Middleville Hospital’s Electronic Health Record

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Table of Contents

Functional Requirements
Evaluation Plan
Factors to Evaluate
References

Functional Requirements

Based on the initial request outlined by the hospital, it is evident that they require a significant upgrade to their EHR facility-wide system. One of the primary requirements is that the EHR must meet Meaningful Use Stage 3 criteria. As established by CMS, MU Stage 3 criteria means that the EHR must offer data interoperability and patient outcomes. It must also have greater thresholds for objectives and clinical measures. This is assuming that the system also meets the criteria for Stages 1 and 2, which are capturing patient data to be shared with providers, advanced clinical practices, and patient portals available to access medical records (Nelson & Staggers, 2016). The hospital wants an advanced and comprehensive system that will contribute to the efficiency and effectiveness of offered care.

The EHR should include key features such as intuitive entry of data for providers and order placement as well as containing all medical history, treatment plans, medications, and other relevant data and tests. Other workflow-related features such as potential automation of certain data entries and determining which departments must receive orders for tests or additional care. A modern, resilient EHR should have a modern dashboard with multiple options, an intuitive interface, and good document management. It is best that there are also integrated features for e-prescribing, billing, and reporting built in as well. Staff should be able to easily find what they need and navigate it quickly in order to efficiently facilitate care (Coleman et al., 2020).

Middleville Hospital requires an EHR that is pragmatic and contributes to the effectiveness of evidence-based care provided by nurses and physicians. This includes most often clinical decision support that can come with sophisticated features. One of the most basic ones is tracking medication and procedure orders issuing an alert if there is a known contradiction or potentially dangerous drug interactions. Based on patient data available or entered, features of clinical decision support may include clinical guidelines, condition-focused order sets, diagnostic support, contextual reference information, and patient-specific reports (HealthIt.gov, 2018). The EHR utilizes access to EBP references, clinical guidelines such as issued by the CDC, and big data taking into account the individual patient and all other patient data that it has access to determine similar cases with best outcomes in test results and eventual discharge. The clinical-decision support functions automatically by providing users with computerized alerts, reminders (such as for nurses to administer medication), and suggestions that improve care quality, prevent errors or potential adverse events and help to supplement the human side of patient treatment and care (Sutton et al., 2019).

Finally, a feature that this hospital likely needs is a cloud-based EHR that is secure but accessible from virtually any device with appropriate credentials. Considering that the hospital is also requesting web-access in all spots of the campus, cloud-based EHR may also be viable for the organization. This feature greatly improves mobility allowing staff to utilize both desktops at stations but also tablets and phones if needed on-the-go anywhere inside and outside of the campus. This is highly secure, as cloud technologies have seen significant innovation, with many experts indicating that cloud-EHRs are more secure than in-house ones because the data is stored on remote servers that do not rely on a single security contingency but rather in a multi-site, increasingly physically and technically secure servers. Meanwhile, cloud-based EHRs offer greater cost-savings, especially relevant for smaller, rural hospitals such as Middleville Hospital. Modern EHRs cost millions of dollars due to both licensing and software but also physical modules, servers, and systems having to be installed. By relying on a cloud-based EHR, much of the physical infrastructure does not have to be installed (Jason, 2020).

