already a suggestion that EMR can contribute to the person being proactive. The negative side of the EMR is hinted at in question number ten which inquires if participant thinks personal information is secure if maintained within an Electronic Medical Record System. The negative aspect would be threat to patient security and privacy. More details about the contents of the survey questionnaire are discussed below.

Respondents Categories

The first two questions are on employment status. These items identify whether the participants belong to the healthcare industry or not. Respondents who answered ‘Yes’ to the question of are you employed within the healthcare industry are considered industry participants. Those who answered ‘Yes’ to the second question of are you otherwise compensated for your participation within the healthcare industry are labeled as non-industry. Those who are contractors, temporary service provider, consultant product sales fall under the non-industry group. The survey uses these variables (industry and non-industry) as the main categories.

Benefits of the EMR

The next four questions (Questions nos. 3-6) in the survey focus on the benefits of the EMR. Familiarity, ease of use, and easy access are the usual advantages of digitized products and digitize devices. The goal of research is to investigate whether participants have the same experience and perceptions about the EMR. Question number3 inquires if one familiar with the term Electronic Medical Record. The researcher is aware that respondents may have seen or even used the EMR but were not aware that such document was called an EMR. A question is included in the benefits question because awareness about a document is necessary before such document can be assessed.

The fourth question inquires if one has observed if primary health care provider currently utilizes a computer or other electronic device such as a tablet (ipad or similar device).
This question is meant to establish that the use of digital devices is already very common. If health providers are already using digital devices then they would not have a difficulty using the EMR. Since the primary health care providers are already using gadgets as an aid during patient consultations then using the EMR would only transfer that practice to a formal health system record.

The fifth question inquires if one had access to medical records in an electronic format would one be more proactive in managing personal health and looking into the effect of the EMR into the respondent’s health management. An answer of ‘Yes’ to this question will confirm that the EMR can facilitate an individual to better management of his/her health. The word proactive is included in this question to show that the EMR can make it possible for the patient to have a hands-on participation in his/her health management. In asking this question, the goal is to know if respondents have this kind of perception towards the EMR.

The sixth question is about access to the internet while the seventh asks the respondents if they were comfortable in using technology. These questions are meant to identify the status of respondents in relation to technology. The seventh question consisting of you comfortable using technology such as computers, smart phones and tables is both a benefits question and a challenge question.

Challenges to the EMR

The last four questions are aimed at getting the respondents perspectives about the common issues of EMR. These issues refer to acceptability, skills requirement, fees, and security. Security of personal information has often been a major concern with records, thus transforming these into digital form may make it susceptible to hackers and theft. However, placing these in digital form can also make it more secure since access is limited to those with corresponding clearances only. The fact that the issue on security would always have convincing arguments on both sides makes the researcher include question number 10 inquires if one thinks personal information is secure if maintained within an EMR system to determine the perspectives of respondents.

The acceptability of any new method often would look into the aspects of resources and time. How willing are the respondents to spend resources and time for the EMR? The ninth question asks the respondents if one would pay an additional out of pocket fee to maintain access to personal medical record in an electronic format. The eighth question asks would a prerequisite educational requirement, such as an online tutorial reduce interest in electronically accessing your information. The respondents answers to the last four questions in the survey instrument will provide data to the researcher about the challenges facing the implementation of an electronic medical record system.

Research Questions

The research question as identified in chapter one was:
How can we identify, effectively manage and communicate realistic expectations associated with perceived benefits and challenges derived from a new install of an electronic medical record?

Instrumentation

The instrument used is a survey. The survey created using notable Survey Monkey tool. The survey tool is widely used to collect information and is widely adopted. The survey tool maintains documented ability to obtain information from actual participants. The survey questions are located within this document and in the appendix. The type of survey used in the study is an electronic survey consisting of ten questions delivered by the Survey Monkey tool (See Appendix A). The survey questions elicit either ‘Yes’ or ‘No’ responses, allowing simplified summary of findings. The survey is reliable, as the settings in the survey design only allow a survey participant to take the survey one time from the same computer IP address reference. The survey was sent directly to email addresses of those located within the population. The survey was not distributed to random email addresses, but rather to a defined list of potential participants meeting the inclusion criteria. The survey results also generated participant comments (See Appendix B). An additional report of participant comments is located in subsequent appendix (See Appendix E).

All survey participants were individuals who were age18 or older. The expected median age of the survey participants is expected to be approximately 45. All of the participants have completed at least a high school education, with the majority holding a four-year college degree or beyond. The population consists of individuals who primarily reside in Shelby County, TN. All study participants are of working age and should thus have economic resources to maintain a personal internet connection. All study participants directly associated with the healthcare industry maintain skills as listed in Appendix C or D. A notable deficiency in this population is the exclusion of individuals approaching retirement (aged 62 or older).

Population and Sample

The population for the survey consisted of individuals located within Shelby County, TN. The survey was submitted to a sample population consisting of 200 individuals. The sample of individuals consisted of an even distribution of both male and females. The sample includes individuals with age range of approximately 30 to 45.

