An electronic health record (EHR) system ensures the efficiency of health institutions by providing a platform for storing patient records in a way that they are instantly accessible and secured (Palvia, Jacks, & Brown, 2015). The Yorkshire Clinic, as an acute clinic, requires a responsive system to ensure that patient-centered records can be accessed faster, thus improving the quality of services that they receive. However, the medical staff at the facility has complained of the responsiveness of the system and the fact that it cannot be upgraded. As such, the hospital’s chief executive officer, Ms. Janet Hendricks, suggested the replacement of this system with a new electronic health record system. Although the respective stakeholders agree with this idea, a needs analysis for replacement and a readiness assessment for implementation are necessary before the replacement. Additionally, it is essential that the benefits and challenges of this replacement and implementation across the organization be assessed to ensure that a viable plan is developed. Health facilities use Electronic Health Record systems (EHRs) to improve efficiency by increasing patients’ records accessibility (Nguyen, Bellucci, & Nguyen, 2015). At Yorkshire Clinic, responsiveness issues and the inability to make upgrades on the current EHRs have led to the management’s decision to replace it with a better version. The stakeholders have viewed the change in the EHR system as a worthwhile investment that will not only improve efficiency but also impact on the patient outcomes. Despite there being an agreement on the change of EHRs, an implementation project plan describing all relevant steps and the staffing needs is necessary. Alongside the project plan, analysis of the testing plan and the importance of a data migration strategy are crucial to aid a smooth transition. The HITECH Act of 2009 aimed to spur the adoption of electronic health records and healthcare information technology (HIT) (Halamka & Tripathi, 2017). Effectively implementing an EHR framework requires a multi-disciplinary methodology — from guaranteeing protection and security consistency to reevaluating practice workflow and preparing staff. Despite complying with the regulation and ensuring successful implementation of the systems, as a form of technology, EHRs become outdated with time. Consequently, they fail to meet the needs of healthcare institutions as in the case of Yorkshire Clinic. It is essential to adopt up-to-date EHRs from the right vendor to keep up with the evolving sector. The decision to settle on a specific EHR vendor is, however, a challenge, especially considering the overwhelmingly high number of software vendors in the country. Ajami and Bagheri-Tadi (2013) provide a guide to choosing the right EHR vendor for an institution’s practice and needs.
Yorkshire Clinic relies heavily on the EHR system to provide the best care for patients with acute illnesses. Although the current system has previously served the needs of the clinic, the need to become a fast and flexible facility has resulted in the urge to upgrade the system (Lipford, Jones, & Johnson, 2017). However, it appears that the ERP system in use cannot be upgraded, which means that an entirely new system has to be installed. Additionally, the need for responsiveness has also created different demand on the EHR system which cannot be achieved with the one that has been in use.
Yorkshire Clinic’s EHR system also faces some barriers that render it ineffective. The lack of responsiveness can also be attributed to being non-user friendly, which means that it takes longer to navigate the system and access any required records (Richardson et al., 2015). Lack of integration is also another challenge with the existing system, which leads to duplication of records and omissions. These issues can be resolved with the implementation of a better EHR system.
Moreover, there are vital factors that are taken into consideration in the caring and provision of treatment to acute patients. Among these issues includes the need for reporting tools and proper communication channels to ensure that all staff members involved in the care for a particular patient receive the right information and at the required time (Lipford et al., 2017). Such factors add up to the critical components of the EHR system, which can be incorporated with the implementation of a new EHR system. Furthermore, the need for new EHR system arises from care coordination strategies that are used in acute care centers. Interoperability is a feature required in health facilities to make information exchange and application easy.
This is the analysis of the requirements and areas of electronic readiness (Yusif, Hafeez-Baig, & Soar, 2017). There are necessities associated with the infrastructure readiness, which include the hardware and software, external data exchange, internal connectivity, and orientation training provided by the information technology department. Furthermore, among these requirements are those that are attributed to process readiness, which includes channels of notifying the stakeholders, process automation, and support processes. Since the hospital already has an ERP in use, it means that it has an IT department that should provide the required support. There is also the availability of hardware previously used with the old system. These requirements are all available, except that the facility will have to improve its software to ensure that it can be integrated with the new system.
