Why are EHR systems important and how do they address the changing health care marketplace?

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Intro to health info system
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Assessment 1 Instructions: Analysis of Electronic Health Records System
• PRINT
• Develop an 8-12 slide PowerPoint presentation accompanied by an audio recording of the presentation that is a maximum 15 minutes. The presentation will focus on an explanation of Meaningful Use Guidelines and how the current HIM system could be optimized to ensure compliance and improved outcomes.
This assessment should be completed first.
Introduction
Meaningful Use Guidelines play a very important role in guiding and directing the path of health information management (HIM) systems in many health care organizations. Along with Meaningful Use Guidelines, other regulations and quality measures drive how health care organizations choose, implement, and utilize their health information systems. In this assessment, the primary focus will be on meaningful use compliance, quality assurance, and the regulatory environment related to HIM. Electronic health records (EHR) are playing an important role in improving quality, accessing important patient data, and improving communication amongst providers. They are a very important part of any HIM. However, new incentive programs such as Meaningful Use Guidelines require that health care organizations pay much closer attention to how patient data is gathered, shared, and collected. In this assessment, you will have the opportunity to work through an interactive scenario at a fictitious hospital and assess an EHR system. You will be tasked with explaining Meaningful Use Guidelines as they relate to the system, making recommendations based on best practices for maintaining meaningful use, and other regulatory compliance.
The importance of understanding meaningful use in EHR and HIM systems is to understand the standardization of the exchange of information, to improve the overall quality of health care delivered, and to reduce costs. As a master’s prepared healthcare professional you will be called upon to help organizations to reduce costs and time to bring safe and effective practices to professionals and patients. It is also incumbent upon the master’s prepared healthcare professional to bring relatable information to patients to assist them in making informed decisions about their healthcare. By completing a review and recommendation cycle of an existing EHR you will gain valuable practice in applying this knowledge and skills.
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as a part of your assessment.
For this assessment, you will need to complete the review of an existing EHR system and provide an overview of current Meaningful Use Guidelines and incentive programs, as well as recommend ways to change either the EHR or workflow processes to ensure continuous improvement and sustainable compliance.
• Why are EHR systems important and how do they address the changing health care marketplace?
• What are the current relevant Meaningful Use Guidelines?
• What are the current incentive programs related to these guidelines?
• How are privacy and security of patient records maintained in an EHR system?
• How can EHR systems impact the experience and quality of patient care?
• What are the future trends for EHR systems and HIM best practices?
This assessment should be completed first.
Scenario
In this scenario, you will assume the role of Quality Assurance Manager at Vila Health’s Independence Medical Center. You have been asked to review the current electronic health record (EHR) system after some concerns were raised about the system not being fully compliant with new regulations and Meaningful Use Guidelines. After your review, you will present your findings and recommendations to the leadership team.
Preparation
Capella Multimedia
Click the following link to work through the media piece.
• Vila Health: Analysis of an EHR System.
HARDWARE
Hospital Leadership
Select Norman Reynolds
Independence Medical Center CEO
The systems we’re discussing are the Electronic Health Record – the EHR; the CPOE – computerized physician order entry, the pharmacy system, the lab system and the PACS, which handles all the digital images from a variety of sources. Overall, the systems do the job they’re designed for, but interoperability has been a problem from day one. We were assured that these systems would work well together, but to a large extent I think we were sold a bill of goods – particularly in terms of the pharmacy system. Nothing is completely bad, but workflows could be much more efficient.
icon to learn more.
• Gwendolyn Zimmer
• Independence Medical Center COO
• One area where we could improve things would be our inventory control. If the system we had interfaced with the EHR we would be able to integrate operational functions with medical needs far more efficiently. Let me give you an example: May Nichols is the head of Environmental Services. She’s responsible for sending housekeeping to the various units for cleaning, linen supply, and so forth. So, say three patients are being discharged from the med-surg unit today. If the EHR fed the discharge information to May’s system, she would know when a team needed to be sent to med-surg and what they needed in terms of supplies. Integrating teams like housekeeping, transportation, and central supply with the clinical systems would help us provide just in time services much more efficiently.
