When evaluating healthcare information systems much of the focus is on the implementation of electronic health records (EHR). The (EHR) market is projected to reach a value of approximately $9.3 billion dollars annually by the end of 2015 (Beckers Health IT and CIO Review, 2014). Part of the allure is the federal government incentives (up to $2 million dollars) awarded to organizations for successful implementation. These financial awards are categorized as meaningful use incentives. Some of the challenges faced by healthcare organizations includes the integration of laboratory information systems (LIS) with the EMR. From February 2010 thru February 2011 there was the compilation of the top ten vendors of EMR systems. The top two companies at the time included Meditech (with 25% of installations) and Cerner Corporation (with 12.8% of installations) (Dark Daily, 2011).
Based on a recent KLAS report out of the top ten ranked vendors from 2011 (Epic, Cerner, and Meditech) were the three that reported the most significant market share gains in the large and small healthcare markets. What makes Meditech (Medical Information Technology) such an attractive vendor partner is that they boast annual revenue of approximately $550 million. Meditech currently has approximately 740 clients including Christus Health in Dallas, Swedish Covenant Hospital in Chicago, and Henry Mayo Newhall Hospital in Valencia, California. The company expresses its commitment to being environmentally friendly and supporting more than forty-three nonprofit organizations (Beckers Health IT and CIO Review, 2014).
Ultimately Cerner Corp. has been chosen as the vendor for EMR integration. In 2013, it reported more than $2.67 billion dollars in revenue. As the largest independent health IT company globally 2014 revenue was projected at $3.3 billion dollars. The company is founded by CEO Neal Patterson (1979) who has an estimated net worth of $1.5 billion dollars. Clients using the Cerner system include Banner Health (Phoenix), Memorial Hermann Health System (Houston) and Adventist Health System (Altamonte Springs, Fla). There are approximately 532 hospitals on board with the Cerner EHR system. Of those clients approximately 37 have reached HIMSS analytics (Stage 7) (Beckers Health IT and CIO Review, 2014).
Although Cerner has dealt with a few lawsuits from clients (i.e. Trinity Medical Center and Girard (Kan.) Medical Center) it consistently gets high marks pertaining to user satisfaction. Cerner also has grown significantly as a result of bold healthcare acquisitions. For example in 2011, Cerner merged with workforce management software vendor (Clairvia). Then in 2012, it successfully merged with behavioral health technology vendor (Anasazi Software). Finally in 2013 it acquired PureWellness a population health and patient engagement software vendor. Cerner also recently announced a partnership with Children’s National Health System (Washington, D.C.). The goal of the partnership is to create the first research institute in the U.S. devoted to health IT. Additionally, Cerner is partnering with Claritas Genomics to create a scalable laboratory solution for molecular diagnostics purposed for modernizing sequencing workflows. Finally Cerner has finalized a massive partnership with Intermountain Healthcare (Salt Lake City) that will integrate Cerner into 22 hospitals and 185 ambulatory clinics (Beckers Health IT and CIO Review, 2014).
In addition to determining which vendor to partner with for healthcare information technology (HIT) integration assembling a team is critical. Critical team members include registration management staff, schedulers, coders, and HIM professionals. Registration management staff will want to ensure that there is a custom centralized dashboard that handles end-to-end patient visits. This includes customizable registration questions, patient types, and patient e-charts. Schedulers will want to ensure streamlined appointment tracking, appropriate resource deployment, and patient wait-time statistics (Meditech, 2015).
Coders will be critical in ensuring that the Information system aptly integrates the right codes for appropriate reimbursement. From a workflow perspective the appropriate filing process should be easily integrated and manageable within the system. Finally, having HIM staff on the integration team is critical. They can provide feedback and input on ensuring the system can aptly manage patient identification and release information, chart completion, and avoid record duplication from a central station. HIM staff should also ensure that scanning and archiving is enhanced through integrated form management (Meditech, 2015).
Ascertaining the value of a healthcare system is a global concern and process. Therefore careful examination of the Comprehensive Rural Health Services Project Ballabgarh, operated by All India Institute of Medical Sciences (AIIMS), provides a global perspective. The HMIS at Ballabgarh has gone through several versions and currently operates on the third version. It also presently utilizes generic and open source software. In order to ascertain the efficacy of computerized HMIS systems face-to-face interviews were conducted with critical stakeholders (i.e. program managers, health workers). Interviewers wanted participants to provide a comparative analysis between the manual and computerized HMIS (Krishnan et al., 2010).
Therefore a comparative analysis was conducted with feedback from Health Workers representing AIIMS and Non-AIIMS Primary Health Centers. They provided cost comparison and the value of manual versus computerized HMIS systems. The primary metrics utilized were resource utilization and market costs of each system. Feedback from interviews revealed no significant hardware problems when computerized HMIS systems were used. Approximately 95 percent of data was determined as accurate in a computerized HMIS system. Health workers specifically appreciated the HMIS in terms of service delivery, data storage, workplans, and report generation. Program managers found the ability to monitor and supervise employees as well as data management helpful (Krishnan et al., 2010).
