UM and UC Family Health Clinic - Meeting Meaningful Use of Billing Function EHR Infosys - Case Study Example

UM & UC Family Health Clinic - Meeting Meaningful Use Of Billing Function EHR Infosys Evaluate the Organizational Environment in the Health Care Industry to Recognize How Use of Billing Function EHR Infosys Enable Strategic Outcomes Electronic Health Record (EHR) system provides a successive flow on the work procedure as well as appropriateness in the financial system of various health care organizations. In this case, emphasis is more on the effective functioning of EHR system of Infosys for billing. The Infosys EHR is the multi-dimensional setup established for proper data sharing to enhance the effectiveness of organization. This system provides comfortable support and excellence in various billing operations handled by the employees of the organization. This creates more transparency and uniqueness in maintaining the records and makes the process of billing easier. This system helps to generates more customer satisfaction, reliability and safety towards the patients. EHR system also supports the automatic recording of charges and their claims in respect to patients. This also keeps appropriate records of medicines prescribed by physicians of the respective patients to avoid mistakes and confusion. EHR system also provides effective performance in the overall medical procedure of patients. Moreover, EHR system stores all requisite records from admission to discharge of the patients to make the process of organization smooth and effective. The day-to-day requirement of every necessities whether it would be their room charges, food, medicine, treatment and testing expenses are consistently recorded in these EHR systems. Hence it can be concluded that implementation of EHR system in health care industry will help to enhance medical care, safety and services to the patients in an effective manner. This will ultimately provide a competitive advantage and profit maximization for the health care industry (Health IT.gov, 2013; Carroll et al., 2012). Evaluation EHR Infosys In The Health Care Industry To Improve The Quality Of Care, Safety, And Financial Management Decisions Infosys Electronic Health Record System (EHR) is an architectural design, which must be implemented by UM & UC Family Health Clinic to improve the quality of care, safety and decisions regarding the financial management. EHR delivers comprehensive health care services through electronic devices, various tools of health management, referral management, scheduling and clinical messaging. Through the application of EHR healthcare organizations delivers extreme quality performance towards care and safety of patients. EHR will build transparency and accuracy in maintaining as well as storing of various medical records of patients. Due to the implementation of this system there will be less mix of data and the data will be stored in an organized manner. This will benefit the patients as well as the organizations. The inappropriateness of various records such as the necessary medicines, food, treatment and testing of every perspective patients will lead to a disastrous effect in the quality of care and safety, which must be provided to the patients in the healthcare. EHR system also enhances the performance of evaluating and executing decisions with regards to financial management. Financial management is also a crucial aspect in achieving competitive advantage and profitable growth of healthcare organizations. The implementation of EHR system is to gather and deliver accurate records of various operational activities of the organization to improve the efficiency. Furthermore, individual medical service department have their different functionality of operations towards deliverance of quality in care and safety to the patients. There incurs various operational costs, which are easily available as per the requirement of financial management personnel. These costs are human resource management, supply chain management, hospitality management and many others. These three sections of management are the essential pillars of the health care in order to achieve competitive advantage and profitable growth. Financial analysts and experts personnel conduct financial analysis and build monthly, quarterly and annual budget report of the income and expenditure of organization. Through this analytical report they can make strategic decisions towards the strengths and weakness of the organization. They can also reduce the unnecessary cost effective expenses and utilize the cost towards the need of healthcare sector (Infosys, 2007). Implication Of Ethical, Legal, And Regulatory Policy Issues On Health Care Information Systems Ethical issues of health care information systems can be mitigated through the implementation EHR systems. This will enable to enhance the system and techniques of keeping various ‘paper medical records’ and make the healthcare system more organized in terms of its operational activities. Moreover, use of these techniques would change the view of healthcare system in front of individuals and the society at large. A positive image of the organization will be created due to availability of quality services to the people and also with regards to quality management. EHR system will abort the optimal management system of information of the organization. These activities will make easy and timely access of appropriate data and information as per the requirements of doctors and nurses in relation to medical histories, patient daily charts, pathology and laboratory testing reports to deliver appropriate medical treatment. Healthcare organizations have abundant techniques and methods to generate information but lacks in managing that information in a successive manner as per the requirements. These issues can be sorted out through the implementation of EHR systems. EHR systems support the process of improvement, in accurately escalating information on time which would lead to patient satisfaction. This will also provide assistance and guidance towards evaluating research programs for enhancing the quality in