Current Health Care Information Systems

     “Many medical organizations have invested heavily in electronic health records (EHR) and health information exchange (HIE) information systems (IS) to improve medical decision-making and increase efficiency (Ben-Assuli, Shabtai, & Leshno, 2013).”  This means that investing in the EHR and HIE information systems the health care organizations are able to provide better quality care to their patients.  For example, a patient is being treated in the physician’s office for an ear infection.  This patient has a history of being allergic to specific antibiotics which is documented within the EHR. When the physician begins documenting the current diagnosis and treatment the system will pull up the allergy this patient has had in the past which will help to prevent the physician from prescribing this medication to this patient. It could also be as simple as you going to the Dr for a reoccurring problem, your Dr can use your EHR to see what tests have been done so far as to not make you have the same test all over again, if the Dr is stumped he/she could use a mobile device to contact a college for some advice or direction.

      “Hospital implementation of HIT was positively associated with activities intended to improve patient care quality and with higher performance on four of six performance measures (Restuccia, et. al., 2012).”  Every health care organization works to improve upon the care they provide to their patients.  Implementing health information technology has aided in these improvements.  The quality of care provided to the patient is essential because the patient is going to tell friends and family about the care that they have received from the facility.  When the quality of care is not up-to-standard, the patient is going to be less likely to recommend the facility to anyone when they are in need of health care treatment.I know this first hand as the facility I used to work at, I had heard bad things about how patients were treated. A friend of mine told me that there were picketers outside the facility, and news camera crews were there to film it after I had left the job. That is not something any facility wants.

           More recently, the health care organizations have begun to use a new form of technology which will allow more remote patients to receive care that they desperately need.  This technology is known as virtual consultations.  “Virtual consultation between physicians may provide a method of streamlining care, potentially saving patients the time and expense of added visits (Palen, et. al., 2012).”  These consultations can be done with the use of an internet connection along with a system that includes a monitor, a webcam, and audio equipment.  This type of consultation can create a way in which a patient can utilize the experience of a specialist while setting in their primary care physician’s office.  For example, a patient has been diagnosed with a mental illness and must utilize the services of a therapist.  This therapist is located in another town that will consist of traveling two hours to get to the appointment and another two hours to get back home.  The use of virtual consultations will allow the patient to receive therapy from the professional without the four hours of travel time.  This creates a more financially compatible service for the patient and the health professionals alike.I wish the VA would use this technology, I have my appointment that take time for me to get there, get checked in, wait for the Dr then go through my test results etc, to me all this could be done with a Virtual consultation. I would rather do the waiting at home or maybe I could take a break at lunch and have a virtual visit from my smartphone or tablet. That would be nice

       

  Current health care information systems have brought about ways in which patient-centered care is more prevalent than the potential for financial gains.  This means that patients are able to put more trust in the care that they receive from their health care providers because the up-to-date health care information systems allows the providers to focus more on the patient and a little less on the paperwork that used to be involved in the patient care.At the end of the day isn't that what all this new technology, EHR's HIE's and IS , is for? Yes vendors make money, hospitals and facilities make money, although without the patients they wouldn't make the money. The better you treat the customer(patients) the more money you will receive.  Seems like everyone wins.

Ben-Assuli, O., Shabtai, I., & Leshno, M. (2013). The impact of EHR and HIE on reducing avoidable admissions: Controlling main differential diagnoses. BMC Medical Informatics and Decision Making, 13. Retrieved from ProQuest database.

Restuccia, J., Cohen, A., Horwitt, J., & Shwartz, M. (2012). Hospital implementation of health information technology and quality of care: Are they related? BMC Medical Informatics and Decision Making, 12. Retrieved from ProQuest database.

Palen, T. E., Price, D., Shetterly, S., & Wallace, K. B. (2012). Comparing virtual consults to traditional consults using an electronic health record: An observational case-control study. BMC Medical Informatics and Decision Making, 12. Retrieved from ProQuest database.

Continuous quality monitoring and accreditation and healthcare

Continuous quality monitoring and accreditation and healthcare

In healthcare we are often exposed to accreditation agencies and regulatory compliance standards that we must meet and maintain throughout our operation and interactions with patients. Every system, process, and every program must be continually monitored and maintained in order to protect not only the patient safety but exceed HIPAA and security standards. This is done through a variety of benchmarks tools and review bodies such as Boards of Governors, regulatory agencies and accreditation committees such as Joint Commission. Medicare & Medicaid under CMS also have standards that must be met. Today, as one of the longest-standing Medicare quality reporting initiatives, the Hospital IQR Program includes more than 50 care measures related to process, outcome, structure, and patient experience. The program also focuses on several high-impact conditions, including acute myocardial infarction, heart failure, stroke, and pneumonia (Smith, 2012).

