Posted: May 25th, 2022

Electronic Health Records Essay

Health Care continues to undergo fundamental change. Legislation such as the affordable care act has created a much higher percentage of insured citizens. Patent legislation is now allowing for much more competition for popular drugs. Generic drugs in particularly which are cheaper for consumers and much more profitable for producers are now eroding the market share of popular products. Even the use of cloud computing is changing the way care is administered within a facility. Even with these innovations, facilities still struggle with bloated cost structures, inefficient behavior, and lack of staffing. MGH is not different in this regard. It suffers from a large influx of patients with the inability to provide timely care. Below is a description of the issues combined with possible real world solutions.

Describe the current process and identify the specific areas that slow the process.

The current process has is inadequate primarily due to staffing issues related to PATA. First, only 65% of patients are actually seen during their scheduled appointment time. Of those, many of them have waited nearly 4 hours to simply see the doctor. This congestion is exacerbated, as guidelines are not clear for when an examination is even needed. The specific areas that slow down the process consist of redundant information gathering. In many instances, patients have to repeat the same process over within the same visit. Paperwork and questionnaires are done multiple times, even though they ask the same questions.

In also appears that the overall staff is overloaded with patients. Thankfully, MGH is world renowned for its quality of care and medical expertise. Many patients are willing to travel long distances to simply utilize this high level of medical care. Unfortunately, staffing or the facility itself is not adequately addressing the influx of patients. Currently 34,000 surgeries are preformed each year. However, MGH only has 52 operating rooms. As a result, coordination between all stakeholders is very difficult due primarily to time constraints, inefficient systems, and lack of available space within the facility. For example, incomplete or missing work-ups often delay the start of surgery. With surgery being delayed, other patients are then forced to wait. The bottleneck continues as the facility only has 52 rooms, all of which are in use. These delays contribute to roughly 57,000 minutes of lost productivity a year.

The charge nurse also appears to slow the process down. It appears that the charge nurse manually keeps track to patients and assigns them on a first come first serve basis. However, because the inputs are manually done as oppose to electronic, errors can occur. Specifically, the charge nurse can simply forget to the assign the patient. As a result, two provides could work with the same patient thus creating inefficiencies. In addition, the system relied heavily on provides informing the nurse when they were available to see a patient. Without proper communication, providers may go do other tasks, purposefully not inform the charge nurse, or simply forget to do so.

Describe whether the proposed options in the case make sense and could any of them be a solution.

Many of the proposed solutions to the case make sense. In particular, the solution regarding electronic medical records would make the largest impact on revenue, customer service and efficiencies (Roukema, 2006). Although the initial start up, training, and implementation costs are high; an electronic medical records system would reduce many of the causes of inefficiencies within the facility. Namely, electronic records and transfers would allow patients to complete needed paperwork at home prior to their arrival in the facility. In addition, RN’s would be able to review this information prior to the patient’s arrival. Currently, an RN spends 27 minutes reviewing past medical history. They spend another 11 minutes providing assessments and explaining procedures. The average patient is spending nearly 2 hours in the facility. Assuming that an RN can review the medical records prior to the patient’s arrival, nearly 25% of the patients wait time would be reduced.

I believe the electronic system could be a solution as it has implications for the entire facility as oppose to simply one particular aspect. The other solutions, such as expanding the facility and increasing hours are viable but not as impactful as the electronic system. With expansion, the facility will constantly need expansion as the general population continues to grow. In addition, the baby-boomers are nearly retirement, which will also require a constant influx of expansion at the facility. Although this expansion, at some point will be warranted, it does not address the fundamental problem of inefficient activity. Of all the solutions, the electronic medical records solution gets to the root of the problem with a simply and effective solutions.

Based on your analysis, make specific recommendations on how the current process could be modified to increase capacity.

The simple solution would be to add more rooms. Although this is simply, it is not the most practical as the activities of the firm are not efficient. Therefore in addition to adding more rooms, I would eliminate the charge nurse role altogether. I would also call for the immediately implementation of electronic medical records. Implementation of an EHR system, for example, would expedite processing times, increase efficiencies, and improve customer service. For example, the nursing assessment form and anesthesia consent form are required by law and must be completed by an RN and an MD, respectively. Through electronic means, the RN or MD can complete these forms prior to the patient’s arrival.

Conclusion

In conclusion, the solutions presented above are mainly derived from technology. MGH and PATA should heavily utilize technology to make their operations more efficient. As the case noted, simply expanding operations or hiring more people is not an option. Instead, the facility must become smarter with how it uses its time. The solutions presented above to just that. The elimination of the charge nurse, clear guidelines on when to see a patient, the use of electronic records, and having patients pre-fill out any necessary documents all increase inefficiencies. This will ultimately reduce costs; increase customer service, and work place moral.

References

1) Roukema, J.; Los, RK; Bleeker, SE; Van Ginneken, AM; Van Der Lei, J; Moll, HA (2006). “Paper vs. Computer: Feasibility of an Electronic Medical Record in General Pediatrics.” Pediatrics 117 (1): 15-21

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