Evaluation Plan

Criteria 1 – Usability/ Intuitiveness of interface for EHR/ potential for customization	Regardless of available features and technological capabilities, an EHR with poor usability, a lagging interface, and a lack of ergonomic and thought-out UX design, it will simply serve as frustration to staff and disrupt workflows rather than create efficiency.
Criteria 2 – Charting/ Records/ Orders/ Clinical Decision/ System Interoperability	This criteria simply evaluates all aspects of functionality and usability of the EHR, ranging from ease of charting and sharing of information to placing orders and the range of clinical decision aid tools available. The system interoperability among all elements of the EHR software, as well as interaction with out-of-system devices, should be smooth with as few barriers as possible.
Criteria 3 – Strong quality metric measurement	As any health organization, the hospital seeks to improve its performance, which can be done through evidence-based initiatives as well as data to support that changes are needed. Given the comprehensive nature of most EHRs, data collection and presentation are crucial for health and management decision-making for the hospital leadership. Furthermore, if the EHR has AI learning features, it can use the data to improve elements of its clinical decision support and use data analytics to make better recommendations (Kundu, 2021).
Criteria 4 – Cost efficiency	The cost will remain a significant factor for most facilities. The cost factor is dependent on providing as much functionality for the most appropriate price (not necessarily the lowest). The cost will depend on aspects such as the range of features, and the set-up of the system, as described earlier, cloud or in-house.
Criteria 5 – Security	The EHR must adhere to the latest security standards and policies such as HIPPA for patient data protection. Both internal and external protocols must be secure and have protections against unauthorized access and manipulation.
Criteria 6 – Long-term partnership/value-added services	It is best to select a vendor who has the experience and good reviews of long-term partnerships with organizations. EHRs are not one-time systems, consistently needing updating, maintenance, and expansion. Building a working relationship with a vendor can be effective for solving any IT issues, given the hospital IT staff is limited. Furthermore, if a vendor provides additional services such as training, implementation, project management, and others, it can result in cost savings (Monica, 2018).

Factors to Evaluate

One factor that could be evaluated is the ability of the EHR to create a digital environment in the hospital that contributes to the overall quality of care, including that of non-medical and administrative aspects. Partially falling under the guise of system interoperability, since a digital environment in a large facility includes a wide range of devices, both mobile and stationary, supporting digital infrastructures such as access to networks and the Internet, and finally, cameras and sensors tracking critical data, such as beds available. An effective EHR is a software that can encompass all components of the healthcare that the specific facility offers, be customizable to meet the needs of the client, and be modifiable for future iterations and add-ons from both technological and medical points of view. This is the trend for the future, creating a digital hospital environment, so any modern EHR installed should be future-proof for at least a decade or more into the future as technology rapidly develops. This may include automation of more processes in improving patient experiences, redefined care delivery such as bedside sensors and alarms, digital notification, education, and communication tools for each patient. However, most importantly is the capability of the digital EHR to improve operational efficiencies of the hospital, including digital inventory management, supply chains, automatic ordering, robotics, and back-office efficiencies (Thomas, n.d.).

Another factor in evaluating is provider satisfaction. This takes into account the whole combination of factors ranging from interface to processes to functionality, and finally, the outcomes of the EHR. Despite all the benefits, if the satisfaction with the system remains low, it will see slow acceptance and adoption by the staff, and if forced to use it, lack of positive outcomes. The healthcare providers must accept and be excited to use the system to benefit patient care and, ideally, it should improve their workload due to efficiency and automation, allowing to focus on the more human-oriented side of care. If satisfaction remains low after adoption, there are measures that can be taken to resolve the issue, such as customizing the UX for accessibility from the vendor side, providing greater training opportunities for providers to learn to utilize the system, and having a provider support specialist on-hand that will help at the individual level to navigate any challenges that the staff may experience. Satisfaction is a difficult aspect to measure, but it is possible with standardized tools. It is in the best interest of the facility to see high satisfaction scores with the EHR to justify such a high-cost investment.

References

Coleman, C., Gotz, D., Eaker, S., James, E., Bice, T., Carson, S., & Khairat, S. (2020). Analysing EHR navigation patterns and digital workflows among physicians during ICU pre-rounds.Health Information Management Journal, 50(3). Web.

HealthIT.gov. (2018). Clinical decision support. Web.

Jason, C. (2020). 3 reasons to favor cloud-based EHRs over in-house EHRs. Web.

Kundu, M. G. (2021). Statistics and machine learning methods for EHR data – from data extraction to data analytics.Journal of Biopharmaceutical Statistics, 31(4), 1–2. Web.

Monica, K. (2018). AMA offers guidance for EHR vendor selection in new playbook. Web.

Nelson, R., & Staggers, N. (2016). Health informatics: An interprofessional approach. Elsevier Health Sciences.

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: benefits, risks, and strategies for success.NPJ Digital Medicine, 3(1), 1–10. Web.

Thomas, S. (n.d.). The digital hospital of the future. Web.

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Middleville Hospital’s Electronic Health Record

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