Meaningful Use of Electronic Health Records for Physician Collaboration: A Patient Centered Health Care Perspective

EHRs (Electronic Health Records), can contribute greatly to improving care and managing the rising costs of healthcare. The use and the integration of EHRs (Electronic Health Records) in supporting collaboration to increase the efficiency and effectiveness of healthcare remains a challenge. It appears that the physicians are at the center of this bottleneck. As healthcare is provided by interdisciplinary teams of clinicians and collaboration and coordination are key to success. Literature suggests reasons for the limited use relate to policy, financial and usability considerations, but it does not provide an understanding of reasons for physicians\u27 limited interaction and adaptation of EHR. This paper investigates how meaningful use of EHRs by physicians enable patient centered healthcare to be achieved. Following an analysis of qualitative data, collected in a case study at a hospital using interviews, this research shows how a collaborative technology architecture can enable the reduction in the costs of healthcare and improvements in the quality of care by enabling more patient centered health care

Teething Pains: Examining the Integration of Electronic Records in Dentistry and Medicine

The modern American healthcare system features a long-standing divide between medical and dental care. This divide is the product of long historical trends, but it has resulted in less optimal care for patients. Recent research shows that integrating care can improve patient outcomes and decrease the cost of care for patients with chronic disease. This integration can be mediated by integrated electronic health records. Interviews with practicing dental professionals at an Austin community clinic with an integrated patient record show high satisfaction among users and increased efficiency of care. In particular, the study showed that integrated records helped the oral healthcare providers fill gaps in their patient’s medical histories. This study opens the door for considering the integration of dental and medical health records in institutions like community clinics, perhaps through incentives from the government.Plan II Honors Progra

A Measurement of Readiness for Tennessee Hospitals to Implement “Meaningful Use” Criteria Resulting from the American Recovery and Reinvestment Act, 2009

In 2009, the American Recovery and Reinvestment Act was signed into law. This legislation provided for monetary rewards for those acute-care hospitals that meet meaningful use computerization and reporting criteria. The study used a descriptive, nonexperimental design to answer three research questions (1) What is the level of readiness to meet meaningful use criteria in the Tennessee Hospital Association (THA) member hospitals; (2) What is the level of readiness to meet meaningful use criteria in the rural THA member hospitals; and (3) Is there a difference in the readiness to meet meaningful use criteria between rural and urban THA member hospitals?. A survey was sent to 115 THA member hospital, with a return rate of 83% (N=95). The inclusion criteria focused on acute-care hospitals, with rehabilitation, psychiatric and long-term care hospitals falling into the exclusion criteria. The Readiness Score was determined for the total survey respondents (N=95), as well as for the rural (N=41) hospitals and urban (N=54) hospitals in the Tennessee Hospital Association member hospitals meeting the inclusion criteria. Z-scores of the readiness score were examined and indicated that there was one outlier with z\u3e3.0. Therefore, that case was removed from the comparison in the t-test (N=94). The t-test comparison of rural and urban hospital found a significant difference at (p=.002), two tailed. To ensure that the slightly nonnormal distribution of the readiness scores did not explain the difference found with the t-test, an additional nonparametric test was also conducted. The Mann Whitney U-test showed that even with the assumption of a normal distribution is not made, the difference in readiness between urban and rural hospitals is still statistically significant at p=0.026

Design and Development of Simulation-based Instruction on Meaningful Use and Interprofessionalism Core Competencies in a Healthcare Team-based Learning Environment

Policymakers and electronic health records (EHR) experts agree that healthcare professionals lack proficiency in meaningful use of EHRs. This competency gap can result in increased medical errors. It is essential for health professions graduates to acquire skill sets that are adaptable to any electronic health information technologies including the EHRs to facilitate work process and information access. Simulation as an instructional method to create transformative learning experiences has shown promise in the medical profession. In simulations, learners are able to engage in real-life scenarios and practice their cognitive, affective, and psychomotor skills in a safe environment. The goal was to design and develop a simulation-based instructional module on meaningful use of EHR and interprofessional collaborative practice core competencies and evaluate students’ performance and satisfaction under an inter professional teambased setting. Using a design and development research approach, a simulation-based instructional module on meaningful use of EHR and interprofessional core competencies was designed. An internal validation of the module was conducted with an expert panel of medical professionals and instructional designers. Following validation, the instructional module was developed and pilot tested with a group of 21 second- and third year health professions students in medicine, pharmacy, and nursing in an interprofessional team-based learning environment. Students’ performance on meaningful use and interprofessionalism core competencies and their satisfaction during the simulation-based training were evaluated. The results confirmed that the students properly implemented the core competencies based on their performances during the immersive virtual patient encounter in the 3D virtual world. The analysis also showed how the students’ satisfaction was met as a reaction to the guided experiential learning’s (GEL) simulation-based instructional intervention, and in some instances were not sufficiently met. The analysis of the students’ testimonials further confirmed their overall satisfaction with the immersive simulation experience.The findings, based on the feedback from the students and faculty in this pilot implementation, highlighted simulation-based interactive gaming instruction and the hands-on experience in a 3D virtual world guided by GEL as an effective and engaging way to train healthcare professionals in the preparation to deliver care in a safe and effective manner under interprofessional team-based settings for better patient safety and outcome