care and safety towards the patients. Furthermore, this also provides extreme support towards reducing mistakes in maintaining and storing appropriate medical records of the patients (Winkelstein, n.d.). Another important aspect is regarding the legal issues on health care information systems, which can be mitigated through the implementation of EHR systems. Different medicines are prescribed by different physicians after thorough medical verification of the patients and their past histories and records. In this regard, maintaining of these hand written prescriptions and gave rise to huge problems for every departments as well as slowed the process altogether. Therefore, the inappropriate maintenance of records can affect doctors, nurses, pharmacists and other specialized medical personnel who deliver medicines, treatment and testing as per the requirements of the patients. These issues may lead to wrong treatment and testing referred or suggested by the doctors due to misplacement of successive stages of records by the employees of the organizations. Therefore, the use of the EHR system will provide full proof support towards the descriptive information about the manufacture and expiry dates of the medicines, which are referred by various doctors as per the treatment of the patients. Moreover, EHR system will also give an overall data and information about the patients with which they are dealing. This will generate strict legal offence and severe punishment according to the law of medical care if the above issues are faced due to the mismanagement of data leading to wrong treatment (Appari & Johnson, 2008). Subsequently, regulatory policy issues on health care information systems can also be mitigated through the implementation of EHR systems. Regulatory bodies such as health care organizations and agencies should have preventive measures to build policies and procedures, which are beneficial towards delivering quality care and safety to the patients. Through the implementation of EHR system the healthcare organizations will be able to avail accurate data and information about the performance and growth, which the organization can escalate in the market to gain preference and believe of the customers. If the EHR system will not be implemented in the healthcare then there can be chances of mistakes in maintaining and storing of records leading to several unavoidable issues. Due to the lack of organized records and data wrong information will be provided to the doctors about the case history of the patients. Doctors due to this will suggest wrong treatment and testing to the patients. These actions will not only charge the doctor for malpractice but also lead to the cancellation of license of the doctors. This will ultimately effect the competitive advantage of regarding the of quality healthcare system of the organization. EHR systems therefore will assist in reducing the cost effectiveness resulted from gathering information through various divisional sources, which are data providers, patients, payers and researchers. Therefore, the Government bodies should take initiative to encourage implementation of EHR system in various health care organizations. They should organize practical programs to show the importance, which leads to reduction in information cost and mitigate the mistakes occurred if not implemented by the organization. Public regulators should escalate the information about the importance of EHR system towards the growth of the organizations in order to increase the effectiveness of the same (Madison, 2007). Recommendation of Medical Incentive Program Medical Incentive program is the program in which proficient professionals and qualified hospitals are given incentives for adopting, implementing, enhancing and demonstrating importance of EHR system. In this regard, two different EHR incentive programs have been taken into account to give justification and recommendation about the effective medical incentive program. These are Medicare and Medicaid incentive programs. Comparative table has been given below to provide a proper justification about the quality inconsistency with low cost effectiveness from the program (CMS.gov, 2014). Comparison between Medicare EHR Incentive Program and Medicaid EHR Incentive Program is depicted hereunder:- From the above comparative study of the two programs, it is preferable to recommend Medicare EHR Incentive Program though its incentive amount offered to providers and professionals are lesser than Medicaid EHR Incentive Program. However, it has a consistency of incentive payment as well as it launches program every year, which encourages and creates interest of the providers and professionals to actively participate in this programs. Although, the amount is less but the other activities of the program makes it effective for the organization in the long run. Furthermore, the table 1 below expresses about three consecutive years incentive payment to eligible Medicare professional. Table 1 Contextually, the objective of UMUC family Clinic with regard to EHR will be as elaborated below in the Table 2 Table 2 About 15 Core Objectives For UMUC Family Clinic Report Count Core Objective Measure Explanation of how the objective will be met at the UMUC Family Clinic using the selected EHR (minimum of 2 sentences each) 1 Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2-20 years, including BMI For more than 50% of all unique patients age 2 and over seen, height, weight, and blood pressure are recorded as Structured data. Since, the clinic is a family medical practice, this information that is already being captured in the workflow and will be entered in the EHR during the visit. At reporting, the EHR system will automatically extract the percentage satisfying this measure. 2 Maintaining Patient record procuring gender, language and birth date Above 50% of overall patients check by eligible professionals data are recorded. EHR system will record each data in relation to the patient information when entered by medical professionals. This will provide variant data according to status update of patients in EHR system. 