Data Collection

Written permission was obtained from Human Resources, Corporate Legal and from the VP of Clinical and Revenue Transformation to prepare this report, with specific focus on our journey of implementing an electronic medical and practice management system. Next, a literature review was conducted with a focus on academic journals, reports, and books reporting on the historical context of electronically medical records, the implementation of electronic medical records, and challenges associated with implementing electronic medical record systems. The next step was to develop and conduct a survey of industry professionals, in order to gain understanding of their perspectives of benefits and challenges pertaining to the adoption and use of electronic medical record systems. Permission to survey staff was requested, specifically indicating that the target population would be individuals involved in Reporting, Data Collection, Quality, Patient Safety, and Compliance. However, all others directly involved in keeping patient records or using data derived from patient records were also included in the study sample. The total available population at the study site exceeds 500 staff. However, a sample consisting of at least ten percent of the available population is deemed sufficient for the subsequent analyses. Once permission was obtained from corporate human resources and corporate legal department, survey was electronically distributed to the study population, with the introduction from corporate communications department and senior leadership, requesting all survey results be returned to my office within two weeks. The survey was conducted using a professional version of Survey Monkey, which allows results to display in both summary and graph format, and is thus suitable for analysis. The participants are required to acknowledge the consent form prior to taking the survey, and notice was included as the first page of the survey. Once the consent acknowledge granted, the survey would begin. The survey and data collection method maintain a high degree of fidelity and structure as all of the input from participants is date and time stamped. In addition, the unique IP addresses are maintained within the survey tool for added validity of the data provided. The automated nature of the abilities within the survey tool increased fidelity. Further, results are collected directly from the survey tool, and all of the calculations specific to the survey questions are completed within the tool whichis then utilized for analysis.

Data Analysis

The data was collected electronically from Survey Monkey. The survey was marked as closed and the option to analyze data was selected. This option results in all of the responses being tabulated for analysis.

Once respondents have submitted the filled-out questionnaire, research continued to the next step in the analysis. This was analyzing the quality of the available data. Finding the chi-statistic is appropriate to the analysis of categorical variables thus, this was used. A Chi Square Statistic provides an objective comparison between the different variables. It makes use of the frequencies or the tallies for each of the question in every category. In this study there are two categories thus; the comparison would be how frequent do respondents belong to a certain category answer ‘Yes’ to the questions in the survey instrument.

The function of the chi-square statistic in quantitative studies is to determine whether there are relations existing between the nominal variables. The symbol for the chi-square statistic is X2and the formula is the following:

It is actually a way of comparing the expected (E) frequencies and the observed (O) frequencies. The expected frequencies results from a calculation while the observed frequencies are the figures from the raw tables in the survey. When the differences between the E and the O become bigger, then it means that the data collected may be non-random. Before the chi-square is calculated, it is assumed that the figures are derived from random sampling.

A 2 x 2 contingency table is presented for each of the 8 variables namely (a) familiar with EMR; (b) observed PHC use of the electronic device; (c) enables being proactive; (d) has access to the internet; (e) comfortable with technology; (h) willing to spend time for tutorial; (i) willing to pay additional fees; and (j) believes that EMR is secure. Information for each table is specified in this sample.

Category one is Industry. This refers to those who answered ‘Yes’ to Question one and ‘No’ to Question number two. They are the ones who are employed in the health care industry. There are 30 respondents who belong to Category one. The term Category two means Non-Industry. This refers to respondents who answered ‘Yes’ to Question number 2 and ‘No’ to Question number one. There are 20 respondents who consider themselves not employed in the health care industry.

The purpose of the chi square is to compare the different variables. At the simplest, it compares the two data types in the two categories, thus, the 2 x 2 table. To calculate the chi square statistic in the 2x2 table, the following formula is used.

Results

A contingency 2x2 table for each of the variables in questions two-tenis presented below.

The answers to this question were not limited to a ‘Yes’ or a number ten percent from the non-industry group and another 10% from the industry group either did not know the answer or expressed that they did not observe their primary health care provider.

According to the majority of the respondents, (90 % of industry participants and 85% of the non-industry), the EMR would make them more participative or hands-on in managing their personal health. All respondents gave a ‘Yes’ or ‘No’ answer for this item.

Only one respondent or 3.3% expressed that he/she was not comfortable in using technology from the industry participants. In contrast, 100% of respondents from the non-industry group are comfortable using technology such as computers, smart phones and tablets.

Additional time for the tutorial will lessen the interest in the EMR of only 16.76 % of respondents from the industry group. A third of those in the industry group (35%) are saying that having to spend additional hours to learn the tutorial about the EMR would lessen their interest.

The results of Question number nine which are presented in Table 7 that the majority of the respondents are not willing to pay for additional fees to maintain access to their medical information in electronic format. Those who said ‘No’ from the non-industry respondents comprise 75% of their group while the in the industry group, only 31 % was willing to pay an out of pocket fee to access their electronic records.

Human participants were not harmed in this study. Individuals were provided a survey electronically by way of Survey Monkey. Moreover, the survey was extremely time efficient, as it could be taken only once, from the same IP address, limiting the need for multiple entries. The participants were not guaranteed privacy while taking the survey. One survey question was included to confirm additional sources of compensation to determine any potential for conflict of interest. As no significant conflicts were noted, the integrity of the survey was not compromised.

The survey respondents did not receive any compensation for taking part in the study. However, it should be noted that a small minority work directly for a medical software vendor that supplies electronic medical records. In addition, several participants are linked to associated services or hardware sales, which directly support any implementation or installation of an electronic medical record system. This population, which received additional compensation from the industry beyond their primary employment, consisted of 9.8% of the total population (5 respondents).

Summary

Chapter 3 outlined the Survey and Chi Square methodology and basic procedures underlying this study. The design selected served to determine the relationships between variables of industry and non-industry participant perceptions of benefits and challenges of using electronic medical record. The relationships studied were reflected in the list of survey questions located within the appendix. The Chi Square method was determined to be most appropriate instrument for survey questions where participant can return a response of ‘Yes’ or ‘No’.

