Question

Mercy Medical Center has determined that within 3 years, the paper-based health record it currently uses will be replaced with an electronic health record (EHR). You are a member of a multidisciplinary committee that will evaluate and select the EHR. The chief medical officer (CMO) prefers to have a vendor install an EHR that allows for some tailoring to its institutional needs (clinical), but not everyone in the committee is in agreement with this desire. You have been tasked to examine the HIM and legal aspects of the vendor selection and EHR implementation and report back to the committee.

There are two parts to your response: (1) What quality (consider QM, RM, and UM) issues should you raise to the committee about HIM barriers and problems with individualizing and implementing an EHR including specialization by function (business and/or clinical areas), and (2) discuss what legal issues should be addressed with the committee and hospital in the evaluation and selection process from the HIM perspective. Include any federal or state legislative or regulatory guidance that would be instrumental in the topics you presented to garner support from the team.

Answer 1

As per Mercy Medical Center's precise data upcoming 3 years will bring blooming change in healthcare industry as the paper-based health records will be replaced with an electronic health record (EHR).
As a member of a multidisciplinary committee responsible for evaluating and selecting EHR. The CMO would prefer to go with choice of a vendor to install an EHR implementing some tailoring to institutional needs of EHR and not everyone in the committee is in agreement with this desire.
Accumulating all the above scenario, I would elaborate to committee in my evaluation report key factors for vender selection in terms of legal and technical aspects and ways to implement EHR system. Here EHR implementation isn’t a easy task. Getting an entire clinical institute on board and finding the time and resources to make changes is a major fact.

A. Firstly we should focus on quality of the documentation to be preserved and quality of data to be generated in EHR by means of managing quality, risk and utilisation management. For that the actual status of current practice needs to be analyzed in terms of efficiency and effectiveness of current paper health record system along with its organizational structure. If current workflow is well mapped then workflow on an EHR will remain same. Apart from these all some other basic requirements also need to be taken care of such as preparation of questionnaire for EHR, computer literacy of staff, available high speed internet access, facility readiness, and financial feasibility and practice priorities.
Planning for appropriate conversion of paper charts to electronic records:

1. Privacy must be maintained: keeping in mind federal regulations regarding destruction of protected patient information.
2. Ease of access: Format should be easy to understand with demographics, true patient data and must have all subsequent visits on the paper chart to be changed in the EHR to improve flow and storage of information.
3. A Strategic Plan: proper strategy must be implemented to overcome barriers to EHRs as their are some potential barriers in mid way.
a. Usability chalanges:-
EHR systems with multiple screens, unclear navigation and too many options leave physicians and nurses frustrated.
b. Technical Ability:-
Such as computer literacy, internet connectivity can be more difficult in a rural compare to city.
4. Cost: EHR systems can be expensive as technical skilled personnel's and electronic system needs to be hired along with maintenances of all will cost a organisation almost highly expensive compare to current traditional record keeping. So finding the capital to invest in the infrastructure, personnel, training and support required to install and maintain an EHR system can be a barrier, especially for small to mid-sized practices.
5. Mentality of People: Healthcare organizations may have to deal with patients and providers who reject EHRs or are easily discouraged by the challenges of technical ability, cost and usability.

The EHR barriers can differ from organisation to organisation and person to person for example, barriers for a nurse can differ from the barriers faced by a doctor or an IT professional in EHR handling. Where as if patient is having any concerns about EHR then it can't be denied. These all are certain challenges in implementation of EHR System.

B. Legal issues which needs to be taken in consideration:
1. According to HIM perspective and federal or state legislative or regulatory guidance once the EHR system is up and in running state, Medicare and Medicaid programs which are providing financial incentives for achieving levels of “meaningful use” must insist to improve the quality of patient care, engaging patients and family, improving coordination of care, improving public health and ensuring privacy of personal health information.
2. These indicators are achieved through such means as e-prescribing, clinical quality measures, patient reminders and patient-specific education resources.
3. The EHR and associated processes need to be constantly evaluated to assure efficiency and accuracy.
4. The staff may need to be reorganized to account for changes and improvements in patient flow and data management.