The initial costs at the two Primary Health Centers was approximately $1674, 217 (USD 35, 622). Equal annual costs of capital items were approximately $198, 017 (USD $35, 622). The projected annual savings is approximately $894, 283 (USD $11, 924). The value of a computerized system is that health workers will cut costs associated with record keeping and report generation. The initial costs associated with automation is recovered in approximately two years following complete implementation. Further computerization enhances service delivery, monitoring, and supervision processes (Krishnan et al., 2010).
Recently Middlesex Hospital conducted an evaluation of CMMS systems currently used by hospitals. With a fixed budget finding the right CMMS required a thorough investigation of cost versus value. The features that Middlesex required included ease of use, efficiency in reporting (i.e. material, inventory, service records), task and event planning, scalable, 24/7 tech support, and relevant training. Those optional features included handheld PDA/barcode scanner capabilities, web based work order request features, RFID integration, and automatic alerts and recalls. Although this was not a conclusive list of daily functions it provided a basis for objective system evaluation. The goal was to identify the most capable system to operate their own CMSS system. Additionally the hospital conducted independent research, had discussions with other healthcare organizations, and had vendors present on features and benefits (CLINICAL ENGINEERING MANAGEMENT, 2008).
In terms of selecting a company the primary goal was to identify a vendor partner that could provide functionality for a clinical engineering department. It was also important to identify a vendor that was reputable, had a long-term business history, and specialized in CMMS. Networking also took place as Middlesex Hospital biomed team attended events like the New England Society of Clinical Engineer meetings. This ensured that they could gain useful feedback from healthcare organizations that had experience and information regarding relevant CMMS solutions. They also strategically spread the word that they were in the market for a CMMS system. This leveraged their buying power and created a bidding war, which they hoped would diminish cost and increase the package valuation (CLINICAL ENGINEERING MANAGEMENT, 2008).
The case study from Middlesex reveals critical lessons regarding the implementation of a CMMS system. The first lesson is the value of extensive and targeted training. After the initial information is shared employees need time to absorb and be able to master the information. Secondly, the software package should include the relevant training costs. Also the IT department should be a stakeholder actively engaged in the decision-making process. Third, the CMMS system should be continually updated to ensure everything is tracked within a department, eliminating the need for service reports. An updated CMMS system also enables a healthcare organization to ascertain time spent on tasks, maintenance activities, and materials purchased, ensuring proper use of the technicians time. This system effectively provides clinicians with the ability to generate work orders online when required. By including the IT department in decision making a healthcare organization can ascertain information including server and database requirements, and network infrastructure. The IT department will also be useful in the designing of specific custom reports (CLINICAL ENGINEERING MANAGEMENT, 2008).
The bottom line for most healthcare organizations is finding an electronic solution to mitigate medical errors, replication, and other areas of wastefulness. The improvement of such factors will effectively enhance the overall quality of care. This aptly describes an interoperable healthcare system. Anticipated outcomes include reduction of administrative functions, phone calls, and office business tasks. Additionally, there is more comprehensive patient data which is useful in treatment decisions. Efficacy in patient interactions should positively influence performance and regulation compliance. Also operational costs should decrease due to a streamlining of workflow and management responsibilities. Other benefits include reduced paperwork, workflow automation, improved efficacy in interacting with other providers and third parties (endingthedocumentgame.gov, 2015).
Provider benefits can be summarized into four key areas including quality of care, administrative efficacy, patient interaction, and public health and security. There is also more interactive (end-to-end) patient care as physicians can share test outcomes (i.e. labs, pharmacies, clinics). Effective EMR systems will also enable physicians to highlight relevant patient data and outcomes, linking relevant information together. Electronic records enables physicians to share patient charts (in a HIPAA Compliant manner) and have consultations regardless of time zone or demographic. Since a patient’s medical history and charts will be electronic they will be accessible in all departments (i.e. ER, exam room, a physician’s office) anywhere there is web access (endingthedocumentgame.gov, 2015).
Although the full magnitude of access to patient data cannot be fully comprehended it is vital. In many instances for example ER physicians are unable to access patient information resulting in a limited capacity to diagnose and even understand key factors to quality care. Such factors could include patient history, previous surgeries, and interaction with certain medication. In the ER there are often patients that receive ongoing treatment and therefore the implementation of an interoperable system can mitigate suffering and reduce deaths. There can also be an improvement of patient and physician relationships as patients will feel more confident seeking medical care for any maladies knowing all providers have access to all medical records (endingthedocumentgame.gov, 2015).
It is critical that the selected healthcare system provides instant lab results, and enable physicians with the ability to conduct database queries. Such queries are useful for identifying relevant patterns that a patient is experiencing. For example simply having lab and drug information in a centralized location is extremely helpful. An interoperable system with such features would also be equipped with relevant protocols for assorted medical situations. Providers will have the ability to select appropriate protocols based on specific patient situations. Subsequently they can use patient data (on a macro level) to establish standards and healthcare protocols (endingthedocumentgame.gov, 2015).