• Albert Lynton
• Operations Manager
• My department is responsible for responding to whatever movement of people is occurring. Admissions, Security, Safety, and Environmental Services – they support the daily operations. The Environmental Services department has a materials information system and a cart management system they work with. Safety works with other departments systems – the EHR and the census management system, and Security has its own system relevant to building and access monitoring. One issue that’s been raised time and again is that the supply systems don’t tag to the EHR, so the nursing staff has to manually enter supplies that are being used for patient care to the patient’s record so supplies are accurately billed. Most of the time, they do it, but it’s a clunky system and no-one thinks it works well.
• Leticia Craig
• Director of Business Services
• I’m responsible for medical records, admissions, and contracts management. My people access and create patient data in a variety of ways. Admissions gathers information about incoming patients – through pre-registration and then when the patient actually arrives at the facility. Primarily, we’re working with the EHR for admissions. The biggest problems we see relate to interoperability and … well, just problems with how information can be retrieved. It’s all there, but it isn’t always easy to work with. Billing is an ongoing problem – different insurers have different requirements for how we provide information. Things as simple as dates – some insurers want it in a completely numeric format – month, date, year. Another one wants it in numeric and alpha format – 7 APR 1958, for example. And not 07 Apr 58, either. Which is fine, except that the EHR only outputs the information in a numeric format. There are a number of situations like that where we have the information, but we can’t customize the reports or output in more than one way.
• Angela Thornton
• Medical Records Supervisor
• One issue I’ve been running into is that our EHR has some components that were retrofitted to meet the requirements of the Affordable Care Act. That’s fine, but because it was a retrofit, it was sort of rushed and we’ve been seeing issues where records aren’t showing up in audits. It’s my understanding that it’s a bug that was introduced when we were trying to use the system for Meaningful Use certification. There were also issues when some departments tried to use wireless devices to access the EHR and the devices weren’t syncing the way they were supposed to. So someone would think she was in the system, but it didn’t actually save to the patient’s record.
• Emily Strickland
• Business Services Supervisor
• My direct reports are admissions specialists, who gather information from patients as they’re being admitted, or in the case of elective admissions, beforehand. If the record is being created prior to the admission, the specialists provide information to the patient. Things like what prep they should do, what they can or might want to bring, whether they should have someone with them, in the case of an outpatient procedure, for instance. That sort of thing. And often they are the ones to gather discharge instructions for the patient or the caregiver when the patient is ready for discharge. So, my people are in the EHR or the patient scheduling system usually. If things are slow, the admissions specialists help with data entry, so they might be working with other systems, but the EHR is their primary tool.
Analysis of an EHR System
Clinical Services – Leader
Patricia Deering
MS, Chief Medical Officer
In order to provide the best care, physicians and the rest of the care team need a complete patient record. Our current EHR struggles with integrating the many different kinds of information that makes up a patient record and so we continue to have health information in multiple locations – some digital and some physical. That’s just not acceptable any more. We need to be able to get all the information integrated into one record. I’m told, though that doing so would be a massive undertaking. The system that I receive the most complaints about is the EHR. There are two reasons for that: One, the EHR doesn’t communicate with the existing systems the way we were led to believe it would, and two, the EHR itself is clunky and just doesn’t work very well. I have to admit, I’d give anything to be able to scrap it and start fresh – preferably with one of the industry leaders. There are two that have really taken over the market and we really should be looking at either one of those.
Shawn Hayden
Chief of Diagnostic Services
My area of responsibility is the diagnostic departments: Imaging, lab, pharmacy, audiology, neurology. Those departments all need to be able to schedule tests, and a way to communicate the results to the doctors or other providers who need them. They need regular maintenance or replacement of the equipment they use, and a way to communicate their needs if equipment stops functioning.
