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Health Information Security

As part of MI227: Clinical and Laboratory Information Systems, we need to give our response to a sample scenario

You are part of a group practice that has decided to implement an electronic solution for clinical documentation. However, you have come across many horror stories regarding health information security that have led to failed clinical information system implementations. How would you prevent this from happening to your group practice?”

We are to create a list of questions that my group practice should be able to present to prevent horror stories regarding the failure in health information security.

  1. What is the type of Health Information System (HIS) our group plan to implement?
  2. What is the budget and time frame in building the HIS?
  3. What types of information will the HIS gather from the patients?
  4. Who will have access to the information gathered by the HIS?
  5. Will the HIS be hosted off-cloud or on-cloud?
  6. Will the HIS be custom built or bought off the shelves?
  7. How will the HIS be compliant with the Data Privacy Act of 2012?
  8. Where will the backup of the information be stored?
  9. Who will ultimately be liable in case of a data breach?
  10. What is the step-by-step plan in case of an event of a data breach?

These are just some of the questions that my group will present and try to answer in order to come up with a save and secured Health Information System.

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Barriers to acceptance of Electronic Health Records (EHRs)

Barriers to acceptance of EHRs

For this week’s coursework in MI227, we will assume the role of a project manager for a Department of Health (DOH) project with the task of implementing a national Electronic Health Record (EHR) that all government hospitals will implement.

The main objective of the article by Albert Boonstra and Manda Broekhuis was to identify, categorize and analyze the barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) using a systematic literature review method. Among the eight main categories they identified, two – Organizational and Change Process – seemed to be mediating on the other barriers (Financial, Technical, Time, Psychological, Social and Legal). In particular, the change management perspective presents an opportunity to overcome the other barriers and assist in the implementation of EMRs.

The change process means that there will be a major change in the current system. Members of the government hospitals might already have their own system in place that works for them that they have been doing for years. A working electronic information system needs an organization-wide use of the new EHR in order to help all members be more accepting of the change process involved in using the EHR. Organizational support may be bolstered by incentives and the promotion of participation. If I were a project manager, I would first seek the “buy-in” of management in the promotion of an EHR system. I will also request the need for a team within the organization to promote the EHR within the organization. I will also request for approval for the use of incentives. For example, departments which actively use the EHR system may receive financial bonuses or the training sessions may come with company sponsored meals. One thing to consider is whether repercussions may be used to discourage absences from training sessions. Lastly, I would seek to engage “EHR Champions” who will be early adopters of the technology and will cascade the information down to their teams. These EHR Champions will be those who have influence within their teams and may be able to motivate others to adopt the EHR system.

As a Project Manager, I will also look at the organizational size and type of my organization in coming up with a strategy or plan for the EHR adoption. According to Boonstra and Broekhuis, larger practices have a higher EMR adoption rate than those in smaller practices because in larger practices, physicians have more extensive support and training systems. If my target government hospital were a small one, I would need to explore ways to give extensive support and training regardless of size. This may mean requiring the EHR provider to be on call for the support and training that will be needed. This may also mean hiring a full time technical support or officer to assist the personnel during the transition and afterwards.

The other barriers – Financial, Technical, Time, Psychological, Social and Legal – may be dealt with through a well-designed change management strategy and with full organizational support. Financial barriers in government hospitals may be overcome by getting the support of the board or management to seek additional funding or allocating resources. Technical barriers may be managed by putting in place the human resources who will train and support health personnel. Time, psychological and social barriers may be overcome by promoting a change culture. Legal barriers, particularly privacy or security concerns, may be overcome by putting in place the proper safeguards and ensuring that health personnel are adequately trained.

In sum, as a project manager, I will need to engage different stakeholders – management, my team, EMR providers and EHR champions – in the change management strategy. It is with their active participation and support that an EHR system can be fully and successfully implemented.

 

 

Reference:

Boonstra, A., & Broekhuis, M. (2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Services Research.

 

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Allons-y!

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Barriers to the Adoption of EHR Systems in the Kingdom of Saudi Arabia

For this week’s coursework in MI227, I have focused on the article tackling the barriers to the adoption of EHR systems in the Kingdom of Saudi Arabia.

o    What are the key points of the article?

The article discussed the findings of a study conducted to identify the adoption of Electronic Health Records (EHR) Systems. The study used a Systematic Review of Literature based on 6 search engines namely, PubMed, EBSCO Host, Web of Science, ACM, IEEE and Google Scholar. Articles were limited to peer reviewed, empirical studies within Kingdom of Saudi Arabia (KSA). 12 studies were used by the authors which were extracted, analyzed, summarized and categorized empirical results related to EHR barriers.

Through the study, it was revealed that there are many barriers that hinder the implementation of an EHR system in KSA. These barriers are largely composed of (1) lack of computer experience, (2) lack of perceived usefulness, (3) lack of perceived ease of use by the healthcare professionals and (4) technical limitations. The article further discussed that the barriers may be classified into two categories based on the target of interventions to increase the adoption of EHRs —  individual-level adoption barriers, and organization-level adoption barriers. Individual-level adoption barriers or user-level adoption barriers refer to those which would hinder an individual healthcare professional from choosing to accept and use an EHR system. On the other hand, organization-level adoption barriers or authority-level adoption barriers refer to those which would discourage an organization from adopting and implementing an EHR system. The presence of individual or use-level adoption barriers has an impact on an organization as they affect “resistance to change,” which is an organization level barrier.

o    What lessons learned does it describe?

