Implementation of an Electronic Health

Record SystemBy: Na’Shea Merritt

Future Compliance Requirements

The principle objective of this presentation is to discuss the necessary requirements for the Top Notch

Clinic transitioning from a paper-based health care system to an electronic health record (EHR). The

alarming cost of health care alone with frequent medical errors have greatly encouraged the government to

focus on ways to alleviate these problems. The Health Information Technology for Economic and Clinical

Health (HITECH) Act, a part of the American Recovery and Reinvestment Act (ARRA), was the nation’s

first federal commitment supporting the adoption of EHRs. When functioning properly the EHR system

proves more beneficial than paper records by offering increased practice efficiency, patient participation,

and cost savings. The quality of care and accuracy of diagnosis also improve with EHR offering better

health outcomes (HealtIt.gov, 2014).

Obstacles During Implementation

The obstacles will be in learning a new system and how it works. The greatest obstacle in transitioning from paper

to EHR is in the cost. The system costs takes into account the design, development, interfaces to other systems, and

periodic upgrades. The initial purchase of software along with annual maintenance fees are consistent with license fees of

commercially available systems. Induced costs are inclusive to the transition from paper to electronic taking into account

the brief decline in physician productivity due to transitioning. It is with assumption that the initial productivity loss will

be twenty percent the first month using average annual provider revenue with an ensuing return to baseline productivity

levels after the third month (Wang et al, 2003).

Plan of TransitionTransition from paper charts to an EHR is a

complex journey. The adoption of EHR system takes

years to fully evolve (AHIMA, 2010).

Building an effective EHR implementation

team or committee is essential to the transitional

process because everyone plays a role in selection,

implementation, and continuous monitoring. Staff

training will prove beneficial but will take time in

adjusting to a such an advance system.

To aid in a smooth transitioning process

collaborative efforts and decision-making from the

Top-Notch Clinic stakeholders must be ensured.

Stakeholders Position

The key stakeholder is the primary physician which makes all the final decisions for the clinic. It is based upon his

past experience and expertise that he carry out each decision. He takes what has worked great in previous health care

settings and use that to his advantage. Basing his decision on what will profit this facility most.

The employees input is always welcome because the stakeholder realize that each individual can offer valuable

information from their aspect of the clinic. Each employee provide skills, knowledge, commitment, and a different

perspective in the process of implementation. Everyone plays a role in selection, implementation, and continuous

monitoring.

Top EHR Systems

Aspects of IT System

eClinicalWorks V10 is ICD-10 compliant and enables integrated voice to text options with five hundred plus enhancements. This version is faster and more intuitive in completing clinical documentation. Immediately upon using eClinicalWorks V10 the Progress Note options will draw attention with its voice to dictate clinical findings, help with eClinicalWorks Scribe tab, and the structured text. Also, the Orders tab is easily navigated for placing order for the patient. This allows for effortlessly ordering before the patient leaves the office. Medications, labs, procedures, and immunizations can be quickly searched (eClinicalWorks, 2014).

eClinicalTouch eClinicalMobile eClinicalWorks RCM Healow & Healow

Messenger

Estimated Cost of Implementation

Upon examining the costs of the EHR it is important to categorize the costs into two groups including:

system costs and induced costs. The system costs are inclusive of software/hardware, training, implementation,

ongoing maintenance, and support. It is with assumption that the hardware will be replaced every three years. The

system costs takes into account the design, development, interfaces to other systems, and periodic upgrades.

The costs estimated range is $2500 and $3500 per provider for initial purchase of software along with

annual maintenance fees (Wang et al, 2003). These fees are consistent with license fees of commercially available

systems. Induced costs are inclusive to the transition from paper to electronic taking into account the brief decline

in physician productivity due to transitioning. It is with assumption that the initial productivity loss will be twenty

percent the first month using average annual provider revenue with an ensuing return to baseline productivity

levels after the third month (Wang et al, 2003).

Funding

According to Health Information and Management Systems Society (2010), there are three prominent funding options.

1. Installing the EHR application along with the database server in the clinic. Top-Notch Clinic will have to

purchase the software license, hardware, professional services, implementation consultants, network infrastructure, and

device deployment. The database physically resides within the clinic with an internal data center.

2. Deploying the application service provider (ASP) version of the EHR. This consists of the same help with

project management through the same purchases needed in the first option. However, the clinic will not be obligated to

purchase hardware nor software from vendor (HIMSS, 2010). The Top-Notch Clinic can have all features of EHR

without being held responsible for internal data center, it is remotely managed by vendor for a monthly fee. This process

is known as Software as a Service (SaaS).