On the other hand, there are areas of readiness that should be taken into consideration. The organization culture is the first case, which entails the perception of the stakeholders towards the new EHR (Yusif et al., 2017). Since the stakeholders already agreed to the new system, it means that they are ready for this change. The technical readiness of this clinic is as required since the hospital already has IT management capabilities.
Benefits and Challenges
The primary benefit of implementing a new EHR system is in the responsiveness that it will provide the stakeholders. The medical staff will have a system from which they can easily access patients’ records and share them among themselves, thereby increasing accuracy and efficiency in the provision of services (Koppel & Lehmann, 2014). Another benefit that the new HER system will offer the clinic is that it will allow the hospital to invest in a flexible system that is up to the current levels of technology. Additionally, the hospital can get a system that will allow upgrades in the future, which means that it will not have to spend more resources on changing the electronic health records system.
On the other hand, the major drawback of the new system is in the high cost of implementation and training of the employees to use the system. In addition, the facility will also encounter high cost in communicating the changes to the patients and maintaining the system. Another disadvantage is the disruption of the hospital’s workflow during the implementation period. Yorkshire Clinic will suffer a possible decline in productivity when the new system is being adopted.
The development of the implementation plan depends on organizational needs. In Yorkshire Clinic, the main aim is to replace the entire EHRs and get one that is responsive, which is upgradable in the future. The first step of developing the implementation plan includes determining the critical staff members that will be involved in the process (Nguyen, Bellucci, & Nguyen, 2015). A project manager is required to overlook the entire process and ensure that all stages of the implementation process are undertaken. The administrator works along with the application analyst, software developer, and QA test engineer, who carry out data migration, system customization, and system testing respectively. The three staff members can be outsourced from the company that develops the new EHRs. Physician, Nurse, and billing advocates should be included to represent their departments and to advice on the training methods that best fit their areas of operation.
The next stage includes the definition of the critical goals of the project. At the clinic, the main aim is to replace the entire EHR system with a new one; thus, increasing the efficiency of the facility. Alongside this objective is to ensure that all records of existing patients are moved to the new system (Boonstra, Versluis, & Vos, 2014). The data should be transferred while providing that no information is lost. Additionally, the objectives of the project also include ensuring that the new system is user-friendly and can be developed to fit the various hospital aspects.
The next step includes forecasting the costs that will be incurred in the process and developing a budget (Boonstra, Versluis, & Vos, 2014). Yorkshire clinic will incur expenses in network upgrades, productivity loss, consultancy costs, and data backups, which average to $8,000. The facility should also budget for the cost of training the employees. The training fees are not expected to be high since the clinic does not have a large number of staff members; the cost is estimated at $4,000. The facility should also set aside $4,500 for workflow inefficiencies that may arise and payment of overtime for those involved in the process. Moreover, a period for the implementation process is necessary, which includes six months for the implementation and an additional six months of testing and maintenance. Once the budgeting is done, and the resources are available, the new system is installed, and the data is transferred to the new system.
Importance of Data Migration Plan
Data migration involves moving the information from the current storage method to the new EHRs (Saleem & Herout, 2018). The importance of data migration plan is to ensure that all operational requirements of the hospital that influence data transfer are taken into consideration. Moreover, its significance is also seen in that it allows the stakeholders to be consulted to determine the relevance of data and the order in which it should be transferred. With an organized process in place, time can be saved in the transfer procedure; thus, fastening the implementation of the EHR system (Saleem & Herout, 2018, 2018). Therefore, the failure to develop a plan for this process can lead to the loss of crucial data or a mix up in the information; hence, leading to confusion among the users.
