Discuss about the Foundation of Information System for EHR System.
During the implementation of the EHR system, Kaiser faced a large number of problems that resulted in delaying of the project up to seven years. In addition to the significant increase in the delivery time, the problems also incurred heavy costs; Kaiser needed to overspend significantly in order to drive the project towards completion over the period of seven years. The root causes of this problem are as follows.
Lack of Project Knowledge – From the analysis of the project delay issue, it is evident that the company did not have sufficient insight and knowledge of project management[1]. As a result, in spite of planning the project for three years, they failed to develop a proper roadmap for the project and as a result, the project gradually moved out of scope and took so much additional time and cost for completion.
No Fixed Parameters – Any successful project execution requires proper definition of the project parameters. This includes project scope, schedule, budget, quality management plan, stakeholder management plan and others. However, Kaiser executed the project without defining any of these parameters and hence, faced significant problems during the project.
Continuing Project and Daily Operations on Same Schedule – Another vital mistake that resulted in the problems in the project is the scheduling of the project along with the daily operations together[2]. As a result, while the project hampered regular therapy and healthcare sessions inside the hospitals, the daily requirements for urgent healthcare responses to the patients meant the project work was hampered as well.
Kaiser’s experience is truly typical of leading edge companies in terms of development and implementation of new and ground breaking technologies. The new EHR system has completely changed the entire healthcare background of the hospital. Furthermore, this new system is quite new in the existing healthcare industry and Kaiser has taken every step possible to achieve the ultimate goal[3]. However, unlike most other leading edge companies, Kaiser did not prepare suitable project planning before the execution of the project. Most of the leading edge companies spend significant amount of time in planning and consulting with various developers before actually proceeding with the project. On the other hand, Kaiser simply set a time frame of three years and a specific budget before starting on the project[4]. During the course of the next seven years, the company faced numerous problems and issues before being able to bring the project to completion. However, due to the nature of the system and the leading edge technology, the company started receiving the benefits from the system so that they have been to recover from the losses in the project and brought about significant changes in the existing operational system in the hospitals[5]. The company also has further plans to build on the current EHR system and upgrade the system with even more and better features that will not only reduce the workload from the employees (physicians and nurses) but will also significantly increase the overall efficiency of the regular hospital operations.
Kaiser has deployed a number of researchers who are responsible for working and researching on the existing system to make further new innovations and discoveries that will make the system even more efficient than it is currently. During search research activities, some the researchers of Kaiser have been able to make certain discoveries in the areas like whooping cough, cancer detection method, use of birth control pills, HPV vaccination and others. In order to make these discoveries, the researchers needed to access patient databases where the medications, diagnosis details and other information are provided[6]. However, in this regard, some ethical and security issues may arise if external researchers are allowed to access these databases even if it will be for research purposes. These issues are discussed as follows.
Ethical Consideration – The main issue associated with this is the ethical considering. While the internal researchers work on their research activities, they take written permission from the doctors and the patients for accessing the health records for research purposes. They also need permission from the hospital authority before are able to access to the EHR databases. Furthermore, the researchers are not allowed to change the contents of the database files in any way and for any kind of issues occurring in the database, the researchers will be held accountable except technical and unavoidable issues[7]. On the other hand, the external researchers cannot be relied for such ethical work and once permission is granted to them for accessing, they may use the patient data for unethical use. Furthermore, the patients of the hospital may not be acknowledged if external researchers are provided with access to their diagnosis data.
Security – Another major issue associated with this access is security issue. EHR databases are very preferred targets for hackers who use advanced hacking technology in order to break into the system and steal the personal and diagnostic information of the patients[8]. Chances of these attacks can increase due to mishandling of the data by the researchers. Chances are even increased when the external researchers are allowed access. Internal researchers work under protected environment where security firewalls are used. However, external researchers work in independent environment whereas there may be lack of cyber security options. As a result, if data is provided to them for research, cyber attacks may occur resulting in stealing of these files and data of the patient diagnosis. These data and information can be used unethically by the hackers or even the external researchers for personal gain.
Charging fees from researchers for accessing the healthcare data for research is a good idea for offsetting system development costs. However, heavy charges for accessing the files will discourage the researchers to conduct research especially if they have limited monetary resources[9]. Hence, there should be specific fee structure for these researchers. For instance, if the researchers are charged with a certain amount of fee for accessing internal data of the EHR system, they will also be rewarded with some scholarship or funds for funding their future research endeavors.
There are a large number of strategic advantages that Kaiser is gaining because of the new EHR system. It is mainly due to these strategic advantages that Kaiser has been able to recover from the massive losses encountered during the implementation phase of the project. The current strategic advantages gained by Kaiser are explained as follows.
