Implementation of Electronic Medical Records in Stanford Hospitals and Clinics - Case Study Example

EMR: - EMR stands for electronic medical record. It is primarily employed at an that provides healthcare facilities i.e. at a hospital or at a physician’s clinic. Its primary purpose is to improve the communication among different departments of a hospital to increase productivity, to minimize errors and to improve customer care. Main Characteristics: - One of the main characteristics of EMR is its cohesive bond with information and technology (IT). The reason for employing IT is to make sure that all the organizational information stored in hospital’s mainframe can be communed to particular departments, which need particular information. Of course this approach takes technical expertise of people associated with IT and additional expenses, but on the bright side it decreases all the other costs i.e. cost of paper based information system. Thus, decreases the errors and mishaps by a considerable margin and saves a lot of time that can be utilized in other areas of the hospital to increase productivity. Potential Benefits of EMR: - Time Saving: EMR is most beneficial when it comes to time saving. In times of recession, where many hospitals are closing down or going bankrupt, EMR comes as life saver in maintaining and obtaining patient records. It is particularly helpful in times of quarantine and medical panics where manually trying to get patient’s information could be a tedious task, that might take a lot of time, but with EMR this problem has been solved comprehensively. All the doctors, surgeons, technicians or attending physician has to enter the general information of the patient i.e. Name, Birthday, Day of admittance in the hospital and the patient’s complete record will pop-up on the computer screen. The following chart is taken from MSDC, (Medical Systems Development Corporation), to illustrate the benefit of using EMR instead of manual medical record keeping, (Benefits of EMR, 2008) Portable: EMR is useful because the information can be transferred from one place to another easily and swiftly. Due to which it is a far better choice than the old-style paper information management. (Wheeler, Wong, & Shanle, 2009) Cost Differential: It is also less expensive because of the low amount of IT staff required to handle EMR operations which in turn results in decrease in the amount and energy spend on the manual tabulation of the information of patient. Although the initial investment on the equipment procurement and training of staff is required, but all this money can be recovered in a small time provided that the EMR operations run smoothly and effectively (Varshney, 2009).SHC initially did not care about the amount of money they were going to spend, but instead they focused on quality of the services that they received. The result of which is shown below. Reasons influencing SHC toward implementing EMR: SHC (Stanford Hospitals and Clinics) implemented EMR because of its reputation of accurate data handling, which enabled them to sustain their quality of work and integrity. SHC is known throughout the world for its patient care and its handling of records and to treat rare diseases and genetic disorders. (Clinical Centers, 2012) Another reason for implementation of EMR by SHC was, because one of its boards of directors, Sue Bostrom noticed that as compared to other hospitals, SHC lacks far behind in IT sector. According to her, “When I came onto the board, I was surprised by where the IT capabilities were at Stanford. Given their prestige as an academic institution and a medical school and hospital, I expected that their IT capabilities would be equal to other hospitals….but they were lagging far behind” (Benefits of EMR, 2008) Implementation of EMR has its benefits and drawbacks as well, therefore, an organization must evaluate before its implementation to ascertain the negative and positive checks on its working. One of the prime changes in organization culture is that too many employees and workers would have the power to enter information into the system. If they decided to pursue with EMR, the board of directors of SHC were aware of the fact, while some members wanted to keep the EMR strictly to IT department and administration staff, but the majority of the member were in favour of utilizing EMR in a way that it was within reach of majority of hospital employees. Their rational for this approach was that in the current era of Information and technology a generic and vanilla type of EMR would simply function in way through which EMR would become a liability instead of asset. (Mintz, 2011) Another change in culture of the institution SHC was the use of software. Before the implementation of ERM most of the departments had the liberty to choose any system of their choice and a change might not be understood by the employees of IT in different departments. But the above mentioned situation has not met with much resistance and the end result has been SHC getting the 7 stage rating on HIMSS Designation for Electronic Medical Record System for its efforts of four years. SHC have a decentralized structure, which also created minor problems i.e., earlier physicians were able to have ordered their individual order sets of equipment without having to ask for authorization this would have changed resulting in SHC organization structure much more centralized risking a decrease in sense of power in the eyes of the physicians but this was solved by Epic Design Parameters i.e. a training program initiated by SHC to make the doctors and representatives become more accustomed with EMR. (See below). The implementation of new software did create chaos instead of a blessing due to the change in technology IT professionals faced some difficulty in adopting the new culture of EMR. The members of the staff were familiar how information was followed and they were aware of the privacy and technical problems involved and how to cope up with them. Getting familiar with new software did take a lot of time and news challenges in accord with it weren’t easy to handle. SHC developed an evaluation criteria, through which; out of the eight aspects of evaluating a vendor they divided 5 into the most prioritized list and three into medium prioritized aspects i.e. when evaluating a vendor, what shall they prioritize i.e. quality, price customer service etc. According to Kevin Tabb, The chief medical and information officer at the time, remarked, “We decided that we would embark on fairly rapid but formal evaluation process.”