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Conduct A Case Study Analysisthe Electronic Medical Record Efficient

Conduct a case study analysis The Electronic Medical Record: Efficient Medical Care or Disaster in the Making? Dale Buchbinder You are the Chief Information Officer (CIO) of a large health care system. Medicare has mandated that all medical practices seeking Medicare compensation must begin using electronic medical records (EMR). Medicare has incentivized medical practices to place electronic medical records in their offices by giving financial bonuses to medical practices that achieve certain goals. These EMR systems are supposed to allow communication between practitioners and hospitals, so medical information can be rapidly transferred to provide more efficient medical care.

The EMR will enable physicians to allow access to the records of their patients by other providers. Eventually these records are supposed to be easily accessed so any physician or hospital will have complete medical information on a patient. The physician practices in your health care system have been mandated to use the Unified Medical Record System (UMRS). The UMRS was designed by a central committee; all hospital-owned physician practices have been mandated to use the system. As part of the incentives, Medicare will add dollars back to each practice when they meet goals for reaching meaningful use (MU).

MU has been defined by the U.S. Department of Health and Human Services (n.d.) as “using certified electronic health record (EHR) technology to: • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and family • Improve care coordination, and population and public health • Maintain privacy and security of patient health information”. It is a step-by-step system requiring “electronic functions to support the care of a certain percentage of patients” (Jha et al., 2011, p. SP118). One of the hospitals in your system has many primary care and specialty practices; however, the UMRS system was designed primarily for the primary care practices.

The committee that developed UMRS did not take into account the needs of the specialty practices, which are significantly different from the primary care practices. This issue has been brought to the forefront by several medical specialists who have stated UMRS is not only cumbersome, but also extremely difficult to use. UMRS also does not give the specialist the information he needs. Specialists noted that after UMRS was implemented, it took them approximately 10 to 15 minutes longer to see each patient. Since an average day for a specialist consists of seeing between 20 and 25 patients, adding 10 to 15 minutes per patient adds 200 to 250 additional minutes, or 3 to 4 hours more each day.

And, the physician cannot see the same number of patients each day. In reality, this represents a 30% decrease in productivity because of the amount of time it takes to use UMRS. Now the specialist office schedules constantly run significantly later than they should, and patients become unhappy and impatient. Several of the specialists reported that a number of patients have gotten up and left without being seen. In short, the mandate to use UMRS has impacted the efficiency and productivity of the subspecialists and specialists, further decreasing revenues for the system.

In addition, all of the physicians have complained the UMRS does not communicate well with other electronic medical record systems, or even the hospital’s own patient information systems. There is no real integration of the medical databases as intended, levels of meaningful use are unclear, and in some areas, difficult to achieve, again because the UMRS was tailored to primary care practices’ prescribing patterns. Surgeons, particularly, do not write a large number of prescriptions. Surgeons have been mandated to write electronic prescriptions to reach meaningful use; however, in many cases, this is not appropriate for surgical patients. All of these issues and concerns were reported to the central committee that created UMRS in response to federal mandates and financial incentives.

The committee responded it cannot modify the system to make it more friendly to specialists and subspecialists, despite the fact that procedures performed by the subspecialists account for substantial revenues. Revenues are down and the morale of the specialists and subspecialists has plummeted to the point that many are talking about taking early retirement or leaving the system. Still, the committee refuses to fix the problems. Since you are the CIO of the entire health care system, the situation is now in your hands. What will you do?

Discussion Questions

1. What are the facts in this situation?
2. What are three organizational issues this case illustrates?
3. What are the advantages and pitfalls to EMR? Should all types of practices be required to use the same system? What role should physicians play in selecting and developing an EMR system to fit their individual practices? Provide a rationale for your responses.
4. Is there a way to bring consensus and standardize the EMR systems without alienating productive physicians who bring large revenues to the hospital? How can the dilemma of inefficiency and patient dissatisfaction be prevented? Create and present a plan for how EMR could be implemented in a system with multiple types of practices. Be sure to address the issues of physician specialty, productivity, and satisfaction, as well as patient satisfaction.
5. What steps should the CIO take in the future to prevent these types of issues from occurring again? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.