I really don't have any experience with quality and accreditation boards although I know they are important. I have been through numerous quality inspections in my career in healthcare. From the paper medical record to the new electronic health record, rules and requirements in the formats may have been changed but many of the standards have become stricter.  The biggest focus is in detailed information documentation and system processes in order to protect patient’s safety and privacy (Cassidy, 2011). Both Joint Commission and CMS have strict standards that must be met to protect health information and patient safety. Each set of surveyors will review policies, procedures, records in all formats and interview patients and staff. By having an effective health informatics system in place with the necessary safeguards helps make accessing this information easier. Failure to meet or exceed these standards can be cause for fines and loss of accreditation. This can also be tied into lost revenue and reimbursements.  

NAHQ

Health informatics tools are a way of being able to meet regulatory standards as well as a means to continually monitor quality within an organization and provider. This will be an ongoing process, especially when dealing with computers, mobile devises and the internet.There must also be processes in place to measure and monitor the system that is collecting this information. Data collected in the Hospital IQR Program is reported by Medicare and can be found on the Medicare Quality Care Finder website (www.medicare.gov/quality-care-finder/) under “Hospital Compare.” The Hospital IQR program plays an important role in the evolution of the Hospital Value-Based Purchasing (Hospital VBP) Program, as measures included in that program must first have been available under Hospital Compare for at least 1 year (Smith, 2012).   

By continually monitoring our systems and maintaining accreditation status positively affects not only the patient as well as the provider. Staff is trained just what the regulatory standards are that they must meet and exceed as well as what acceptable benchmarks must be met based on processes procedures and  the systems that are in place. Patients benefit with positive clinical outcomes based on safety measures that are in place. As a safeguard, being monitored by the organization itself as well as outside agencies sets a bar we must always obtain to provide quality care.

One area of particular focus for positive clinical outcomes (and is often the starting point for most surveyors) is the electronic medical record as well as CPOE. This type of technology helps to reduce errors and has the capacity to derive reports and data based on the information that is stored in this format (Armitage, Newell & Wright, 2010).  Surveyors review this information for accuracy and any outliers. It is also be benchmarked against other processes. They often wish to know how we are using the information we are able to gather. Everyone is affected when it comes to clinical monitoring and quality especially the patient. This monitoring is beneficial for all involved, just think when you get the age where you may need this type of care, wouldn't you like to know the type of quality care you are receiving?

The major impact on society is that accreditation standards and continuous monitoring processes allows the public to understand who is meeting or exceeds in providing care. It also serves as a means to alerting others what problem areas maybe in place at specific facilities or organizations. With the advent push towards electronic health record adoption transparency is now being provided so patients can review the information easily and quickly ask questions of their healthcare provider. Individuals can access results and surveys on specific website in order to see how their facility organization stands up against its peers, benchmarks and itself. Ultimately the patient is one that is greatly affected by the outcomes that are noted.

Smith, H. L. (2012). Quality Reporting in the Hospital Inpatient Setting. PT In Motion,4(11), 36-39.

Cassidy, B.  (2011).  AHIMA's Code of Ethics. Journal of AHIMA, 82(3), 10.  Retrieved from the ProQuest database.

Armitage, G., Newell, R., & Wright, J. (2010).  Improving the quality of drug error reporting.  Journal of Evaluation in Clinical Practice, 16(6), 1189-1197.  Retrieved from the EBSCOhost database. 