Chapter 4: Findings and Results

The most significant perceptions related to benefits and challenges of implementing an electronic medical record system was end users not fully understanding the way in which the entire operational system will continue to function.

These issues are raised by the staff, physicians, and patients, as they consider how they will access their medical records in the future. The findings do indicate a degree of concern related to the security of the technology, as well as for the need for proper training for those who could potentially need to access an electronic medical records system. These key findings can be translated to an integrated system as follows:

The organization under study is addressing perceptions of both challenges and benefits by requiring all employees who took on the challenge of working on this project to remain fully committed to the project. This process is working well, and employees are reporting that they are mostly very pleased with their decision to work on this very fast-paced and demanding project.

Response Rate

The personal sphere of influence included individuals aged 35 to 45 (Table 2). These individuals maintain a range of occupations ranges from customer service to executives. The majority of participants in the personal sphere of influence do not work directly within the healthcare industry, which is evident in the proportion of healthcare workers versus non-healthcare workers. The work sphere of influence consisted of a population of workers from local suburban hospital, which maintains approximately 100 licensed beds. The hospital is a full service facility, inclusive of emergency and surgical care services. The hospital currently employs at minimum 500 staff. Therefore, the total population who received the survey exceeded the minimum requirement of 200. The number of respondents from the hospital environment might have been greater if the survey was sent to any available email address, rather than only work email. Typically, during work hours, this segment of the population would have limited time to devote to the survey as their primary focus would be patient care.

The survey consisted is a majority of female participants. There was one participant that skipped question related to industry classification resulting in the ability to compare 50 participants between known categories.

Findings

The survey was available for completion for a total of 14 days. The survey was released to both populations on the same day, and ran for equal amounts of time. The participation in the survey was unpaid, and no party received any compensation or benefit for taking part in this study. Survey was structured based on the premise that individuals who are directly employed within the healthcare industry do have a general understanding of electronic medical records.

General industry consensus by some lesser-informed medical professionals is that electronic records will eliminate jobs and result in more work required adequately to document activities and vitals into a patient record. Therefore, the relevance of the present study is in its ability to shed additional light on the perceptions of potential users, in terms of the benefits of implementing an electronic medical record exceeding the initial challenges.

The data for this qualitative study was conducted by way of survey designed within the Survey Monkey survey tool. The survey was delivered electronically, primarily to staff members of a hospital with less than 100 beds. The survey was reviewed by appropriate administrators and corporate legal counsel prior to distribution. The survey consisted of 10 questions required ‘Yes’ or ‘No’ responses. A total of 51 responses were received during the 14 days allocated for data collection.

As the survey was sent to email addresses of some members in the population at their work computers, it is likely that they would not have placed survey as a priority, especially if involved in direct patient care. This is potentially an issue during the work shift, and explains why the number of responses is lower than expected. Nonetheless, the volume received is sufficient to reach a conclusion that there are both benefits and challenges related to the implementation of electronic health records. The overall conclusions were that the benefits of implementing electronic medical records outweigh the challenges.

Question two of the survey asked, “Are you otherwise compensated for your participation within the healthcare industry by method other than general employment?” This information is presented below in Table 2. This question was asked, as it is very important for a survey of this nature to avoid any commercial bias. It was confirmed that those who indicated that they received some degree of compensation from the healthcare industry work as part time nurses or care assistants. In addition, those receiving additional compensation may also work within the fitness arm of the healthcare industry, in the role of fitness instructor. Others may work in medical insurance sales or pharmaceutical/device medical sales.

The third question asked whether the participant is familiar with the term “electronic medical record." More than 88% of the respondents were familiar with the term. These results are presented in Table 3. This question was important, as if the respondent is not familiar with the term electronic medical record, they would not necessarily have formed an opinion of the benefits they would receive from having access to electronic medical record. Moreover, they would likely not be aware of the potential challenges of implementing a system. Thus, they could not offer an informed option regarding whether they would be willing to use such system to continue making advancements within their medical care.

The participants who were less familiar with electronic medical record work for smaller companies. Although they do have commercial insurance, they have lower quality plans with higher deductibles and limited communications from their plan administrator. Therefore, it is concluded that the 11% (or 6) of the respondents who were completely unfamiliar with the term “electronic medical record” are likely to be healthy, and thus require very few visits to a healthcare provider.

Question four inquired whether participants observed their provider using an electronic device during a medical visit. This is a very relevant question because it would reveal opportunities for opinions to have formed based upon the participants personal experience with their provider using an electronic tool in providing care. The responses revealed that more than 70% of participants have observed their personal providers utilize an electronic device of some sort to provide care. This information is reflected in Table 4. The respondents that did not know whether their provided used technology comprised 9% of the total sample and appear to be mostly composed of the same population who are otherwise not familiar with electronic medical record system (this is also reflected in Table 4).

The question whether the respondent was familiar with electronic medical record suggested that more than 88% of respondents would be more proactive in managing their medical care if they had access to electronic medical record, which is reflected in Table 5. This is directly aligned with the entire purpose of electronically medical records, HiTech, and Meaningful use. The goal of these programs is to reduce waste, and one way to reduce waste and redundancy is to have more direct involvement of patients. Patients are busy and do not have time repeatedly to call their providers for information. Hence, allowing patients to access their information directly is a highly desirable step towards patient compliance.

It is very important for patients to have access to internet services in order to benefit from an implementation of electronic medical records. As all the survey respondents were of working age, they should all have economic resources to maintain a personal internet connection. As previously noted, the population sample did not include individuals approaching retirement, i.e., those aged 62 or older, who might not be familiar with the latest technology or use internet. Nonetheless, owing to the inclusion criteria, as shown in Table 6, the studied population maintains internet access at 100%.

