Running Head: FINAL EXAM

Final Exam
Ashley Winans
National University
HTM 680
Professor Sary Beidas

January 30, 2016

FINAL EXAM

Final Exam
1. Successful Tablet implementation
A successful tablet implementation would depend upon numerous factors. These are the
five most important practices that I think would lead to a successful implementation and project:
1. Scope: Make sure that you order the proper amount of tablets and any additional
accessories (i.e. covers or booklets). This will avoid having too few or an excess of
tablets. It would also be important to determine whether these tablets will be given to
patients permanently, or whether they return them after a specified period of time.
2. Implementation Project Timeline: This will help to prioritize items. You can
also divide the project into different phases with goals and items to achieve by certain
dates. additionally, you can look back and see what has been achieved after a specific
time frame (i.e 90 days) and see what has been accomplished and what need to be done.
3. Training: Proper training is necessary to ensure that patients would be able to use
the tablet and the accompanying patient portal correctly. Staff should likewise be trained
and prepared to answer patient questions and enroll them in a patient portal or other
components. Certain staff should be designated as trainers.
4. Security: Making sure that the tablets as well as the connections used to access
patient data is secure and will NOT lend itself to a breach.
5. Testing: Work out any bugs ahead of time. Dont wait for issues to creep up on
you and take a proactive approach to finding both problems and solutions connected to
the tablets. This includes both technological issues as well beta testing with patients and
staff.

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2. EHR Opportunities
An EHR has the potential to transform healthcare from both the provider and patient
perspective. In the 2012 EHR User Satisfaction Survey, engaging and rewarding features and
entire systems were highlighted. Additionally, the worst features and EHRs were likewise
discussed and rated. End users were most engaged by EHRs when they enabled them to
facilitate intra-office messaging and tasking (60 percent), find information (58%), document data
(57%), and facilitate electronic prescribing (56%).
Features such as patient portal, when effectively marketed and utilized, can also help to
engage patients and get them interested as well as invested in their health. Another initiative,
Open Notes, allowed patients access to their doctors notes. Patients responded positively to the
transparency. Numerous benefits included improved understanding of their conditions, better
adherence to medications, and 70-72% were found to take better care of themselves overall.
Physicians also responded positively to this initiative and found that their relationships with their
patients had improved. In the same satisfaction survey, end users were the most disappointed in
the following areas: the effect on productivity (16%), the effect on the physician's ability to focus
on patient care (24%), and vendor support (36%).
Some EHR shortcomings can be used to determine what features deter end users from wanting to
use technology. For example, Allscripts tends to have numerous pop-ups and is an all around
cumbersome to navigate. Systems such as this one would need a complete overhaul to become
user friendly. Providers also tend to dislike systems with too many alerts or pop-ups. A
streamlined EHR would allow for productivity and would not interfere while a provider is trying
to document at the point of care.

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3. HealthMap
There are several HealthMap features that I would change and looked at it from a
functional end-user perspective. I visited the HealthMap website and searched for my current
location which is Ventura, CA. In the top left corner, the map tells me that there are 16 alerts for
all diseases, which is a jarring statistic to come across! However, when you read across the top
bar, it lets you know that only one of these alerts is within the current week.
The outbreaks in the current area pop-up is also blocking a large portion of the map, so I
can only see the small location to the left of it. Probably the most disturbing feature is that there
is no legend for the colors of the outbreaks! When I clicked on an alert, I was surprised to see
that it was actually located in Los Angeles, about 50 miles from Ventura. Additionally, the other
alerts were from all over Southern California and nowhere in my immediate area. I also noticed
this is the screenshot from the prompt. It was supposed to highlight the San Diego area, but alerts
included all of Southern California as far north as Santa Clarita. I also clicked on the Zita
Outbreak link and was disappointed. I hadnt heard of Zita and thought the link would give me
more information. Instead, it lead me to a random page with no information whatsoever. I had to
Google Zita outbreak on a different site in order to find out more about it.
4. On HIT Governance
CDS, or Clinical Decision Support, can be essential for improving health care quality and
safety. Governance of these systems is just as important as the quality of the CDS itself.
Organizations with internally developed systems are responsible for the entire process of
development, implementation, and ongoing management and assessment. The healthcare system
that I chose to look at is Partners Healthcare in Boston, MA. They have an internally developed
outpatient EHR with clinical alerts, order sets, comprehensive chronic disease-management

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systems for diabetes and coronary disease, outpatient results management application. Patients
also have access to an online health record. Partners Healthcare is a centralized organization and
they have clinically trained subject matter experts who work in small teams with knowledge
engineers in order to develop and implement CDS. They make use of a three-stage life cycle
process which includes the creation of knowledge, deployment, and a periodic review process.
The pros of this model is that you are not beholden to an outside entity or vendor for
governance. Everything is controlled internally, even though many of the suggested changes
have to go through the approval of an internal committee. This can also be just as much of a con;
vendors can provide invaluable support. The differences seem similar to renting vs. owning a
house. This system requires a large number of specialized staff and a CDS system is more likely
to be mandated. Financial resources, for a smaller organization, may also be stretched and limit
the project. I work in a clinic setting and we are affiliated with a county system and do not have
full control over our EHR, which is largely why the governance system that Partners Healthcare
utilizes. However, for an individual clinic it might not be realistic due to the number of
specialized staff it would require as well as the finances required for an endeavor.
5. Ideal HIT Job
I located my ideal job on the Indeed website link and it can be found at:
https://www.healthcaresource.com/lomalinda/index.cfm?
fuseaction=search.jobDetails&template=dsp_job_details.cfm&cJobId=103687&source=Indeed.c
om
It is for an EHR Application Specialist at Loma Linda University in Southern California. The job
specifications require that the candidate have a minimum of a Bachelors degree as well as 0-1
years of relevant Healthcare or Information Technology experience. The position also requires

FINAL EXAM

a Microsoft Office competence and experience as well as a basic knowledge of clinical or

business/revenue cycle workflow in healthcare. Both verbal and written English skills are
emphasized. The position also asks for a variety of soft skills such as interpersonal and
interdepartmental communications, the ability to work independently and under pressure, and
pay close attention to details.
I would be qualified for this position because I have more than the required health care
experience as well as education. I have four years of experience working for an orthopedic
practice where I was an EHR Trainer and Medical Scribe Program Manager. I have almost one
year of experience working as a Health Informaticist. In my current position I also provide
Microsoft training to new employees, especially Excel, and function as the resident Microsoft
guru and help troubleshoot and assist with any Microsoft Office-related issues that arise. I have
also worked with two different EHR systems, Omni WebMD and Cerner. Even though this
position will require the employee to pass an Epic certification within 90 days of their hire date, I
am confident that I would be able to do so. I also have an MA in English and this job requires
excellent verbal and written English skills.

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References
Hughes, R. G. (n.d.). Retrieved January 30, 2016, from
http://www.ncbi.nlm.nih.gov/books/NBK2656/
2012 EHR User Satisfaction Survey Provides Feedback From FP Colleagues. (n.d.). Retrieved
January 30, 2016, from http://www.aafp.org/news/practice-professionalissues/20121119ehrsatsurvey.html
Wright A, et al. Governance for clinical decision support: case studies and recommended
practices from leading institutions. J Am Med Inform Assoc. 2011 Mar-Apr; 18(2): 187
194.