HIMSS is an Acronym which stands for Healthcare Information and Management Systems Society. HIMSS is therefore a non-profit making U.S organization which aims at promoting a good understanding of information regarding management systems and health care information. HIMSS Level 7 is the recognition of using the highest degree of electronic health implementation. HIMSS therefore rates hospitals basing on a scale of 0 to 7 using its Electronic Medical Records Adoption Model. The achievement of stage 7 or level 7 implies that the hospital is largely paperless. The organization therefore deals with the use of optimal management systems and Information technology for the betterment of human life. EMR is an acronym which stands for Electronic Medical Records (Wager, et al, 2009).
Electronic Medical Records or sometimes referred to as Electronic Health Records are digital records which are kept by the doctors, insurance companies or other facilities which someone seeks medical services. EMR systems are therefore used in keeping track of the medical history and general health of a patient through electronic and computerized formats. This report is being written so as to improve the services of Metro Hospital with a view to lead it to achieve Level 7 of the HIMSS EMR Adoption Model by the year 2025. It is important for Metro Hospital to achieve HIMSS level 7 by 2025 because it help the hospital in keeping medical records of patients in computerized forms and therefore not only making the records to be easily retrieved but also making the navigation of a patient through the healthcare system to be more efficient and much safer. This report is therefore being written as a roadmap towards the achievement of HIMSS level & EMR for Metro Hospital by the year 2025 (Lyer, et al, 2006).
Vision for the Electronic Medical Records
My vision is to see Metro Hospital attain the HIMSS EMR Adoption Model by the year 2025 through having a fully electronic environment other than having the manual way of carrying out tasks as it is now. By adopting an electronic Medical Record model, the hospital will cut costs arising from employment of employees to carry out manual work while at the same time ensuring that tasks are carried out promptly and efficiently with the aid of electronic systems. In order to lead the hospital to achieve level 7 of the HIMSS EMR Adoption Model by the year 2025, the first task will be to ensure that the hospital participates in the Annual HIMSS Analytics Study to make it receive the EMRAM Score. The attainment of a full electronic environment by the hospital by 2025 will therefore enable it to offer its services efficiently and effectively to its customers (Gasch, A. et al, 2010).
The implemented EMR system
Once the vision of having EMR has been implemented by 2025, it will comprise of systematically collected electronic health information regarding populations or individual patients. The system will be able to contain records in digital form which will be able to be shared through different health care departments of Metro Hospital through a wide information network connected embedded systems. To ensure that the HER system creates a positive impact for Metro Hospital and increase its revenue cycle, the system will be designed with key attributes like for instance, it must be able to provide an integrated clinical information which be helpful to health care providers to determine the condition of the patient as regards to the overall medical history of such a patient. The Electronic Medical System for Metro Hospital will be designed in such a manner that it can easily be accessed by physicians, clinicians and general ancillary staff. The implemented EMR system for Metro Hospital should be able to integrate a full range of data in summary or comprehensive format comprising of personal stats such as weight and age, billing information, medication and allergies, medical history, demographics, vital signs, radiology images, laboratory tests, immunization status among others. The implemented EMR system for Metro Hospital should be able to have full records about the patients’ encounters which allows for easy automation and streamlining of such information in the healthcare setting and therefore increasing safety via quality management, outcomes reporting and evidence based decision support. A fully implemented Electronic Health Record for Metro Hospital by 2025 will enhance the hospital’s ability for revenue cycle because it will have the ability for provision of integrated clinical information and easy accessibility of Data from the Electronic Health Records (Scott, et al, 2007).
A fully implemented EHR system for Metro Hospital by 2025 will create room for enhanced applications which will support more accurate and complete charge capture and offer improved documentation through automation and coding thus speeding up the process of billing. An implemented Electronic Health Record system for Metro hospital will ensure that the quality of care is improved and therefore lessening the suffering of patients as a result of the inability of the analysts to gauge quality and prevalence of medical errors. The use of information technology through the implementation of the Electronic Health Record system reduces costs in administration which in turn frees up the time and money that is spent caring for a patient. Implementing the EHR for Metro Hospital will also reduce medical errors through provision of decision support to healthcare workers through easy proliferation of continuing improvements in the health care industry and enabling faster access to contemporary practices in medicine and medical literature. The EMR system will also have the capability of offering onscreen layered and ordered presentations which offers easy to relevant coding concepts and information regarding medical procedures through browser capabilities applied on the screen (Lehman, 2006).
