Brief Company Background
The Cleveland Clinic is one of the largest hospitals in the United States and has a long history of patient care. It was founded in Cleveland, Ohio in 1921 on the basis of Frank J. Weed’s surgical practice. It staff originally included 60 employees, which included four nurses and 14 physicians. The hospital steadily grew over the years with new buildings being purchased and constructed to accommodate more patients and new types of treatments. However, on May 15, 1929, a terrible fire broke out in the hospital, taking 123 lives. The fire began due to the combustion of nitrocellulose x-ray films that were stored in the basement of the building. However, the reason for their ignition was not discovered (“Access anytime anywhere,” 2017).
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Through the efforts of a philanthropist Samuel Mather and a number of people from the community, the hospital was able to temporarily move to a building next door. The original building was subsequently renovated. Throughout the following decades, the hospital continued to grow, with larger volumes of patients requiring additional buildings and staff. This subsequently grew into a major issue with the organization of health records (“Access anytime anywhere,” 2017).
Discussion of the Business Problem
Due to the long history of the hospital, it has accumulated a great number of patient records. Historically, the records archive was maintained at a physical location in the hospital, with staff being responsible for its service. It was always a complex system of patient’s medical records divided into various categories. The files are placed in boxes which are then stored on shelves. With growing volume of patients, this system cannot stay reliable for long.
The problem comes from the inefficiency of the current registration process. The hospital still uses physical files as the main type of patient registration, and it creates many problems for the organization. Registration is slow, files can be lost, and they cannot be quickly accessed. This means that patients have to wait for a long time before their treatment can start. People responsible for the registration are often stressed out as a result. Also, the system makes working with files a much harder process than it should be. Although there previous attempts at implementing rudimentary computer systems for patient record management, the effort did not involve the latest technologies and only partially addressed the issue.
This is not a rare problem in the world of modern medicine. Due to such factors as the phenomenon of defensive medicine, and the boom of medical technology, hospitals all over the United States are starting to deal with more patients than they can accommodate. The difficulty of keeping and managing physical records has become a major issue which the introduction of electronic health record systems is trying to address (King, Patel, Jamoom, & Furukawa, 2013). The systems allow almost instant electronic access to the patient’s health records from any computing device on the network (Nguyen, Bellucci & Nguyen, 2014). I believe that this type of systems can be the perfect solution for this issue.
Benefits of Solving the Problem
There are many studies that show that when a hospital creates or updates its patient registration system to use electronic health records, the efficiency of the work quickly rises and improves different aspects of the organization (Lee, 2014). Systems like these improve the speed of patient registration, decrease the level of stress in patients and employees, decreases the waiting time for medical treatment, improves customer service, and reduces the phenomenon of burnout. Also, the hospital would be able to treat more people at a faster pace when paperwork becomes easier to work with. As a bonus benefit, the system can be used as a database of patients where any file would be easily accessed by a doctor or any other person working in the hospital. This would improve efficiency in many hospital operations.
It is likely that the number of patients will continue to grow, and with time the physical archive systems will become inefficient to the point where it cannot be maintained, even if additional people are hired for this task. However, this would not be the case with a system based on electronic health records. Although the initial process of converting physical records into electronic ones will take considerable time and effort, it will make it possible to quickly transfer them in the future.
This ability allows the system to receive radical updates without losing access to any of the previously acquired data. It is inevitable that in the future, a new and improved version of the electronic system will be developed and implemented, and this time the process will take much faster due to the electronic nature of the records. Therefore, this solution will not only increase the efficiency of the system, but it will ensure that the system would be able to improve without extraneous issues.
Business or Technical Approach
By analyzing the reasons for the inefficiency, it becomes clear that a mostly technical approach is required for this task. The efficiency is low because of the method that the hospital uses to store information about its patients. It takes too long to register new patients and to retrieve the previously inputted information. The solution lies in the implementation of a powerful information system that would store the information digitally. This solution would involve a range of technological hardware.
Servers would be used to store and access the records. Due to the large size of the network, it would have to be a powerful machine that can send and receive large amounts of data at a fast speed and without a chance of a malfunction that could destroy the database. Another essential type of hardware would be computers. To ensure the highest possible efficiency, computers could include mobile computing devices such as tablets. The business side of the hospital would remain mostly undisturbed. However, some staff and organizational changes would be required to make sure that the system performs reliably.
Business Process Changes
Some parts of the business process would have to change after and during the implementation of the system. Electronic health records require the employees to be able to operate computers on a relatively competent level. To ensure this, a temporary coach might need to be hired to teach the staff on how to use the new operating system, software, and hardware. After the current staff becomes familiar with the new work process, they would be able to help new employees acclimatize to the work environment faster. Research shows that such systems do not take an extended amount of time to teach due to the competencies currently required from the hospital staff.
Another business change might lie in the need to open or expand the current IT department of the hospital. A system of this type requires a lot of maintenance to operate without errors. The team would be responsible for servicing the system in case of a malfunction, helping the hospital staff to acclimatize to the new system, updating and expanding the system if necessary, as well as general maintenance of the system.