It should be noted that the results reported here are not generalized beyond the studied sample, approximately 98% of which indicated feeling comfortable with using technology. The ability to use technology will be instrumental in effectively using the tools offered by an electronic medical record system. Patients will need to be able effectively to register for an online account to receive notifications and additional information that would aid them in managing their personal healthcare.

The study participants are, as previously noted, well educated. Therefore, it is interesting that nearly 25% would find additional educational requirements a deterrent to accessing their personal health information by way of electronic medical record. Their concerns primarily relate to lack of time to take on any additional tasks while balancing family and work. Thus, the need to take any additional training, even if for a short period, would not be ideal for this group. Equally surprising is that the majority of these same respondents, who maintain commercial insurance primarily, would not be willing to pay any additional fee or maintenance charges to have access to their electronic medical records. Hence, in both these situations, it is imperative to ascertain willingness to take action regardless of the provider efforts to implement a system for the benefit of the individual responding to the survey.

The next survey question related to the willingness to pay an additional fee to access a personal medical record. It resulted in mixed responses and elicited more comments than any other question on the survey. The survey reflects that 28% of the population would not be completely opposed to paying for the additional benefit if offered at a low cost. However, the majority (72%) responded that the added benefit should be included in the current cost of care

The final question on the survey is one that is very relevant in climate of today, as it relates to privacy and security. Thus, it is reassuring to note that 58% of the respondents think their information would be secure if located within an electronic medical record system. This is an interesting finding, as about 60% of respondents are employed directly within the healthcare industry.

The survey was delivered electronically to the study population, and two weeks were allowed for the data collection, to ensure sufficient number responses required for the data analysis. The survey was delivered to two groups—those in the personal sphere of influence and individuals in the work sphere of influence, which was a much larger group. This method did result in obtaining more than the minimum number of survey respondents required for this study.

As this survey consisted primarily of questions aimed to determine if there is perception that the challenges associated with implementing an electronic health record outweigh the benefits, a mixed analysis inclusive of an electronic survey was utilized. The respondents were limited to a binary response (‘Yes’, or ‘No’). Respondents were also allowed to provide comments for all of the questions. The questions were designed to allow willing participants to complete the survey quickly and efficiently. The ability to respond within a short amount of time was important, as many respondents completed this survey during their shift hours. The primary dependent variable within this survey was familiarity with electronic health records. Other dependent variables related to the assessment of comfort using and accessing technology.

Summary

In summary, the data was analyzed upon retrieval from the survey tool and was subsequently analyzed within the electronic tool by selecting analyze data option that generated the results based upon the input generated from Survey Monkey survey tool. The survey questions were designed to require only ‘Yes’ or ‘No’ responses, which was appropriate to evaluate perceptions related to benefits and challenges of electronic medical record system. There were a total of 51 responses to the survey, and based on the degree of freedom being set to the number of observations minus one, i.e., 50, and the cumulative probability of one, the critical value was calculated at 112. There was one participant who did not respond to grouping question resulting in confirmation of industry vs. non-industry with 50 respondents. Each question was analyzed for the level of completeness, distribution, and relevance to the problem under investigation, i.e., whether there is a perception that the challenges associated with the implementation of electronic health records are greater than the benefits.

The results included responses from a wide range of respondents with unique backgrounds. It is believed that, due to the demographic makeup of the overall population, all participants completed at least high school education, and the majority also holds at least a four-year degree. Overall, the majority of responses to all questions reflected a positive attitude towards implementation of electronic medical record system. The comments from participants related to questions focused on obtaining information about the perceptions associated with electronic health records were also extremely positive. The results provide that, irrespective to the links to the healthcare industry, most respondents do maintain a general degree of knowledge about electronic healthcare records. In particular, respondents that represented the patient population from the community indicated that they would take advantage of additional benefits, which would be available to them through the integrated records system. They understood that this would allow them to access electronic data and manage their health more proactively. The largest concern identified in the survey is related to security and privacy. Majority of respondents felt that their electronic medical record information would be safe, and the overall results indicate that the population does agree that reasonable precautions to protect records are in place currently. Moreover, they believe that these protections would continue and or increase as organizations continue to gain increasing levels of experience with the management of electronic medical records. The subsequent chapter will highlight the results, conclusions, and recommendations.

Chapter 5: Summary, Conclusions, and Recommendations

Introduction

This research suggests that, although there is considerable information available on the implementation of electronic medical record systems, it is difficult to ascertain how it influences the public opinion. The data supporting the view that implementing an electronic medical record system is associated with numerous the challenges is considerable. However, there is also considerable opposing information available, which highlights the benefits to the patients by providing improved efficiencies that lower redundancy and reduce cost. Most importantly, the introduction of electronic medical records is shown to improve patient safety and quality of care, as well as lower the cost for organizations that fully implement and utilize an electronic medical record system.

Summary

The purpose of this study was to analyze both the benefits and challenges of implementing an electronic health record system. This aim was achieved by firstly conducting a literature review, the findings of which guided the design of a survey distributed to the study population. Subsequently, the survey responses were subjected to data analysis, which yielded the conclusion that access to electronic medical record system is expected to generate positive outcomes. As displayed in Table 5, the majority of respondents indicated that they would be more actively engaged in their personal healthcare if electronic record system was in place, allowing easy and cost-effective access to their records.

