MHI 525: Chapter 19

Chapter 19 Notes

List factors that influence the decision whether to implement a new health information system or upgrade a current system

providing safe and up-to-date patient care

meeting federal mandates such as Meaningful Use (MU) and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirements

leveraging advanced levels of clinical decision support

List examples of major decisions

vendor and system selection

determining go-live options

redesigning workflows and processes

developing procedures and policies

What dictates the timeline and scope of the project?

expenses

staff

resources

drop-dead date for go-live

What does project success depend on?

a well-thought-out and detailed project plan with regular review and updating of the critical milestones

unwavering support from the organization’s leadership

input from users during the design and build phases

thorough testing

end user education

mitigation of identified risk factors

control of scope creep

List reasons why healthcare organizations may decide to implement or upgrade their HIS

changing government regulations

best practices; incorporating evidence-based content and clinical decision support systems

patient safety and improved quality of care

American Recovery and Reinvestment Act (ARRA)

enacted in 2009 and spawned the Health Information Technology for Economic and Clinical Health (HITECH) Act

its primary goals was that each person in the United States would have a certified digital medical record by 2014, including the electronic exchange of health information across healthcare institutions to improve quality of healthcare

Health Information Technology for Economic and Clinical Health (HITECH) Act

created a $27 billion federally funded incentive program providing Medicare and Medicaid payments over 5 to 10 years to eligible providers (EP), eligible hospitals (EH), and critical access hospitals (CAH)

there are two EHR incentive programs: the Medicare EHR Incentive Program administered by the Centers for Medicare and Medicaid Services (CMS) and the Medicaid EHR Incentive Program, which is governed by individual states and territories

critical access hospitals (CAH)

defined as rural hospitals certified to receive cost-based reimbursement from Medicare

EHR Incentive Program

has 3 stages

not established to cover the total cost of implementing an EHR system but to encourage or “incentivize” healthcare organizations and healthcare providers to use an EHR in a meaningful way, called Meaningful Use (MU), and to foster faster rates of adoption across the nation

other terms often used for this incentive program are “stimulus funds,” “stimulus package,” or simply “ARRA funds

EHR Incentive Program Stage 1

began in 2011

emphasized capturing patient data that was expected to be shared with other healthcare professionals and the patient

EHR Incentive Program Stage 2

began in 2014

focused on advanced clinical practices and providing patient portals where patients could access their medical records

EHR Incentive Program Stage 3

began in 2017

accentuates data interoperability and patient outcomes while increasing the thresholds for the objectives and clinical measures

What should an EHR do to meet MU requirements?

the EHR should be a “certified complete EHR” or have individual modules that are “certified EHR modules”

certified complete EHR

means that they are certified by the Office of the National Coordinator for Health Information Technology (ONC)

means that the system has the functionality, required data elements, and logic to support ambulatory, emergency room, outpatient, and inpatient MU requirements

certified EHR modules

means that the ancillary application meets one or more requirements

most hospitals and physician offices purchase a commercial system that is deemed certified, meaning that the vendor incorporated these essential capabilities

Certification Commission for Health Information Technology (CCHIT)

tested and certified new software applications beginning in 2006

ceased testing and certifying EHRs for financial reasons and changed its role to advising healthcare providers on how to comply with the government’s regulations and providing guidance to health IT developers on how to meet the government’s requirements for a certified EHR

works with HIMSS to advance programs and policies that strongly promote interoperability and to advocate using IT between patients and providers as another tool to transform healthcare

EHR Alternative Certification for Healthcare Providers (EACH) program

a three-step program to certify homegrown systems or existing EHR technology not already covered by a vendor certification

provides a mechanism to obtain certification by demonstrating that the system meets the U.S. Department of Health & Human Services (HHS) MU requirements

ICD-10-CM codes

used to classify all inpatient and out-patient diagnoses, report medical care and cause of deaths, process payments, calculate trends, and perform statistical analyses

e-iatrogenesis

term used to describe the most critical of the new type of errors seen in EHRs

List 3 major resources that will have the most impact on whether to implement a new system or to upgrade an existing one

staff

budget

physical or environmental resources

List the 2 approaches to implementing an EHR

best of breed

best of breed approach

involves reviewing several vendors for their “best” module or application, such as an admission, discharge, and transfer (ADT) system or emergency department module

purchase decisions are based on each module’s or application’s most desired or robust features and connectivity capabilities

provides the customer with tools to customize the application according to local, specialized needs

frequently selected by large medical, university, and research medical centers

List disadvantages of the best of breed approach

the need for multiple complex interfaces to integrate all of the products

the need for highly skilled and specialized IT staff to support the different interfaces

the existence of various hardware platforms and operating systems that may be on different versions of software and therefore complicate integration

each module may have a different user interface, meaning that each application looks and acts differently to the end users

more expensive and resource intensive approach

monolithic/fully integrated health information system

an EHR system that includes a suite of modules to support care

typically easier to install and easier to support and usually has a similar-looking user interface across modules, which helps users learn the EHR more quickly

all applications share a common database, the information exchange among the modules is quicker

initial installation is frequently faster and less expensive because a scaled-down IT department is required at the local site

smaller medical facilities and those not wanting large IT departments tend to favor this approach

List disadvantages of the monolithic/fully integrated health information system

system may not have specific features that the health facility needs

vendors often have applications that are excellent for some areas and less optimal for others

customer cannot easily customize the system without assistance from the vendor, which may involve a work order and additional cost

system changes can incur long delays from large vendors as they prioritize changes across many clients

List the main phases of the systems life cycle

analyze

plan

develop or purchase

test

implement or go-live

maintain and evolve

evaluate

List the 2 key points of the life cycle that become more intense

the planning required for system selection

the planning required for system implementation

workarounds

a method used to circumvent a problem without solving it