A security specialist might also be required if the currently employed staff member is not able to address the new types of dangers. One of the largest risks and potential points of failure lies in the digital and interconnected nature of electronic systems. Although currently this issue has been given extra attention due to its high priority, there have not been a massive loss of confidential patient records information yet. In the current age of constant danger coming from the internet and malicious software, no one wants to have such valuable information to be accessed without permission, with a full leak being a possible worst case scenario. This should not be permitted, and therefore, the electronic security department would have to be either established or additionally trained to ensure safety (Ben-Assuli, 2015).
Technology Used to Augment the Solution
As previously mentioned in the paper, the augmentation of the solution would come from the technological approach. The system would consist of efficiently powerful hardware tailored specifically for the tasks commonly performed in hospitals. These tasks would revolve around patient record management and access. For example, currently, a physician might want to take another look at the x-rays for their current patient, but cannot do it immediately because it would take additional time that they cannot spare. With the new system, this would be possible due to the use of tablets which can provide access to patient records and display them onto a screen (Ben-Assuli, 2015).
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This type of technology is provided by a large number of companies with the leading five systems being: Cerner PowerChart Ambulatory EHR, EpicCare Ambulatory – Core EMR, Allscripts Professional EHR, NextGen Ambulatory EHR, and athenaClinicals. The vast number of these systems allows for additional choices for the hospital depending on the requirements of its staff. Each system is slightly different and provides various capabilities to its users (“The top 100 EHR companies,” 2017).
High-Level Implementation Plan
A high-level implementation plan would create an overview of the potential steps of implementation of one such system for the Cleveland Clinic. The first step would involve the analysis of the needs of the hospital staff. During the analysis, such issues as slow speed of patient registration and health record retrieval would be examined. Through interviews with the staff, possible solutions could be found, as well as the information on what kinds of features the staff believes would improve the efficiency of the workflow. All of the suggestions would be gathered and utilized during the next step (Ben-Assuli, 2015).
The second step would be to take all the gathered information on this issue and to apply it to the electronic health record systems available on the market. Due to the differences in these systems, some are more likely to be beneficial than others (Ben-Assuli, 2015).
The third step is to contact the manufacturer of the system and order it with all the considerations of the staff that you were able to analyze in the previous step.
Next, the chosen company can be used to gather information on the skills required to operate the system, people who could professionally teach the staff, as well as people who could provide adequate protection against cyber-attacks (Ben-Assuli, 2015).
The fifth step would be organizational because the new departments would have to be established for the systems to function properly. This might be a complex process as the current team is less proficient with technology than it is required by the system. Therefore, the IT department would need to be either overhauled completely to address the new and different purposes or to train the current one to service the new system. The same solution applies to the network security department (Ben-Assuli, 2015).
The sixth step is dedicated to training. A schedule would have to be developed that could facilitate the training sessions without the loss of productivity. Medical practitioners often work beyond their work hours, which make this an extra-hard step. However, perhaps with more people who know the workings of the system, this information could spread faster, allowing the team to learn how to operate these systems faster (Ben-Assuli, 2015).
Finally, after all the hardware and software have been installed, after all the departmental issues have been resolved, and after the staff has been sufficiently trained, the system can become operational. Just in case something goes wrong, the system would have to be monitored and evaluated after some time. The aspects of evaluation would have to be the following: potential increase of speed in patient registration, a number of mistakes done before and after the implementation of the, as well as the general condition of the staff. Medical practitioners often suffer from stress-related issues so knowing if this implementation had a positive effect on their stress issues could be very beneficial for further study. These steps might be adjusted when the plan would be in motion as new opportunities might arise after a useful suggestion influences further actions (Ben-Assuli, 2015).
Conclusion and Recommendations
Electronic records have shown to have a highly positive effect on the workings of the hospital. Despite the scope of the project, it was still able to benefit the hospital in record time. The difficulty of setup is completely negated by the effect it has on the workflow of the hospital. For the future of the system, close attention should be paid to its updates. If the IT team is proactive, this should not take much effort on their part and would let the system stay up to date with the latest fixes it might require. Another recommendation would be in encouraging the staff to help each other in acclimatizing to the new system.
Access anytime anywhere. (2017)
Ben-Assuli, O. (2015). Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy, 119(3), 287-297.
King, J., Patel, V., Jamoom, E., & Furukawa, M. (2013). Clinical benefits of electronic health record use: National findings. Health Services Research, 49(1), 392-404.
Lee, V. (2014). Mobile devices and apps for health care professionals: Uses and benefits. P&T, 39(5), 356-364.
Nguyen, L., Bellucci, E., & Nguyen, L. (2014). Electronic health records implementation: An evaluation of information system impact and contingency factors. International Journal of Medical Informatics, 83(11), 779-796.
The top 100 EHR companies (Part 1 of 4). (2017).