EHRs
Electronic Health Records are a broad category of HITs containing a patient’s clinical history. The system’s primary user is the provider and would encompass primary clinical information relevant and unique to the patient from the provider’s perspective. Some of the information contained in EHRs include demographics, medication reports, patient charts, laboratory data, and past medical information. Thus, the system is an automated version of patient information offered as part of the support process from various interface users (Keyhani et al., 2008). This paper considers the lifecycle of EHRs through a description of the process involved in selecting a new EHRs product such as Cerner.
The four phases of EHRs Life Cycle
Needs assessment/analysis
The needs assessment phase is most important part of the EHRs-driven change project. According to McCartney (2010), this phase offers the direction required for issue identification and EHRs selection. The primary tasks under needs assessment include issue identification, exploration of possible issues, and the selection of a suitable system. Also suitable is the identification and definition of goals to establish shared perspectives of the system in question. Ideally, patients should be the chief beneficiaries of EHRs. Therefore, it is vital to conduct an assessment in ways that offer customized EHRs solutions as applied to clinical practice.
System selection and design
This phase encompasses the project’s tactical plan that involves system selection, budget, and scope. The senior management forms a team of experts from all departments to identify the technical and role-based needs of the EHRs as well as available products under this category. The search would include a review of product platforms, literature, networking, and conference presentations. The selection process further includes the designing and submission of proposal requests (RFP) for suitable vendor recruitment. Notably, it would be ideal for the team to allow onsite modification and performance testing to enhance adaptability (Lorenzi, Kouroubali, Detmer, and Bloomrosen, 2009).
Implementation
At this stage, the change management team customizes, tests and installs the EHRs. This phase encompasses staff training on system installation, maintenance, and outcome evaluation. According to Lorenzi et al. (2009), implementation will also attract the evaluation and designing processes to have it fit organizational needs. For instance, as a EHRs product, Cerner should have the capability to address the organizational requirements in the ambulatory setting. Further processes would include outlining the tasks in ways that address role conflicts, complicated communication patterns, and regulatory constraints. Ideally, a good change management team is imperative to address the issues surrounding the new EHRs during the implementation stage.
Evaluation and Maintenance
This phase recognizes the dynamic nature of radical changes in healthcare environments concerning HITs. McCartney (2010) notes that the system would require constant adaptation exercises to emergent practices and organizational behavior. Some of the notable accommodations include the changing interpersonal and staff relationships, technological advancements, regulatory requirements, and the environment. On one hand, evaluation implies the utilization of a multidisciplinary team to identify issues that can affect the functionality of the selected EHRs. The evaluation process touches on problem identification, planning, design, and auto-correction. Contrarily, maintenance concentrates on analyzing system viability for successful system sustenance.
Diagram of the phases
Elements to be included in a Needs Assessment
The most basic form of needs assessment here would include three major elements described as follows. First, there would be a time to determine ideas about the current organizational situation as well as identify areas that require improvement. The next element involves needs identification through data collection. The last element would include a series of needs descriptions and the establishment of an implementation or solutions plan (Ajami, Ketabi, Isfahani, and Heidari, 2011).
In this case, the organization conducts a needs assessment to ascertain that it requires EHRs to streamline most of its operations. Some of the problems identified relate to efficiency and QI issues associated with traditional clinical methods. The change management team then collects and analyzes information to determine the importance of EHRs adaptability in the clinical environment. Ideally, the organization would want to improve its patient outcomes through the enhancement of care systems. Therefore, it could consider selecting a product that would have a positive impact on existing systems to further streamline organizational operations (Ajami et al., 2011).
Members of the steering committee and their importance
The steering committee would contain an appropriate leadership as appointed by the chief executive and heads of department. In this case, it would be essential for someone with a background in Informatics or ICTs to lead the change management project. Ideal leaders include the head of the IT department or the Informatics Nurse as directed by the Chief Nursing officer. Nonetheless, both professionals should be part of the steering committee that would oversee the project’s life cycle. The reason is that IT managers and Informatics Nurses would use their expertise to drive change and identify appropriate areas that require maintenance. The committee would also include representatives from the finance, administration, pharmaceutical, medical departments (Lorenzi et al., 2009).
Strategic Product Selection
The steering committee will have an active involvement in the creation of a product selection strategy. There will be a series of factors to consider in this strategy to cater for the long term and short term needs. Some of these strategies could involve the following pointers. First, the process would begin by brainstorming for a series of EHRs products and vendors that could meet current HIT requirements. Next, the product in question should reflect the services available as compared to the competition. Third, the product’s price should be reflective of the market price of similar products and their equivalents. Third, the product’s components should support the organizational objectives and operations for efficiency maximization. Finally, the ultimate product selection should fall within the organization’s budget limits for a period covering the entire program lifecycle (Yen and Bakken, 2012).
Components of the EHRs to be evaluated
There are five basic components of the EHRs under analysis. These components include patient management, clinical management, lab, radiology, and billing. The patient management aspect would be vital for key patient information operations such as registration, transfer functionality, and admission. This component would encompass a number of PHI such as demographics, contacts, and insurance (Keyhani et al., 2008).
The clinical component includes order entries, nursing, and documentation. The three major items allow providers to maintain useful data repositories through documented patient notes, drug-diagnosis interaction, drug formulary, and vitals among others. The lab component would capture results from lab tests as well as integrate them with billing requirements. Furthermore, the EHRs requires the radiology component for ease in managing workflows, images, and ordering processes. Finally, it would be vital to incorporate a billing system to help in capturing all the charges generated during the care process (Keyhani et al., 2008).
Potential Training Requirements of Users.
Resistance to change comes from the idea that the new system is not compatible due to poor implementation techniques. Therefore, end-user training would help in mitigating some of this resistance. Also, it would minimize chances of technical abuse and failure through the extensive provision of information on usage and professional mix. As a vital support strategy, training aims at achieving compliance and acceptance among end-users. This process would include initial user support, the importance of patient PHI protection, security controls, and the importance of the EHRs in the new clinical set-up (Yen and Bakken, 2012).
References
Ajami, S., Ketabi, S., Isfahani, S., & Heidari, A. (2011). Readiness Assessment of Electronic Health Records Implementation. Acta Informatica Medica, 19 (4), 224–227.
Keyhani, S., Hebert, P. L., Ross, J. S., Federman, A., Zhu, C., & Siu, A. L. (2008). Electronic health record components and the quality of care. Medical Care Journal, 46 (12), 1267-72.
Lorenzi, N., Kouroubali, A., Detmer, D., & Bloomrosen, M. (2009). How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Medical Informatics and Decision Making, 9 (15), DOI: 10.1186/1472-6947-9-15.
McCartney, P. (2010). What Is the HIT Systems Life Cycle? American Journal of Maternal Child Nursing, 35 (5), 301.
Yen, P., & Bakken, S. (2012). Review of health information technology usability study methodologies. Journal of American Medical Informatics Association, 19 (3), 413–422.