Each of my departments has its own tracking system for patients and tests, or in the case of the pharmacy, for patients and meds. These tie into the EHR so my people have to check there to see what else has been ordered. These systems take in orders and track what test or image or med is required for which patient. In many cases the actual image or test is being accomplished digitally and the results are stored within these systems. One complaint about the current system is that people downstream don’t automatically see the results. They can see that the imaging or tests are complete but they can’t view the results without manually importing them into the patient’s record.
Charles Ortiz
Clinical Laboratory Manager
The lab information system – LIS – we currently have works well for our purposes. It lets us track all our samples, tests, results, and related information. We also work with the EHR in that it’s the system that tells us when a test has been ordered and reflects the results. One problem we have is that because our system and the EHR are two separate systems, the information isn’t the same in the two systems. The EHR gets a report, but unfortunately not the full result.
Aaron Johnson
Pharmacy Manager
So far as technology needs for the pharmacy go, we need to be able to keep track of every single medication that comes into the hospital, what and how to compound them, and every medication that goes out to a medical unit. We also need to be able to communicate what medications we have on site so doctors aren’t prescribing something we don’t have, and to get prescription orders from the medical units. The systems we use most often are the formulary; the pharmacy system; the EHR; and the medication management system, which is a subsystem of the main pharmacy system.
Diane St. John
Chief Nursing Officer
All of my nursing managers need to be able to schedule 24/7 coverage for their units, and get help if their coverage isn’t complete. They need to be able to see doctors’ orders for patient treatment so they can deliver medications, do bedside blood draws or deliver the more ambulatory patients for lab tests or images, and check vital signs relevant to those orders. They need maintenance for whatever on-site equipment they have in their unit, including replacement or repair, and they need a way to communicate their needs beyond the routine restocking of surgical tools and supplies when they come up. They need access to discharge instructions when patients are ready to go. So … the computer systems that control all those functions, we need to be able to access. The routine use systems, though, would be the CPOE, the EHR, the patient scheduling software, and Central Supply’s supply request system, whatever that’s called. Oh … and the transportation scheduling system. That’s an outlier, but used all the time.
Clinical Staff
Select each icon to learn more.
Linnea Eckert
Nurse Manager – Ambulatory Services
Our technology needs have become more significant, particularly with the advent of Meaningful Use guidelines. We need technology to tell us which patients are coming in and why. We need it to keeps all the information about a patient in one place. We use the computer to pull instructions and guidance about various conditions that’s written for patients and their families. We need technology that alerts us to drug interactions or other warnings. We have all kinds of needs… and theoretically the EHR and other resources the hospital pays for are designed to help meet those needs.
Lack of integration is a real headache. Because our systems are still sort of patchworked together, instead of having one record to go to, we have to pull records from a couple different sources. That isn’t necessarily a problem, but it does interfere with workflow and efficiency. And, quite frankly, the EHR isn’t easy to use. It isn’t intuitive or geared to how we actually interact with patients.
Evan Schmidt
Nurse Manager – Cancer Center
Well, we’re primarily concerned with accessing orders, since a large part of what we’re doing is chemo and radiation for patients in active treatment. We have to see who is scheduled to come in for treatment, and whether it’s chemo or a biopsy or surgery. And I need to be able to schedule for coverage or request temporary staffing if I don’t have enough. For the most part we use the EHR to review the orders and meds of the day, and to generate the case notes that tell the next nurse on shift what’s been done and what needs doing. The EHR we use here at Independence doesn’t always support our work flows. For anyone who remembers what the flow of information in a hospital used to be like, the EHR is great, but this system in particular could be some much better. Clunky is the best way to describe it.
Debra Green
Nurse Manager – IC
In the ICU we’re dealing with patients with acute conditions and there’s technology for monitoring these conditions – heart monitoring, repeated blood tests for a whole range of stuff, that kind of thing. So we need more monitoring technology than the other nursing units have, and we generate more orders for tests, procedures, and images. Other than that, we have the same needs the other nursing units have: scheduling, supply ordering, maintenance, and so forth.
