Healthcare Management Capstone
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Healthcare Management Capstone
Over recent years, the revolution in the healthcare system and the implementation of technological programs have been widely adopted and utilized in an efficient way. All the major corporations have shifted to fully computerized systems in all departments. Electronic Health Record (EHR) has the prospective to transform the healthcare management for the purpose of delivering higher quality patient-centered care. According to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the bill was signed with an explicit purpose of providing incentives to the health providers to adopt the EHR system.
Financial and Health Benefits of Implementing EHR
In many countries, the healthcare industry is the source of social and economic interest; thus, implementation of EHR in the healthcare systems has undergone serious consideration. EHR in the organizations have helped reduce the billing errors and an improvement in cash flow and revenue. Improving the quality and efficiency of healthcare system is the priority of national policies. EHR implementation has been related to the quality of care and patient safety. Research in an outpatient setting has established that the computerized reminders by the use of EHR have been associated with an improved rate of influenza and pneumococcal vaccination. On a wider prospective, the use of EHR has resulted in the prevention and lower risks of disease outbreaks. Studies have also supported that the EHR implementation has reduced the medical error significantly ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"CWHuIGFG","properties":{"formattedCitation":"(Menachemi & Collum, 2011)","plainCitation":"(Menachemi & Collum, 2011)","noteIndex":0},"citationItems":[{"id":294,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/23GIG7Y3"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/23GIG7Y3"],"itemData":{"id":294,"type":"article-journal","title":"Benefits and drawbacks of electronic health record systems","container-title":"Risk management and healthcare policy","page":"47-55","volume":"4","archive":"PubMed","archive_location":"22312227","abstract":"The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 that was signed into law as part of the \"stimulus package\" represents the largest US initiative to date that is designed to encourage widespread use of electronic health records (EHRs). In light of the changes anticipated from this policy initiative, the purpose of this paper is to review and summarize the literature on the benefits and drawbacks of EHR systems. Much of the literature has focused on key EHR functionalities, including clinical decision support systems, computerized order entry systems, and health information exchange. Our paper describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality, reduced medical errors), organizational outcomes (eg, financial and operational benefits), and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs). Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. Overall, experts and policymakers believe that significant benefits to patients and society can be realized when EHRs are widely adopted and used in a \"meaningful\" way.","DOI":"10.2147/RMHP.S12985","ISSN":"1179-1594","journalAbbreviation":"Risk Manag Healthc Policy","language":"eng","author":[{"family":"Menachemi","given":"Nir"},{"family":"Collum","given":"Taleah H"}],"issued":{"date-parts":[["2011"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Menachemi & Collum, 2011).
Estimated Cost of Implementing and Managing EHR
Qualitative studies have suggested that the implementation and quality improvement of EHR highly depends on the use and recommendation of physicians. U.S. national policy includes the delivery of quality care and adoption of innovative techniques and methodologies in the health system. In 2009, EHR received wide acceptance and undoubted support; thus, the U.S. Congress allocated around $30 billion for the promotion and adoption of EHR in the system ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"phQkLD4b","properties":{"formattedCitation":"(Ajami & Bagheri-Tadi, 2013)","plainCitation":"(Ajami & Bagheri-Tadi, 2013)","noteIndex":0},"citationItems":[{"id":290,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/DZ83ZGEE"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/DZ83ZGEE"],"itemData":{"id":290,"type":"article-journal","title":"Barriers for Adopting Electronic Health Records (EHRs) by Physicians","container-title":"Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH","page":"129-134","volume":"21","issue":"2","archive":"PubMed","archive_location":"24058254","abstract":"CONFLICT