Telecommunications and networking concepts for healthcare

Telecommunications and networking concepts for healthcare

   I used to use different methods of telecommunications and networking concepts to provide patient information throughout the continuum of care. Telecommunication and networking allows providers to share patient information in a wide variety of methods and devices. In the beginning medical health care information was stored with the provider in a paper medical record. This document had to be requested by permission to the next level of care. Or care by vendors was needed and so was the information concerning the patient. Information was copied, mailed, faxed to the provider. Or just printed.This could  take days or weeks depending on the location of the provider. In turn this greatly affected the clinical outcomes for patients as they had to wait to receive appropriate medical care. Information sharing at that level was very lengthy and slow. Today, telecommunication and networking has reduced this time frame and allows providers and patient easier access to health information and records. Although sometimes there are still hiccups while everyone gets used to how telecommunication works in healthcare.  News and social media, such as websites, mobile phone text messaging, interactive websites, YouTube, Twitter, and Facebook. Here, communication and rhetoric of science scholars can help shape the future efficacy of Web2.0 healthcare communication and the strategies its practitioners use toward patient activation (Roundtree, Dorsten & Reif, 2011). Organization are mandated by Meaningful Use to implement EHR’s by a specified time frame. Failure to do so will result in reductions of reimbursements. This also includes training and identifying technological leaders within the organization to implement and plan technology changes well into the future (Joshi, et.al, 2013).

The experience with  has been both positive for me with positive patient clinical outcomes noted. Daily I was able to review patient census, diet information, medical health information, the location of patients, any pending tests that are needed. I was also able to communicate via electronic devices, the intranet any orders for medications or tests that had been done for the patient. This information is channeled through our intranet, networking within our organization and within our facility. This type of telecommunication and networking environment allows providers to interact quickly and safely with each other as well reviewing patient’s prior medical history, allergies or medications for contraindications. There can also be multiple users with an electronic medical record at one time. This method is very effective and safe. It allows all systems to work together to provider centralized information sharing with the patient at the center.

Telecommunications and networking concepts for healthcare provides an explanation about how individuals are able to communicate by way of electrical formats as well as networking concepts. This is done by illustrating how the patient is at the center of the care with a wide variety of services encircling them. Organizations communicate to the individuals, to their staff, providers and regulatory agencies using many devices and software platforms. Each and every physician that would touch or access this information needs to be trained on the software itself and what record information is to be inputted in the system (Dalrymple, 2011).In the acute care arena different types of providers are able to access lab results, CT scan results, MRIs and telemetry in order to monitor a patient's medical condition. This has become increasingly important as there is a shortage in both physicians and nursing currently in our communities. This will only increase over time as providers struggle with reimbursements.Hopefully as technology becomes more widely implemented everywhere, and it becomes the new norm reimbursements will not be an issue.

Some of the new mobile devices allow physicians to interact and communicate with patients via iPhone, smart phone applications, tablets, laptops and desktops. When I worked in Rehab mobile device usage was a requirement for the job. These mobile devices can reside in the office, the hospital or even at bedside. Physicians and nurses or therapists can enter information directly into the medical record as it occurs. Bar code scanner can record and dispense medication bedside with verification of a bar code on a patient wrist band.Like in some hospitals. In turn this information is collected, recorded, verified to the orders, checked for accuracy all in a matter of seconds. Reports can then be extrapolated to provide clinical reviews and financial billing. Instead of having all of the information stored in a paper medical record all of this information is now easily communicated to the patients and accessible almost immediately. Access will continue to improve as it can now reach the individual patient wherever they are and provide access to community support (Joshi, et.al, 2013).

Roundtree, A. K., Dorsten, A., & Reif, J. J. (2011). Improving Patient Activation in Crisis and Chronic Care Through Rhetorical Approaches to New Media Technologies. Poroi: An Interdisciplinary Journal Of Rhetorical Analysis & Invention, 7(1), 1-14.

Joshi, Ashish, MD,PhD., M.P.H., Meza, J., PhD., Costa, S., PhD., Perin, D. M. P., M.P.H., Trout, K., M.P.H., & Rayamajih, A., M.S. (2013). The role of information and communication technology in community outreach, academic and research collaboration, and education and support services (IT-CARES). Perspectives in Health Information Management, , 1-1g. Retrieved from http://search.proquest.com/docview/1507286836?accountid=32521

Dalrymple, P. W. (2011). Data, information, knowledge: The emerging field of health informatics. Bulletin of the American Society for Information Science and Technology (Online), 37(5), 41-44. Retrieved from http://search.proquest.com/docview/870844500?accountid=32521

The Impact on the Electronic Medical Records Integration

           Integrated electronic medical records have revolutionized the way that health care is practiced across the globe. Organizations that have made steps to integrate solutions are seeing areas of improvement within the EMR, which would help physicians improve health outcomes, facilitate collaborative efforts and increase practice inefficiencies (Electronic, 2011). All of these gains are making the practice of medicine  less costly, and more efficient which has directly led to gains in patient care. A good side effect of these gains is that the medical community is seeing them and is more willing to take steps to further enhance their electronic systems, essentially building creating success built on past successes.