So, we’re working with the EHR, and Central Supply’s system. We can’t look at their inventory, but we can request what we need through the clinical-facing side of their system.
One problem we encounter is that the problem list – that’s a feature of the patient’s chart – often isn’t updated when a patient is admitted to the ICU.
Cathy Petters
RN, Cancer Center
You want to know what technology I use most in my day to day work? My own two hands, my eyes, and my brain. Yeah, I use the EHR. But not because I want to. I know there isn’t any point to complaining, but I hate the EHR. A lot of the nurses hate that thing, and use it as little as they can. It doesn’t work, the information in it is untrustworthy – at least in that it’s incomplete – and we do more of our work around it than in it, if you see what I mean. The problem is that virtually every screen is asking for information we don’t need and putting up roadblocks up that make charting take far too long. The amount of time we have to spend using technology to document what we do is starting to outstrip what we actually do. How am I supposed to make a patient comfortable or attend to her needs when I’m busy clicking boxes?
Ruby Martindale
RN, Emergency Department
Since I have to document what I’m doing, both for later nurses or docs and the meaningful use business, I need a system that can do that. Quickly and preferably one that actually works, unlike our EHR. And of course I need to see the orders for the patients on my shift, including meds and if they’re moving somewhere else or going home. I use the EHR, of course; the CPOE; the pharmacy’s formulary. And of course, the patient scheduling software. Occasionally I’m the charge nurse for the day, so I might have to use the staffing software.
For the most part, the various systems meet our needs and when they don’t, we just find a way to get it done anyway. I would say that the way people use the EHR is a problem, and I include myself in that. I don’t feel I’m wrong to find a shortcut when I’m dealing with an emergency, but I know that billing and other departments sometimes don’t have what they need because of my shortcuts. But it takes forever to get small things changed, and sometimes we have to ask repeatedly. I don’t think it’s Jason’s fault, and he keeps us in the loop, but he can’t make the vendor respond faster.
Matthew Allen
Laboratory Technician
I regularly use the EHR, our LIS, and the various admin systems. I also on e-mail and the Internet for working with the lab in Waterloo. The EHR and LIS provide information about what tests or blood draws I need to do. The EHR has the patient record, and the lab system has information about normal ranges and what out of range results indicate. Oh … and I think that billing and coding has to get the lab tests into the EHR in order to bill the procedures to the appropriate insurance. It’s pretty smooth. Well, except not having the full report in the EHR sometimes causes problems for the billing and coding people. They don’t always have everything they need for coding and even small omissions in billing can result in denial of claims.
Emma Young
Pharmacist
In order to do my job, I use the computer to see what orders need filling, to review the patient’s record and med list to make sure there are no incompatibilities, and to get instructions for compounding if necessary. We have a dispensing system here, so that technology is part of doing my job. Yeah, that’s pretty much it. On a daily basis, I use the EHR and the pharmacy information system.
Activity complete!
Having met with a wide variety of employees at Independence Medical Center, you should now have a solid understanding of what health information systems are in use, who uses those systems, and how well those systems are meeting the needs of their users and the hospital as a whole. You should be able to use this information to prepare your analysis of the current EHR and your recommendations for improvements.
Answer each question based on your observations.
What are your main observations about the EHR in use at Independence Medical Center?
(Maximum 2500 characters)
From the perspective of regulatory compliance, what areas should be addressed first?
(Maximum 2500 characters)
Save Your Responses

• A headset with headphones and a built-in microphone, or some other hardware with audio capability.
If you do not already have audio capability with your computer system, a headset is recommended as an inexpensive option. Please set up and test your headset to verify the compatibility of the hardware as soon as possible. Refer to the manufacturer’s directions for installing and connecting the device to your computer.