3 Starting of patient medicine Medical professionals check above 80% of total patients and found only 2 entries are recorded. EHR will give overall information about the patients prescribed medicine. Patients whose medicines are initiating as well as patient whose medicines are in progress. 4 Allergy patients list from medicines Medical professionals check above 60 % of overall patients and found on 4 entries are recorded of these cases. EHR system will provide overall information about the patients who are suffering from allergy after activation of medicines. This will also give support to take remedial measures to rectify the mistakes. 5 Record of 13 years and old smoking patients Eligible professionals verified above 80% of patients and data are recorded. EHR systems have various tools as well as techniques through which it can provide total record of smoker and non-smoker patients. This will give scope for eligible professionals to deliver necessary steps to prevent smoking. 6 Maintain an up-to-date problem list of current and active diagnoses based on ICD–9–CM or SNOMED CT Eligible professionals verified above 80% of patients and data are recorded. Through implementation of EHR system total record of patients who have problems in their treatment due to wrong diagnosis by doctors will be detected. After the detection of the same remedial measures can applied. 7 Computerized order entry of physician for medicines More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE EHR system will help to maintain proper and accurate data about the order provided by various physicians for different cases of the patients. There will be less chance of mistakes in recording the information in respect of order of respective physicians. 8 Interaction checks due to changes in drugs Eligible professionals has enabled this functionality for the entire EHR reporting period EHR system will give total data about the interaction cases from changes in drugs preferred by physicians for patients. Physicians can get the information and take necessary measures. 9 Electronic generation and transmission of permissible prescriptions Above 50% of all permissible prescriptions written by the EP are transmitted electronically EHR system will give extreme support on electronically maintaining the prescription of medical needs for the patients. This will create safety for the healthcare organizations if patient parties face issues in concern to the medical requirements depicted in prescriptions. 10 Implement one clinical decision support rule Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance for that rule EHR will provide accurate data to the management professionals which will help in delivering proper decision. This will generate transparency and trust between patients and the organizations. 11 Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Done one testing practice to judge the effectiveness of electronically exchange key clinical information Through EHR system information can be easily shared to various providers, patient parties and health care agencies so that referrals can be easily made available for patient case histories and its further treatment. This will increase the operational process of treatment of the patients. 12 Provide clinical summaries for patient for each office visit Eligible professionals provided clinical summary to more than 50% of overall patients EHR system will make easily availability of clinical summaries of various patients due to accuracy in maintaining the records. Summary report is the case history of the patient and improvement status after treatment. 13 Provide patients with an electronic copy of their health information, upon request More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within three business days EHR system helps to keep successful and updated track record of all types of patients. So for the eligible professionals it does not procure much time to deliver electronic copy of the health information report. 14 6 clinical quality measures report to CMS (Medicare EHR Incentive Program) In 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in section II(A)(3) of this final rule For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of this final rule The implementation of EHR system helps to generate fund from various government organizations and public entities. This will also encourage eligible professionals such as doctors to fully get involved in sharing information about this technology. 15 Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Conduct a security risk analysis and implement security updates as necessary and correct identified security deficiencies as part of its risk management process EHR system is structured with incorporation of safe and security measures in relation to the protection of records of the organizations. Even though they conduct ‘security risk analysis’ to ascertain the protection capability of EHR system. (Source: eClinicalWorks, 2014) Table 3 Table 3 about 10 Menu Objectives for UMUC Family Clinic report Count Menu Objective Measure Explanation of how the objective will be met at the UMUC Family Clinic using the selected EHR (minimum of 2 sentences each) 1 Implement drug formulary checks. The Clinic has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period All that needs to be done is to ask the EHR vendor to enable this functionality and to have access to at least one internal or external formulary for the entire EHR reporting period. Then at reporting attest to “Yes” 2 Hospitals Only: Record advance directives for patients 65 years old or older More than 50% of all unique patients 65 years old or older admitted to the eligible hospital have an indication of an advance directive status recorded EHR offers extreme support towards tracking the record of the patients who are above 65 years of age. Through this facility of record extra facility and support to these senior citizen patients can be delivered. 