Additional Resources

• Borkowski, N. (2011). Organizational behavior in health care (2nd ed.). Sudbury, MA: Jones and Bartlett.
• Buchbinder, S. B., & Buchbinder, D. (2012). Managing healthcare professionals. In S. B. Buchbinder & N. H. Shanks (Eds.), Introduction to health care management (2nd ed., pp. 211–247). Burlington, MA: Jones & Bartlett.
• Cresswell, K., Worth, A., & Sheikh, A. (2012). Integration of a nationally procured electronic health record system into user work practices. BMC Medical Informatics and Decision Making, 12, 15.
• Fallon, L. F., & McConnell, C. R. (2007). Human resource management in healthcare: Principles and practices. Sudbury, MA: Jones and Bartlett.
• Hudson, J. S., Neff, J. A., Padilla, M. A., Zhang, Q., & Mercer, L. T. (2012). Predictors of physician use of inpatient electronic health records. American Journal of Managed Care, 18(4), 201–206.
• Jha, A., Burke, M., DesRoches, C., Joshi, M., Kralovec, P., Campbell, E., & Buntin, M. (2011). Progress toward meaningful use: Hospitals’ adoption of electronic health records. The American Journal of Managed Care, 17(12 Spec No.), SP117–SP124.
• Mandl, K., & Kohane, I. (2012). Escaping the EHR trap—The future of health IT. The New England Journal of Medicine, 2240–2242.
• Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett.
• Shen, J. J., & Ginn, G. O. (2012). Financial position and adoption of electronic health records: A retrospective longitudinal study. Journal of Health Care Finance, 38(3), 61–77.
• Tiankai, W., & Biedermann, S. (2012). Adoption and utilization of electronic health record systems by long-term care facilities in Texas. Perspectives in Health Information Management, 1–14.
• U.S. Department of Health and Human Services. (n.d.). EHR incentives & certification: Meaningful use definition & objectives. Retrieved from
• Yan, H., Gardner, R., & Baier, R. (2012). Beyond the focus group: Understanding physicians’ barriers to electronic medical records. Joint Commission Journal on Quality & Patient Safety, 38(4), 184–191.

Sample Paper For Above instruction

Introduction

The implementation of Electronic Medical Records (EMRs) has been heralded as a significant advancement in healthcare, aiming to improve efficiency, safety, and patient outcomes. However, as evidenced in the case of a large healthcare system mandated to adopt the Unified Medical Record System (UMRS), the transition has highlighted numerous organizational, operational, and technological challenges. This analysis explores the facts surrounding this situation, examines the key issues involved, and proposes strategic solutions to optimize EMR benefits while minimizing adverse impacts on physicians and patients.

Facts of the Situation

The healthcare system has been compelled by Medicare incentives and federal mandates to implement EMRs via the UMRS. The system includes primary care and specialty practices, with the latter expressing significant dissatisfaction due to system incompatibilities and inefficiencies. The UMRS was primarily developed for primary care physicians, failing to accommodate the distinct workflows of specialists. Consequently, specialists experience increased consultation times, decreased productivity, and higher patient dissatisfaction. Furthermore, the UMRS lacks proper integration with other hospital and practice systems, complicating data sharing and communication. These issues have led to revenue declines, morale issues among physicians, and concerns about patient safety and care quality.

Organizational Issues Highlighted

1. System Design and Usability: The UMRS was designed without sufficient input from specialists, making it cumbersome and ineffective for their workflows.
2. Communication and Integration: Poor interoperability between UMRS and other electronic systems hampers seamless data exchange, affecting care coordination.
3. Physician Engagement and Satisfaction: Resistance from physicians due to system inefficiencies results in reduced morale, productivity, and increased turnover intentions.

Advantages and Pitfalls of EMR

EMRs offer numerous benefits, including improved documentation, electronic prescribing, and data accessibility, which enhance patient safety and streamline operations (Arthur & Buntin, 2011). They facilitate better care coordination, support population health management, and promote patient engagement (Cresswell et al., 2012). However, pitfalls comprise increased administrative burden, workflow disruption, high implementation costs, and potential technology incompatibilities (Borkowski, 2011). Uniform systems across diverse practices can overlook specific workflow needs, resulting in user dissatisfaction and reduced productivity (Yan et al., 2012).

Requiring all practices to use the same EMR system can promote standardization and data sharing but risks alienating specialized providers whose workflows differ substantially from primary care practices. Physicians should notably be involved in selecting or customizing EHR systems to align with their clinical routines, ensuring usability and acceptance (Shen & Ginn, 2012).

