Evaluation of the Electronic Health Record

Abstract

This evaluation proposal has been put forth to assess the use of Electronic Health Record system (EHRs) in a hospital set up. Specifically, this evaluation will analyze how the use of EHR system affects issues of patients’ confidentiality or patients’ security. This proposal will outline different methodologies that will be used in carrying out the evaluation. Throughout, this paper will focus on different goals of the evaluation to encourage other healthcare institutions to adopt the EHRs.

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Electronic Health Record is a computer-based system that enables healthcare providers like hospitals to store patients’ health records electronically. It is as an alternative of using paper-based records (Parish, 2006). Electron Health Record is an emerging concept that is gaining popularity in many sectors including the healthcare.

Back Ground Information

Electronic Health Record system lies at the center of information technology (IT) in any computerized healthcare information system (Barbara, 2008). Without the use of the EHRs, other modern facilities including Decision Support System (DSS) cannot be able to work competently (Barbara, 2008). The use of Electronic Health Record system in our hospitals will improve delivery of quality care. To many researchers around the globe, the implementation of the EHR system will be a reward to more than 20 years of hard work and extensive research (Barbara, 2008). In deed, many researchers and healthcare professionals have been looking forward for successful implementation of EHRs in the hospitals. With the implementation of EHRs, this dream will become a reality (Parish, 2006).

Despite that, the use of EHRs in the hospital setting can be able to bring efficient, safer and higher quality care, the EHRs has not widely been used in the US. In addition, the use of EHRs has not penetrated in the healthcare sector compared to other departments where electronic record system is being used efficiently in finance department, industrial sectors, and the transport industry (Parish, 2006). For some time now, the Electronic Health Record has been used effectively for many administrative issues. If reorganized, EHRs will be effective for clinical purposes too. As such, this evaluation plan will enlighten the stakeholders and familiarize them with electronic health record system, which is very effective in its usage (Barbara, 2008).

Literature review

Several sources have provided adequate and valuable information about EHRs. Many online resources have explained about implementation, evaluation, advantages, and disadvantages of EHR system in healthcare facilities. Barbara (2008) says that, as the demand for better health care for patients’ increases, there has been a growing need to organize the data storage systems for rapid and improved health care. EHR system makes it easier for health care providers to communicate and transfer patients’ information promptly while maintaining confidentiality.

In addition to this, Gina (2006) argues that the use of EHRs can reduce potential clinical errors especially those that are associated with drug prescription. Recording of patient personal information such as demographic information, drug alerts, and generational information reduces chances of medical prescription errors. Barbara (2008) argues that, in order to enable access of information and maintaining confidentiality in clinical assignments and routines, implementation of EHRs should consider the following. First, the system should be able to store all records including dates of diagnosis and the onset of treatment for a patient (Barbara, 2008).

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Secondly, the system should keep medication lists, record who administered certain drugs to the patient and record when the drugs were administered (Barbara, 2008). Such useful information will help the healthcare institutions to ensure accountability in patient care. Finally, Barbara (2008) says that the system should be designed to provide high level of privacy. Healthcare institutions should ensure that only the right people access patients’ information. Access of patient information using EHRs should only be granted by use of security codes, which will guarantee that patients’ information is kept private as much as possible.

Gina (2006) concludes that, the EHR system has many benefits for patients and clinicians. It is important for any organization planning to implement the system to ensure that it has put adequate measures to maintain patients’ confidentiality. Additionally, this system is able to reduce cases of negligence, enhances accountability, and improves health care (Carter, 2008).

Goals of this evaluation

Generally, this evaluation aims at improving issues of patients’ confidentiality by reducing the number of security loopholes in our healthcare institutions. As such, this evaluation plan will investigate how the use EHR system affects issues of privacy in our hospitals. On the other hand, this evaluation plan will also focus on assessing numerous advantages associated with the EHR system. The goals of this evaluation are to ensure that there is increased quality care in our hospital facilities (Gina, 2006). In addition to this, implementation of EHRs will ensure cases of negligence have been eradicated and hence improving patient safety. If this project is implemented in large hospitals, the EHRs will play a big role in improving issues of patients’ record keeping.

Goals of stakeholders

Most of the stakeholders expect to observe improved health care and reduced cost of health care provision. However, stakeholders have different goals, which they hope will be achieved by implementation of this project. Patients’ expectations are that, the EHR system will improve issues of confidentiality. On the other hand, the hospital management expects that implementing the EHRs in healthcare institutions will be able to save time (Carter, 2008). They also expect that, costs that are associated with data storage using paper based system like refunds from negligence can also be avoided.

EHR system will be able to ensure that there is improved efficiency in healthcare provision. It will also ensure that exchange in patient information is easy and effective (Carter, 2008). The clinicians and other health workers will be able to enjoy reduced workload. Paper filing is very tedious and time consuming compared to Electronic Health Recording. This will give health practitioners enough time to offer quality healthcare.

