Answer

Abstract

THE FIVE facilities have been utilizing Cerner EHR as their Electronic Health Record of choice since September 6, 2006. It has grown to provide clinical, financial and operational support for their hospital system. Although Cerner EHR has come a long way, their system will run into deficiencies that can affect the workflow, productivity, and efficiency of the physicians and hospital staff. This theoretical research paper will dive into five deficiencies that can be resolved to increase or improve these processes. The deficiencies that could or may have occurred in the Cerner EHR system can range from human error to the programming of the EHR itself.

Sharp EHR Deficiencies Report

Sharp Hospital and Sharp Rees-Stealy facilities would like the Health Information Management seniors to provide ways to improve and resolve deficiencies in their Electronic Health Record (EHR). Cerner EHR is one of the most popular electronic health records systems in the market and it is also the choice of many government, for-profit, and non-profit healthcare entities. Like any electronic system, there will always be ways to improve and update the system to provide a better experience for the end user, and provide useful information on performance. Many of the workflow processes that can affect productivity and efficiency are the deficiencies of the EHR. This theoretical paper will include research and personal anecdotal experiences to implement features and or updates to the Cerner EHR to resolve common hospital and health information deficiencies.

California Bylaws

Deficiency #1: Handwritten Scanned Documents

Scanned Documents

Office visits are documented either on paper or electronically. Hospitals that have not fully converted are called hybrids in which they use both paper and electronic. Paper documentation must be scanned into the EHR and the information extracted from these paper documents can be inaccurate. This process Handwriting Illegible handwriting can slow the productivity of health information technicians as they will have to read and transcribe the scanned document into the EHR. Much of the historical health records are available in handwritten form; it requires human chart abstraction and labor-intensive process to transcribe them into electronic records (Hoover, 2016). Potential barriers that hinder full use of the EHR include high cost, lack of computer skills, security concerns, time constraints, and workflow issues (Rasmussen et al., 2012). Storage of medical records in electronic format is recommended since California’s Assembly Bill 1688 (Chapter 511, Statutes of 2017) requires healthcare providers and hospitals to maintain medical records for 10 years. The law was effective as from Jan 01, 2018 (Richardson, 2017).

Deficiency #2: Patient Health Record Duplicates

Health Record Duplicates

Health record duplicates occur when two or more records for the same person are created.

The EHR system should auto-detect duplicate information before fully accessing a patient that may have a duplicate record. This auto-detection should let the end user know that there is a potential chance of a duplicate(s) and should be verified and confirmed before access to the record. This will make sure that the end user is aware and if merging potential duplicates is necessary if it is the same person. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was designed to prevent duplication of tests and diagnoses to save on costs. Unique identified should be used to identify duplicate records and duplicates to make the records more reliable and accurate (Kerwin et al., 2016).

Deficiency #3: Missing Required Electronic Signatures

Purpose of Electronic Signatures

The purpose of electronic signatures is to ensure that the physician and hospital staff confirms that they are present at time and date of service for a patient. This is a common deficiency seen in most EHR’s that a physician and or hospital staff (nurse practitioner, registered nurse, licensed vocational nurse, etc.) at the time of visit did not sign or confirm that they were the service provider at the visit. The EHR system should auto-detect a missing electronic signature before allowing a physician or hospital staff to submit the charge claims. This auto-detection should notify at time of submission of charges that a signature is missing and that they need to add the necessary information in the documentation before it can be officially submitted. In accordance with HITECH Act of 2009 records with missing electronic signatures may be considered incomplete (Kerwin et al., 2016).

Implementation to EHR

During the implementation phase the system should create reports to identify deficiencies within a certain time frame.

METHOD AND RESOURCES

Purpose of Dashboard Tracking

Performance measurement is a process by which many organizations such as Sharp monitors important aspects of its programs, systems, and care processes. Data is collected to reflect how its processes are working, and that information is used to drive an organization's decisions over time. Typically, performance is measured and compared to organizational goals and objectives. Results of performance measurement provide information on how an organization’s current programs are working and how its resources can be allocated to optimize the programs’ efficiencies and effectiveness. Performance measurement can be best understood through considering the definitions of the words 'performance' and 'measurement' according to the Baldrige Criteria. Performance refers to output results and their outcomes obtained from processes, products, and services that permit evaluation and comparison relative to goals, standards, past results, and other organizations. Performance can be expressed in non-financial and financial terms. Measurement refers to numerical information that quantifies input, output, and performance dimensions of processes, products, services, and the overall organization (outcomes). Performance measures might be simple (derived from one measurement) or composite.

STRATEGIC PLAN

Health Information Management (HIM) Deficiency Strategic Plan

HIM currently has many elements in place but not well integrated. Deficiency reports are to be generated and distributed to local administrators weekly. Deficiencies remain on the report until the deficiency is corrected. The department will build a team of information governance (IG). This will assist to:

• Assemble a multidisciplinary team
• Create a strategic initiative
• Cultural Collaboration
• Map Data
• Apply guiding principle for creating and IG program

Information Governance Strategy Implementation

HIM is responsible for the specification of decision, rights and accountability framework to encourage desirable behavior in the valuation, creating, storage, use, archival of Health Information deficiencies.

The collection of patient information during every phase of medical care: treatment, research, outcomes improvement and government reporting.

Key Performance Indicators

• No duplicate records
• Accuracy of health records
• Completeness of records
• Reduced reliance on paper-based records

Workflow

Figure 1: Physician Suspension System (Sharp, 2018)

Table 1: Objectives and Strategies

Figure 2: Project Mind Map

Conclusion

The goals are to support continuous evaluation and positive change in order to improve patient outcomes, cost effectiveness and efficiencies, and support the delivery of safe patient care. Patient safety is the fundamental responsibility of every individual in the healthcare delivery system. The purpose is to promote an effective delivery system. Sharp staff among other things will support a learning environment that encourages and fosters the reporting and review of all errors, near-misses, adverse events, and system weaknesses.  The goal is to promote and collaborate across the intra-professional disciplines to find sustainable solutions to any patient safety issues.

Scenario

Patient health records have a unique identifier called a Medical Record Number (MRN) to differentiate patients with the same or similar name(s). Duplicates can occur and can result in adding personal health information into the wrong patient record. One of the few examples that can occur is someone with the same first and last name, a woman’s maiden name and married name, and legal name changes. The most common scenario would be a woman’s maiden name legally changing to her new married name. It is the same person, but the system may not detect that it is the same person which can result in the duplicate deficiency.