Conclusions

The survey conducted as part of this study revealed that, although the general perception is that US public is not in favor of the implementation of electronic medical records, the majority of the respondents did indicate that they would use electronically medical records for additional management of their personal health. Further, the majority also noted that the availability of electronic medical record would promote their ability actively to participate in their care, for which they would be willing potentially to pay additional fee. They also felt that this initiative would promote their ability to participate in additional education related to maximizing the use of the information available within their personal electronic medical record. The findings reported here suggest that the perceived challenges of implementing an electronic medical record system are indeed significant, but do not exceed the benefits that will be generated by the availability of electronic medical record. There were no comments within the survey, or research identified within the literature review that revealed a completely negative outcome of the implementation of electronic medical record system without there being at least one positive outcome. This current study thus maintains several key aspects which are relevant.

Discussion

The organization under study is a large integrated system working to implement an electronic medical record system for a large number of hospitals and many multi-specialty clinics. The organization under study also worked diligently to address perceptions of both benefits and challenges of implementing an electronic record system by operating with complete transparency sharing information with the end users which include the staff, providers and patients. The organization under study operates with the direction of the governing body and executive team where decisions are presented, and consensus for all major decisions jointly decided.

The organization addressed the initial challenges related to cost of the application by agreeing fully to engage staff to work efficiently to install the application. This staff engagement included long-term commitment from staff to complete the project and to encourage continuity and familiarity with the processes. This commitment from staff directly involved in the project provided assurance and eases the concerns of staff members who were not directly involved in the actual implementation process.

The next steps address challenges revolve around training and this was addressed by the deployment of an extensive training program open to all users who will be directly involved with data going into or being retrieved from the system. This training addresses the challenge of understanding how the system will work and all associated operational workflows.
During this same time, various surveys were continuously deployed within the system to learn of any other perceptions of challenges which required additional information, education or transparency. The implementation team frequently provides immersion opportunities whereby there was direct communication with end users and the community who would generally less involve, but concerned of the perceived challenges. The immersion opportunities where educational events which describe the application, how it works, and the benefits gained from the system such as improved opportunity to continue enhancements in patient safety monitoring, resource efficiencies and data reporting.

Over time, the amount of anxiety among potential internal users appears o have decreased. At the same time, communication to the non-industry users and beneficiaries of the electronic medical record system was occurring to address these perceptions related to explaining how they would directly benefit from the installation of electronic medical record system. Ongoing education and marketing campaigns explain to non-industry participants how an integrated record improves efficient, patient safety and provides an added opportunity for their engagement in their personal health and the health of family members.

As a result of all of this ongoing activity, the research study of this paper was approved to study both non-industry and industry professionals to gain insight into their current opinion of how their current perception of benefits and challenges associated with the implementation of electronic medical record system. The problem this study addressed relates to the perception of benefits and challenges which come with implementing. Additionally, this study has benefited from having access to well represented population, consisting primarily of individuals who are well informed, maintain commercial insurance, and are thus more likely to be concerned with wellness to promote more efficient utilization of healthcare services. Upon completion of the survey, the results displayed consensus from population study the benefit they will receive from having access to their information in form of electronic medical record system was beneficial and the benefits directly received or received for the benefit of a family member are greater than the perceptions of challenges associated with the implementation of a system.

Recommendations

The study findings reflect a significant interest in the implementation of electronic health records. Although there are well-publicized challenges with implementing such systems, the overall view is that electronic records and systems provide benefits to both the patients and the communities the healthcare providers serve. The perceptions related to personal data security are issues that will be continually addressed by the industry and providers to gain additional acceptance. If those within the industry are not completely confident in the protocols established to maintain their records in most secure manner possible, it is likely that the patients would share this view, and this will be an area for potential future study. However, the results prove the benefits are greater than the risks, and the recommendation is to move forward with the installation of electronic health record system when viable option is available. One recommendation for future researchers is to continue to monitor the adoption and acceptance of the implementation of electronic medical records, as additional data will be available, reflecting benefits and challenges that arise with implementation and adoption. As perceptions of challenges are expected to decrease, as current adopters of the technology learn from prior mistakes, it would be useful to repeat this study during an optimization period after complete implementation.

The Shingo Model

The contemporary companies are constantly seeking for improvement in their respective organizations. Thus, for the companies and in fact in any organization to be thriving for a long-term, they should be involved in a constant pursuit to make things better for their organizations. On the other hand, if the organizations fail to make this an organizational preference will certainly cause an organizational collapse.

Accordingly, excellence should be the quest of all great organizational leaders. Indeed, the fervent search for perfection, even seeing it is highly impracticable to realize, elicit the very best capabilities in all organizations.

Improvement in a company necessitates the change of a culture to one where every single worker is involved each day. All the modern organizations are constantly in flux. Thus, the critical issue is how the organizations are being changed and what are the factors of the transformation?”

The Shingo Model claims that successful organizational change takes place when the organizational leaders comprehend and take personal accountability for developing a strong and long-lasting culture of constant improvement in the companies. According to the CEO of a highly successful company stated, “Leaders lead culture!”
Following are the salient recommendations suggested by The Shingo Model for the Companies that seek to implement EMR normally in their organizations in both hospital and clinic environments in particular.

Continuous Process Improvement

Continuous improvement starts by explicitly explaining the values by means of the viewpoints of clients. The expectations from the process should be plainly discussed so the EMR systems can be outlined to fulfill the clients’ requirements. All the workers should understand the best possible path for improvement whether the process is generating good products or services. Special focus should be given on a faster, more flexible reaction all over the EMR system.

