The Electronic Medical Record: Efficient Medical Care or Disaster in the Making?
Dale Buchbinder
You are the Chief Information Officer (CIO) of a large health care system. Medicare has mandated that all medical practices seeking Medicare compensation must begin using electronic medical records (EMR) . Medicare has incentivized medical practices to place electronic medical records in their offices by giving financial bonuses to medical practices that achieve certain goals. These EMR systems are supposed to allow communication between practitioners and hospitals, so medical information can be rapidly transferred to provide more efficient medical care. The EMR will enable physicians to allow access to the records of their patients by other providers. Eventually these records are supposed to be easily accessed so any physician or hospital will have complete medical information on a patient.
The physician practices in your health care system have been mandated to use the Unified Medical Record System (UMRS). The UMRS was designed by a central committee; all hospital-owned physician practices have been mandated to use the system. As part of the incentives, Medicare will add dollars back to each practice when they meet goals for reaching meaningful use (MU). MU has been defined by the U.S. Department of Health and Human Services (n.d.) as “using certified electronic health record (EHR) technology to:
• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and family
• Improve care coordination, and population and public health
• Maintain privacy and security of patient health information.
It is a step-by-step system requiring “electronic functions to support the care of a certain percentage of patients” Qha, Burke, DesRoches, Joshi, Kralovec, Campbell, & Buntin, 2011, p. SPl 18).
One of the hospitals in your system has many primary care and specialty practices; however, the UMRS system was designed primarily for the primary care practices. The committee that developed UMRS did not take into account the needs of the specialty practices, which are significantly different from the primary care practices. This issue has been brought to the fore from by several medical specialists who have stated UMRS is not only cumbersome, but also extremely difficult to use. UMRS also does not give the specialist the information he needs. Specialists noted that after UMRS was implemented, it took them approximately 10 to 15 minutes longer to see each patient. Since an average day for a specialist consists of seeing between 20 and 25 patients, adding 10 to 15 minutes per patient adds 200 to 250 additional minutes, or 3 to 4 hours more each day. And, the physician cannot see the same number of patients each day. In reality, this represents a 30% decrease in productivity because of the amount of time it takes to use UMRS. Now the specialist office schedules constantly run significantly later than they should, and patients become unhappy and impatient. Several of the specialists reported that a number of patients have gotten up and left without being seen. In short, the mandate to use UMRS has impacted the efficiency and productivity of the subspecialists and specialists, further decreasing revenues for the system.
In addition, all of the physicians have complained the UMRS does not communicate well with other electronic medical record systems, or even the hospital’s own patient information systems. There is no real integration of the medical databases as intended, levels of meaningful use are unclear, and in some areas, difficult to achieve, again because the UMRS was tailored to primary care practices’ prescribing patterns. Specialists, particularly surgeons, do not write a large number of prescriptions. Surgeons have been mandated to write electronic prescriptions to reach meaningful use; however, in many cases this is not appropriate for surgical patients.
All of these issues and concerns were reported to the central committee that created UMRS in response to federal mandates and financial incentives. The committee responded it cannot modify the system to make it more friendly to specialists and subspecialists, despite the fact that procedures performed by the subspecialists account for substantial revenues. Revenues are down and the morale of the specialists and subspecialists has plummeted to the point that many are talking about taking early retirement or leaving the system. Still, the committee refuses to fix the problems. Since you are the CIO of the entire health care system, the situation is now in your hands. What will you do?
In this case study, you can answer the questions. You DO NOT need to show any external resources. Thank you!
Response Needs to be in an essay format. Introduction , body and conclusion
Discussion Questions
1. What are the facts in this situation?
2. What are three organizational issues this case illustrates?
3. What are the advantages and pitfalls to EMR? Should all types of practices be required to use the same system? What role should physicians play in selecting and developing an EMR system to fix their individual practices? Provide a rationale for your responses.
4. Is there a way to bring consensus and standardize the EMR systems without alienating productive physicians who bring large revenues to the hospital? How can the dilemma of inefficiency and patient dissatisfaction be prevented? Create and present a plan for how EMR could be implemented in a system with multiple types of practices. Be sure to address the issues of physician specialty, productivity, and satisfaction, as well as patient satisfaction.
5. What steps should the CIO take in the future to prevent these types of issues from occurring again? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.