OF INTEREST: NONE DECLARED. INTRODUCTION: Electronic Medical Records (EMRs) are computerized medical information systems that collect, store and display patient information. They are means to create legible and organized recordings and to access clinical information about individual patients. Despite of the positive effects of the EMRs usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. The EHRs represent an essential tool for improving both in the safety and quality of health care, though physicians must actively use these systems to accrue the benefits. This study was unsystematic-review. AIM: The aim of this study was to express barriers perceived y physicians to the adoption of the EHRs. METHOD OF THE STUDY: This study was non-systematic reviewed which the literature was searched on barriers perceived by physicians to the adoption of Electronic Health Records (EHRs) with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. DISCUSSION: FOR OUR SEARCHES, WE EMPLOYED THE FOLLOWING KEYWORDS AND THEIR COMBINATIONS: physicians, electronic medical record, electronic health record, barrier, and adoption in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 27 of them were selected based on their relevancy. Electronic health record use requires the presence of certain user and system attributes, support from others, and numerous organizational and environment facilitators.","DOI":"10.5455/aim.2013.21.129-134","ISSN":"0353-8109","journalAbbreviation":"Acta Inform Med","language":"eng","author":[{"family":"Ajami","given":"Sima"},{"family":"Bagheri-Tadi","given":"Tayyebe"}],"issued":{"date-parts":[["2013"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Ajami & Bagheri-Tadi, 2013). It is up to physicians to evaluate the costs of bringing in and promoting new I.T. applications or vendors for the provision of services. Cost management is an important aspect as organizations have to assess the total cost of care and its viability. The total cost of care includes purchase price, coordination, monitoring, transferring, upgradation, and governance costs. Implementation of EHR in a 5-person practice is approximately $162,000 in the first year and $85,000 for maintenance annually and can reach up to a million ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gSKE3Q9Z","properties":{"formattedCitation":"(Palabindala, Pamarthy, & Jonnalagadda, 2016)","plainCitation":"(Palabindala, Pamarthy, & Jonnalagadda, 2016)","noteIndex":0},"citationItems":[{"id":292,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/FARUW3XF"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/FARUW3XF"],"itemData":{"id":292,"type":"article-journal","title":"Adoption of electronic health records and barriers","container-title":"Journal of community hospital internal medicine perspectives","page":"32643-32643","volume":"6","issue":"5","archive":"PubMed","archive_location":"27802857","abstract":"Electronic health records (EHR) are not a new idea in the U.S. medical system, but surprisingly there has been very slow adoption of fully integrated EHR systems in practice in both primary care settings and within hospitals. For those who have invested in EHR, physicians report high levels of satisfaction and confidence in the reliability of their system. There is also consensus that EHR can improve patient care, promote safe practice, and enhance communication between patients and multiple providers, reducing the risk of error. As EHR implementation continues in hospitals, administrative and physician leadership must actively investigate all of the potential risks for medical error, system failure, and legal responsibility before moving forward. Ensuring that physicians are aware of their responsibilities in relation to their charting practices and the depth of information available within an EHR system is crucial for minimizing the risk of malpractice and lawsuit. Hospitals must commit to regular system upgrading and corresponding training for all users to reduce the risk of error and adverse events.","DOI":"10.3402/jchimp.v6.32643","ISSN":"2000-9666","journalAbbreviation":"J Community Hosp Intern Med Perspect","language":"eng","author":[{"family":"Palabindala","given":"Venkataraman"},{"family":"Pamarthy","given":"Amaleswari"},{"family":"Jonnalagadda","given":"Nageshwar Reddy"}],"issued":{"date-parts":[["2016",10,26]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Palabindala, Pamarthy, & Jonnalagadda, 2016). Costing remains one of the biggest challenges for small to medium sized organizations without extended budgets allocated for the use of I.T.
