Class: Health Information Management Systems This is for a EHR system, this week
ID: 391128 • Letter: C
Question
Class: Health Information Management Systems
This is for a EHR system, this week is final phase of the system implementation that results in the acceptance, rejection, or modification of the project, and release, suspension, or deduction of the contracted amount to the vendor(s)—system maintenance. Complete this section in 2-3 pages.
Ensure that all hardware work together.
Ensure that every function of every application of the computer system works and the system meets the functional requirements and the RFP specifications.
Ensure that data between different systems interfaces and is transferred smoothly and in correct format.
Ensure correct transference of data from old to new system (conversion testing).
Ensure that the system can work under maximum load (volume/stress testing).
Verify that the system works as expected in a live environment.
Explanation / Answer
Overview of the EHR
The Electronic Health Record (EHR)– then called the Electronic Medical Record (EMR) or Computerized Patient Record (CPR)– received it first real validation in an Institute of Medicine's (IOM) report in 1991 entitled "The Computer-Based Patient Record: An Essential Technology for Health Care.(www.nap.edu)" IOM drove home the idea that the EHR is needed to transform the health system to improve quality and enhance safety.
The specialty of family medicine has also stated that the EHR is a core technology for the future of family medicine in the Future of Family Medicine Project. This project outlines a "New Model" of care for family medicine with the EHR as "the central nervous system" of that model. The EHR becomes a tool through which the family medicine office can transform practices to meet its needs and the needs of its patients. Enhanced workflows and access to information make the practice of medicine more efficient for physicians and their staff. Decision support and automated reminders help the practice deliver safer and higher quality care to patients and the community.
The EHR is about quality, safety, and efficiency. It is a great tool for physicians, but cannot ensure these virtues in isolation. Achieving the true benefits of EHR systems requires the transformation of practices, based on quality improvement methodologies, system and team based care, and evidence-based medicine.
Basic Terminology
The following is a list of basic terms you will need to know as you navigate the EHR market:
Potential Benefits of an EHR
Benefits of an EHR can be categorized as follows:
Potential Productivity and Financial Improvement
Additional potential benefits may include: population management and proactive patient reminders; improved reimbursement from payers due to EHR usage; and participation in pay-for-performance programs.
Quality of Care Improvement
Job Satisfaction Improvement
Customer Satisfaction Improvement
Hardware Basics for Electronic Health Records
Basic Terms
Desktops
The basics:
Advantages:
Disadvantages:
What your peers have to say:
"Have had wired computers [desktops] in the exam room since 1998 and think it is the best way. I find it less hassle than carrying a computer around all day, worrying about batteries running out or losing wireless connectivity or dropping the computers. The computers are much cheaper both to buy initially and fix if something does happen. Tried a tablet but did not like it all. Never had a problem with children or adults interfering with the computer in the examining room and if you log out when you leave, HIPAA is not an issue."
-- Keith Stafford, MD, Greenville, South Carolina
Laptops
The basics:
A laptop is a fully functioning computer that is small enough to be portable. Laptops can take advantage of wireless as well as traditional networks. A laptop can easily serve as a desktop machine and can connect via a docking station to a larger monitor and a standard keyboard.
Advantages:
Disadvantages:
What your peers have to say:
"We work wirelessly with laptops. All [prescriptions] print from one central printer right outside the exam rooms. Benefits of laptop:
"I'm hooked on my laptop and am so accustomed to carrying it around that I don't even notice even though it is Dell's heaviest one."
-- Sue Andrews, MD, Murfreesboro, Tennessee
Tablet PCs
The basics:
There are two main types of tablet PCs: a slate tablet PC, which is a tablet with no attached keyboard (although one can be added), and a convertible tablet PC, which is basically a laptop computer with a screen that can swivel and fold onto the keyboard to create the tablet.
Advantages:
Disadvantages:
What your peers have to say:
"I have been using a Gateway tablet in the room with my OB patients for the past two years. We use an ASP prenatal record called eNatal. I wouldn't trade for it. It has three methods of entering data on the screen, all vastly improved with the SP2 for Windows XP for Tablet.
"The first method is through tapping on a screen-based keyboard with the stylus (slow but very accurate). The second is through straight handwriting recognition. I have relatively poor handwriting, but it is amazing how accurate and fast this is! The only thing that seems to trip it up is some abbreviations, acronyms, or words that it can not find in the dictionary. The third option is a letter-by-letter handwriting recognition panel that is slower but extremely accurate.
"We've had no downtime. The wireless connection works well. The battery life is good (I plug it into the docking cradle between OB patients). We have used laptops and desktops for eNatal in the rooms and the tablet works best by far. As we look to add a full EMR, we hope to use a tablet-based system, probably the Motion Computing tablets with the biometric (fingerprint) access."
-- G. Jeffrey Young, MD, FAAFP, Levelland, Texas
Using EHR technology require a certain adjustment in the way you're used to interacting with your patiens and their charts. Deciding how to do this in the way that makes you the most comfortable will help guide your choice of hardware -- e.g. using a desktop, laptop, or tablet PC.
Examanation Room Setup
Read what your colleagues are trying to help you determine what might work for you.
Joan E. Wurmbrand, MD, Bexley, Ohio, says:
"Our architect designed (and the cabinet makers built) storage cabinets with a pull out desk. We can be facing patients in their chairs as we sit on our rolling stools. When it comes time for the exam, the patient can stand to move to the exam table and we can slide the desktop back into the cabinet. It has worked out well and I can set my wireless laptop on it easily."
Thurman Pedigo, MD, Nashville, Tennessee, says:
"Based on recent experience, I would have everything I can on wheels. We are wireless in exam rooms and discovered the convenience of having a computer desk on wheels so that the entire setup will move easily to another location if needed. Every exam room should be identical. My opinion is that four room clusters are a good exam room configuration, although three room clusters for slower physicians may be adequate. A very small sink and useful counter in the exam room is a must as well as access to both sides of the exam table. Position the door close to the desk-do not position patient between the doctor and the door."
David Voran, MD, Leawood, Kansas, says:
"In our on-site clinic we're going to experiment with large LCD screens positioned so the physician and patient can both view it comfortably. Each clinician will have their own wireless tablet PC and, when sitting down with the patient, can use the wall-mounted LCD as the second monitor. That way the clinician can slide those items to be shared with the patient onto that monitor, while keeping the other parts of the record or other personal productivity applications on the tablet's screen."