The motivation for constant improvement cannot simply be quality or cost. however instead it should encompass all features of value as perceived by the workers, consisting of improvement, quality, cost, flexibility, fast delivery and a holistic viewpoint of healthcare and security.

Moreover, the Continuous improvement in the system should focus on flow of value that necessitates both logical thinking and the capability to discover and remove redundant values.

Principle – Seek Perfection

It should be considered that to comprehend the continuous process improvement fully in implementation of EMR in the organization has no specific end points. This outlines Shingo Model organizational values that the companies should always seek for the problems where there does not seem to exist. Besides, the quest of perfection shows that there exist constant prospects for improvement in the companies. As well, there continues to be wastage, and the more a given process is followed, the more wastage emerges. Thus, seeking perfection helps in the improvement and the forward movement at the right direction.

The problem-solving may suggest that when an EMR is implemented in a company then improvement is accomplished. Hence, looking for perfection in combination together with scientific reasoning helps in clearly outlining values for the customers. There are four goals of improvement that should help in making things easier, better, faster and cheaper for the implementation of EMR in the organizations. Specific stress should be put on a faster, more responsive base all for the implementation of EMR system.

Principle – Focus on Process

A process-focus should recognize that all out-puts, whether it is product or service, are generated by processes working on the inputs. There is a general maxim which is normally ignored i.e. good procedures will create the desired productivity, given that proper inputs are offered.

In addition, process-focus assists in problem-solving endeavors on process instead of people. As well, a holistic movement to process-focus removes the trend to find the workers who made the mistakes; however it rather initiates a search of the real culprits that contributed in making the mistakes. Hence, process-focus also helps the cultural enablers, outlining an environment wherein learning from the oversight can become an influential aspect of continuous improvement.

Principle –Embrace Scientific Thinking

A motivation on process leads to scientific thoughts, a natural method for learning and the most effective approach to improvement of the system in the organizations. All the workforce should be taught to apply scientific philosophy to enhance the system processes where they work, generating a culture that offers common perception, methodology and culture concerning the improvement. Scientific thoughts are also results-oriented in the modern organizations that place a payment on explaining and discussing favorable consequences all over the organization.

Principle – Flow & Pull Value

Flow value thinking is thought to be the focus on reducing the lead-time from the initiation of the value stream to the conclusion of the value stream with the removal of all obstacles that hinder the generation of value and its supply to the client.

Moreover, the Flow value is considered to be the best driver to generate the processes quicker, easier, cheaper and superior. As well, other prospective drivers like unit costs or process variability are considered too strictly emphasized, varied preferences and offering sub-optimized consequences. In addition, a cost focus is especially problematic when it generates poor motivations and budget management concerning to concrete improvement.

On the other hand, Pull value is the notion of comparing the speed of manufacturing with the level of customers’ demands in any situation. However, Pull value is not practicable or cost-efficient without the flexibility and brief lead times that occur from Flow value.

Flow and pull values generate a large amount of positive advantages in all facets of business activities. Accordingly, the Flow value will cause improvements, consisting of improved security and drive, more reliable quality with a smaller amount of defects, rise in on-time delivery and flexibility and reduced expenses, without meeting the conventional trade-offs. Besides, daily and weekly consequences become more reliable and conventional.

Principle –Assure Quality at the Source

The companies should be dedicated to stop and fix processes that create defects in the implementation of EMR, instead of maintaining products and services forward whilst planning to resolve the issues afterward. In fact, the proper utilization of the human resources in the brainstorming, assessments, problem-solving and the execution of EMR is significant to constant upgrading.

Stabilize Processes

Stability in process making is the basis of any advancement in the EMR system that creates stability and repeatability. As well, the stability is a requirement for enhancement of the system offering a rationale for problem recognition and constant enhancement. Nearly all of the constant improvement principles in the EMR depend on the stability.
As well, stability is the forerunner to realize the flow. A number of the explanations for waste are rooted on the volatility of processes since they seem beyond the human control. Rather than, the companies should apply the fundamental tools in hand to decrease or remove instability and generate processes that facilitate the identification and removal of waste with the help of EMR.

Standardize Processes

Whilst stability is a crucial requirement for generating flow and enhancement the standardization creates control into the procedure itself. Standardization works as a fundamental principle to maintain advancement, instead of reverting to earlier practices and outcomes.

As well, standardization removes the need to control EMR operations by means of cost criteria, production goals or other conventional management methods. When standardization is ready, the work itself operates as a management control instrument. The managers are relieved for other assignments as they are not needed to supervise and manage the work process.
Insist on Direct Observation

Direct observation is considered as a supporting concept related to systematic philosophy. Indeed, it is the gateway of the logical process. Direct observation is vital to comprehend correctly the process or events being analyzed. Normally, ideas, past events, discernments and imprecise norms are misinterpreted as authenticity. By means of direct observation, realism can be observed, validated and recognized as the consent.

Focus on Value Stream

Flow and Pull Value together with Focus on Process evoke the need of explaining value streams and motivating organizational focus on them. In fact, a value stream is the compilation of all of the vital steps needed to offer value to the clients. To explain what clients’ value is a vital step to concentrate on the value stream. Besides, clearly comprehending the whole value stream, nevertheless, is considered as the only pathway for a company to enhance the value delivered and to improve the procedure by which it is offered.

Keeping it Simple & Visual

In the modern society, there is a frequent predisposition towards multifaceted solutions and a payment offered to those who appeared to deal successfully with the complexity. Nevertheless, it is normally the case that optimum consequences at a reduced expenditure can be realized by generalization.