Testing Plan and Documentation
EHR test planning includes developing a testing strategy that will be best applicable to the clinic. Alongside the approach is the allocation of a timeline for each component and the specific resources required. The first component is the unit and functional testing, which is inclusive of the functionality of the system as per the user manual, customizations requested, screen appearance, and appropriate fields and alerts. On the other hand, there is system testing, which is inclusive of smooth exchange of information between departments through the system, connectivity, accurate data processing, population, and appropriate system access. Moreover, integrated testing is carried out, which factors in interoperability of system components, a reflection of new workflows, attempts of overrides, and functionality of support aspects (Ben-Assuli, 2015). Finally, stress and performance testing are carried out to measure response time, simulate high traffic in the system, and the time required in report generation.
Ajami and Bagheri-Tadi (2013) emphasize the following: the need for an organization to assess its EHR needs, perform an analysis aimed at identifying vendors in the market, and evaluate the designated vendors based on the number of practices they serve nationally. The authors further insist on assessing the specialties and sizes (in terms of staff members) of the practices using their systems, the involvement of the systems on a day-to-day basis, and strategies in implementation. Other key areas to consider include the design of the system and the ability to integrate ideas submitted by end users. The aspects mentioned can be used as guidelines for selecting the right EHR vendor for Yorkshire Clinic.
Out of the available vendors, eClinicalWorks is among the best option. eClinicalWorks is a leading and widely adopted EHR vendor in the U.S. healthcare sector. More than 80,000 healthcare facilities have implemented the system with over 850,000 healthcare professionals using it on a daily basis. It also can support a patient base of close to 500,000. Its latest version, eClinicalWorks V11, is improvised with care planning, analytics, kiosk, pre-visit planning, online presence, and telehealth tools. The vendor is also the first to develop an integrated virtual assistant (Coustasse, Andresen, Schussler, Sowards, & Kimble, 2018). Thus, considering the guidelines given by Ajami and Bagheri-Tadi (2013), an analysis of practices served nationally, and the design of the system shows it is effective software.
Other than the above, PrimeSuite is also a preferred option. PrimeSuite is an EHR vendor with a proven track record and designed to meet the needs of individual users and those of the office in practice. Its features include data import or export, necessary reports, and online customer support among others. Thus, like eClinicalWorks, it is also similarly effective.
Finally, iSALUS EHR software can also be preferred. The software is a highly rated electronic health records management solution for healthcare institutions of all sizes. Its core features and functionality include patient education, care planning, automatic refill requests, drug, and allergy alerts, medical history, and order tracking among many others. It leads with a 60% rating in functionality, has customer ratings of close to 4.5, and a significant vendor size in market share (Ratwani, Moscovitch & Rising, 2018). As this software is similarly effective, it is then essential to consider the specific needs of the Yorkshire Clinic to make the right choice.
With a capacity of 12 key staff members, several ancillary staff, and the number of patients it deals with, iSALUS EHR software would be the best option for Yorkshire Clinic. The software has additional functionalities that are not in the other features and has a favorable price. With enabled features like security, task management, backup, and document management, the company would be secure from the prevailing cases of patient data breaches and loss. It also comes in all available operating systems thus making it ideal for the organization regardless of the operating system being used.
As EHR implementation proceeds in healthcare facilities, managerial and physician administration should effectively explore the majority of the potential dangers for medical errors, system failure, and legitimate duty before pushing ahead. Guaranteeing that physicians know about their obligations in connection to their charting practices and the profundity of data accessible inside an EHR framework is significant for limiting the danger of malpractice and claim. healthcare organizations, in this case, the hospital facilities must focus on normal system upgrading and corresponding training for all users to decrease the danger of errors and antagonistic occasions or adverse events.
In conclusion, the needs analysis and readiness assessment highlighted the reasons why a change is necessary for the clinics’ EHR and the preparations that it should make before adopting the system. From the analysis, it is clear that the change is required to ensure that quality service is provided. From the benefits and drawbacks, it is clear that this is a necessary investment for the facility. The implementation of EHRs at the Yorkshire clinic requires adequate planning to ensure a smooth shift from the old to the new system. The process is inclusive of the composition of a project team and the budgeting to ensure a smooth running of the operation. Once the implementation is done, data mining and transfer should be undertaken, which is essential in preventing the loss of data during the change in systems. Lastly, testing is carried out to ensure that the EHR system functions as per the management’s expectations. Ajami and Bagheri-Tadi (2013) provide a guide to choosing the right EHR vendor for an institution’s practice and needs. The emphasis is laid on, among other things, the need for an organization to assess its EHR needs. An assessment of favorable options including eClinicWorks, PrimeSuite, and iSALUS EHR, reveals the best alternative for Yorkshire Clinic would be iSALUS EHR. The software has additional functionalities that are not in the other features and comes at a favorable price.