The implementation of an EMR system Model for Metro Hospital will be advantageous because many electronic medical record systems will be able to be connected and therefore it will be easier for coordination of patients willing to seek appointments in cities with academic research centers for appointments to participate in clinical trials or specialty treatment. Given the fact that Metro Hospital has got good links with the Division of General Practitioners in the area, the implementation of an Electronic Health Records system will present it with an opportunity and a global medical environment which will easily enable international patients to link with it and furthermore shop for their own procedures (Hawamdeh, et al, 2008).
What the EMR system will do and Offer for Metro Hospital
EMR is therefore a digital, computerized and paperless system that will be used by Metro Hospital to maintain the data of patients and reduce documentation errors while at the same time increasing the efficiency of processes in the hospital. The achievement of the HIMSS EMR Adoption Model by Metro Hospital enable the hospitals operations to be totally paperless and enable the hospital to share its clinical data and information through electronic standard transactions which will include CCD, CCR and other state mandated electronic transactions with all the departments or entities that are found in the health information networks. The adoption of this model will therefore enable Metro Hospital to share wellness and health information between the general medical, oncology, surgical, nose and throat, maternity, ophthalmology, vascular, children services, ear and other entities found within the hospital (Harman, et al, 2006).
Critical success factors when building an Electronic Health Record
In order for the Electronic Health Record to be successful, then essential technical factors should be considered. This will therefore include the planning, implementation and management of the health records department from an inefficient and overburdened environment towards an electronic automated environment. Work processes, technologies and staff should therefore be well adapted in the provision of real time quality information despite being challenged by scarce capital resources and increased expectations. Some of the critical and technical factors that will be need to be considered when building an Electronic Health Record for Metro hospital includes realigning of processes, development of staff capacity, renovation of the physical environment and implementation of new systems that support the strategic plan of Metro Hospital (Warren, 2007).
Development of staff capacity is important because it will help Metro Hospital to manage the cultural changes that will emerge and meet the future needs of departments by provision of education and other opportunities aimed at career development. Building of staff capacity is also essential because it helps in the measurement of customer and staff satisfaction. Te development of a qualified ad committed team for Metro Hospital is therefore a critical success factor that is crucial for the preparation of the Electronic Health Record. Realignment of processes for Metro Hospital is essential because it helps the hospital to plan and execute efficiently the sustainable processes changes and process improvement methodologies. The realigning process is also vital because it helps in measuring changes of the Electronic Health Records. Process redesigning or alignment is also vital because it ensures that all departmental workflows and renovations are aligned for best practice processes. Renovation of the physical environment through decommissioning of the satellite area and remodeling of the physical environment in order to have an optimal workflow is important because it will lead to reduced time in filling charts and retrieving them. There must be adequate space that can be able to accommodate the filling of active charts accurately and quickly. The security of patient information is important especially when physicians, hospital employees and other third parties are granted access to such information and this should therefore be part and parcel of the renovation process (Walker, 2006).
In order to achieve optimal collection and general of information for Metro Hospital, the possession of successful applications that require successful processes is critical success factor that should be considered by Metro Hospital should be considered in the implementation of the new Electronic Health Records.
Analyzing the Current Situation
To be able to review the current Status of informatics within the Metro Hospital, I need to be informed how the hospital carries out its operations when serving its clients and general hospital operations. Currently, Metro Hospital is expected to provide a high level of technological tools and academic demands through provision of information management solutions to enhance the quality of health care that is provided to its clients, something that is missing from the current environment of the hospital. To be able to achieve this, a new strategic electronic information management and technology is a major enabler to help Metro Hospital in the achievement of the HIMSS EMR Adoption Model by 2025. The hospital is overburdened by an inefficient preparation environment which makes it hard for it to properly serve the high number of patients. Delivery of health care services at Metro Hospital is solely based on the use of paper charts and therefore the introduction of Electronic Medical records for the hospital is one of the crucial aspects that must be reviewed to ensure that clinical information is easily shared through electronic transactions. The hospital as of current, is not fully utilizing its functionality in the provision of efficient, safe and effective health care for its patients because of the ineffective ways of carrying out its operations manually (Conrick, 2006).