Standardization and Consensus Building

Achieving system standardization without disenfranchising productive physicians involves a collaborative approach. Establishing physician advisory committees, involving specialists in the customization process, and incorporating flexibility into system design can foster consensus (Buchbinder & Buchbinder, 2012). Offering tailored modules for different specialties, along with comprehensive training programs, can improve system acceptance.

Further, ensuring interoperability through adherence to Health Level Seven (HL7) standards, integrating multiple electronic health record (EHR) platforms, and fostering communication among stakeholders can prevent patient dissatisfaction and workflow inefficiencies (Mandl & Kohane, 2012). Regular feedback mechanisms, continuous system improvements, and aligning incentives with productivity and satisfaction are also vital.

Implementation Plan for Multi-Practice EMR System

To implement an effective EMR system across diverse practices, the following steps should be undertaken:

1. Stakeholder Engagement: Form multidisciplinary committees including primary care, specialty physicians, IT professionals, and administrators to guide customization and implementation strategies.
2. Requirements Assessment: Conduct thorough workflow analyses to understand diverse practice needs, especially those of specialists and surgeons.
3. Flexible System Design: Develop or select EMR platforms that allow modular customization, enabling features tailored to different specialties (Wang & Biedermann, 2012).
4. Training and Support: Provide specialized training, ongoing technical support, and change management initiatives to encourage adoption and proficiency.
5. Interoperability Solutions: Adopt standardized communication protocols and integrate various EHRs via interfaces to facilitate seamless data exchange.
6. Monitoring and Evaluation: Establish metrics to assess system performance, user satisfaction, and patient outcomes, with iterative improvements based on feedback.

Addressing physician productivity and satisfaction involves balancing system complexity with usability, recognizing the unique workflows of each practice, and ensuring that EMR tools support rather than hinder clinical care.

Future Prevention Strategies

To prevent similar issues, CIOs should implement proactive strategies such as:

• Early and continuous physician involvement in system planning and customization.
• Regular training and updates aligned with evolving clinical practices and technological advancements.
• Establishment of interoperability standards and participation in broader health information exchanges.
• Monitoring of system performance and user feedback to guide ongoing enhancements.
• Alignment of incentive structures to promote meaningful use and satisfaction rather than sheer compliance.

In conclusion, effective EMR implementation requires a collaborative, flexible, and strategic approach that considers the diverse needs of various clinical practices. By fostering stakeholder engagement, standardizing communication protocols, and emphasizing usability, healthcare organizations can turn EMRs into valuable tools for enhancing care quality without compromising efficiency or physician satisfaction.

References

• Borkowski, N. (2011). Organizational behavior in health care. Jones & Bartlett.
• Buchbinder, S. B., & Buchbinder, D. (2012). Managing healthcare professionals. In S. B. Buchbinder & N. H. Shanks (Eds.), Introduction to health care management (2nd ed., pp. 211–247). Jones & Bartlett.
• Cresswell, K., Worth, A., & Sheikh, A. (2012). Integration of a nationally procured electronic health record system into user work practices. BMC Medical Informatics and Decision Making, 12, 15.
• Mandl, K., & Kohane, I. (2012). Escaping the EHR trap—The future of health IT. The New England Journal of Medicine, 2240–2242.
• Shen, J. J., & Ginn, G. O. (2012). Financial position and adoption of electronic health records: A retrospective longitudinal study. Journal of Health Care Finance, 38(3), 61–77.
• Wang, S., & Biedermann, S. (2012). Adoption and utilization of electronic health record systems by long-term care facilities in Texas. Perspectives in Health Information Management, 1–14.
• Yan, H., Gardner, R., & Baier, R. (2012). Beyond the focus group: Understanding physicians’ barriers to electronic medical records. Joint Commission Journal on Quality & Patient Safety, 38(4), 184–191.
• U.S. Department of Health and Human Services. (n.d.). EHR incentives & certification: Meaningful use definition & objectives.
• Fallon, L. F., & McConnell, C. R. (2007). Human resource management in healthcare: Principles and practices. Jones & Bartlett.
• Hudson, J. S., Neff, J. A., Padilla, M. A., Zhang, Q., & Mercer, L. T. (2012). Predictors of physician use of inpatient electronic health records. American Journal of Managed Care, 18(4), 201–206.