As
the process of storing and retrieving patient information is changing from
paper based records to electronic medical records, facilities are noticing very
specific improvements in business operations and processes. This impacts health organizations and patient
treatment especially in rural communities where health care access may be
limited.
The
challenges that facilities face in implementing these systems is enormous and
routinely underestimated. Since the
‘top-down’ perspective assumes the improved benefits from an EMR the reality is
there has not been much talk on ‘how’ to implement these integrations (Oneill,
2007). The implementation of an EMR
consists of a total business reprocess engineering effort. This affects every aspect of a health care
facility from top managers, employees, staffing, physicians, and billing. Challenges that paper-based facilities encounter
are that the paper record needs to be in two places at once. Sharing of the information between
departments is tedious and time consuming not to mention trying to track the
paper chart throughout the facility. At
any given time employees from lab, diagnostic imaging, pharmacy or billing may
need to access a patient’s chart simultaneously to get information for
treatment. This is one reason for
electronic medical records integration.
The first step in the process is vendor selection.
Vendor
selection is a critical part in starting the process for EMR
implementation. Vendor selection for a
rural health care facility is a bigger challenge due to the lack of IT funding
and ability to hire consultants. An
example of this is Dryden Family Medicine located in a rural community with
only four staffed physicians. They
realized the need for an EMR but as with all health care facilities lacked
funding. Because of this they comprised
a team of leader employees (with limited IT knowledge) to help select a
vendor. They came up with a list of
priorities such as service, support, reliability, stability, and cost. Using the resources they had available and
researching trade journals and product reviews they selected a vendor they felt
met their list of criteria (Oneill, 2007).
EMR implementation is usually done in stages to maximize benefits.
The
first step in EMR implementation is to work on integrating current operational
systems. Acquiring billing information,
patient records, internal communications, and generating prescriptions are the
usual day to day first level of operations.
This can impact a practice by making information easier to retrieve/ share
saving the staff time. According to
Oneill (2007) the first phase of implementation made a huge difference on
office, clinical, and physician staff by “faxing of prescriptions greatly
reduced the potential for medication errors due to illegible handwriting or
incorrect dosages….[staff time] reduction in phone calls to and from
pharmacies….internal e-mail and messaging allowed for more efficient internal
communications” (p. 28). The second
phase consists of establishing links with other parties and integrating with
specialists, hospitals, labs and pathology departments and the third phase is
the quality and disease management and preventative maintenance portion of the
EMR. With all of these working properly
it can impact a practice financially decreasing costs, increasing profits and
most importantly increasing the care and safety of all patients.
Implementation
of an EMR will impact job descriptions and responsibilities within the
organization. Flexibility is an absolute
for the successful implementation when going through this process. Many employees will be asked to do jobs they
would not necessarily do so flexibility is a key feature. EMR’s improve nursing care so they can spend
more time on patient care instead of remedial tasks, physicians can spend less
time on patient phone calls because information was available to staff to
answer higher level questions and billers no longer had to depend on ‘doctor
staff’ diagnosis coding to bill procedures. For Dryden Family Medicine this process
increased their bottom line by 11 % the first year and 20% the second year
(Oneill, 2007). Interestingly enough the
patient volume over these two years remained stable.
An
EMR can impact all sizes of facilities from large multi-national hospitals to
rural community care clinics. EMR’s
organize, maintain, share, and improve efficiencies. They keep consistency in the medical practice
generating increased income and providing clinicians with the necessary
information for proper and safe patient treatment.
Thanks Chelley
(2010,
July 07). Benefits of an EMR [Web Video]. Retrieved from
http://www.youtube.com/watch?feature=player_detailpage&v=TiQ8c11dkU0
Oneill,
L., Klepack, W. (2007). Electronic medical records for a rursl family practice.
A case study in systems development. Journal
of Medical Systems, 31(1), 25-33. doi
http://dx.doi.org/10.1007/s10916-006-9040-1
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