Introduction
California Correctional Health Care Services (CCHCS) is a medical organization that provides care, including medical, dental, and mental health services for California inmates. The introduction of an IT system in this facility may be an acceptable solution, as it will simplify the health workers’ work and improve treatment rates. This paper aims to provide a detailed assessment of implementing the EHR system in California Correctional Health Care Services, determine the best supplier of such systems, conduct ROI analysis, and draw up a project implementation strategy.
Benefits of the IT System
The most common IT systems in medicine are EHRS for electronic records and patient information storage. These systems simplify the day-to-day work of doctors and nurses, allowing better data structure and access. The use of EHRS creates better opportunities for the analysis and synthesis of medical data, both in scientific research and in work with patients. These systems have already been implemented in many states and have proven to be effective. The introduction of EHRS in CCHCS will help improve patient care for several reasons. Most scientists agree that the benefits of using EHRS at work outweigh the potential risks. In particular, EHRS is particularly useful in treating patients in complicated social situations. Scientists Gold et al. (2017) note that when treating patients, it is imperative to take into account the social determinants of health (SDH), which are preclinical factors that determine patients’ health. Since EHRS makes it easier to document and analyze SDH, scientists believe it could lead to better health outcomes.
There are three types of electronic records – Electronic Health Records (EHR), Electronic Medical Records (EMR), and Personal Health Records (PHR). All of them serve similar purposes; however, they are located on different IT platforms and use other technologies and standards (Heart et al., 2017). EHR typically has access to health information from multiple vendors’ IT systems, and is an inter-organizational system, while EMR is an internal organizational system. PHR allows integrating information components into EMR and EHR systems.
Scientists note the advantages of IT systems, including the improved quality of medical care and reduced costs. The PHR is a person-centered system that allows patients to independently maintain medical records, leading to greater awareness and interest (Heart et al., 2017). EMRs are considered more convenient for sharing information within an organization, while EHRs provide the ability to transfer data between different vendors’ systems. Besides, IT systems can combine demographic, lifestyle, and behavioral data with health records to create personalized care opportunities.
Choosing a Vendor
Since patient information is handled not only by doctors and nurses but also by medical staff, pharmacists, and laboratory personnel, there is a need to familiarize the entire team with various EHR systems. Then, the IT systems’ disadvantages and advantages will be analyzed, and employees will express their comments and suggestions. The management of the medical organization will make the final decision. When choosing the most suitable EHRS, one should consider installing and maintaining the system, and special offers, like telemedicine apps or patient access to their data. The most well-known and well-established EHRS suppliers are Epic, Cerner, and Allscripts.
The Epic EHR has been a long time on the market; it is the most widely used system and has the most valuable features. The company’s software is built in-house, and Epic invests 50% of its operating expenses in further research and development. The company offers software called EpicCare EHR, as well as programs for practice management, public health, and patient interaction (Epic EHR Overview, n.d.). Specifically, the EpicCare Ambulatory EHR Suite provides mobility features with main applications, patient engagement through MyChart, online scheduling, and access to the Epic community. Besides, Epic offers revenue cycle management solutions and access to public health data through Healthy Planet.
Finally, Epic EHR has modules for different specialties such as Bones (for Ortho), Stork (for Obstetrics), and Cupid (for Cardiology). During the IT system implementation, healthcare providers will receive support from the Epic team that will work with the healthcare organization (Epic EHR Overview, n.d.). The company provides certification courses, one-to-one training, additional resources, system monitoring, and regular audits. Most importantly, Epic offers full interoperability with third-party platforms and access through the Share Everywhere app, which does not require an EHR installation and allows employees to work over the Internet.
Cerner EHR also provides its users with many benefits, including a full suite of analytical solutions, a wide range of clinical documentation tools, voice recognition, patient portal, patient education, and full integration with revenue cycle solutions. Cerner and Epic have approximately equal market shares – 28% and 33%, Meditech has 16%, McKesson – 4%, Allscripts – 5%, and others – 14% (Newman, 2020). Cerner also has opportunities to manage the income cycle, increase productivity, and manage social income (Cerner EHR Overview, n.d.). Depending on the healthcare organization’s size, Cerner offers Cerner Specialty Practice Management for small and medium-sized practices with up to 10 vendors and Cerner PowerWorks Practice Management for large organizations.
In this way, Cerner EHR streamlines the billing, reimbursement, and accounting processes. Cerner EHR has differentiation for over 50 specialties, which is vital for large organizations. The company also provides consultations through the service center, via chat, or a hotline. Cerner recommends that healthcare organizations designate a web security officer responsible for monitoring user access levels. Finally, Cerner offers a single sign-on platform that allows a separate account for all applications and programs.
Another vendor with the most enthusiastic reviews is Allscripts. Among the platform’s main advantages are openness and interaction with other suppliers’ platforms, functionality, and benefits in issuing electronic prescriptions (Allscripts EHR Overview, n.d.). Simultaneously, the main disadvantages are the high price for ongoing maintenance and installation of updates, the need to formalize contractual obligations, which complicate the subsequent change of the EHR supplier. Another major drawback is the lack of communication between the company departments, which results in fragmented service when purchasing various software solutions from this supplier.