USING KALTURA
Note: In this assessment, you will be required to create an audio recording to accompany the PowerPoint presentation. You may use Kaltura or, with instructor approval, you may use an alternative technology to record and deliver your presentation.
In preparation for recording your presentation, complete the following:
• If you have not already done so, set up and test your headset or built-in microphone, using the installation instructions provided by the manufacturer.
• Practice recording to ensure the audio quality is sufficient.
• Refer to the Using Kaltura [PDF] tutorial for directions on recording and uploading your presentation in the courseroom.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services to request accommodations.
Review the Vila Health: Analysis of an EHR System media simulation and the information provided to learn more about the Vila Health organization.
Before reviewing the EHR system, you will want to familiarize yourself with Meaningful Use Guidelines. Take a moment to review these sources and conduct an additional research as needed on the Centers for Medicare & Medicaid Services (CMS) incentive program from EHR: Meaningful Use. Refer to the Meaningful Use section of this assessment for links to different resources you might use.
Next, review the Vila Health EHR system. While analyzing the EHR, you will want to think about not only the flow of data, how it moves through the system, and compliance with Meaningful Use Guidelines, but also about the patient experience and implications on quality of care. Consider privacy and security of patient records as well.
To prepare for this assessment, use the Capella University Library and the resources provided for this assessment to research the following topics:
• Digitization of the nation’s medical records and the privacy challenges.
• EHR incentive program requirements.
• Best Practices for compliance with Meaningful Use Guidelines.
• EHR and HIM best practices for quality, privacy, and regulatory compliance.
• Types of information technologies that are used to improve the quality of patient care.
To complete this assessment, you will prepare an 8–12 slide PowerPoint presentation of best practices and emerging models in HIM and EHRs. Your presentation will be assessed using the following criteria:
• Explain Meaningful Use Guidelines and what they mean to an organization’s current state of compliance.
• Explain an organization’s current electronic health record system and its data process to meet regulatory guidelines.
• Analyze how an electronic health record system could improve the quality of care, simplify existing processes, and improve patient outcomes.
• Explain best practices for an organization to maintain meaningful use compliance as it relates to current incentive programs and policies.
• Recommend evidence-based approaches for implementing new practices for the end user functions, training, and ongoing compliance.
• Communicate analysis and recommendations of an electronic health records system in a manner that is clear and concise.
• Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.
Below is one potential outline for the presentation that could help you to address the assessments grading criteria.
• Introduction:
• Present what Meaningful Use Guidelines are and what they mean to the organization.
• Present Independence Medical Center’s current state of compliance.
• Current HIS:
• State the current EHR being used in this organization.
• Present your findings on the evaluation of the EHR.
• Explain how the EHR could improve the quality of care, simplify existing processes, and improve patient outcomes.
• Discuss how the data are currently captured, tracked, analyzed, and shared and whether each area meets regulatory policy and incentive guidelines.
• Upgrades and Improvements:
• Present your findings from your research on maintaining Meaningful Use Guidelines.
• Present best practices for long-term compliance to current incentive programs and policy.
• Make additional recommendations on the EHR system including end user functions, training, and ongoing compliance to the department heads.
• Provide evidence-based recommendations for implementing new practices and emerging models in the identified departments.
Audio Recording
Use Kaltura, or other instructor-approved alternative technology, to record an audio to accompany your presentation. Before you begin recording, you may find it beneficial to write a script or detailed outline that you can refer to as you record. Your recorded audio should be no more than 15 minutes in length.
Include the notes or script of your audio recording. You may choose to include these in the “Notes” sections of the presentation slides, the script you may have used when you created your recording, or a detailed outline. This will serve to clarify any insufficient or unclear audio, or if you cannot complete the audio recording.
Note: If you did not include your notes or script in the presentation, please include them in a separate document along with the other presentation elements.
Additional Requirements
Your presentation should meet the following requirements:
• Written communication: Written communication is free from errors that detract from the overall message.