The table below represents a summary of different goals of the stakeholders:

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GOALS / OBJECTIVES Chief Executive Officer Chief Medical Officer Chief Information Officer Chief Financial Officer Community
members
Clinicians Patients
Improve quality care ˣ ˣ ˣ ˣ ˣ ˣ ˣ
Improve safety care ˣ ˣ ˣ ˣ
Reduce cost of care ˣ ˣ ˣ
Improve records keeping ˣ ˣ ˣ ˣ
Improve patient confidentiality ˣ ˣ ˣ

To deem the project successful upon its implementation, patients will be able to get quality health care. There will be high level of confidentiality in all patients’ medical records. There will also be reduced costs in provision of health care, improved record keeping in the hospital and increased level of patients’ safety.

Evaluator effort

Generally, this evaluation will be carried out in five hospitals (2 private and 3 public hospitals). It is a requirement that the five selected hospitals must have an efficient and updated EHR system, which will be used in the evaluation process. The essence of evaluating private and public is to promote equity and for comparison purposes.

Participants

Evaluators and several IT experts will carry out the evaluation process. IT experts will be guiding the stakeholders in carrying out the evaluation. The evaluators for this project are experts with full knowledge of EHRs; they are conversant with specific methodological and technical about the program (Carter, 2008). They include program manager and other program staff members.

Audiences

The audiences of this evaluation are community members, patients, clinicians, hospitals director, hospital management, and government representatives. However, each group of the respondents has different expectations based on their goals. Because each group has different goals or expectations, the evaluation will use different modes of communication to different groups.

During the evaluation process, the evaluators will prepare and present reports to the stakeholders every month. Written reports will contain detailed information about how the evaluation is progressing based on audiences’ feedback. It is important to present reports to the stakeholders for approval (Davidson, 2002).

Findings or the feedback by the respondents from five of the selected hospitals will be used to convince other healthcare institutions to adapt the EHRs. The feedback will also display the outcome of the evaluation based on its objectives. If the project is successfully implemented, there will be increased patient safety, improved record keeping, quality health care, reduced prescription errors, and improved patients’ security/ confidentiality (Carter, 2008). Based on the effectiveness of the EHRs, more institutions will benefit from this paperless record keeping system.

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Quantitative evaluation

General information

This evaluation has been set forth to investigate how the EHR system impacts patients’ confidentiality in the hospital setting. This is a goal-oriented evaluation (Davidson, 2002). Therefore, this evaluation is not being carried out to seek funding for support of a similar project. This evaluation only aims at assessing the current EHRs. The findings will be used to encourage other health institutions to adapt this project.

During this evaluation, 50 clinicians, 50 patients, 50 community members, 5 government representatives, and 2 management officers from each of the selected case study hospitals will be selected as the audience. Below is a detailed discussion of the methodology to be used in the evaluation plan.

Time frame/ period

The period of the evaluation will be long enough to ensure quantitative data is accessed efficiently. Therefore, the period allocated for this project/ evaluation process is strictly 12 months.

Study design/ comparison group

Our sample of interest in this evaluation process is the stakeholders. The stakeholders include patients, clinicians, community members, and management officers (CEO, CFI, CIO, and CMO).

Data collection plan

In quantitative analysis, data collection will be done until the evaluators have reached the saturation point. Once the evaluators will have collected enough data, the process of data collection will be stopped (Kumar, 2005). A list of questions will be provided to the clinicians, hospital management, community members, and the patients. Data collection will be done in two phases

Phase I: During phase I of the evaluation procedure, there will be a general survey. A list of questions will be provided to all stakeholders. To avoid cases of missed values or a situation in which respondents skip some questions, the survey questions will be prepared in a simple and easy manner. There will be a number of evaluators guiding the stakeholders to answer survey questions. However, the role of the evaluators is only to clarify or explain questions in case the respondent filling the survey has not understood a specific question; the guide cannot influence the response.

List of Questions for Phase I

Survey questions phase I Yes No Explain if necessary
1 Do you feel that the use of EHRs has improved quality care?
2 Do you think use of EHRs impacts confidentiality?
3 Have you observed increased costs with the use of EHRs?
4 Have you observed reduced cost with the use of EHRs?
5 Are there any advantages you have observed with the use of EHRs?
6 Are there any other changes that you have observed with the use of EHRs?
7 Has the use of EHRs fulfilled your expectations?
8 According to you, do you feel there is need to improve the system?
9 With the use of EHRs, have you observed reduced time in proving services in the hospital?
10

Phase II: In phase II of data collection, there will be a list of questions to be answered by clinicians only. The main aim of phase II in this evaluation is to get specific information from the clinicians like nurses and doctors since they are more involved in using the system. Phase II will investigate how EHRs affects patients’ security or confidentiality. Since clinicians are the ones using the EHR system, phase II will be relevant because nurses and doctors will provide relevant information about patients’ security given that they are more involved with the patients. In phase II, 25 clinicians who participated in the phase I of data collection will answer the survey questions

List of Questions for Phase II

Survey questions Phase II Yes No Explain if necessary
1 Does the use of EHRs ensure patients security/ confidentiality
2 Do you use security codes to access patients’ profile?
3 If yes, do you share the security code with others?
4 Apart from the clinicians, are there other people who access patients profile using the EHRs?
5 Have you received special training concerning how to use EHRs?
6 Is EHRs user friendly?
7 Is EHRs easy to use?
8 Has the use of EHRs fulfilled your expectations?
9 Are there any changes that should be made to improve the system?
10 With the use of EHRs, have you observed some improvements in issues of record keeping?