Expert Solution Preview
Introduction:
The implementation of electronic medical records (EMR) has become essential in the healthcare industry for efficient information management, sharing and to improve patient care. For the medical practices, implementation of EMR is a must if they want to receive financial incentives from Medicare. However, there are potential downsides to the implementation of EMR, which this case study delves into. As the Chief Information Officer (CIO) of a large healthcare system, it is my responsibility to address and solve the issues that are faced with the implementation of the Unified Medical Record System (UMRS) for specialist practices.
1. What are the facts in this situation?
The healthcare system has been mandated by Medicare to implement EMR systems for more efficient medical care. The UMRS system was designed by a central committee and primary care practices have been mandated to use it. The implementation of UMRS has impacted the efficiency and productivity of the subspecialists and specialists, further decreasing revenues for the system. The UMRS system was not designed to cater to the needs of specialty practices, thus it is extremely difficult for them to use. Additionally, the system does not communicate well with other EMR systems or the hospital’s own patient information systems.
2. What are three organizational issues this case illustrates?
The first organizational issue that this case illustrates is the lack of planning and consultation by the central committee with the specialist practices before designing the UMRS system. The second issue is the resistance by the committee to modify the system to make it more friendly to specialists and subspecialists. Thirdly, the lack of clear integration of medical databases and unclear levels of meaningful use make it difficult for specialty practices to adapt to the system.
3. What are the advantages and pitfalls to EMR? Should all types of practices be required to use the same system? What role should physicians play in selecting and developing an EMR system to fix their individual practices? Provide a rationale for your responses.
The advantages of EMR include faster and more efficient medical care, improved patient safety and error reduction in data entry. Pitfalls of EMR include high implementation costs, learning curve, and potential privacy and security breaches of medical information. Not all types of practices should be required to use the same system. They should have the liberty to choose an EMR system that is best suited for their needs. Physicians should actively participate in selecting and developing an EMR system to fix their practices. They are the end-users, and their input is essential to ensure that the EMR system will integrate seamlessly into their workflow. A system that does not fit their work processes and requirements will be ineffective and difficult to use, leading to decreased patient productivity and satisfaction.
4. Is there a way to bring consensus and standardize the EMR systems without alienating productive physicians who bring large revenues to the hospital? How can the dilemma of inefficiency and patient dissatisfaction be prevented? Create and present a plan for how EMR could be implemented in a system with multiple types of practices. Be sure to address the issues of physician specialty, productivity and satisfaction, as well as patient satisfaction.
Consensus can only be achieved by involving physicians and stakeholders in the decision-making process of the EMR system. Consultation with physicians in different specialties must be done to ensure that the system caters to their needs. The system must be tailored to different specialties, and the needs of subspecialists must not be overlooked. This can be achieved by creating a committee composed of representatives from different specialties that will advise on the development and implementation of EMR systems. Due to the learning curve associated with converting to the new system, a well-planned and structured change management program is required to ensure that physicians and staff are well-trained before the implementation. Patient satisfaction can be improved by ensuring that workflows are streamlined, leading to reduced wait times and more efficient appointments.
5. What steps should the CIO take in the future to prevent these types of issues from occurring again? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.
In the future, the CIO should ensure that consultations with stakeholders and physicians are done before the implementation of any EMR system. A process for continuous feedback and improvements of the system should be put in place to address any issues that may arise. The CIO should ensure that physicians are actively involved in the development and selection of EMR systems that suit their practices. The approach to the implementation of a new EMR system across a healthcare system should be standardized to prevent inconsistencies across specialties. The change management program should be structured to allow sufficient training for physicians and staff before implementation, leading to a seamless adoption of the new system. Finally, the CIO should keep up to date with technological advancements in the healthcare sector to ensure that the EMR system remains relevant and efficient in their healthcare system.
Conclusion:
In conclusion, EMR systems can improve patient care and efficiency in the healthcare industry. However, the implementation of an EMR system must be tailored to address the requirements and needs of specialties to ensure adequate workflow management. Consensus among stakeholders and physicians is essential for the successful implementation and adoption of the system. A well-structured change management program and standardized approach to implementation can alleviate concerns of physician dissatisfaction, patient dissatisfaction, and reduced revenues across specialty practices.