3. Partnering with a hospital or either an Independent Physician (IPA). This option allows for a hospital to pay

eighty-five percent of EHR costs for an independent provider. The IPAs normally support price discounts on either

purchase or SaaS model for memberships (HIMSS, 2010).

Funding Cont’d

The transition from paper to eClinicalWorks V10 can

be funded with an HITECT Act grant. In 2009, an estimated

twenty-seven billion in incentives were authorized through a

federal stimulus for critical access hospitals (CAHs),

hospitals, and providers to transition to EHRs (Gottlieb &

Millsaps, 2011). Some of HITECH funding is specifically for

supporting infrastructure such as: state Health Information

Exchanges (HIEs).

HIEs were established to enable data sharing and

provide discounted opportunities. Sixty-two Regional

Extension Centers (RECs) have been formed around the

world to serve physician practices (HIMSS, 2010).

These centers assist in selection, implementation, and

meaningful use. The Top-Notch Clinic qualifies for this

funding as it mainly targets small primary care facilities.

Ongoing Barriers

When contracting for a cloud-based EMR such as eClinicalWorks V10 system privacy and security is addressed by

Health Insurance Portability and Accountability Act (HIPAA) and Patient Protection and Affordable Care Act (PPACA) rules

and regulations.  Contract terms comply with the HIPAA business associate requirements (McWay, 2014).  Data centers with

high level encryption methods and security rendering unreadable data to aid in achieving HIPAA compliance (CareCloud,

2014).  According to American Academy of Orthopaedic Surgeons (AAOS), quality reporting was made priority in 2007 and

since then PPACA has expanded the Physician Quality Reporting Incentive (PQRI). This introduced a penalty structure for

any failure to report replacing the current positive reward structure in 2015 (Mather, Hettrich, & Nunley, 2011). A breach of

confidentiality should only be done with an ethical or legal exception such as a person being at high risk for serious harm or

legal obligation to report infectious disease. (DeBord, Burke, Dudzinski, 2013). Otherwise the breach in confidentiality may

result in costly fines.

Conclusion

A transition from a paper-based system to eClinicalWorks V10 is deemed necessary for the Top-Notch Clinic. The benefits of eClinicalWorks V10 (eClinicalMobile, eClinicalTouch, eClinicalWorks RCM, Healow, and Healow Messenger) all are effective ways to aid in performance measurements. The qualities offered through this system excels far beyond what most EHR systems use and can give the clinic a promising future with an advantage over other organizations. This will prove to be a costly endeavor initially but definitely worthwhile.

ReferencesCapterra. (2012). Top 20 Most Popular EMR Software Solutions. http://www.capterra.com/infographics/top-emr-software

CareCloud Corporation. (2014). Five Advantages of a Cloud-Based HER for Small Practices.  

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DeBord, J., Burke, W., & Dudzinski, D. (2013). Confidentiality. Ethics of Medicine. Retrieved from https://depts.washington.edu/bioethx/topics/confiden.html

eClinicalWorks (2014). www.eclinicalworks.com

Gottlieb, D. & Millsaps, W. (2011, October 25). Financial Incentive Programs for Electronic Health Records: physicians express interest, but obstacles remain.

Retrieved from http://medicaleconomics.modernmedicine.com/medicaleconomics/news/modernmedicine

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Health Information and Management Systems Society. (2010, October 28). Funding Options Available for Providers Seeking to Purchase an Electronic Health Record.

Retrieved from http://www.himss.org/files/HIMSSorg/content/files/EMRFundingOptions.pdf

HealthIt.gov (2014, August 14). Benefits of Electronic Health Records. Retrieved from http://

www.healthit.gov/providers-professionals/benefits-electronic-health-records-ehrs 

References Cont’dMather, C., Hettrich, C., & Nunley, R. (2011). Penalties Coming Under PPACA, PQRI. American Academy of Orthopaedic Surgeons.

Retrieved from http://www.aaos.org/news/aaosnow/jan11/advocacy2.asp

McWay, D. (2014).  Today’s Health Information Management: an integrated approach (2nd Ed.). Clifton Park, NY: Delmar

Cengage Learning.

Wang, S., Middleton, B., Prosser, L., Bardon, C., Spurr, C., Carchidi, P., ….Bates, D. (2003, April 1).  A cost-benefit

analysis of electronic medical records in primary care.  The

American Journal of Medicine, 114, 397-403. http://nyehealth.org/wpcontent/uploads/2012/07/Wang_EMRCostBenefit.pdf