Identification & Elimination of Waste

Concentrating on the removal of waste will constantly motivate suitable activities, whilst the incorrect motivation can become a problem to improve large stock record etc. One method to consider waste slows or hampers the constant flow of value to the clients.

No Defect Passed Forward

The concept of No Defect Passed Forward (NDPF) is important for operational value from various outlooks. From a manager’s outlook, it needs great courage to prevent the process long enough to recognize the fundamental rationale and espouse a countermeasure that stops the event from resurfacing. For the organizational leader, this, usually, implies dealing with any temporary loss for large long-standing benefits. Moreover, the systems must be ready to guarantee that any outcome that differs from the norm generates a prospect for immediate response. However, the concept of NDPF necessitates an approach of tenure and liability. When the norms are clearly explained, each person must understand their benefits. The managers must prove themselves as a role model then outline the conditions for fellow workers to create the approach of individual reliability. It implies that no one person would ever intentionally or eagerly advance the result of their value contribution to somebody else if it consisted of the slightest deviation from the norm.

The concept of NDPF facilitates the attitude and tools for continuous improvement in the EMR environment and generates the necessary conditions for perfection.
Integrate Improvement with Work

With a tendency to migrate towards a principle-based society, the activities and methods for constant improvement become an essential aspect of the routine work of all employees in a company.

The human resources constantly evaluate the existing status of their processes and chalk out a better prospect condition that will improve the value, or it will remove the waste and thus realize a perfect condition. Each employee in a company carries out the routine work. Thus, when improvement is linked with work, the workers accept responsibility for improvement of the routine work processes.

The managers are duty-bound for enhancing strategy creation processes as well as resource alignment procedures. In fact, they are mainly given the task to organize mission-critical strategy and standards all over the company in such a way that all workers not only must have a clear vision of the company’s goals but are also stimulated by the company’s mission that generates a convincing case for improvement.
In addition, the managers in the company are given the task for developing quality systems, and various systems to work optimally. The line workforce is given the task for advancing their cycle periods, as well as quality of work and production.

Rely on Data & Facts

The Shingo model emphasized the importance of data-focused to realize constant improvement. The Model commonly gave examples of particular circumstances where data was compiled; however, it might not be the right data being utilized in the improvement process in the companies. Finally, the Model was inflexible that the comprehension of the true process is so comprehensive that when implementing an EMR process, the improvement, as shown by the data, could be calculated. Hence, understanding is needed between the estimated outcomes and the true outcomes to make the improvement process data-driven. Moreover, when the data is considered inaccurately, there exists a trend to ignore possible improvement and not to accomplish any improvement in the organization.

Alignment

It must be noted that the most major malfunction of the contemporary management system is its motivation on strategy and planning without taking due care to its implementation. In order to be successful, the modern companies must develop EMR systems that support work behaviors with principles and direction in the manner that are uncomplicated, understandable, practical and homogeneous. The company leaders are unable to create individual methods without initiating huge waste in the companies.

The organization of study necessitates a management system built around systematic philosophy, along with more stress on learning cycles than on ideal planning. Thus, it is important to create efficient communication methods to gain consensus, patent accountability as well as the EMR systems where implementation and countermeasures are organized and pursued. Fundamentally, operational excellence in the contemporary organization is the characterization of successful business strategy operation when the strategies are linked with true principles. In fact, the creation of value for the clients is eventually realized by means of the successful placement of every value stream in the company.

Align Systems

The stakeholders believe that the total potential of the company is realized only when the critical aspects of the enterprise have the distinctive rules of operational excellence, management systems and tools for the EMR. Whilst it is hoped that the companies create some unique traits of their local traditions, it is moreover hoped that rules become a frequent, unified feature of each environment.

Align Strategy

Policy organization for EMR is a planning and implementation process that depends on systematic ideas, workers participation and reverence for the individuals. Moreover, at the strategic echelon, the policy organization offers the company with the essential rules, systems and tools to circumspectly link core objectives and implementation strategies of the company whilst facilitating it to realize those targets.

Principle – Think Systemically

Systemic thinking implies the principle that fuses together all other rules of operational excellence and facilitates the companies to uphold their philosophy of constant improvement. Moreover, it necessitates the companies to both study and analyze. The analysis is primarily concentrated on thoroughly assessing various aspects of companies operations.
The organizational leaders appreciate the effects of synergy. In view of the fact the managers plan and align the EMR systems with precise rules, they must think systemically. Consequently, the full value of operational excellence is accomplished all over the organization. Moreover through these practices, they develop the needed outlook to start carefully improving the projects independently.