Yorkshire Clinic: Request for Proposal (RFP)
Yorkshire Clinic Hospital is a leading private hospital in West Yorkshire located at the woodland grounds of Cottingley Hall, Bingley. Established in 1982, the hospital has seen tremendous improvement and growth with enormous investments in advanced medical technologies. As such, the facility offers a variety of healthcare services. The facility has five fully equipped theaters with ultra clean air technology particularly suitable for special procedures such as knee cartilage surgery, knee arthroscopy, knee ligament, cataract surgery, and shoulder muscle repair. The highly experienced staff caters for a patient population of more than 14,000. Commitment to the adoption of up-to-date technologies and adherence to the requirements under the Health Information Technology for Economic and Clinical Health (HITECH) and Affordable Care Acts have made Yorkshire consider acquiring a suitable Electronic Health Records (EHR) that will meet the needs of the institution.
The primary objective of the EHR adoption is to select a vendor that will fulfill the needs of the organization while ensuring the adherence to the health sector requirements. The chosen vendor will meet all the needs of the internal and external stakeholders of the hospital. The implementation of the EHR system by the organization is required to satisfy the following expectations as recommended by healthcare information technology experts DesRoches et al. (2013): accuracy, up-to-date, and completeness in the provision of patient data and information at the various points of care. More so, it should e have quick access to patient records, and enable secure information sharing between the patients and the healthcare givers. Therefore, the EHR will also provide more effective diagnosis, safer care, and reduce medical errors. In turn, the hospital will improve patient interaction, provide safer and reliable prescriptions, enhance privacy and data security, and improve staff productivity.
With these expectations, the hospital plans to transform the healthcare services rendered through a variety of ways. Through a suitable EHR, the organization will offer improved healthcare services through advanced patient care services. These services include effectiveness, safety, communication, equity, education, efficiency, promptness, and focus on patient needs as well as expectations. In addition, the system will improve the organization’s clinical decisions by integrating patient information from various departments at a moment’s call.
- A system that fulfills the needs of the organization
Currently, Yorkshire Clinic has employed ten physicians, two assistant physicians, one nurse practitioner, and several ancillary staff who attend to a population of about 14,000 patients. The EHR system is expected to meet the needs of this team and the patient population.
- Task Management Capabilities
The EHR software must oversee the management of mundane tasks, ancillary responsibilities and other roles that make up the daily schedule of the facility. A system that will remind users to sign notes, review lab reports, approve medications, and respond to queries raised by patients or any other person with access to the system.
- Accessibility and Flexibility
- Accessibility of the system by various users is a crucial consideration. Users should access the software using multiple platforms such as PC, Mac, smartphones, and other computerized devices (Mandl & Kohane, 2016). It should, therefore, be accessible in any computerized device regardless of the operating system. That is to say; it should be compatible with Windows, iOS, Android, Mac and any other OS. It should also allow for remote access at all time – 24/7.
- Effective Documentation and Image Management
The system should permit users such as doctors to monitor patient data by disseminating it in real-time between the various attending parties. More so, the system must support the transfer of large documents, digitize imagery data and avail it for review promptly.
- Data Security and Patient Privacy
As mentioned by Hawn (2013) the world is increasingly driven by technology including the healthcare sector. With this, issues of data breaches and other cybersecurity issues are also on the rise. Therefore, the software must incorporate security features that enhance the safety of patient records and their privacy from the hands of unauthorized parties.
- Technical and legal requirements
According to Vest, Greenberger, and Garnatz (2017), the main reason for the implementation of EHR systems is to comply with the current healthcare regulations. As such, the software must meet all the legal obligations of the set rules and standards. Additionally, it must meet all the technical requirements of the institution.
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