To be able to review the contemporary status of Informatics in Metro Hospital, it is essential for me to evaluate and determine if the cost of meeting the Electronic Health Records system is worth the cost of meeting it and the costs that Metro Hospital will incur as a result of adopting electronic Medical records. For instance, I should be able to determine whether the requirements in Stage one will exceed the value of incentive check and ascertain the costs that will have to be incurred in meeting all the stages even after they have passed auditing. I should also review if the Electronic medical Records meet their meaningful use and ascertain the time frames (Steele, 2002).
To be in a good position to evaluate or review the current status of Informatics in Metro Hospital, I should be able to assess the current status of the hospital’s component deployment, understand the corporate goals of the hospital and be able to appreciate the hospital’s short term needs. Currently, the hospital has got good links with the Division of General Practitioners in the local area but they are not electronically linked. One of the most important aspects that I will review in Metro Hospital is making sure that an electronic health record is put in place to link these physicians and practitioners with the Hospital’s electronic records. The delay exhibited when serving patients because of the use of manual processes should therefore be reviewed to ensure that the manual way of searching for records is replaced by the Electronic Health records to save the time and resources spent on such tasks. Another specific aspect that I will review is the amounts of time spend when attending to patients at Metro Hospital. This will help me to ascertain whether the introduction of an electronic health record system will be beneficial for Metro hospital (Huang, 2010)..
Information Management Practices that must be implemented to ensure the Effectiveness of an EMR
Staff of Metro Hospital should be well informed of the management practices that must be enforced in order to ensure the efficient running of the electronic Medical record. Employees of Metro Hospital should therefore become aware with the relevant regulatory authorities, regulations and requirements regarding the use of electronic records. Regulatory authorities determine the existing guidelines and regulations about creating, maintaining, retaining and destructing traditional paper records and EHRs and EMRs and therefore such issues should be well known. Privacy legislation concerning the collection, use and final disclosure of patient’s personal information should be upheld and respected. The EMR will also be effective if the hospital management and staff as a general consider patient consent and their rights to accessing their health information that is stored in EHRs/EMR’s (Tan, 2009).
Critical functions of electronic signatures must be taken into consideration while at the same time putting into mind the 5 key principles of transition from the manual to electronic system which include: securing of patient information and maintaining of the privacy of the information for patents. Medical records should also be kept and maintained through integrity and the integrity of clinical workflow should be supported and maintained (Brazell, 2004).
Analysis and planning of level 7 of the HIMSS EMR Adoption Model
In order to lead Metro Hospital into achieving level 7 of the HIMSS EMR Adoption Model by the year 2025, I intend to carry out a proper analysis and planning of the whole model by being informed of all the stages the hospital has to undergo in order to achieve the Final level 7. Initially, Metro Hospital has not implemented radiology, laboratory and pharmacy ancillary department systems despite the fact that some of the clinical automation are present. The first procedure to embark on towards the achievement of Level 7 status by Metro Hospital will therefore be to install all the main three ancillary systems in the hospital which will include the radiology, laboratory and pharmacy department systems. The second stage is to ensure that all the major ancillary clinical systems deposit data into a CDR (Clinical data Repository) which allows the physicians to retrieve and view results (Ochs, 2010).
The Clinical Data Repository will therefore comprise of clinical decision support or rules and a controlled medical vocabulary which gives room for checking of any rudimentary conflict. During this second stage, information obtained from document imaging systems can be able to be linked to the Clinical data Repository. During the third stage of the HIMSS EMR Adoption Model, the Metro Hospital’s clinical documentation like flow sheets, vital signs e.t.c will be required while the eMAR (electronic Medication Administration Record), care plan charting and nursing notes are scored with extra points and are integrated and implemented with the Clinical data Repository for one of the services in the hospital. Clinical decision support is implemented during the first level to in order to check for errors with the order entry in the pharmacy like for instance drug/lab, drug/food, drug/drug that are common in the pharmacy. At stage three, there must be some level of communication system which can allow physicians of Metro Hospital to gain access through the hospital’s intranet or other secure networks that are available outside the confines of the department of radiology (Robertson, et al, 2008).
During the fourth stage, CPOE (Computerized Physician/Practitioner Order Entry) to be used by any Metro Hospital clinician will be added to the Clinical data repository and nursing environment together with the capabilities of the clinical decision support that are related to the medicine based evidence protocols. The completion of the previous stages will signify the achievement of stage four. Stage five will now include the implementation of the closed loop administration in one of the patient care service environments implementation and integration of the bar coding, eMAR and other technologies used in auto identification like the RFID (Radio Frequency Identification) in order to maximize safety of the point of care processes used in the administration of medication. Stage six will involve the total documentation of Metro hospital’s physician charting/documentation for at least one of the areas in the patient care service. All the clinician activities are guided through level three of the clinical decision support which is related to protocols and outcomes in form of compliance and variance alerts. All the film based images are displaced by PACS radiology systems which provide physicians with medical images through an intranet (Felder, et al, 2008).