Data analysis plan

In quantitative evaluation, data analysis will be done using data tabulation technique. The use of data tabulation technique will ensure that the most important indicators are analyzed, it will produce high level of analysis, and it will disseminate survey results in timely manner (Gina, 2006). In tabular analysis, the evaluation will use two way and three way tables. Using two way and three way tables will help in describing the relationship between the goals and the research findings (Kumar, 2005).

Power/ sample size calculations

As mentioned, our sample of interest is the stakeholders. The respondents for this evaluation will be selected from 50 clinicians, 50 patients, 50 community members, and 2 representatives from each hospital management. This sample has been selected based on fact that the target population is big. As such, we must take many samples. By using the selected sample, the entire population is represented. We considered inherent variability (Kumar, 2005).

Evaluation goals and potential measures

Evaluation Goals Measures
  1. The EHRs will have improved patients’ confidentiality
  1. There will be improved healthcare
  1. The cost of diagnosis has gone down
  1. There will be improved record keeping
  1. Improved patient safety
  1. The clinicians can only access a patient’s health records by use of security codes
  2. The number of prescription errors and negligence cases reported by patients is low
  3. The patients and hospital management will experience reduced cost
  4. Clinicians and hospital management will be able to access and store data easily and efficiently.
  5. The cases of error and human negligence will have reduced drastically

Qualitative evaluation

General information

In the qualitative evaluation, this assessment will be carried out using survey method. There will be both online and paper based survey. A list of questions will be formulated and printed in many copies. Each audience will be given a copy to fill the answers. Paper based survey will be reliable in rural areas considering that some of the audiences are community members.

Timeframe

The survey exercise will be conducted for a period of one year in order to get adequate data. Throughout this period, reports will be submitted to the stakeholders every end of month to check the progress.

Study design

Survey questions will be designed in such a way that the audiences will be able to give feedback with ease. As such, the survey will be “direct and straight to the point questions” and the interviewee will be required to tick yes or no. The audiences will also provide explanations to each question where necessary.

The most appropriate study design that can measure the impact and effectiveness of a program is the “Before-and-after design” (Kumar, 2005). This design will be used in the evaluation project. Before-and-after design is reliable method because it does compare results before and after implementation of a specific program (Kumar, 2005). In this case, the evaluation will compare how the EHR system has impacted patients’ and quality of healthcare among other goals before and after implementation of the EHRs.

Data collection plan

A list of questions will be formulated, printed, and circulated to the stakeholders. Alternatively, a set of similar questions will be available online. This will mark the onset of data collection process. The questions will be presented to the patients by the clinicians in every of the selected hospitals. To avoid interfering with the hospitals programs, nurses will present questions to the patients and guide them in answering the survey questions.

Data analysis plan

In qualitative analysis, the descriptive data will be analyzed using data coding. The content of the survey will be assessed using a procedure known as content analysis (Kumar, 2005). The goals of the evaluation will be assigned specific codes, the feedback will be classified under each goal, and the data will be integrated to enhance disseminating the findings (Kumar, 2005).

Subsequent measures to be evaluated in the same format

There are different modules in a hospital setting that can be used to measure the general success of the EHRs on issues of patients’ security, safety and the general improvement in the quality of healthcare. Systems that deal with billing, employee scheduling, data security, and employee profile and data storage can be evaluated to identify the general impact of the EHRs program (Barbara, 2008). A proportional research can be done within the five hospitals that have already adopted the EHR system to compare the results obtained.

Reference List

Barbara, G. (2008). Do EMRs Make You a Better Doctor? New York: Physicians Practice.

Carter, J. (2008). Electronic health records: a guide for clinicians and administrators. Sidney: ACP press.

Davidson, J. (2002). Evaluation methodology basics: the nuts and bolts of sound evaluation. London: Sage.

Gina, R. (2006). The Perils of Customization. Journal of AHIMA 77, (6) 24-28.

Kumar, R. (2005). Research methodology: A step by step guide for beginners. (2nd Ed.). London: Sage.

Parish, C. (2006). Edging towards a brave new IT world. Nursing Standard 27(1) pp 15-16.

Strauss, L. (2007). Qualitative analysis for social scientists. New York: Cambridge University Press.

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