The identification of barriers is useful in assisting policy makers in planning and designing policies to increase the adoption of EHRs. It will also help EHR vendors in system development and marketing. For instance, because lack of familiarity of the medical staff with EHR was cited as the most frequently cited barrier, training programs on computer literacy would increase healthcare professionals’ adoption of EHR systems. To respond to the barrier of lack of perceived usefulness, proponents of an EHR system should strive to provide a clear understanding of the benefits of the e-health technology by its users. Future research should take into account these findings with a view to the development of an appropriate framework for the adoption of EHRs in the KSA.

o    How can this relate to the local setting in the Philippines?

A similar study to identify the barriers to adoption of EHR systems in the Philippines would be beneficial. Researchers may adopt the same methodology and see whether they would come up with the same result. Some of the existing challenges identified by the author by way of background – i..e the misdistribution of healthcare services, rapid population growth and the need for effective Chronic Disease Management (CDM) programs – are challenges that are similar to what the Philippines faces. It would be of great interest to know whether a Philippine-focused study will also yield the same results as KSA on the barriers to entry. If so, Philippine policy makers and EHR proponents may find it useful to keep track of how KSA responds to these barriers in coming up with its own framework for the adoption of EHRs.

 

Sources

  1. Alqahtani, Asma, Crowder, Richard & Wills, Gary., Barriers to the Adoption of EHR Systems in the Kingdom of Saudi Arabia: An Exploratory Study Using a Systematic Literature Review. 2017 July 09. Vol. 11 No. 2, 2017. Journal of Health Informatics in Developing Countries.
  2. Raposo VL. Electronic health records: Is it a risk worth taking in healthcare delivery? GMS Health Technology Assessment. 2015 Dec 10;11.
  3. Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, et al. Can electronicmedical record systems transform health care? Potential health benefits, savings,and costs. Health Affairs. 2005;24(5):1103–17.

 

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Allons-y!

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The Tardis Technician, aka MS Health Informatics Student.

A person can choose to never stop learning and this is the philosophy that I have adopted. I graduated from college more than ten years ago but since then, education, whether formal or informal, has and will always be a part of my life. My career can be said to be quite a curious one – I have an industrial economics degree, which I’ve applied in two industries, namely the automotive and hotel industries, and I also have a bachelor’s degree in nursing and I’ve worked in hospitals and aged care facilities. While these fields, at first glance, appear dissonant, I’ve learned that the skills in one can also be applied to the other. In particular, in my operations experience in the automotive and hotel industries, I have seen the advantage of the use of technology and believe that this can be used to an advantage in providing greater benefit in providing better patient care. It is this intersect — that of medicine and technology — that I would like to focus on and develop myself professionally. It is a direction where I can harmonize and apply what I have learned in my current and past roles. It is a field that is of extreme interest to me, not only because of its potential but also because I believe it is where I will develop my strengths. I have a natural inclination to the use of technology as I recognize, and have availed of, its benefits. At the same time, I feel fulfilled when I work in the medical field. It is challenging and rewarding to be directly responsible for the care and happiness of each patient that I have assisted.

Self-directed learning as a method of instruction is ideal for post-graduate studies. A more mature student can be trusted on to take initiative in seeking out answers and not merely relying on others to provide them. Education is as much the process as it is about the outcome. Self-directed learning promotes resourcefulness and discipline. It also makes the student accountable for his education. Because the student has actively chosen the path of his studies, he places a greater value on what is learned. In the modern world, it also creates an opportunity for a student to explore and develop his own interests and to adapt his studies to real world scenarios and experiences.

I lived in Australia for an extended period, during which, I took the opportunity to observe how hospitals and health care facilities used facilities to the benefit of patients. The use of technology helped in minimizing waiting time, assisted nurses and doctors in their tasks, improved efficiency and accuracy. This use of technology was not exercised not only in the high-end facilities but also in public hospitals. In stark contrast, I also worked in a Philippine local government hospital where I witnessed that there was a lack of resources, leading to problems such as not having a standard method of information data-gathering and patients experiencing delays in receiving medical attention. I would like to explore whether the prevalent use of technology, such as in Australia, can be replicated to some extent by our public hospital and facilities.  With this in mind, I’ve considered the following as possible areas of research: (A) because I’ve seen how long it can take to verify and re-verify the patient coming from one hospital to another, whether there can be a standardized system of patient information gathering and sharing among and between government and private hospitals – i.e. whether it would be possible for the hospital industry in to share a secured database for all the patients in the country, which would minimize the time it takes for patients to be admitted from a one hospital to another, may it be private or government; (B) maximizing mobile technology in improving patient care. Mobile technology such as tablets and smartphones have become affordable thus increasing accessibility.  This would be of particular help to low budget hospitals and health centers that would not have the capacity to purchase computers. I would like to know if there is a way to use this kind of mobile technology as a tool in improving the much needed improved data gathering of patient information and data access to help minimize the waiting time of each patient from the time they arrive in the medical institution until they are diagnosed and treated by the doctors; (C) whether mobile technology can be used by a barangay health center in monitoring data of its constituents, which would enable local government officials to: (i) ensure that it has the proper resources for the needs of its people such as medicines and equipment, and (ii) to promote the appropriate education/awareness campaigns and programs. I am hoping that in the course of my studies, I can get advice on which of the foregoing would be the most worthwhile pursuing or if these preliminary ideas can be further developed and formed into clearer research topics.

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Allons-y!

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