EMR: The "Write" Choice
The Health IT for Economic and Clinical Health Act (HITECH) attached to the American Recovery and Reinvestment Act (ARRA) of 2009 established incentives and reimbursement to all health care providers. HITECH required all health care providers to initiate electronic prescribing of medications and health records. Both of this Acts started a whirlwind for health care providers including hospitals, clinics, pharmacies and Information Technology (IT) companies to fall in line with the mandates. The health care providers seeking software to meet their needs and IT companies scrambling to develop programs to meet those needs. The move from paper to typing (free hand) notes or click on drop down options became a necessary update for all involved.
The Center for Medicare and Medicaid (CMS) concluded that electronic prescribing and medical health records would offer and increase patient safety, patient education and faster transferring of information.
Innovation Plan
My innovation plan addresses training students in recording the eye exam electronically as well as on paper. An ophthalmic medical personnel (OMP) should be able to receive and record the same information from the patient whether the tools are mouse/computer or pen/paper. The OMP should deliver the same respect and excellent standard of care to the patient, even when maneuvering between different screens and pop-ups. Multi-tasking, communication and critical thinking are must skills the student must possess or quickly develop to be a successful OMP in the workforce.
Presentation on EMR Innovation Plan
The EMR presentation displays some of the crucial points involved in installing an EMR program. It will help those non-clinical individuals understanding the importance of training students on medical charting electronically.
The transfer from the use of paper charts to an electronic chart is not an easy accomplishment. Several elements must be considered and reviewed to determine the proper software, program, vendor and staff training options before the purchase and installation begins. Those same elements must be examined and benchmarked before initiating training of the eye care program student.
Literature Review
After comprehensive investigation and review of the literature, I have been able to justify and make small adjustments in my innovation plan.
The justifications are the eye care student must be proficient in preforming an eye exam using electronic and paper charting and recording upon completion of OPTS 2441. The skillful student will be an asset to the clinical practicum site without spending several hours learning electronic medical charting the first few weeks. Valuable time best used in developing other medical and technical skills required for certification.
Lessons Learned
The textbooks and tutors available on electronic health records have good general medical charting tools. The only problem is they are not ophthalmology/optometry specific and thus not a tool for the eye care student’s needs. The cost out ways the benefit for the student.
Purchasing an EMR system for charting mock patients is a costly endeavor that would involve the college's IT support. This endeavor would require finding a vendor that fits all clinical practicum sites requirements and the approval of IT's ability to handle a larger network of information. Not all electronic medical records are created equally. Again, a lot of manpower and resources involved for non-existing patients.
Developing a program from scratch to see real-clinic patient's would not be beneficial and more costly than purchasing from a vendor. But for the practical use in our laboratory settings of mock patients, an in-house remedy will achieve the goal of addressing the innovation plan of EMR training.
Adjustments Made
One adjustment learned is don't completely leave paper charting out of the training. There may always be an occasion to chart with pen and paper. Those occasions are when the network is down, in the mist of changing vendors and offices still using paper and scan chart into a system.
The second adjustment is to develop San Jacinto Eye Care's electronic medical record form using a Microsoft platform. This will be added to the current paper forms mimicking clinical sites. By using several methods of charting, the student will understand being fixable with converting from one system to the next. The student may experience up to four different clinical sites, all of which have different methods of charting, paper and EMR.
Adding to the in-house medical record form will be electronic prescribing of medication screen to complete. The screen will give the student exercises in completing a prescription of the most commonly used medications in an ophthalmology office.
Patient education information will be available on Blackboard to aid the student in preforming verbal patient instructions.
Each student will submit their EMR work-ups to at the end of each lab. The student will be given feedback and be able to see what improvements need to be made in the next class/lab. The mock patient will show-up again so the student can follow the physician's orders for the next visit.
These small adjustments will met the student learning outcomes for the course and be cost-effective for the student, program, and college. The adjustments will enhance the clinical practicum experience for both the student and the site.
With the end result of developing and providing a well-trained OMP to the workforce in the community, state and internationally.