INTRODUCTION Electronic Medical Records (EMRs) are “a system that integrates electronically originated and maintained patient-level clinical information, derived from multiple sources, into one point of access” (Kazley, 2007, p. 375). I would like to propose an organizational change to implement this documentation at the Home Health Agency where I am employed.
This paper will address the need for EMR, barriers to change, factors that might influence implementation of an EMR, organizational readiness for the change, the theoretical model that relates to implanting EMRs, resources available to support the change, and methods used to monitor implementation of the EMR. THE NEED FOR ELECTRONIC MEDICAL RECORDS There is a great need to implement EMRs in the Home Health Agency where I am employed. The rationale for this change is related to improving patient safety, efficiency of the Agency, financial reimbursement, effective communication, and patient outcomes.
Paper documentation is no longer efficient or readily accessible to all Clinicians. An EMR will standardize medical terms, decrease documentation errors, improve coordination of patient care and allow all employees in the Agency to access the same database of patient information, therefore enhancing continuity of care between disciplines (Kunz, 2010). According to Tillett (2012), President Obama hopes to computerize the nation’s health records in five years, saving the nation billions of dollars in health care costs.
In an effort to support this transition, the government has allocated $20 billion to enable healthcare institutions to develop and implement health information systems. There is currently no mandate for the use of EMRs, but there are financial incentives for compliance to encourage health care organizations to implement it by 2015. My Agency is making the transition for these reasons. BARRIERS TO CHANGE According to Kunz (2010), there may be several potential barriers to embracing an EMR. An Agency has to consider that the selection and implementation of the electronic system is expensive.
Purchasing the software and the documentation device, developing the system to meet the Agency’s needs, and training the employees to use the system can be very costly. Also, some employees may resist accepting and adapting to the new system because they are satisfied with the status quo. Employees will better support changes when the rationale for the change is given, the final outcome is envisioned, and the employees are encouraged to participate in the change development (Noah, 2011). FACTORS OF INFLUENCE
Factors that might influence this proposed change include employee commitment, quality of the leadership, and a clear vision. The level of employee commitment to the organization will influence the success of the change effort. When employees are engaged and motivated, their commitment to the success of change efforts increases according to Noah (2011). The quality of the leaders and their skill level of leading change will influence how well the implementation of an EMR occurs. According to Kunz (2010), a clear vision will help align people toward a common goal, which will increase success for the change.
Employees need to realize that implementing an EMR will improve the documentation process, making it more efficient and more effective. ORGANIZATIONAL READINESS Factors that can influence organizational readiness for an EMR include effective leadership, committed individuals and effective communication. Noah points out that “effective leadership and sound change management processes are vital ingredients in making the shift from paper to electronic health records” (2011). Without this in place, EMR implementation is likely to fail.
Leadership must consider the issues faced by the individual users. Critical ownership among the individual employees is crucial in the early implementation phase. Any employee that has any interaction with the patient’s medical record should be involved in the design and work flow of the EMR. This involvement allows the individuals to feel they have ownership of the EMR. Lastly, communication is critical to raise awareness of the rationale for and implementation of the EMR, and also to keep all the employees up to date regarding the upcoming change (Noah, 2011).
THEORETICAL MODEL The theoretical model that relates to implementation of an EMR would be goal setting as developed by Latham and Locke. There are three steps in this model including setting the goal, obtaining goal commitment and providing support elements. According to Borkowski (2005), the goal of the organization must be specific and measurable, challenging yet reachable. In the case of an EMR, the goal would be for all users to transition smoothly and easily to electronic documentation.
In order for this to occur, obtaining goal commitment from the employees is crucial. Managers need to provide training on the EMR to increase employee’s skills and knowledge of the program and therefore their self-confidence that the goal can be achieved. Lastly, managers must ensure that employees have adequate resources like equipment, time; training and IT support to ensure a smooth transition from paper documentation to an EMR. RESOURCES TO SUPPORT CHANGE Ongoing training is one resource available to support implemetation of EMR.
Allocating enough resources and time to training is imperative. Training will start from the time the computer program is initiated and continue well after implementation. Owens (2008) points out that with a rapid rollout of the documentation system, there will be a steep learning curve for the employees, reduction in productivity for a short time, and increase need for technical support to fit the system to their needs. Knowledgeable IT personnel will be an important resource for the employees as they navigate the new system.
Maintaining a successful change also requires putting the right people in the job, training employees for success, sharing data that reinforces the value of the change, and monitoring for return to the “old way” of doing things. METHODS TO MONITOR CHANGE Effective long term change implementation requires new skills and competencies on the part of the Agency’s employees. According to Spector (2010), reinforcing new behaviors and skills of the employees helps build their commitment to the implementation of an EMR.
In order to monitor this, it is important to get regular feedback from the employees using the EMR to determine their acceptance and use of the system, as well as find out any problems in work flow that might interrupt their documentation. If problems are identified, it is important to address them quickly to maintain efficiency. CONCLUSION In conclusion, the use of Electronic Medical Records (EMR) is a growing trend in part due to government incentives to adopt this method of documentation.
Home health clinicians are on the frontlines of health care in the home and their participation in the design, implementation, and follow through of an EMR is crucial. It is also crucial to support and train employees thoroughly and provide resources for them on going in order for the implementation to be successful. According to Gjevjon and Helleso (2009), home health nurses face different challenges than nurses in institutionalized care because of a focus on chronic illness rather than acute disease. The need for comprehensive nursing documentation in home health is significant and electronic documentation can help facilitate this.