Therefore, it is reasonable to choose the vendor Epic since it demonstrated the best value for money. This provider is also the most popular among other healthcare IT systems. It will be incredibly convenient to install and use it in California Correctional Health Care Services to optimize the work with patients’ data, including social determinants of health, which will be highly practical for the psychiatry department. Finally, the most significant benefit is Epic’s free healthcare training.
ROI calculation
Return on investment analysis, also called ROI, is often used when approving business plans and high-level strategic development plans requiring additional investment. ROI is calculated using a simple formula: ROI = Net Income / Cost of Investment. Net income typically includes all the benefits that a company will receive after the investment, and the cost of investment reflects the specific amount spent on strategy implementation.
In this case, the investment cost will be equivalent to the program’s cost, since the program’s implementation, in the case of the Epic vendor selected for this purpose, is included in this figure. Epic also provides free employee training and quality technical support. Therefore, the net income will consist of lower accounting costs since accounting software is part of the EpicCare suite. It will also reflect the improvement in the quality of medical services and better interaction. Finally, since the introduction of the EHRS will save healthcare providers a lot of time, this benefit must also be factored into the net income.
Limitations and Implementation Strategies
Before describing the implementation strategies, it is necessary to pay attention to the risks and limitations associated with the implementation of EHRS. It is noteworthy that some studies have been carried out in this direction by scientists. The main obstacle to the implementation of EHRS is usually the lack of support and adverse reaction from the medical, nursing, and administrative communities (Fragidis & Chatzoglou, 2018). At the same time, the participants’ interest and commitment are some of the critical success factors.
Another significant risk factor is threats to the privacy of patient data and their concerns in this regard. Besides, although doctors and the public consider EHRS to be a useful tool, there are concerns about the increased financial burden and workload (Entzeridou et al., 2018). Patients also expressed concerns that an unauthorized third party could gain access to their information, as well as possible discrimination due to disclosure of health data. One solution to this problem was a proposal to grant full access only to doctors and restrict access for medical staff, pharmacists, laboratory personnel, and other health workers.
Therefore, EHRS implementation strategies should aim to overcome the barriers listed above. In particular, it will be necessary to conduct interviews with healthcare professionals to get them interested in implementing EHRS and enlist their support. Cybersecurity and the procedure for providing access to patient information will deserve particular attention. Besides, guidelines for working with the EHRS should be developed, which will spell out the rules for working with patient health data and the possible consequences of violating these rules, for example, fines or reprimands. Finally, to increase motivation, a reward system will be introduced for employees who have completed the training. The responsibility for implementing the strategy will rest with management and senior nurses. Noteworthy, since Epic guarantees that their specialists will help implement EHRS in a healthcare organization, the strategy implementation process will be smooth and successful.
High-Level Implementation Plan
It will be necessary to define objectives, people, set a time frame and a budget, and identify risks to develop the high-level implementation plan. The project objectives will be a successful implementation of EHRS in a healthcare organization, including purchasing and installing software and staff training. Presumably, this process can take several weeks, with the bulk of the time spent on staff training and obtaining certifications. Since Epic has highly skilled professionals, it will likely take less than a day to install the EHRS. Therefore, the primary responsibility for implementing the project will lie with the staff, which will have to be conscientiously trained and familiarized with the guidelines. Potential risks can be associated with fears of employees or their failure to receive training. The budget expenses will include the cost of the software installation since the training is free.
Conclusion
Thus, a detailed assessment of implementing the EHR system in California Correctional Health Care Services was provided. The ROI analysis was carried out using a simple formula, and a project implementation plan was developed to overcome possible risks and create a structured implementation schedule. The EHRS providers Epic, Cerner, and Allscripts, were chosen for a detailed analysis. They all offer quality services; however, the EHRS of the Epic Company promised the best variety of functions. EHRS implementation may require additional financial and labor costs, but it is necessary because it will benefit the organization. Responsibility for the implementation and monitoring of the project will lie in the medical organization and senior nurses’ leadership.
References
Allscripts EHR Overview. (n.d.). Web.
Cerner EHR Overview. (n.d.). Web.
Entzeridou, E., Markopoulou, E., & Mollaki, V. (2018). Public and physician’s expectations and ethical concerns about electronic health records: Benefits outweigh risks except for information security. International Journal of Medical Informatics, 110(2), 98-107.
Epic EHR Overview. (n.d.). Web.
Fragidis, L. L., & Chatzoglou, P. D. (2018). Implementation of a nationwide electronic health record (EHR). International Journal of Health Care Quality Assurance, 31(2), 116-130.
Gold, R., Cottrell, E., Bunce, A., Middendorf, M., Hollombe, C., Cowburn, S., & Melgar, G. (2017). Developing electronic health record (EHR) strategies related to health center patients’ social determinants of health. The Journal of the American Board of Family Medicine, 30(4), 428-447.
Heart, T., Ben-Assuli, O., & Shabtai, I. (2017). A review of PHR, EMR and EHR integration: A more personalized healthcare and public health policy. Health Policy and Technology, 6(1), 20-25.
Newman, D. (2020). Top EHR vendors 2020 – Epic, Cerner, Meditech, Allscripts, Athenahealth.Healthcare IT Skills. Web.