The final stage known as level 7 or stage seven will ensure that Metro Hospital has achieved an electronic or paperless EMR environment in which clinical information will easily be shared through electronic transactions and all entities of the hospital will be able to exchange electronic records within a regional network. For instance, the Division of General Practitioners in Metro’s local area, subacute environments, ambulatory clinics, patients, patients, employers and other hospitals will be able to share vital health information. As envisioned in the level 7 of the HIMSS EMR Adoption Model, it is this stage that will ensure that true electronic health records are supported by HCO (Andersen, 2008).
My implementation plan will have a purpose, system overview, management overview which will include the description of implementation, the points of contact, the major tasks, the implementation schedule , security and privacy, system security features and security set up during the process of implementation. Apart from that, the implementation plan will consist of the software, hardware, materials and facilities, documentation and personnel. Under personnel, it will involve of the training for the implementation staff and staffing requirements. The implementation plan will consist of the performance monitoring, implementation impact and configuration management interface. Lastly, the implementation plan will consist of the implementation requirements by site requirement details (Skolnik, 2010).
Resources required in implementing the project
Some of the resources that will be required in order to implement the EMR project will among others include Citrix which is a technology that will be used to provide remote access from the office and home through utilization of wireless infrastructure, qualified personnel, hardware which in this case will include laptops, tablets, desktops, touch screens and carts. The allocation of the various administered and departmental funds together with all the budgetary allocations should be highlighted. Being able to ascertain the relevant resources needed for implementation of the project will enable me to know early warning signs of under spending or overspending or even possible savings and therefore enabling me to effectively track down expenditure. In general, resources needed can either be financial or non financial or both (Kiel, 2001).
Specific goals and timelines for achieving a ‘fully digital’ status by 2025 by Metro Hospital
Implementation of an HIMSS level 7 by 2025 for Metro Hospital is not one single project but rather, it is a series of initiatives which represent a journey more than a destination. The implementation process will therefore consist of challenges, solutions and the impacts that will have on the clinical process. Some of the critical goals towards the achievement of a full digital status for Metro Hospital will therefore include planning of the Electronic Health records and the acquisition of the ambulatory Electronic Health Records. Thereafter, the process of intake and assessment will follow after which the medication process will be clearly evaluated. Clinical support and documentation will be followed through the provision of E-communication patient providers and portals. The stage of finally implementing the ambulatory of the Electronic Health Records will make the electronic system for Metro Hospital to be its legal health records by the year 2025. Although initially Metro Hospital had no plans of becoming a digital hospital, it has always been my goal to achieve this electronic status. There is need for us to use automation and Information technology in order to improve the care given to our patients (Finn, 2009).
In order to achieve specific goals and timelines for achievement of a fully digital status for Metro Hospital by the year 2025,a vision, consensus and a strategic plan must be build at the board or executive level aimed at transforming care delivery through a business initiative. A governance structure should also be build in order to facilitate decision making, accountability, prioritization and management which include a user-focused comprehensive plan which deals with informing people how to deal with change. After that Information Technology infrastructure that deals supports the Electronic Medical Records together with a disaster business/recovery continuity plan for Metro Hospital must be build. Supplier/consulting decisions should be made and then the technologies should be implemented in the right order. Managing of change, measurements and achievement of the technology should be kept as an in day to day work. A governance structure should be build in order to facilitate prioritization, management, accountability and decision making which includes a comprehensive functional steering committee. Measurement of the business processes will need to stretch the goals and need to be balanced so as to embark on this long journey of achieving level 7 by 2025 for Metro Hospital (Lorenzi, 2005).
Benefits for achieving HIMSS level 7 by 2025 for Metro Hospital will also require that the benefits are quantifiable and the whole executive team should always be accountable for achieving the goals. The business value for the benefits should always outweigh the costs of IT increasing operational expenses and implementation costs. Metro Hospital should plan in using the EMR in demonstrating data agility during the whole implementation process. In order to avoid situations where the stakeholders of Metro Hospital might get disengaged before the whole project is rolled out, incremental benefits arising from the use of EMR data entry must be seen. In general, the roadmap for achievement of the HIMSS level for level 7 by 2025 for Metro Hospital will involve the following goals and timelines (Sharma, 2005).
