Implementation of an electronic medical record

As more technologies emerge to increase the delivery and efficiency of patient care, the more vulnerable and complex that the management of patient information and data becomes. The implementation of electronic medical record (EMR) in the department of Infections Disease is a critical need. The coordination of care for patients with chronic conditions is essential to efficient patient management. More doctors and health care facilities are moving away from the use of paper records and adopting more software applications that help improve patient care.

The primary goals in healthcare is to implement EMR to allow fast, reliable, and secure access to patient information and data across varying facilities. Successful EMR implementation is not accomplished by the purchase of an “out of box” software product, but by the definition of a clear plan, acceptance of the plan by key players, sufficient funding, and adherence to the compliance of current HIPPA standards. The biggest challenges regarding implementation of EMR are security, software imperfections, and costs.

According to the World Health Organization there are approximately 1. million in the United States and 34 million people worldwide, living with HIV and AIDS. The motivation behind the implementation of the EMR in the departments of infectious disease is to ensure the effective treatment of these chronically ill patients. Delivery of effective maintenance drug therapy and patient participation increases the potential for better patient outcomes. The implementation of EMR in infectious disease departments allows for the patient to be more involved in the specific processes surrounding treatment and allows physicians to better organize the patient’s medical history.

Due to the social and funding challenges of treating HIV patients the interoperability of EMR helps boost the care for HIV patients and promotes more successful treatment. A customized EMR is of paramount importance in HIV care, in which successful treatment decisions and practice management rely on clinical history tracking, comprehensive reporting and data analysis (Hardy, 2010). Another critical component in the implementation of EMR in an infectious disease department is its integration with that departments computerized physician order entry (CPOE) system.

Computerized physician order entry systems (CPOE) encompass a variety of computer based systems that share the common feature of automating the medication ordering process. The CPOE is strategically interfaced to address the critical need of reducing prescribing errors and is supported by researchers, clinicians, pharmacists, and a number of health agencies and health administrators. To achieve the best results, following the EMR implementation model adopted by Advocate Healthcare would be the most reliable.

Advocate Healthcare is one of the nation’s top 10 healthcare systems, located in Illinois. Advocate Healthcare utilizes information technology developed by the company Certify. Certify’s interoperability solution known as HealthDoc will allow hospitals to easily interface with hospitals and physician’s EMR record in real time. What is dynamic about HealthDoc is that it allows the flow of critical electronic medical data such as laboratory tests, pathology results, and radiology reports between physicians and affiliated hospitals regardless if the facility uses a different EMR system.

Most importantly the successful implementation or adoption of an electronic medical record into any facility will require approval from the “key players” involved such as the chief financial officer and medical director. The morale surrounding the project also contributes to successful implementation. Choosing a respected staff member and/or physician champion to rally the team, show enthusiasm and set expectations can make a huge difference (Saphington,2009). An analysis of costs related to post-implementation, technology constraints will determine the success of implementation.

Seventy-five percent of providers flag technology/implementation costs as the number-one challenge to successful EMR roll out, and 44% cite IT infrastructure challenges. Implementation will be dependent upon the appropriate funding which is influenced by the motivation behind the implementation behind EMR. At the executive level where many of the decisions will be made there must be a clear definition of purpose for the implementation. The commitment and vision must be clear and concise.

Recognition of the strategic vision and establishment of a clear path to implementation leads to the overall success of the project. Implementation projects fail when organizations go against their strategic initiatives. Sticking to a consistent plan with pre-set goals and involvement of staff in the progression of implementation can benefit the organization during training after post implementation. The most challenging aspects to implementation will the selection of a reputable software provider and security for the new system.

The fundamental computer security concepts are confidentiality, integrity, and availability. These concepts are referred to as the C-I-A triad or informational security triad. Informational security, when discussed, will return many varying definitions however; when considering these three concepts, informational security is the confidentiality, integrity, and availability of information. Confidentiality ensures that information that is secret remains secret and proprietary. In the medical industry confidentiality is important to the protections of patient information.

To enforce this concept legislation known as the Health Insurance Portability And Accountability Act (HIPPA) was enacted in 1996 and afforded families health insurance protections and established a set of standards to improve efficiency and effectiveness of the nation’s healthcare system. Integrity is concerned with the trustworthiness and correctness of information. To protect the integrity of accessible information companies implore the use of computer logon which requires personnel to identify themselves when accessing confidential patient information.

Computer logon is a form of access controls put in place to not only protects access to patient information but also to protects the origin or source of patient information. Integrity in patient records would address unauthorized modifications of patient information. Information availability, while not as important but is necessary to support the conceptual need for integrity and confidentiality. If the information is not available then the other concepts are irrelevant.

Patient information must be accessible and readily available; attacks against availability are called denial of service (DoS), Attacks such as this would occur when attempts are made to make information unavailable to authorized users. The organizing principles that guide computer security are: multiple layers of security, distributability, disposability, adaptability, detection, and behavior. These organizing principles are designed in likeness to the function and purpose of the biological immune system.

Multi-layered security is common to the protection of all modern computer systems just as multilayered protection is common in biological systems. In computer informational systems types of multi-layered security would include operating system updates, firewalls, and antiviral software. Distributability is the ability of the system to defend when the attack is not in one local area but in multiple areas at the same time. An example of this type of security may occur when a computer system is flooded by DoS attacks.

HIPPA security standards indicate that PHI stored within an intranet must be securely stored and access to it must be strictly regulated (Hanson, 2010). In regards to networks PHI requires access to be regulated by the use of logons and passwords. In addition HIPPA mandates that access to these files be audited and tracked for analysis.. HIPPA the development of formulated policies for the management of forgotten or suspect passwords, the use of emails, and access to work stations. Hanson, 2010). HIPPA also has standards regarding the maintenance, destruction, and movement of PHI. These standards are designed to prevent malicious intent or mismanagement of PHI. The HIPPA standards are not only in place for security but also for Privacy. Multi-tiered access and even biometric identification methods are being considered to not only protect PHI but to ensure that only certain clinicians or those with specific access can retrieve patient data.

These methods will limit the number of individuals with access to patient data. These methods can protect the patient and the organization against legal issues. Successful implementation of EMR is not an easy accomplishment. The purchase of some standard software out of the box will not be sufficient enough to address the challenges of interoperability with current health record system; nor will out of box software be able to comply with the legal security compliances related to HIPPA legislation.

Successes that lead to the effective implementation of an EMR are research, strategic planning, software selection, and key leaders in membership whom will support funding and boost morale for the staff. Within a facility supporting the critical care needs of HIV patients, the EMR will allow physicians and other clinicians to easily track patient data and collect statistics on patient care and treatment.

The doctor patient relationship is more effective because the patient would be more involved in their personal care. With the biggest concerns relating to security and privacy, it would be imperative that an infectious disease facility be able to update their software with time and be able to continue to provide patients the access they need. Through the implementation of the EMR across the nation, our lives would be a little easier and our doctors would be well informed of their patient medical histories.

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