1.

Describe the benefits to the patient of an enterprise system for patient medical information and for patient prescriptions and related medical therapies. Source: http://qualityandsafety.partners.org/ Benefits for patient medical information o Electronic Health Record (EHRs) Gives caregivers complete health information for a patient so that he/she receives safe and coordinated care Data is consistent across network High quality of data= better treatment o Information is versatile (patient information residing anywhere within network is available to all PHS service providers) Benefits for patient prescriptions o Higher rate of hospital medication orders through CPOE o Use of software to write orders for drugs/tests/impatient treatments ensures that correct prescriptions are given (no issues of non-legible orders) Can include tips/reminders/checks to help caregivers follow proven clinical practices o Reduces medication errors (through adoption of electronic health records) EHR tool can suggest more cost-effective drugs o Electronic prescribing can help avoid allergies/harmful drug interactions Help doctors know which drugs are covered by patients insurance (cost-saving for patient) Benefits for related medical therapies o Use of electronic medication administration record (EMAR) Barcodes patients, providers, drugs Lets nurses see list of all medications ordered for each patient Uses barcode technology to match scanned medication and patient with doctors order (verify correct administration of treatment) o Ensures safer transitions in care Use of EMR system= consolidation medical data, comments from previous and current healthcare professionals, scans and test o Implementing CPOE requires ongoing collaboration of all caregivers Unique to each hospital/medical specialty 2. Compare the total cost of ownership (TCO) implications of the LMR/CPOE investment and the type of legacy systems that were likely previously in place? TCO of LMR/CPOE Investment TCO Legacy Systems Source:

Training caregivers/doctors/nurses to use system (ex. know how to input and access data) Ongoing support of end users Means to collect and consolidate information about given patient overtime into an integrated digital record (hardware and software needed) Increase in number of desktop devices, wireless devices as well Need software capable of reading from/writing lists of key data types Installation/integration of hardware and software Server and network hardware/software Developing the infrastructure to support LMR/CPOE Need infrastructure that can support speed needed for physicians to effectively and efficiently use CPOE

http://www.articlesbase.com/businessarticles/modernizing-legacy-systems1379231.html Downtime due to inability to access data immediately (paper records take time to be transferred) Data inconsistencies= diminished performance, patients have to wait (may lose revenue) Backup and recovery process costs If data is lost (especially with paper copies)

Maintenance of information management team- IS team Initial training of employees Possible temporary loss of productivity during time implementing LMR/CPOE Time spent transferring data from paper to digital format Implementation of security of access/confidentiality issues (cost

Maintenance and upgrade of legacy system Preventative and breakdown maintenance expenses If system needs upgrade for greater functionality (gaps between legacy application and integrating it with a new application) Cost of middleware to connect existing systems Hardware/software of system Installation of hardware/software

Cost of IT employees needed to support system

involved with that along with maintaining data integrity) Mechanisms for data collection made more rigorous Cost of new data management platform Future upgrade/scalability expenses Need to have infrastructure w/capacity to include more/new possible PHS service providers Cost of system upgrades Maintenance of PHS services network Users need to be able to have access to information at anytime Cost of implementing system evaluation and testing

Training costs

Security of legacy system (although internal still need to keep information/data protected)

3. Describe the challenges faced by Partners institutional management in implementing an enterprise-wide electronic medical records system. Means to collect and consolidate into an integrated digital record all the information about a given patient over time o Include transcribed comments of those health care professionals with whom the patient interacts; and objects, such as x-rays, MRI scans etc. Need to establish decision support processes that support the medical practitioner in making best recommendations for drugs/other therapies based on likely benefits to patient at the lowest cost (operational excellence) Need a knowledge management processes to derive best practices from observable outcomes of recommended medical therapies o Employ lessons learned to inform the ongoing delivery of services and the reform of existing therapies o Continual improvement (innovation) Must assess ability/want to customize enterprise-wide electronic medical records system o Ex. If system administrator can perform customizations/vendor will need to perform task How will data integrity be ensured? o Make sure data is secure How will the system interact with current systems?

Will remote access be needed and is the network infrastructure stable? Is there a consistent/user friendly interface? Need to consider training/support o Will there be a training methodology? What system evaluation and testing is in place? o Problem identification and resolution involving the users

4. Describe the operational and tactical benefits and challenges posed by the LMR/CPOE systems now in place? a. For PHS health care practitioners? Operational/Tactical Benefits Automating the scheduling, medical record and billing processes in the practice Focus attention on patients instead of transporting information through inefficient process where there is significant possibility of error/inconsistencies Save time at each step of care/prescription delivery process Opportunity for increased revenue (can manage more patients) Workflow in the practice is more streamlined o Records are available real-time Overall improved patient experience o Can increase customer intimacy/connection Enhanced availability of data for clinical decision support o Higher data quality Challenges Implementation of new systems requires changes in operational business processes Caregivers/physicians etc. had to adopt the use (learn how to use) o Possible end-user resistance Need to have infrastructure to support requirements of systems High implementation cost Changes in culture (how physician interacts with patient) b. For health care practitioners and allied agencies (such as insurance companies and state and federal agencies) that must interact with PHS? Operational/Tactical Benefits Denial notifications from insurance companies are minimized o Billing is more accurate due to precise documentation o Automated coding= accurate claim submissions Availability of clinical data in consistent formats allows local/state health departments to identify trends o Can increase community awareness o Federal funding and support is justified Challenges Security in place to ensure that data is not accessed/shared with wrong users

Need access to database/system to make use of information

c. For the PHS IT unit/team? Operational/Tactical Benefits Provided integrated platform for collection, processing and dissemination of information across PHS network Ensure quality/integrity of data going into systems New data platform based on service orientated architecture Challenges Need higher level of data quality Mechanisms for data collection, validation, cleansing and warehousing= made more rigorous Review rules engine that enables CPOE platform (update) Re-documentation and cleanup of systems knowledge base o Must convert past paper-based medical records to digital format Additional training needed to use new system