The above processes should therefore take 14 years for Metro Hospital to be fully digital. During the first stage above, all the ancillaries namely the laboratory, the Pharmacy and the RAD are not installed and this stage is referred to as stage 0. At stage one, all the three ancillaries are installed followed by stage two in which Controlled Medical Vocabulary Clinical Data Repository and the CDSS inference engine might have Document Imaging. Stage 3 will involve clinical documentation and error checking which will in turn be followed by stage four which will involve Clinical Decision Support protocols. Stage five will thereafter involve the administration of Closed Loop medication and then under stage six, physician Documentation and full variance and compliance of CDSS will be undertaken. Finally, stage seven will ensure that Metro hospital has a fully digital status by 2025.
Governance is a very important part in the implementation of the HIMSS EMR Adoption Model by 2025 for Metro Hospital because having unclear governance plans may pose as a big risk to the hospital in the implementation of other aspects. The governance for Metro Hospital will be under the responsibility of two committees which will oversee the implementation of the HIMSS. The two committees will be the IT Committee and the other one that represents the operational and clinical departments that are affected by EMR-EHR. The various people who will be involved in management of various implementation processes should be known together with their responsibilities and the people they are accountable to in Metro Hospital. Procedures and rules for decision making should always apply throughout the whole project and governance arrangements should include all the agency lines of accountability and reporting coupled with the relevant executive committees and agency boards in the hospital. The project should be governed in such a way as to include all the services that are supposed to be delivered as a result of adopting electronic medical records. Clinical Staff and all Physicians for Metro Hospital should conduct a needs analysis in order to be sure that the implemented EMR-EHR system will serve as a proper decision making guide for the caregivers. The separate governing bodies for Metro Hospital should therefore work hand in hand to see that the project is implemented successfully. The committees should be able to meet as many times as possible to discuss any emerging issues and hear any updates about the whole project (Edgar, et al, 2010).
Likelihood of Success and identification of risk
I have high hopes that I will be able to achieve level 7 of the HIMSS EMR Adoption Model by 2025 because of the supportive and understanding Metro Hospital Staff. However, there is a high concern that some of the practitioners linked with the Metro Hospital from the area will struggle in meeting some of the proposed rules for quality reporting requirements aimed at meaningfully using health information technology. Some of the risks that may be faced with Metro hospital upon completion and final implementation of the Electronic Health Record will include incomplete or weak and lack of enough policy awareness and malicious misuse by insiders. The Metro Hospital’s Electronic Health Records may also be exposed to external attacks through either social engineering, defacement of the website, electronic mail phishing or through social engineering phone calls which may be detrimental to the hospital because vital information may be lost. Metro Hospital should also be concerned about weak incident response recovery policies and weak disaster recovery plans (Perezgonzalez, 2005).
In order for usability ratings to give more than comparative information, it is necessary to use benchmark metrics to establish them. These benchmark metrics can be developed through measuring the actual clinical environment of clinician users for each scenario or task. The clinician panels will then compare good actual performances against the perceived ideal performance by users so as to establish a target score which reflects better the needs of the users unlike the present state of the Electronic Medical Records performance (Gumpper, et al, 2008).
In order to make the adoption of level 7 of the HIMSS EMR Adoption Model by 2025 for Metro Hospital to be a success, it is vital for me to look at the benefits, barriers and risks. There is a significant relationship between the benefits and barriers of adopting HER systems by Metro Hospitals. The transition by Metro Hospital from manual operations to electronic medical records is a significant change in the medical practice towards clinical processes. The ability of Metro Hospital to transform its medical records into electronic form will create further opportunities for the hospital to start clinical practice changes not only at individual levels but also at population levels. The success of the EMR-EHR for Metro Hospital will therefore largely depend on the input that will be derived from all the departments of the hospital what will use the system in improving the quality of care given to patients and increasing productivity. Committees dealing with governance in the implementation of the project should never be underestimated because it is through them that other stakeholders are able to give criticism, ideas, advice and suggestions. Relevant approaches should always be approached in order to ensure that the EMR-EHR system is properly implemented to ensure that improved healthcare and regulatory practices are upheld (Jain, Et al, 2010).
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