Another key area that a comprehensive system is useful for is in the proactive treatment of chronic diseases. There is a growing number of chronic conditions each year requiring the old healthcare model to change. Presently the healthcare system is shifting from a focus on treating infections to chronic conditions. In fact according to various statistics approximately 50 percent of the U.S. Population lives with chronic conditions. A healthcare system that is comprehensive, interactive, and centrally located will ensure enhanced patient outcomes due to speed and efficacy of care. It will also enable physicians to more quickly offer patients feedback necessary to mitigate and possible prevent chronic diseases (endingthedocumentgame.gov, 2015).
Another key advantage of a comprehensive EHR system is enhanced prescription writing and pharmacy operation through e-prescribing. Prescriptions placed with a pharmacy using an interoperable system eliminates issues of legibility or the risk of paper prescriptions being misplaced. Physicians can also quickly determine if a patient has filled or refilled a prescription. Further it eliminates the likelihood of a patient receiving multiple prescriptions which is healthcare fraud. Healthcare providers can utilize safeguards currently implemented by pharmacists in the mitigation of drug interaction. In short data is effectively synthesized, distributed, and utilized which naturally improves administrative efficacies (endingthedocumentgame.gov, 2015).
Another identified benefit is the mitigation of duplicated work. The patient files are easily kept up-to-date minimizing unnecessary patient and physician repetition. One example is a situation where a patient’s psychiatrist orders blood work. If the same patient goes to see their general practitioner who also needs bloodwork there is greater likelihood the general practitioner can utilized the same information. This is also helpful for patients who move from one city or State to another, their new doctor can access their medical history (endingthedocumentgame.gov, 2015).
Finally, additional benefits include enhanced and streamlined workflow. When systems are electronic standard practices such as payroll, timekeeping, billing, and transcription are improved. This means better tracking of administrative functions, mitigation of misplaced transmission (i.e. fax, mail) and protection of patient information. There is also a scalable system that offers quick reporting and tracking capacity. When new healthcare policies require paperwork changes healthcare organizations can quickly update online forms. If there are new filing requirements then various departments or functional groups are able to quickly incorporate such changes (endingthedocumentgame.gov, 2015).
In order for a healthcare organization to remain competitive, and compliant it must continually evaluate systems and processes. Not only are physicians seeking to provide the most comprehensive patient care, they are simultaneously seeking to reduce costs. There are also demands to quickly assess patient needs which necessitates access to multiple types of information. A healthcare organization that has a great relationship with its vendor can make necessary modifications whenever required. Therefore a healthcare organization should not rush into a decision regarding an EHR system. Rather the organization should seek feedback from multiple sources, research desired needs and functionalities (endingthedocumentgame.gov, 2015). Meaningful use incentives by the government are one way to offset initial capital expenditures. Depending on the speed of implementation a healthcare organization may choose to gradually phase in components of its EHR system. Rather than assume the entire cost at one time they may choose to spread out costs over the course of a specified period of time. Such an approach will also enable them to begin to realize value and possible cut relevant costs.
Beckers Health IT and CIO Review. (2014, July 14). 50 Things to Know About Epic, Cerner, MEDITECH, McKesson, Athena health and Other Major EHR Vendors. Retrieved from http://www.beckershospitalreview.com/healthcare-information-technology/50-things-to-know-about-epic-cerner-meditech-mckesson-athenahealth-and-other-major-ehr-vendors.html
CLINICAL ENGINEERING MANAGEMENT. (2008, July/August). Selecting a Computerized Maintenance Management System. Retrieved from http://biomed.partners.org/main/newsitems/cemgmt_cmms.pdf
Dark Daily. (March 25, 2011). Ranking Top 10 Hospital EMR Vendors by Number of Installed Systems. Retrieved from http://www.darkdaily.com/ranking-top-10-hospital-emr-vendors-by-number-of-installed-systems-32511#axzz3bCnl3fcY
Krishnan, A., Nongkynrih, B., Yadav, K., Singh, S., & Gupta, V. (2010). Evaluation of computerized health management information system for primary health care in rural India. BMC Health Services Research, 10(310), 1-13. Retrieved from http://www.biomedcentral.com/content/pdf/1472-6963-10-310.pdf
Meditech. (2015). EHR Solutions. Retrieved from https://ehr.meditech.com/ehr-solutions/healthcare-information-management
Meditech. (2015). Meditech Hospitals. Retrieved from https://www.meditech.com/productbriefs/pages/producthcis.htm
endingthedocumentgame.gov. (2015). The Healthcare Delivery System. Retrieved from http://endingthedocumentgame.gov/PDFs/HealthcareDelivery.pdf
http://www.providersedge.com/. (2003, October 28). Electronic Medical Record (EMR) Functional Requirements. Retrieved from http://www.providersedge.com/ehdocs/ehr_articles/BPHC_EMR_Functional_Specs-Cerner.pdf
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