• APA formatting: Resources and citations are formatted according to current APA style and formatting guidelines.
• Number of resources: At least one APA formatted in-text citation and accompanying, congruent APA formatted reference.
• Length of presentation: 8–12 slides.
• Duration of audio recording: Maximum of 15 minutes.
• Font and font size: Arial, 18 point or above for headings and explanatory text and 24 point and above for slide titles.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services to request accommodations.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
• Competency 1: Apply emerging models or best practices to implement a health information system that improves operations and patient outcomes. (L8.4, L12.2, L14.3)
• Explain Meaningful Use Guidelines and what they mean to an organization’s current state of compliance.
• Analyze how an electronic health record system could improve the quality of care, simplify existing processes, and improve patient outcomes.
• Competency 2: Analyze administrative, clinical, management, and decision-support information technology tools. (L12.1, 12.2, 14.3)
• Explain an organization’s current electronic health record system and its data process to meet regulatory guidelines.
• Competency 3: Apply best practices relative to the financial assessments and decisions required for the implementation of health information systems. (L 8.1, 8.2, 8.4)
• Explain best practices for an organization to maintain meaningful use compliance as it relates to current incentive programs and policies.
• Competency 4: Apply evidence to influence buy-in from all stakeholders. (L10.5)
• Recommend evidence-based approaches for implementing new practices for end user functions, training, and ongoing compliance.
• Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration. (L6.1, L6.2, L6.3, and L6.4)
• Communicate analysis and recommendations of an electronic health records system in a manner that is clear and concise.
• Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

The resources provided here are suggested and provide helpful information about topics relevant to the assessment. You may use other resources of your choice to prepare for this assessment however, you will need to ensure that they are appropriate, credible, and valid. The MHA Program Library Guide can help direct your research.
These resources aid in understanding the processes and application of electronic health records.
• Boonstra, A., Versluis, A., & Vos, J. F. J. (2014). Implementing electronic health records in hospitals: A systematic literature review. BMC Health Services Research, 14, 370–394.
• Pratt, M. K. (2017). 6 tips to help practices adapt to a new EHR. Contemporary OB/GYN, 62(2), 42.
• Richter, L. L. (2017). Sharing an EHR application across multiple organizations. Journal of AHIMA, 88(10), 52–53.

Resources: Legal and Policy
• PRINT
• This article addresses the legal issues involved in the use of health information systems and the policy implications of ownership of data.
• Cartwright-Smith, L., Gray, E., & Thorpe, J. H. (2017). Health information ownership: Legal theories and policy implications. Vanderbilt Journal of Entertainment and Technology Law, 19(2), 207.
Resources: Meaningful Use
• PRINT
• These resources address the impact of meaningful use in the stages of implementation and the adoption and practice of EHRs.
• Adler-Milstein, J., Everson, J., & Lee, S.-Y. D. (2014). Sequencing of EHR adoption among US hospitals and the impact of meaningful use. Journal of the American Medical Informatics Association, 21(6), 984–991.
• HealthIT.gov. (n.d.). Meaningful use and MACRA. https://www.healthit.gov/topic/meaningful-use-and-macra/meaningful-use-and-macra
• Heisey-Grove, D., & King, J. A. (2017). Physician and practice-level drivers and disparities around meaningful use progress. Health Services Research, 52(1), 244–267.
Resources: Presentation Resources
• PRINT
•
• Microsoft. (n.d.).Basic tasks for creating a PowerPoint presentation. https://support.office.com/en-gb/article/Basic-tasks-for-creating-a-PowerPoint-presentation-efbbc1cd-c5f1-4264-b48e-c8a7b0334e36?ui=en-US&rs=en-GB&ad=GB
• Microsoft. (n.d.).Basic tasks in PowerPoint 2010. https://support.office.com/en-gb/article/Basic-tasks-in-PowerPoint-2010-35308dfb-792d-400a-b69a-1188b019c66a?ui=en-US&rs=en-GB&ad=GB
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