When
implementing a strategic implementation plan for an electronic health record
(EHR), a facility must consider the benefits of the system vs. the cost of
implementation, including training. While most hospital systems throughout the
country are already using some form of an EHR, consideration must be given when
implementing a new system or upgrading an old system. One of these systems,
EPIC, has been growing rapidly in the
medical community. In 2003, EPIC was
chosen by Kaiser Permanente to provide the electronic system to cover 36
hospitals and over 8 million members. Currently, its
systems will cover 127 million patients with active electronic health records
by July 2013. (Freudenheim, 201One of the core functions of a successful EHR is enhanced reporting
systems. One of EPIC's department or module EHR is the Radiant Radiology
Information System, this system "combines tools for
rules-based scheduling, documentation, results communication, chart/film
tracking and detailed statistical reporting in a unified system that is fully
integrated with our clinical systems. Radiant allows clients to link images and
reports with a single system that can be accessed simultaneously by multiple
users in multiple departments." (EPIC, 2012)
Enhanced reporting systems are an essential part of the EHR. This allows
for health care providers to keep track of patient information, doctor orders,
and results of tests. For the administrator, enhanced reporting systems show
the statistics of the department and see the cost/benefit ratio.
Assuming a hospital has already begun to implement the EPIC system, a
strategic plan needs to be in place for each of the departments within that
hospital. The Radiant Radiology Information System that EPIC offers is to be
implemented, and as such, a strategic plan needs to be enacted to successfully
integrate the department's functions.
According to healthit.gov, there are six steps in implementing an EHR.
·
Assess
your department's readiness
- The first step in EHR implementation is to conduct
an assessment of the current department and its goals, needs, and financial and
technical readiness. With an accurate view of your level of preparedness, your
department can design an implementation plan that meets specific needs.
·
Plan
your approach - Planning draws on the information
gathered during the assessment phase, to outline the department's EHR
implementation plan.
·
Select
an EHR - In this case, EPIC is the system that has been
chosen to meet the needs of the hospital as a whole.
·
Conduct
training and implement the system - EHR implementation
involves the installation of the EHR system and associated activities, such as
training, mock “go-live,” and pilot testing.
·
Achieve
meaningful use - The final phase of EHR implementation
includes successfully attesting to demonstrating meaningful use of EHRs, and
reassessing what you have learned from training and everyday use of the system
·
Continue
quality improvement - Emphasizes continuous evaluation of
your practice's goals and needs post-EHR-implementation to continue improving
workflows that achieve the individual practice's goals while leveraging the
functionality of electronic health records. (healthit.gov, 2013)
Once the EHR has been implemented, it is now time to see the benefits of
the system, particularly the enhanced reporting systems for the radiology
department. According to Danton, Radiology reports
contain a wealth of data that could be used for research purposes if it were
easily extractable. (2010) These reports could be standardized and structured
with an EHR. Structured reporting has been characterized as having 3 features:
headings, such as history and findings must be consistent; the report is
itemized, with short, descriptive terms, and; the report uses a standard
lexicon with codified terms.(2010)
Additionally, Danton goes on to say, "Many current structured
reporting systems use a click-based approach where reports are constructed by
pointing the mouse at a series of options. These systems are most commonly used
for mammography, but are available for the entire body. Unfortunately, the
large number of clicks to generate a report can be discouraging and requires
the radiologist to spend time looking at the reporting screen and away from the
images. An ideal structured reporting system allows radiologists to keep their
eye on the image as much as possible with little glancing away at the
dictation. Once the dictation technique is learned, structured reports can be
standardized throughout a practice or institution and can be designed to
include information required to maximize billing, decrease TAT and improve
readability. With codified terms that can be catalogued, research institutions
will be able to efficiently extract data from accumulated patient
reports." (2010)
An EHR
system such as EPIC can greatly improve the reporting system in the radiology
department. EPIC has currently worked with NUANCE to include voice recognition
software to their systems. This is especially important in the radiology
department, where a radiologist can dictate and have it transcribed immediately
into the system. (Terry, 2012)
Once the
department has been set up with its new EHR system, and has enhanced its
reporting methods, it is essential that the hospital and the department follow
the Health Insurance Portability and Accountability Act(HIPAA) and comply with
all regulations.
According
to Healthit.gov, "The HIPAA Privacy Rule establishes a set of national
standards for the use and disclosure of individually identifiable health
information – often called protected health information (PHI) – by covered
entities, as well as standards for providing individuals’ with health
information privacy rights and helping individuals understand and control how
their health information is used."
In
general, HIPAA Privacy Rule requirements:
- Apply to most health care providers;
- Set a federal floor for protecting individually identifiable health information across all mediums (electronic, paper, and oral);
- Limit how covered entities may use and disclose individually identifiable health information they receive or create;
- Give individuals rights with respect to their PHI, including a right to examine and obtain a copy of information in their medical records and the right to ask covered entities (that’s you!) to amend their medical record if information is inaccurate or incomplete;
- Impose administrative requirements for covered entities; and
- Establish civil penalties.
Additionally, Healthit.gov goes on to say, "An EHR alters the mix
of security needed to keep patient health information secure, and it brings new
responsibilities for safeguarding your patients’ health information in an
electronic form.
The HIPAA Security Rule establishes national
standards to protect individuals’ electronic protected health
information (e-PHI) that is created, received, used, or maintained by a
HIPPA covered entity. The Security Rule requires appropriate administrative,
physical and technical safeguards to ensure the confidentiality, integrity, and
security of ePHI.
These safeguards, when applied well, can help you
avoid some of the common security gaps that lead to cyber attack or data loss.
They can protect the people, information, technology, and facilities that you
may depend on to carry out your primary mission: helping your patients.
The HIPAA Security Rule requires covered providers
to implement security measures, which help protect patients’ privacy by
creating the conditions for patient health information to be available but not
be improperly used or disclosed." (2013)
In
conclusion, it is easy to see how an electronic medical system is implemented
with a strategic plan can be used to improve data collection and reporting within
not only a radiology department within a hospital, but the entire hospital.
Sources:
Freudenheim, M. (2012) Digitizing Health Records, Before It Was Cool retrieved February 18,
2013 from http://www.nytimes.com/2012/01/15/business/epic-systems-digitizing-health-
records-before-it-was-cool.html?pagewanted=all&_r=0
Epic (2012) Departments and Ancillaries retrieved February 18, 2013 from
http://www.epic.com/software-ancillaries.php
Healthit.gov (2013) How to Implement EHRs retrieved February 18, 2013 from
http://www.healthit.gov/providers-professionals/ehr-implementation-steps
Gary, H. D. (2010). Radiology reporting: Changes worth making are never easy. Applied
Radiology, 39(5), 19-23. Retrieved from
http://search.proquest.com/docview/346164814?accountid=32521
Terry, K. (2012) Nuance Adds Voice Recognition To Mobile EHRs retrieved February 18, 2013
from http://www.informationweek.com/healthcare/electronic-medical-records/nuance-adds-
voice-recognition-to-mobile/240009721
Healthit.gov (2013) Integrating Privacy & Security Into Your Practice retrieved February 18,
2013 from http://www.healthit.gov/providers-professionals/ehr-privacy-security/practice-
integration
Beaty, K. (2013) Enhanced
Reporting Systems for the Electronic Medical Record
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