Write a report to Metro Hospital Executive Board on Roadmap to achieving a HIMSS level 7 EMR for the Metro Hospital by 2025.
1. Background / Overview
This report is report is aimed at providing a roadmap to the Metro Hospital, to attain the HIMSS Level 7, by the year 2025. The Director of Informatics for the Metro Hospital in Brisbane compiles it. The Metro Hospital is a 363-bed facility on the North side of Brisbane, Australia, and provides different services to the communities living within its environs. Among the services that the facility provides include general surgical, general medical, oncology, vascular, ear, and nose, and throat, palliative care, and ophthalmology, maternity and pediatric care. By attaining the HIMSS Level 7, an institution is recognized as one that uses the highest level of electronic health management systems (Sensmeier, 2006). The HIMSS according to Sensmeier, (2006) uses the EMR Adoption Model to rate hospitals on a scale of 0 to 7. Stage 7 facilities are entirely paperless and utilize optimal health-information management systems among other Information technologies in order to better the human life.
This report will demonstrate the current situation of the Metro Health facility, as a Level 4 institution on the EMR scale, indicate the measures to be taken in order to achieve Level 7 by 2025, the success factors, the critical aspects, and the goals with timelines to met, in the systematic implementation of the plan. The report will also indicate how this plan will be governed, how it will be affected by the national/and or governmental factors in Australia, and finally provide the recommendations to the board that manages the facility, for implementation of the plan. Simply, the report comprises of a strategic plan, that will enable Metro Hospital achieve the HIMSS Level 7 EMR, by the year 2025.
2. Vision for the EMR
By the year 2025, the MetroHospital should be a leader in the provision of high-quality patient-centered care, which is fully technology-enabled, in Brisbane Australia.
Predicted Characteristics of the MetroHospital by 2025
The MetroHospital will not utilize paper charts and any paper-based management systems in its delivery and management of patient-centered health care options. Electronic management systems will be used to store and manage discrete data, the document images, including patient medical images.
The MetroHospital will by 2025 offer and integrate its services in the following ways.
- It will be able to exchange health information between it and other healthcare systems within Brisbane thus reducing self-reported tests that are duplicated. This will also reduce hospital admissions by above 15% of patients because of information exchange (Journal Of Clinical Engineering 2011).
- The health system will be able to improve vaccine adverse reporting and thus bring about a huge margin increase the adverse vaccine events for concerned institutions such as the Center for Disease Control (CDC) and the WHO(Margaret (n.d). This move will be vital to these institutions to come up with vaccines that are more refined, with minimal side effects, within acceptable limits.
- The MetroHospital will have an integrated utilization of clinical decision-making support in order to aid for instance, newborn baby care especially those with suffering from hyperbilitrubinemia, among others (Netwerken 2015).
- By the year 2025, the MetroHospital will have its sections integrated in that patient information in one section presents a summary of all necessary health information. These sections in the MetroHospital that will be installed with the HIMSS Level 7 EMR standard gadgets include the surgical, the general medical, oncology, vascular, ear, nose and throat, palliative care, ophthalmology, maternity and pediatric sections among others.
- The hospital will also interact with its affiliate institutions on the electronic platform, including the Division of General Practitioners within Northern Brisbane.
Critical success factors for the EMR
For the success of any EMR system, there are different factors that must be considered. These factors will be in line with planning, implementation strategies, and the management of MetroHospital Health Records Management section. They will enable the institution to move from the EMR Level 4 to EMR Level 7, where it will experience electronically automated environment. The current working processes, technologies being used today, and the staff, must be made to adapt well to provide real time and quality information apart from a few challenges such as insufficient resources and high expectations that are on an increasing trend (Sensmeier, 2006). Among the factors to be considered like it is indicated in the Journal Of Clinical Engineering (2011) include the realigning of hospital processes, staff capacity development, physical environmental renovation, and the implementing newer systems, which provide support to the strategic plan of the Metro Hospital.
First, developing the capacity of staff is paramount as will enable the health facility to properly manage the several cultural changes, which will develop, to meet future departmental needs by providing education, among other opportunities in regard to career development (McBride & Tietze 2016). It is essential to capacity-build the current staff as it will enable to measure the levels of both staff and customer service satisfaction. A highly qualified team that is also committed to the objectives of the Hospital in terms of technological advancement must be developed to oversee the match towards the 2025 vision.
Secondly, the realignment of existing processes within the Metro Health is necessary, as it will help the facility to put in place plans and efficiently execute them while improving the process methodologies in delivering quality health care towards 2025. This realigning process is crucial as enables the measurement of Electronic Health Records.
Thirdly, redesigning of different processes within MetroHospital makes sure that each department and renovations being carried out currently and in the future have a smooth workflow, and is done systematically in line with best practice standards (McBride & Tietze 2016). The renovation of the facility’s physical environment is important as it ensures a smooth workflow, and lesser time wastage in the health facility department. Since the security of the information obtained from patients is important, there is need for renovations that aim at restraining third parties, which are not authorized to access patient information, from accessing it.