Innovative Workforce Plan: Recently Graduated Nurses as Super Users for EHR Implementation in a Multi-Hospital Organization

A regional health system’s decision to rapidly implement a new electronic health record (EHR) in order to meet Stage 2 meaningful use requirements led to a need for innovative cost-containment strategies. Tapping the local pool of unemployed newly graduated nurses as half the required super user workforce leveraged the technology skills of novice nurses registered nurses as trainers of experienced nurses in five hospitals. The novel workforce migrated from hospital to hospital, thereby reducing the number of experienced nurses reassigned to super user duties in each hospital. This strategy also reduced the amount of contract labor required to backfill nurse super users’ clinical shifts. The innovative model reduced labor costs associated with super user staffing by 31.8%, while positioning the organization for successful attestation to Stage 2 meaningful use objectives. Employment of the recently graduated nurses as RN Residents upon completion of the EHR implementation enabled the organization to augment its clinical workforce with expert users of its EHR, and to rapidly achieve Stage 2 meaningful use compliance

Factors affecting the adoption and meaningful use of electronic medical records in general practices

Patients typically enter the healthcare systems at the primary care level from where they are further referred to specialists or hospitals as necessary. In the private healthcare system, primary care is provided by a general practitioner (GP). A GP will refer a patient to a specialist for treatment when necessary, while the GP remains the main healthcare provider. The provision of care is, thus, fragmented which results in continuity of care becoming a challenge. Furthermore, the majority of healthcare providers continue to use paper-based systems to capture and store patient medical data. However, capturing and storing patient medical data via electronic methods, such as Electronic Medical Records (EMRs), has been found to improve continuity of care. Despite this benefit, research reveals that smaller practices are slow to adopt electronic methods of record keeping. Hence this explorative research attempts to identify factors that affect the lack of adoption and meaningful use of EMRs in general practices. Four general practices are surveyed through patient and staff questionnaires, as well as GP interviews. Socio-Technical Systems (STS) theory is used as a theoretical lens to formulate the resulting factors. The findings of the research indicate specific factors that relate to either the social, environmental or technical sub-systems of the socio-technical system, or an overlap between these sub-systems. It is significant to note that within these sub-systems, the social sub-system plays a key role. This is due to various reasons revealed by this research. Furthermore, multiple perceptions emerged from the GP and patient participants during the analysis of the findings. These perceptions may have an influence on the adoption and potential meaningful use of an EMR in a general practice. Additionally, the socio-technical factors identified from this research highlight the challenges related to encouraging the adoption and meaningful use of EMRs. These challenges are introduced by the complexities represented by these factors. Nevertheless, addressing the factors will contribute towards improving the rate of adoption and meaningful use of EMRs in small practices

Strategies for Applying Electronic Health Records to Improve Patient Care and Increase Profitability

AbstractIneffective strategies to implement electronic health record keeping systems can negatively impact patient care and increase expenses. Hospital administrators and primary care physicians care about this problem because they would be penalized for not meeting meaningful use guidelines. Grounded in the information systems success model, the purpose of this qualitative multiple case study was to explore electronic health record (EHR) implementation strategies primary care physicians use to improve patient care and increase profitability. The participants comprised five primary care physicians involved in the effective implementation of an EHR application in the central coast region of California. Data were collected from semistructured interviews, company documents, and EHR systems. The collected data were analyzed using the six-step thematic process, and four themes emerged: (a) end-user training, (b) meaningful use, (c) EHR acceptance, and (d) communication. A key recommendation is for leaders of EHR applications to support efficient end-user training, follow meaningful use guidelines, use effective communication, and embrace EHR acceptance. The implications for positive social change include the potential for enhancing the quality of patient care and increasing profitability, which will benefit healthcare organizations and the communities where they are located