Scenario related to EHR
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Electronic Record Adoption Process Scenario
You are the newly hired manager for the health information management department of a growing healthcare system. You receive a call from Sam, the chief information officer (CIO), about implementing an electronic health record (EHR). For the last two years, Sam has been talking with key stakeholders about investing in an EHR system but waiting to see how the technologies would improve. However, as the system’s facility locations and service lines have continued to grow, Sam can see how an electronic record would make workflow much easier. Certain patients are seen for inpatient and ambulatory care at more than one of the three hospital locations, usually out of patient convenience. This presents some difficulty as the hospitals rely on a courier service to transport the records to support the continuum of care. Coding, billing, and other financial services are centralized in a downtown office. That means each chart must go back to the downtown office for coding, and there are additional steps for timely processing. The internal HIM staff also has problems keeping up with records and providing responses to release of information (ROI) requests. Having the record in an electronic format would make record retrieval and availability much easier.
Sam has been speaking with the nursing and ancillary staff and is receiving mixed responses about adopting an electronic record. Most of the nurses prefer having paper in their hands and the ability to locate information on patients by paging through a document. The newly hired nurses directly out of school have been trained in using the electronic record and prefer its ease of use. The coders and transcriptionists are supportive; they see how electronic records would improve their workflow. Many of the younger doctors and nurse practitioners are comfortable with the use of technology.
Dr. Morgan, the physician liaison, prefers the paper record because of familiarity, and Sam believes if Dr. Morgan could be shown some of the benefits of having an electronic record, Dr. Morgan would be on board and work with the implementation team to adopt an EHR. Dr. Morgan is willing to listen but wants to clearly see how this investment will benefit the physician staff and the healthcare system as a whole. Sam has taken Dr. Morgan’s request to the implementation team, and they will support the implementation if they see a cost-benefit to the investment.
Sam is looking to you and your expertise in the health information management field to perform several tasks. First, Sam would like you to form a project team to evaluate the organization’s current workflow and assess how clinicians and staff are currently using health information at all three acute care and the several ambulatory sites. In particular, Sam wants you to meet the nursing and clinical staff. Sam believes if you meet them, spend time with them during their workday, and assess the patient flow, you will be better prepared to address any of their concerns in moving away from a paper record.
After that, Sam would like you to meet with the health information management leadership team. They have several concerns about the workflow within their department. The ROI staff is having trouble fulfilling requests from patients, internal and external auditors, and attorneys due to records being located in the coding office across town or at another facility. The chart analysis staff are concerned about being unable to apply deficiencies because of chart location. There are days when charts are in stacks on desks or in carts waiting to be processed.
Finally, the records processing staff has complained that records often end up in coding before the internal chart analysis functions are complete. There have also been instances where a routing slip was incorrectly filled out and the record was sent to the wrong facility. This slows down access to patient information and limits the provision of quality health care. One of the managers suggests that you also include ROI clerks, chart deficiency analysts, coders, and records processing staff in future meetings.
Sam is asking that you and your project team begin spending time in the facilities, evaluating workflow, and identifying the needs of the staff. In six months, Sam would like to see a report with ideas and some potential goals. If the EHR initiative is approved, Sam would also like you to take a lead role in selecting a vendor for implementing the EHR system. Sam would like you to create an additional report on the details involved in selecting an EHR vendor for the healthcare system.
