RUAYA, Claire Angelie D.

BSMT-1D

Case Study 2
Magnolia Hills Hospital implemented an Electronic Health Record (EHR)about 6 months
ago. Your administrator decided to pull the plug on the project a week ago because of
all the problems that you were experiencing. Physicians refused to use the system.
They made the nurses print out everything so they could review the patients’ medical
records. The physicians would write orders on a piece of paper and ask the nurses to
enter them into the order entry system. The few physicians who did try to use the
system properly were still having problems. The system was down at least 2 hours a
day, and many days for 4 to 5 hours. When the HIM Department printed out reports to
satisfy release of information requests, what they received was more like screen prints
than forms.
This system was the brainchild of Dr. Anderson. He is a retired transplant surgeon
whose name is on the new transplant center building. He and a small group of his
cronies were the ones who picked and controlled the implementation of the system.
There was no input from anyone else other than the information technology (IT) staff.
The screens are cluttered and difficult to use and do not have data quality built in. The
system does not meet Condition of Participation, state licensing, and privacy
requirements.
The HIM director, physicians, nurses, and other staff learned about the system 3 weeks
before implementation. The HIM director was so angry at being left out of the loop that
she took early retirement and left with only 2 days’ notice. Physicians’ training on the
new system consisted of a demonstration of the system at the quarterly medical staff
meeting. Nursing and other staff were given only 1 hour of training. Since the
implementation of the system, there has been turnover in the hospital administrator
position and a new HIM director has been hired.

Contributions:
#2. What should the hospital have done to prepare the staff for the EHR
implementation?
 Explain how the EHR works to give knowledge and motivate the hospital
staff. 
- Since there has been a newly implemented EHR, the staff should be
acknowledged to have a more positive outlook on the sudden change in the
system so that no matter the circumstances, they would develop an optimistic
 perspective on working with the system. Thus, it would result for them to
become more engaged and interested in their work.

(When implementing an electronic health record (EHR) system in an organization, it’s

reasonable to expect a little bit of resistance. Whether you are transitioning from paper-
based records or switching over from a different EHR, the process can feel somewhat
daunting for clinicians and other staff. Any workplace change that alters people’s typical
workflows and routines can be stressful, and EHR implementation is no different. You
may come up against frustrations, but preparing your training in advance helps minimize
any anxiety from clinicians and staff, while making it easier to succeed in the
transition. It's also a good idea at the start of the process to identify which staff
members will play key roles in the planning and training process. One is a "physician
champion" who will motivate the other physicians. If all the other doctors are supportive
of this one doctor, then that creates a trickle-down effect as far as the attitude of the
whole practice.)

 Plan for post-implementation feedback from the medical workers and staff. 
- As this system was newly implemented, there should have been an
evaluation from various people who use the EHR so the HIM department can
get feedback if this system is useful for the doctors. Nevertheless, after
implementing the EHR, there should be a continuous, regular evaluation to be
assessed by the physicians even after there has been no problems at the
preliminary evaluations.
(For this part, I contributed for the second connecting, supporting idea for the first
sentence. I stated that, “After implementing the EHR, there should be a continuous,
regular evaluation to be assessed by the physicians even after there has been no
problems at the preliminary evaluations.” This is simply because evaluating an
electronic health record (EHR) implementation is a critical EHR implementation
step. The hospital should evaluate their EHR implementation approximately every three
to four weeks after the implementation date. If the EHR system is not working, the
practice may revert back to the previous paper-based workflow, which can impair the
overall success of the EHR. To avoid reverting back to the previous paper-based
workflow, it is critical to evaluate the EHR implementation soon after and regularly.
During the post-implementation evaluation, the HIM should check that the
practice/hospital/health center team is still intact and that workflows are running
smoothly, with few workarounds. They should also seek to identify unresolved vendor
issues, interface issues, and staff training needs. Thus, they can use the findings of
their post-implementation evaluation to target and implement initiatives that will enable
their practice/hospital/health center to continue quality improvement.)