Further, the gradual introduction of newer heath records management system applications and gadgets is paramount in the gradual conversion of the institution from the current EMR Level 4, to Level 7 by the year 2025(Netwerken 2015). This of course goes a long with a gradual increase in the facility’s budgetary allocations, aimed at obtaining new technologies for each department within the facility as we focus on achieving the 2025 dream.
3. Analyzing the current situation
Currently, the Metro Hospital is at the EMR Level 4. Therefore, it is still expected offer high level technological equipment among other academic demands by providing solutions for information management aimed so as boost health care quality within Brisbane. In order to attain this particular necessity, there is need for a newer health records management system for the Metro Hospital if it has to reach its plan of adopting the HIMSS EMR Level 7 Model by the year 2025. The health facility still carries the burden of having inefficient preparation environment that makes it difficult to provide services properly to the surging numbers of patients within Brisbane. Health care delivery services are currently using an integrated system that uses both paper work, and computers. In this regard, being at the fourth Level, it is necessary that the facility be developed to be paperless and instead be full electronic by 2025(Bloom 2002). A review of the existing systems is necessary to enable the easy sharing of clinical information through electronic transactions (Netwerken 2015). Currently, Metro Hospital does not fully utilize its functionality, especially in regard to providing of efficient, effective and at the same time safe health care options for the patients due to operating manually at times especially when there is need to share information between different departments that are not yet synchronized electronically.
Today the Metro Hospital has very good relations with the existing local Division of General Practitioners. However, the two institutions are not linked electronically. There is need to provide an electronic link with the two institutions, in order to have a shared platform for information sharing and decision making, while at the same reducing the duplication of duties (Buultjens et al 2007). The exhibited delays at the hospital during patient service due to reliance on manual processes need to be reviewed in order to reduce the time for patients within the facility (Netwerken 2015). The facility also invests heavily in purchasing paper-made data collection tools, a part from paying salaries to individuals who facilitate the se of paper-related health records management. If the hospital attains the 7nth Level of the HIMSS EMR Model by the year 2025, there will be lower operational costs as only electronic technologies will be used.
4. Aspects critical to supporting an EMR
The Metro Hospital staff needs to ensure that they are well informed in regard to the health records management practices which need to be implemented so as to have an efficient and sufficient EMR system (Taylor et al 2005). The individual employees at the facility need awareness in regard to the different established regulations and rules, which govern the professional requirements in EMR management practice. The regulatory authorities including the government of Australia under the health department set the guidelines in terms of creation, maintenance, retention, and destruction of traditional paper-based records, the EHRs and finally the EMRs. This need to be considered, in supporting the development of world-class EMR system within Brisbane ((Taylor et al 2005). Further, there are privacy legislation which concern the collection, the utilization and the final information disclosure regarding patient’s, that must be upheld and very much respected by staff even in the transition phase towards 2025(Netwerken 2015). The effectiveness of the EMR system could also be gauged based on how the hospital management and its staff consider the patients’ consent and rights in accessing their own health information stored within the EHRs/EMR’s.
5. Roadmap for achieving HIMSS level 7 by 2025
Since the facility is still at the HIMSS Level 4, there is need to institute goals that will enable it transit through levels 5, 6 and finally 7, by the year 2025.
The following could be some of the goals:
- To attain Level 5 by the year 2019- In this case, the facility should have a full complement of the radiology PACS systems, which will provide world-class medical images for both physicians and the patients through intranet, displacing the current film-based images and their related technologies (Netwerken 2015). This technology should be operational in all the departments by 2019.
- To attain the Level 6 by the year 2022- In this case, there will be full physician documentation, structured electronic templates, discrete data collection, will need to be present at least two inpatient care service areas(Netwerken 2015). By 2022, level three of clinical decision support should be used to provide guidance for every clinician activity that is related to the protocols and results in terms of both variance alerts and compliance alerts (Coile 2003). There will be closed loop medication administration where bar coding among other auto identification technologies including radio frequency identification (RFID) will be used in different departments((Taylor et al 2005). This will enable right dosage prescriptions, among other utilities.
- To achieve stage 7 by 2025: At this level, each department uses paperless documentation (HIMSS15 Annual Conference & Exhibition 2015). A mixture of document images, medical images, and discrete data will be available in the health facility’s departmental EMR systems (Coile 2003). There will be data warehousing in computer databases to analyze patterns of the existing clinical data in order to improve the health care quality safety of patients, and the efficiency of delivered care.
As Director of Informatics, my implementation plan should have the main purpose, the system overview, and a management overview that will include a description of the implementation process, different responsibilities, and duties for those responsible. Other elements include the main tasks, the schedule for implementation, terms of security and privacy, the security features of the system, and the procedure for setting up patient information security, even through the period of implementation (Overhage et al 2008).
Further, the implementation process will utilize different software, among other hardware, and materials, facilities, documents and various personnel (The National E-Health Strategy (2012). For personnel, the plan will include the training of staff to be part of the change process, through the implementation phase, since they will be the major participants in carrying out the implementation (Stuart et al 2002). This implementation plan will include aspects of monitoring and evaluation, done periodically, and continuously. Time to time Assessment will be done to for each implementation level in order to configure the impact f the implementation, and the future dreams to be achieved in 2025.
