The increased use of health information technology (HIT) has resulted in improved quality, lower costs, and reduced errors in health care delivery. The cumbersome and inefficient paper-based health records systems are on the way out the door. Everyone knows Electronic Health Records (EHR) offers a far more effective and efficient means to provide quality health care. But what has to happen before an EHR system is functioning the way a healthcare provider needs it to?
In September 2009, the Associated Press reported that “fewer than 10 percent of U.S. health care providers are using electronic medical records.” The push is on, however, for EHR implementation because of the prospect of cuts in Medicare and Medicaid payments to providers who cannot demonstrate “meaningful use” of HIT by 2014. How can the lessons learned by the providers who are using EHR help those who have yet to implement it?
Some of the lessons learned can be applied to health care organizations of all sizes. However, there are some challenges and benefits unique to small clinics, physician offices and for the smaller hospitals.
Of course one of the most often cited benefits of an electronic medical records (EMR) system is the elimination of paper records. Health care organizations of all sizes can save time and money when papers do not have to be filed and storage cabinets are no longer needed. If you are a healthcare provider currently using paper-based records, watch how much time it takes your staff to track and acquire those files throughout the day. You may be surprised when you uncover the amount of time your staff spends playing “hide-and-seek.” Frankly, the implementation of EMR and its impact on reducing this amount time alone can many times justify the cost of EMR acquisition. But most important is the improved healthcare delivery with EMR implementation.
One of the challenges of a quality EHR implementation for all organizations, no matter what size, is the critical requirement for computer and network systems to be fast, flexible and reliable. And above all, these EHR systems require significant capital expense for software, hardware and training. Because of this issue, a hospital and clinic can depend on Managed Service Providers (MSP) for their infrastructure. MSPs provide the equipment, maintenance, and support needed for a healthcare delivery system which cannot tolerate glitches or downtime without the cost of going it alone.
a. Lessons for the physician’s office and small clinic practice.
A case study of the EMR implementation at Denver’s Public Health STD Clinic offers several findings for the small clinic. An immense benefit of an EMR is that lab results are available in the exam room so that a clinician does not have to spend time and energy searching for them. Also, the entire patient history is available and can be searched electronically rather than clinic staff flipping through thick folders of paper to gather history and find information.
The Denver study faced a couple of challenges with a staff of generally inexperienced computer users and the entrenchment of established processes. At times, Clinic personnel did not have a high degree of computer literacy and skill, and were anxious about the need to adapt to the computerized EHR system. This required significant time and resources for staff computer and systems training. An MSP can facilitate a more reliable adoption process by supplementing software vendors with experienced computer trainers to bring clinic staff up to speed for the HIT implementation.
Another challenge identified by the Denver study was the need for consultants to thoroughly understand and be able to document the complex processes and workflow in the medical environment. Many MSPs utilize process redesign consultants that have the skill and experience required for this planning phase of the HIT project.
Financing is, of course, an issue raised by most small and medium healthcare providers. Many of these entities are publicly funded, non-profit organizations with chronic capital constraints. They are under particular pressure to show direct return on investment for expenditures and often rely on grant funding which is usually designated for direct patient care. While healthcare IT initiatives are proven to result in improved healthcare quality, it is accomplished in indirect way. Therefore, while cost is a consideration for all healthcare organizations, it is a disproportionate burden for the small and medium healthcare providers. The small practice will benefit greatly from the cost savings realized by engaging an MSP.
b. Lessons for hospitals
In a hospital setting, the immediate access to patient records provided by electronic health record (EHR) systems can make a critical difference in the quality of care. This is especially true in an emergency room setting where healthcare workers rely upon fast and reliable information to make urgent care decisions. Lack of patient history and drug records inhibits timely decision-making on care delivery. Even in non-emergency care, EHRs provide a great benefit in coordination of care between primary care providers, specialists and multiple provider practices.
When the National Health Service in England began the initiative to create a single EHR for every individual in its system, it found an obstacle with public and physician resistance to EHR implementation. Both health care providers and patients were concerned about the confidentiality of health records. Especially they felt threatened by the ease of communicating medical data and the access across provider organizations. MSPs provide an elevated level of security and data integrity that reduces the fears of both patients and providers.
A primary concern for hospitals is the complex nature of IT projects. Any information technology (IT) project has an incredible number of moving parts which must be managed in a systematic, incremental way. With the additional complexity that a healthcare information technology project adds, a Managed Service Provider can be an important resource in assisting IT Managers at overseeing the implementation of these difficult projects.
The American Hospital Association (AHA) has expressed concern about the federal government’s aggressive timetable for implementing HIT. In a letter to the HIT Policy Committee the AHA stated, “…this aggressive schedule could threaten patient safety and quality of care as hospitals are forced to shift to a mere technical implementation of technology rather than the more methodical process of implementing HIT system changes…” The AHA recognizes the change management involved in an HIT project and that the rush to implement may jeopardize the quality of the projects implemented. If hospitals must meet the 2014 timeframe for achieving “meaningful use” of HIT in order to avoid financial penalties, MSPs are valuable partners and managers of these fast-track projects.
Whether a health care organization is small or large, there are many challenges and benefits in a HIT implementation. A Managed Service Provider helps reduce the risks and helps the healthcare provider reap the rewards of an EHR project. MSPs deliver security, reliability and quality to the health care organization seeking to improve its health care delivery.
Works Cited
AHA Letter to HIT Policy Committee. Washington: American Hospital Association, 26 June 2009.
Granger, Richard. Study of Health IT in Government: Challenges to achieving the vision of a universal electronic health record. Intergovernmental Advisory Board. Washington: American Council for Technology, 2006.
McEwen, L. Dean, Brandy, Subiadur, Julie Mitchell and Arthur Davidson. Implementation of an Electronic Medical Record in a County Public Health STD Clinic. Health IT in Government. Intergovernmental Advisory Board American Council for Technology. Washington, 2006.
Moiduddin, Adil and Jonathan Moore. “The Underserved and Health Information Technology: Issues and Opportunities.” Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services, 2008.
Twiddy, David. “Work begins on national e-health record network.” 30 September 2009. Washington Post.com. Associated Press. October 2009 <http://www.washingtonpost.com/wp-dyn/content/article/2009/09/30/AR2009093000522.html>.