Current Security Concerns
Despite the benefits and efficient results of using EHR in healthcare systems, there remain concerns related to the security, privacy, and integrity of the information. These concerns have led people to shy away from disclosing their healthcare data, which eventually leads to life-threatening consequences. In U.S., the Department of Health and Human Services has collected data about the implications of security concerns of using EHR and found out that around two million Americans had been struggling with mental illness as they did not seek any medical treatment due to the privacy concerns ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Td284ywD","properties":{"formattedCitation":"(Y\\uc0\\u252{}ksel, K\\uc0\\u252{}p\\uc0\\u231{}\\uc0\\u252{}, & \\uc0\\u214{}zkasap, 2017)","plainCitation":"(Yüksel, Küpçü, & Özkasap, 2017)","noteIndex":0},"citationItems":[{"id":296,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/RPZ8MCL4"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/RPZ8MCL4"],"itemData":{"id":296,"type":"article-journal","title":"Research issues for privacy and security of electronic health services","container-title":"Future Generation Computer Systems","page":"1-13","volume":"68","author":[{"family":"Yüksel","given":"Buket"},{"family":"Küpçü","given":"Alptekin"},{"family":"Özkasap","given":"Öznur"}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Yüksel, Küpçü, & Özkasap, 2017). Health Insurance Portability and Accountability Act (HIPAA) has defined guidelines for protecting the patient health data and has made the consent certificate binding. Researchers, health investigators, and other organizations will require patient authorization for the disclosure of information ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BCeujXkq","properties":{"formattedCitation":"(Cohen & Mello, 2018)","plainCitation":"(Cohen & Mello, 2018)","noteIndex":0},"citationItems":[{"id":297,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/BKRFUPWY"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/BKRFUPWY"],"itemData":{"id":297,"type":"article-journal","title":"HIPAA and protecting health information in the 21st Century","container-title":"Jama","page":"231-232","volume":"320","issue":"3","author":[{"family":"Cohen","given":"I. Glenn"},{"family":"Mello","given":"Michelle M."}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Cohen & Mello, 2018).
EHR – Decision Making and Problem Solving
The use of EHR in a health delivery process has a promising impact on facilitating shared decision making among patients, families, physicians, and health insurers. In the face of complicated situations, EHR may provide an easy way out by sharing the information between concerned individuals, and then based on the information available, making a sound decision. The shared decision making process by the use of EHR, the patient acquires preparatory education and a holistic understanding of disease diagnosis and available treatment options. The more active role of patients in decision making and solving medical implications also give importance to the patient's values and preferences. It has also proved to be a cost effective and patient-centered care strategy ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"iyXO17y8","properties":{"formattedCitation":"(Kuo, Thavalathil, Elwyn, Nemeth, & Dang, 2018)","plainCitation":"(Kuo, Thavalathil, Elwyn, Nemeth, & Dang, 2018)","noteIndex":0},"citationItems":[{"id":298,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/M74NBPB4"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/M74NBPB4"],"itemData":{"id":298,"type":"article-journal","title":"The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead","container-title":"Medical Decision Making","page":"1040-1045","volume":"38","issue":"8","author":[{"family":"Kuo","given":"Alyce Mei-Shiuan"},{"family":"Thavalathil","given":"Berry"},{"family":"Elwyn","given":"Glyn"},{"family":"Nemeth","given":"Zsuzsanna"},{"family":"Dang","given":"Stuti"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Kuo, Thavalathil, Elwyn, Nemeth, & Dang, 2018).
References
ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Ajami, S., & Bagheri-Tadi, T. (2013). Barriers for Adopting Electronic Health Records (EHRs) by Physicians. Acta Informatica Medica : AIM : Journal of the Society for Medical Informatics of Bosnia & Herzegovina : Casopis Drustva Za Medicinsku Informatiku BiH, 21(2), 129–134. https://doi.org/10.5455/aim.2013.21.129-134
Cohen, I. G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st Century. Jama, 320(3), 231–232.
Kuo, A. M.-S., Thavalathil, B., Elwyn, G., Nemeth, Z., & Dang, S. (2018). The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead. Medical Decision Making, 38(8), 1040–1045.
Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy, 4, 47–55. https://doi.org/10.2147/RMHP.S12985
Palabindala, V., Pamarthy, A., & Jonnalagadda, N. R. (2016). Adoption of electronic health records and barriers. Journal of Community Hospital Internal Medicine Perspectives, 6(5), 32643–32643. https://doi.org/10.3402/jchimp.v6.32643
Yüksel, B., Küpçü, A., & Özkasap, Ö. (2017). Research issues for privacy and security of electronic health services. Future Generation Computer Systems, 68, 1–13.