Efficient Service – Due to the use of the new EHR system, the work efficiency has increased significantly. In the previous system, all operations were done manually including hospital administration, billing, preparation of medication list and others. Not only this process required significant amount of human resources but also the processes were slow especially when there are huge number of patients awaiting medical treatment and diagnosis at the hospital[10]. This process also delayed critical treatment cases that hampered the health of the patients as well. On the other hand, the current EHR system has significantly reduced the need for human resources for internal and external administration in the hospital. Most of the operations have become automated like billing, medication prescription and others. This has resulted in lowering of the wait time and also increased the overall efficiency of the system with lesser errors.
Appointment with Doctor and Online Diagnosis – Another major strategic advantage that Kaiser has gained is the online diagnosis process as well as making appointment with doctors[11]. There may be cases when the patients are unable to travel to the hospital for diagnosis and treatment. In these cases, the patients now have the option to create their personal profile in the hospital EHR portal through which they will be able to interact with the doctors online. They can also upload their previous medication details and data regarding their current condition based on which the doctors will be able to send medication prescription through the portal to the patient directly[12]. As a result, the patient does not need to visit the hospital and wait for appointment before getting diagnosis advice and prescription for their treatments.
Automatic Medication Suggestion – Another benefit of the EHR system is the automatic medication suggestion feature. Whenever a patient visits the doctor and tells his health problems and symptoms to the doctor, the doctor enters the symptoms in the online EHR portal. Depending on the previous records of the same medication, the portal will provide a list of recommended medications to the doctor immediately. Furthermore, based on other medical conditions of the specific patient, the system will provide a list of side effects the medicines may cause on the patient. Based on these recommendations, the doctor can easily provide the medication prescription to the patient[13]. Furthermore, whenever a medication is selected for the particular patient, the medicine retail department will be automatically notified so that they can pack the particular medicines for the patients to pick up at their convenience.
All the benefits can provide significant strategic advantage to Kaiser. Kaiser is being able to provide fast, efficient and convenient services to the patients and hence, have become the patients’ favored destination in spite of a number of hospital chains present in the same area.
There are a large number of benefits for Kaiser Permanente subscribers regarding the use of the HealthConnect system. These benefits are discussed as follows.
Online Interaction with Doctors – The HealthConnect users are able to interact with the doctors online without having to physically travel to the hospital and make appointment with the doctor[14]. Physically travelling to the hospital was also inconvenient as the patient needed to make appointment with the doctor and wait in a long queue of patients before being able to talk to the doctors. Using the current system, they can directly mail to the doctors who can also mail in return for suggesting medications and diagnosis.
Medical Records – Previously, the medical records of the patients were stored in paper documents that could be lost by the patient or damaged easily[15]. However, with the HealthConnect system, the medical records will be stored permanently in form of digital copies that cannot be lost or destroyed and will be stored in the database within the personal profile of the patient.
In addition to the benefits, there are also some potential risks and ethical issues associated with the HealthConnect System. These are as follows.
Personal Information – Creating a profile in HealthConnect requires the patients to enter personal information for identity verification and records. However, if the entire HealthConnect server is attacked by a strong and malicious entity, the personal records and information will be in high risk of getting stolen and potentially misused by the hackers.
Payment Gateway – For the patients seeking online help only, they need to make payment through online payment gateway using their banking cards like credit or debit card. Again, this is not completely secure and strong malicious attacks can easily break through the payment gateway and steal bank details of the patients[16]. The hackers are then able to break into the bank account of the patient and steal money from the same.
From the doctors’ and nurses’ perspectives, these questions can be answered a bit differently. These answers are explained as follows.
Benefits – From the doctors’ and nurses’ perspectives, the main benefit is that they do not have to provide additional physical efforts to treat the patients and provide medications. They can now simply check the emails sent to them by the patients and reply in it accordingly. Furthermore, the medication recommendation system benefits the doctors as they do not have think for a long time regarding the suggestion of the medication.
Risks and Issues – As per the doctors and nurses, the use of HealthConnect system will be extremely hectic for them even though it will not require physical treatment process. Checking thousands of mails from patients is virtually impossible for the doctors to follow up within a short period of time.
Ahmed, Sara, Patrick Ware, William Gardner, James Witter, Clifton O. Bingham, Dahlia Kairy, and Susan J. Bartlett. “Montreal Accord on Patient-Reported Outcomes (PROs) use series–Paper 8: patient-reported outcomes in electronic health records can inform clinical and policy decisions.” Journal of clinical epidemiology 89 (2017): 160-167.
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