3 Incorporate clinical lab-test results into certified EHR technology as structured data More than 40% of all clinical lab test results ordered by the EP, or an authorized provider of the eligible hospital for patients admitted during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data EHR due to its effectiveness has accuracy in maintaining the records. This provides perfect result about the various testing done in laboratories. 4 Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Generated a report listing patients by eligible professionals with a exact condition EHR system will offer necessary records of different levels of services required to patients. It will enhance the quality of care and safety and also lead to research procedure for further development. 5 Eligible professionals deliver information about priority in patients for preventive/follow-up care Eligible professionals have taken preventive measures and follow-up to Above 30% of all patients who are 65 years and above age. EHR system gives information to track the aged patients who need regular follow-up and extensive medical care. 6 EPs Only: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP More than 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to with hold certain information Through implementation of EHR system we can access all relevant information, which is essential for treatment of the patients. This will provide correct information of different patients. 7 Use certified EHR technology to identify patient specific education resources and provide those resources to the patient, if appropriate More than 10% of all unique patients seen by the EP or admitted to the eligible hospital or CAH are provided patient-specific education resources EHR system will also provide assistance and guidance to the eligible professionals. Eligible professionals implement this system for the treatment of patients. 8 The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital or CAH EHR system helps eligible professionals to reconcile the case matters of the patients of the two different organizations. This is done for easy transfer of record from one organization to other. 9 The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or refers their patient to another provider of care should provide a summary of care record for each transition of care or referral The EP, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals Implementation of EHR system will give accurate maintenance of record of patients. These are required by the patient parities as referral if they refer it to other organizations. 10 Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice Performed at least one test of the certified EHR technology’s capacity to submit electronic data to immunization registries and follow-up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically. EHR system will give accurate track record of immunization needed and to be delivered to the patients. This leads to safety measures in concern to law and practice. (Source: CMS, 2010) Table 4 Table 4 about 6 Quality Measures for UMUC Family Clinic report Count CMS eMeasure ID CQM Measure Title Domain Explanation of how the objective will be met at the UMUC Family Clinic using the selected EHR (minimum of 2 sentences each) 1 CMS117v1 Childhood Immunization Status Population/Public Health Using the EHR system to record the vaccines will capture the needed information. A report will be generated from the EHR at the end of the reporting period. 2 CMS165v2 Controlling High Blood Pressure Clinical Process/ Effectiveness EHR will give consistence record of fluctuation in blood pressure of the patients between 18-85 years of age. This will result to deliver remedial measures due to fluctuation of blood pressure. 3 CMS155v2 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Population/ Public Health EHR system will provide consistent track record and weight level of patients. If there is any issue of under and overweight remedial measures can be taken by eligible professionals. 4 CMS131v2 Diabetes: Eye Exam Clinical Process/ Effectiveness EHR record system provides overall accurate information about the eye condition of diabetic patients. If necessary examination or care measures required can be judged by the eye specialist doctors. 5 CMS122v2 Diabetes: Hemoglobin A1c Poor Control Clinical Process/ Effectiveness EHR system will also give accurate record about the glucose level of the diabetic patients. Through this further adjustment in nutrition, medicines and vaccines are can be suggested by doctors. 6 CMS77v2 HIV/AIDS:RNA Control for Patients with HIV Clinical Process/ Effectiveness EHR system also gives track record about the patients who are suffering from HIV/AIDS infections. Through this record, doctors can suggest successive treatment and testing procedure for the sustainability of the patients. (Source: CMS.gov1. 2014) References Appari, A., & Johnson, M. E. (2008). Information security and privacy in healthcare: Current state of research. Center for Digital Strategies, 1-39. Carroll, S.S., Edward, J.N., & Rodin, D. (2012). The Common wealth Fund. Using Electronic Health Records to Improve Quality and Efficiency: The Experiences of Leading Hospitals, 1-40. CMS.gov. (2014). The official web site for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/ CMS.gov1. (2014). Additional information regarding ep clinical quality measures for 2014 ehr incentive programs. Clinical Quality Measures For 2014 Cms Ehr Incentive Programs For Eligible Professionals, 1-28. CMS. Gov. (2010). Medicare & Medicaid ehr incentive program. Meaningful Use Stage 1 Requirements Overview, 1-33. eClinicalWorks. (2014). Meaningful use stage 1 objectives for eligible providers. Retrieved from http://www.eclinicalworks.com/knowledge-center-meaningful-use-stage-one-criteria-core-objectives.htm HealthIT. Gov. (2014). National learning consortium. Continuous Quality Improvement (Cqi) Strategies To Optimize Your Practice, 1-17. Infosys. (2007). Infosys/Oracle Solution for enabling collaborative Healthcare Platform. Clinical Transformation Ehr/ Phr Solution, 1-2. Madison, K. (2007). Uc Davis law review. Regulating Health Care Quality In An Information Age, 40(1577): 1579-1651. Winkelstein, P.S. (n.d.). Ethical and social challenges of Electronic health information. Chapter 5, 139-159. Read More