1. List the concerns of physicians as they learn about the hospital’s impending adoption of an EHR. Which are the most important and must be addressed?
The physicians are concerned regarding the adoption of a certified electronic health record because they anticipate that the adoption will be time-consuming for them. The most common complaints relate to the logistics surrounding the adoption and that, once adopted, it will take them longer to look up patient information in the record (eHealth Initiative, 2010, p. 15). These concerns are justified, as the CEO of the hospital has already confirmed that physicians will need to dedicate time to the implementation of the system (both in first identifying a system, and then consulting on the customization of the system. He also confirmed that the electronic health record will initially take them more time to use.
Any lack of engagement from the physicians must be immediately addressed. The eHealth Initiative (2010) identified physicians as an integral part of the implementation of any health information exchange system (p. 15). Their participation is also key to the success of any such implementation (eHealth Initiative, 2010, p. 15). The CEO has responded appropriately and identified several measures that may alleviate the physicians’ concerns.
2. Should the hospital pay the physicians to participate in a process that will improve patient care?
Physicians have a duty to provide their patients with the best level of patient care possible. In order to do so, a certain degree of planning and documentation is involved. As discussed by Wagner, Glaser, & Lee (2013), patient records are the foundation for patient care, and serve to facilitate the planning process, and document the course of treatment (p. 9). Different healthcare providers are also responsible for defined areas of a patient’s electronic health record. Physicians, in particular, are responsible for the areas of “history and physical information, physician’s orders, progress notes, consultations” as well as any other healthcare informatics specifically related to this area (Wager et al., 2013, p. 17). While the task of maintaining a patient’s medical records improves patient care, it is appropriately placed within the regular course and scope of patient treatment. As such, physicians should not be compensated to participate in the maintenance of electronic health records.
However, the CEO was justified in working to identify ways to alleviate the physicians’ concerns regarding demands on their time in the implementation and initial set up of an electronic health record. Much like consultants would be compensated for this process, physicians who dedicate time and effort towards the implementation (outside of routine patient care), should be compensated as well. As suggested by the CEO, it is appropriate to pay physicians to attend training sessions, vendor presentations, and other meetings.
3. What should the nursing staff’s role be in the selection and implementation of the EHR?
There are several steps to the selection and implementation of the electronic health record. First, the selection process involves an investigation by decision-makers into what system is appropriate and would meet both the needs of physicians, as well as those of the staff (including nurses) (Lorenzi et al., 2009). However, these decisions cannot be made in a vacuum. It is therefore important to first understand what those needs are, and take steps to ensure that any system selected would satisfy the staff’s minimum requirements. Here nurses may provide valuable information during the selection process and would serve in an important role.
Nurses also play an invaluable role during the implementation process of the electronic health record. First, it is important to test the usability of any proposed EHR to identify any possible issues with the system selected (Corrao, 2010). Nurses are uniquely suited to conduct this testing and report back any issues identified during that process. As active users of the record, nurses would receive training on the use and management of the system, another part of the implementation process (Lorenzi et al., 2009). Further, in using the system nurses would be important sources of information regarding the program’s on-going performance following initial testing and subsequent implementation. According to Lorenzi et al. (2009), it is important to continuously monitor the EHR. Lastly, teamwork and staff buy-in are important components of the successful development of an EHR (Lorenzo et al., 2009). Nurses are key members of any health care team and, arguably, there is no more buy-in that is more important than that of the nurses, who serve as a foundation in patient care.
Corrao, N. J., Robinson, A. G., Swiernik, M. G., & Naiem, A. (2010, May 6). Importance of Testing for Usability When Selecting and Implementing an Electronic Health or Medical Record System. National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868635/
eHealth Initiative. (2010). The state of health information exchange in 2010: Connecting the nation to achieve meaningful use. States with operational HIE initiatives. Retrieved from http://www.ehidc.org/files/hie-toolkit/Final_Report.pdf
Lorenzi, N., Kouroubali, A., Detmer, D., & Bloomrosen, M. (2009, February 23). How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662829/
Wager, K. A., Glaser, J. P., & Lee, F. W. (2013). Health care information systems a practical approach for health care management (3rd ed.). San Francisco, Calif.: Jossey-Bass.