(Denand, Mandelson, & Zenios, 2010) The most prioritized aspects were, I. Completeness of offering II. Community Outreach Program Effectiveness III. Support for Research Mission IV. Clinical Outcome Improvement Capabilities V. Patient Safety Medium prioritized aspects were, I. Technical Capabilities II. Cost III. Confidence in Vendor This process was well-conceived because they prioritized internal factors in making a decision instead of external threats which were beyond their control. SHC took the liberty of starting an initiative of sorting out the institutional complexity by the name of Epic Design Parameters through which, all the representatives across SHC would work for four to six months among groups with the help of external management consultants as to how the EMR operations shall be defined once the system was installed and implemented. This policy also worked, but again there were several other problems of new staffing and training the new employees was not cheap which affected the cost of EMR initial installation. Therefore, SHC had to bear the cost of training every time a new member for IT department was hired. Faced with a situation like this, in the future it would be strongly recommended to the board of directors, that the EMR implementation of SHC was not an unsuccessful idea, but still there were some issues, which needed more evaluation and concentration before implementation of it by SHC. SHC’s approach of reaching out to all the representatives of the hospital was not a good move on their part, because the entire function of EMR would lose its purpose. They should have limit the access of patient’s data to specific personals i.e. IT personnel and administrative staff and should have trained only them to make sure that the system is working and intact. The success of this approach in SHC was lucky co-incidence, but the guarantee that it would work in every health care organization is far-fetched. (Gasch & Gasch, 2010) For an organization to successfully implement ERM, it is essential that it follows that Karim Keshavjee way of implementation of ERM, because the end results will be successful until and unless outside factors affect ERM. (McDaniel, 2009) SHC was quite successful in its implementation of EMR because in 2011, it was awarded Stage 7 rating by HIMSS Designation for Electronic Medical Record System for its data and medical record keeping system.(Stanford Hospital & Clinics Awarded Stage 7 HIMSS Designation for Electronic Medical Record System, 2011). According to Carolyn Byerly, “In a little less than four years, we advanced to Stage 7. To do so in that time period is an extraordinary effort accomplished through support and planning as a team across the entire hospital and clinics.” (Stanford Hospital & Clinics Awarded Stage 7 HIMSS Designation for Electronic Medical Record System, 2011) The process of implementing EMR delivered results; SHC moved from step by step towards the top and achieved a rating that has only been achieved previously by 5 hospitals in United States of America. But this is a more than average achievement in the view of Kevin Tabb, who said, “We view this as only the beginning of the journey….. And (we) will benefit our patients in ways that we can only begin to imagine today.”(Stanford Hospital & Clinics Awarded Stage 7 HIMSS Designation for Electronic Medical Record System, 2011) Conclusion: - SHC success in implementing EMR was the result of very well crafted plan, but it also had a little bit of luck and few lucky coincidences to thank to. SHC as mentioned above now has the highest rating on HIMSS Designation for Electronic Medical Record System for its data and medical record keeping system (Stanford Hospital & Clinics Awarded Stage 7 HIMSS Designation for Electronic Medical Record System, 2011). Any health care to implement an EMR like SHC has to look into those lucky co-incidences and figure out why if at all they happened and include the reasons of those coincidences into their plan. References: Benefits of EMR. (2008, November 08). Retrieved June 02, 2012, from Medical Systems Development Corporation (MsdC): http://www.msdc.com/EMR_Benefits.htm Clinical Centers. (2012, January 1). Retrieved June 2, 2012, from Med.Stanford.edu: http://med.stanford.edu/nephrology/patient_care/centers.html Denand, L., Mandelson, H., & Zenios, S. (2010). Electronic Medical Records System: Implementation at Stanford Hospitals and Clinics. Palo Alto: Stanford Hospitals & Clinics. Gasch, A., & Gasch, B. (2010). Successfully Choosing Your Emr: 15 Crucial Decisions. New York: John Wiley & Sons Ltd. Keshavjee, K., Bosomworth, J., Copen, J., Lai, J., Kucukyazici, B., Lilani, R., et al. (2006). Best Practices in EMR Implementation: A Systematic review. Vancouver: Symposium of Health Research. McDaniel, J. G. (2009). Advances in Information Technology and Communication in Health. FairFax: Steering Commitee and IOS Press. Mintz, R. J. (2011). Asset Protection for Physicians and High-Risk Business Owners. FallBrook: Francis OBrien & Sons Publishing Co. Stanford Hospital & Clinics Awarded Stage 7 HIMSS Designation for Electronic Medical Record System. (2011, January 25). Retrieved June 2, 2012, from http://stanfordhospital.org/newsEvents/newsReleases/2010/himss-stage-7-designation.html Varshney, U. (2009). Pervasive Healthcare Computing: Emr/Ehr, Wireless and Health Monitoring. New York: Springer Science + Business Media. Wheeler, D. S., Wong, H. R., & Shanle, T. P. (2009). Science and Practice of Pediatric Critical Care Medicine. New York: Springer Science + Buisness Media. Read More