References

We’ll work on these after the paper is formatted.
Appendix A: Survey
Appendix B: Survey Questions
- Are you employed within the healthcare industry?
- Are you otherwise compensated for your participation within the healthcare industry? (i.e., are you a contractor, temporary service provider, consultant, product sales, etc.)
- Are you familiar with the term Electronic Medical Record?
- Have you observed if your primary healthcare provider currently utilizes a computer or other electronic device such as a tablet (ipad or similar device) to input data specific to your medical complaints during your visits?
- If you had access to your medical records in an electronic format, would you be more proactive in managing your personal health?
- Do you have access to the internet for personal use? (i.e., in your home or on a personal mobile device)
- Are you comfortable using technology, such as computers, smart phones, and tablets?
- Would a prerequisite educational requirement, such as an online tutorial focused on understanding what is included in an electronic medical record, reduce your interest in electronically accessing your information?
- Would you pay an additional out of pocket fee to maintain access to your personal medical record in an electronic format?
- Do you think your personal information is secure if maintained within an Electronic Medical Record System?
Appendix C: List of Basic Computing Skills
Listing of ten basic computing skills necessary for healthcare professionals in the era of Electronic Medical Records
- Organize electronic information (e.g., naming documents, setting up directories, moving files, renaming files)3
- Use a word-processing package to generate simple documents
- Enter and manipulate data using a spreadsheet
- Search a simple database
- Undertake searches and access relevant sites on the World Wide Web and relevant health-related databases
- Retrieve/download electronic documents from various sources and transfer data from one application to another
- Explain the reasons for electronic networking and give examples of its use in healthcare
- Send, retrieve, and acknowledge e-mails and attachments
- Identify examples of the use of information technology as an effective tool in the delivery and management of healthcare
- Evaluate the effective use of information systems in the National Health Service. Discuss why different examples should be paper-based or electronic (Kidd, 2006)
Appendix D: List of Basic Computing Skills
Listing of ten basic clinical informatics skills necessary for healthcare professionals in the era of Electronic Medical Records
- Understand the dynamic and uncertain nature of medical knowledge, and be able to keep personal knowledge and skills up to date
- Know how to search for and assess knowledge according to the statistical basis of scientific evidence
- Understand some of the logical and statistical models of the diagnostic process
- Interpret uncertain clinical data and deal with artifact and error
- Structure and analyze clinical decisions in terms of risks and benefits
- Apply and adapt clinical knowledge to the individual circumstances of patients
- Access, assess, select, and apply treatment guidelines, adapt them to local circumstances, and communicate and record variations in treatment plans and outcomes
- Structure and record clinical data in a form appropriate for the immediate clinical task, for communication with colleagues, or for epidemiological purposes
- Structure and communicate messages in a manner most suited to the recipient, task, and chosen communication medium (Kidd, 2006)
Appendix E: Open Ended Survey Questions Responses
Page 2, Q3. Are you familiar with the term Electronic Medical Record?
1 Using a tablet or pc to keep records during visits and to submit patient's
information on file.
Page 2, Q4. Have you observed if your primary healthcare provider currently utilizes a computer or other electronic device such as a tablet (ipad or similar device) to input data specific to your medical complaints during your visits?
1 My Dr. uses the device at every visit. Recently, I went to the dentist and
observed my status and my teeth profile on the computer.
2 Mostly used by sales force and medical education group May 23, 2013 9:24 PM
Page 2, Q5. If you had access to your medical records in an electronic format would you be more proactive in managing your personal health?
1 Would be very helpful to look at my medical state as the Dr. has recorded in
the records.
May 24, 2013 10:29 AM
Page 2, Q6. Do you have access to the internet for personal use?
(i.e., in your home or on a personal mobile device)
1 Cell phone has internet service. May 24, 2013 10:29 AM
2 Home, mobile, work and tablet. May 23, 2013 9:24 PM
Page 2, Q7. Are you comfortable using technology, such as computers, smart phones, and tablets?
1 I am not as savvy with it as I would like to be. May 29, 2013 8:08 AM
7 of 8
Page 2, Q8. Would a prerequisite educational requirement, such as an online tutorial focused on understanding what is included in an electronic medical record, reduce your interest in electronically accessing your information?
1 I don't think so; I think it would be very good if you didn't work in healthcare. Jun 6, 2013 11:58 AM
2 I don't like required tutorials. An option to participate would be better. Jun 4, 2013 8:11 AM
3 Would be helpful May 24, 2013 10:29 AM
4 But only if its very brief May 24, 2013 3:09 AM
Page 2, Q9. Would you pay an additional out of pocket fee to maintain access to your personal medical record in an electronic format?
1 I don't really know. I can see that I might if I had certain health issues. Jun 6, 2013 11:58 AM
2 Maybedepends on the cost. May 30, 2013 6:59 PM
3 Unless the fee was unreasonably expensive. May 29, 2013 8:08 AM
4 As long as the cost are not excessive. May 27, 2013 8:29 AM
5 Can’t afford any out of pocket expenses. This should be part of medical visits. May 24, 2013 10:29 AM
6 Yes, but it would need to be relatively inexpensive. May 24, 2013 10:07 AM
7 Within reason. May 24, 2013 10:00 AM
8 It should be free with the purchase of medical services, such as Dr visits, exams, etc.
May 24, 2013 8:57 AM
8 of 8
Page 2, Q10. Do you think your personal information is secure if maintained within an Electronic Medical Record System?
1 I used to, but not so sure anymore. Jun 6, 2013 11:58 AM
2 I don't think anything is absolutely secure on computers. Jun 4, 2013 11:36 AM
3 I feel that anyone can access your records even if that person(s) is not involved
in your care.
Jun 4, 2013 8:11 AM
4 But it is only as good as the provider. May 30, 2013 5:35 AM
5 With adequate firewalls. May 29, 2013 8:14 AM
6 I have some concern about that. May 29, 2013 8:08 AM
7 I think so because most electronic systems require a pass code to enter. May 27, 2013 8:29 AM
8 Medical information could be obtained by hackers. May 24, 2013 10:29 AM
9 There are so many hacking attacks with credit cards from retail companies. It
would be difficult to secure Medical data as well.
May 24, 2013 8:57 AM
Page 2, Q11. Additional Comments?
1 The only negative effect I see with EMRS is that MY physician does not check
past visit thoroughly. Often times, I have found my physician were not even aware of a condition I had from a past visit. I guess negligence can plan a part in any situation, including paper records.
2 Technology is a very good way to keep up with records, but back-up records should be kept in some form.