         The best systems, systems that were top of the line for their use but shared little data with the rest of the health system, have fallen out of favor in past years as cheaper, easier to maintain, and integrated platforms have emerged and delivered gains. Systems that were once solid are being replaced with fully integrated solutions that allow all areas to share patient information which has led to huge gain in efficiency  across the board. Patients that once had to be registered into multiple systems can now be input into a single system and multiple users from different department can work in the patient chart at one time. This team approach has shown the biggest gains for the clinical users of patient care. I only wish this was the case for the VA hospital patients. I have been seen at 3 VA facilities within the last 2 years, each time I would go to a new facility I would have to explain my condition and what treatment I was receiving. I feel the VA healthcare is all part of the government, and with everything being electronic they should be able to look up my file. Sad to say that is not true, it is very frustrating. The VA needs to catch up.

     I have interacted positively with my primary care physician on many occasions and watched them input my medical information into a laptop at the bedside and in her office. They are able to retrieve the information accurately and quickly in order to make an appropriate assessment of my medical condition.Once I am in the system, like I explained before. One of the advantages that I have experienced is being able to review x-rays on her laptop or other diagnostic tests and have these explained to me. They are also able to look up any previous treatment if there are any questions about why treatment isn't working.  This is a quality control measure bridging any gaps in communication and education between the physician and patient. Integration of an EMR results in improvements in provider satisfaction and aspects of workflow (Palma, Sharek & Longhurst, 2011). There are also interfaces within the medical record that store medication records to avoid adverse drug reactions. These systems have indicators or alarms that can let the physician know whether there are issues related to multiple medications being taken and administered. While these systems and processes are not perfect and they are a work in progress I do feel that things are getting better and will continue to do so. I feel there will always be some room for improvement.

    

       While gains have been tangible there has still been considerable resistance to the integrated electronic movement, which led to government intervention through the HITech Act and meaningful use. Meaningful use is a metric of actions that require certain measurable number to be hit in regards to a number of patient care and end user data entry objectives. The correlation to meeting those metrics and financial incentives set for the HITech Act has caused a boom in the health information management industry (Bernd, 2011). Organizations large and small are clamoring to get in line with the government incentives to earn bonus money or at least not lose Medicare and Medicaid dollars when the bonus plan turns into a penalty plan in 2015.

             The success of integrated systems have led many to believe that one day there will be an integration of sorts on a national level.  While there are many obstacles, namely structure, data warehousing, and privacy to a national medical record many still have hope that this will help to low costs of health care across the country.  With a national health record patients would be able to walk into any participating health care organization and have best information be pulled from a national database and receive care that is tailored to the patient. Like the do in some parts of Europe. This information would significantly raise the level of care provided to patients and potentially save thousands of lives annually by helping to reduce mistakes caused by unknown past patient medical history. New technology is continually redefining common medical practice.  The most recent change is  that it has furthered the effectiveness of integrated systems and in the widespread use of wireless technology, ie: smart phones, and tablet computers. These  advances have combined to give clinicians unprecedented access to their patients and continue to reduce costs of patient care by shortening stays, creating more accurate and timely documentation. This constant change in HIM and integrated electronic medical records makes this the most exciting time in history to be involved in those technologies.

I like where it is now as a patient and can't wait to see where it takes us as a technician.

References:

Electronic medical records; use of electronic medical records EMR by canadian physicians bodes well for future of patient care. (2011). Telemedicine Business Week, , 3962. Retrieved from http://search.proquest.com.proxy-library.ashford.edu/docview/878461542/C6653A12B56C43EEPQ/1?accountid=32521

Palma, J. P., Sharek, P. J., & Longhurst, C. A. (2011). Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit. http://stanfordhealthcare.org/doctors/l/christopher-Longhurst.publication.html/102544.html

Bernd, D. L., F.A.C.H.E., & Fine, P. S., F.A.C.H.E. (2011). Electronic medical records: A path forward. Frontiers of Health Services Management, 28(1), 3-13. Retrieved from http://search.proquest.com.proxy-library.ashford.edu/docview/892262278/7D8078DA82344D88PQ/1?accountid=32521