6. Resources Required In Implementing the Project
In order to move Metro Hospital from the current HIMSS Level 4 EMR to the Level 7 by 2025, there will be different resources, including both physical, financial and human resources (Goldney 2007). In this regard, the hospital will need the following resources, although provide in different phases, in line with short and long term budgetary allocations of the facility.
- Financial resources-a special budgetary allocation need to set part for de4veloping different aspects of the implementation plan (McBride & Tietze 2016). These include the purchasing of computer systems and HIMSS software, which have been proven fit for use.
- Human resources-the Hospital will need to source external trainer of trainers, to teach different departmental heads and officials, the working of the newer systems, purchased by the institution (McBride & Tietze 2016).
- Physical resources-Include land and or infrastructure , where ICT sections will be constructed specifically for the Hospital’s Health Records Management section
It is clear that governance is paramount in regard to implementing such huge plan, that could entirely bring change to a health facility within a specified period of time. Unclear implementation due to poor governance could on the other hand bring about serious risks (Journal of Clinical Engineering 2008). As the Director of Informatics, I suggest that the governance of the vision 2025 for the Metro Hospital should be put under two committees that will enable the full implementation and the achievement of the HIMSS Level 7 EMR status by the year 2025. These committees include the ICT departmental Committee and any other committee including members from the operational and clinical sections, which must be linked to the EMR-HER systems (Journal of Clinical Engineering 2008). The different personnel to be involved in managing different implementation processes must be identifies, including their responsibilities. They should also take part in the expert trainings through different seminars organized by the two committees, involving external trainer of trainers (Sensmeier, 2006). The procedures and regulations in regard to decision making need to always apply as the Hospital advances through Levels 5, 6 and finally 7by 2025. There is need for lines of both responsibility and accountability (Hawkes, N. (2014). Continuous reporting of progress from the monitoring and evaluation personnel should be done, and the reports given to the heads of the committees, to know the areas o improvement, in terms of the set, strategic plan (Sensmeier, 2006). All the services that need to be transformed into electronic systems must be considered and focused on by the two committees (Marceau 2000). The committees should also ensure that they are allocated sufficient funds, human resource, and physical resources, in time so that set goals, both long-term and short term are achieved within the accepted periods (The National E-Health Strategy (2012). However, the governing committees must ensure that the physicians, to know where to improve within time provide continuous, needs-assessment (Critical Care Nursing Quarterly 2011). The committees to track progress and changes that need to be done at particular stages should hold regular meetings.
For utility ratings to provide comparative information there is need to rely on metrics (Overhage et al 2008). Benchmark metrics may be developed by measuring the real clinical environment for clinician users particularly for every task. The panel of clinicians can then compare the good actual performance and the perceived performance that is ideal for users (Critical Care Nursing Quarterly 2011).This will establish target scores that will reflect how to better meet the needs of users, than the way it is done currently.
8. Alignment to state and national eHealth programs
This vision is in line with the Australian government’s strategies in achieving ehealth programs in the future. The government in its strategies, drawn by the Deloitte Company, aims staging national campaigns to promote automation of health services, providing necessary financial incentives, accreditation of health care providers, proviso of vocational training in ehealth programs, among others (Chubb 2014). Drawn in 2008, the government’s ehealth strategy targeted that in 10 years, there would be developed online interaction within the health sector, improved consumer utility of health-information record systems, over 80% of referrals, prescriptions, and orders for tests are done electronically among other predictions (Rao, 2009). The national ehealth strategy also targeted at ensuring that up to 20% of consultations are done online, between patients and health providers (Chubb 2014).
Therefore, the highlighted strategies above integrate with the Australian health departments’ strategies, with a common vision of ensuring a paperless but integrated system that enables informational sharing with other facilities. If the government enables the public health facilities to also attain the HIMSS Level 7 EMR (The National E-Health Strategy 2012), then by 2025, MetroHospital will be a complementary institution, which will be easily integrated with others in Brisbane and beyond.
9. Likelihood of success and identification of risk
This achievement of the implementation plan is likely to succeed because of the following:
- A committed Metro Hospital Management and staff in regard to the vision
- Availability of resources including human, financial, and physical resources, which are already in place
- As HIMSS Level7 EMR institution, it is likely that the staff and management are aware of the need to reach a highly automated health system by 2025
The risks may include the following:
- The purchase of highly expensive electronic gadgets could make the plans be implemented later than the fixed timeframe
- There will be need for the MetroHospital to hire external experts to monitor and teach the staff, regarding each stage of the implementation plan.
- Conclusion and recommendations
In conclusion, this report consists of the roadmap for Metro Hospital, towards achieving HIMSS Level 7 EMR by the year 2025. The following are the recommendations, based on this particular report.
First, as indicated by Young, et al (2016), there is need to for the Metro Hospital management to consider this implementation plan, and review it to find the necessary areas that they can be able to raise their own concerns.
Secondly, the management should evaluate their current performance at Level 4 EMR, in order to realize the need to move higher through development of proper strategies.
Finally, achieving Level 7 EMR will be in line with the country’s ehealth needs, and thus, the management should view this plan, as an obligation ahead.
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