HITT 1211 Health Information Systems

Question: Case Study: Implementing A Telemedicine Solution Background Information: Grand Hospital is located in a somewhat rural area of the midwest. It is a 209-bed, community, not-for-profit entity offering a broad range of inpatient and outpatient services, employing approximately 1,600 individuals (1,250 full-time equivalent personnel) and having a medical staff of more than 225 practitioners. Grand has an annual operating budget that exceeds $130 million, possesses net assets of more than $150 million, and is one of only a small number of organizations in this market with an A credit rating from Moody’s, Standard & Poor’s and Fitch Ratings. Operating in a remarkably competitive market (there are roughly 100 hospitals within seventy-five minutes’ driving time of Grand), the organization is one of the few in the region – proprietary or not-for-profit – that have consistently realized positive operating margins. Grand attends on an annual basis to the healthcare needs of more than 11,000 inpatients and 160,000 outpatients, addressing more than 36 percent of its primary service area’s consumption of hospital services. In expansion mode and currently in the midst of $57 million in construction and renovation projects, the hospital is struggling to recruit physicians, both to meet the heawlthcare needs of the expanding population of the service area and to succeed retiring physicians. Grand has been an early adopter of healthcare information systems and currently employs a robust, proprietary healthcare information system that provides the following (among other components): Patient registration and revenue management Electronic health records with computerized physician order entry Imaging via a PACS Laboratory management Pharmacy management Information Systems Challenge: Since 1995, Grand Hospital has transitioned from being an institution that consistently received many more inquiries than could be accommodated concerning physician practice opportunities, to a hospital at which the average age of the medical staff has increased by eight years. There is a widespread perception among physicians that because of such factors as high malpractice insurance costs, an absence of substantive tort reform, and the comparatively unfavorable rates of reimbursement being paid physician specialists by the region’s major health insurer, this region constitutes a “physician unfriendly” venue in which to establish a practice. Consequently, a need exists for Grand to investigate and evaluate creative approaches to enhancing its physician coverage for certain specialty services. These potential approaches include the effective implementation of information technology solutions. The findings and conclusions of a medical staff development plan, which has been endorsed and accepted by Grand’s medical executive committee and board of trustees, have indicated that because of the needs and circumstances specific to the institution, the first areas of medical practice on which Grand should focus in approaching this challenge are radiology, behavioral health crisis intervention services, and intensive care physician services. In the area of radiology, Grand needs qualified and appropriately credentialed radiologists available to interpret studies 24 hours per day, 7 days per week. Similarly, it needs qualified and voluntary medical staff to attend to the needs of patients admitted by staff members such as some ED personnel. It also needs to have intensive care physicians available around the clock to assist in assessing and treating patients during times when members of the voluntary attending staff are not present within or immediately available to the intensive care unit. The leadership at Grand Hospital is investigating the potential application of telemedicine technologies to address the organization’s need for enhanced physician coverage in radiology, behavioral health and critical care medicine. What do you see as the most likely barriers to the success of telemedicine in the areas of radiology, behavioral health and intensive care? Which of these areas do you think would be the easiest to transition into telemedicine? Which would be the hardest? Why? If you were charged by Grand to bring telemedicine to the facility within eighteen months, what are the first steps you would take? Whom would you involve in the planning process and why? How would you go about conducting a needs assessment for the organization? Which parameters or system requirements would be most important to include in the needs assessment and why? Answer: 1. Some of the obstacles to the success of telemedicine within the areas of radiology areas highlighted below. The first one is the reimbursement problem. As an illustration, there are serious financial problems which arise because of the insufficient capital expenditure along with lack of reimbursement models which differs from different states. Just as the licensing laws, the reimbursement models usually vary from one Nation to the other (Eadie et al., 2014). When the reimbursement is limited, the patients within the affected areas are usually underserved, and in most cases, the cost of telemedicine becomes a burden which hospitals should bear. The second barrier is security concerns. Under these circumstances, the existing legal and regulatory rules surrounding privacy together with security has to be known clearly since they relate to telemedicine. Furthermore, telemedicine usually brings more sensitive data into healthcare space which may require hospitals to update their risk analysis together with privacy practices (Gagnon, 2016). The third obstacle is the online prescribing where physicians have to be in a position to prescribe medications to patients who are treated via telehealth. In that case, only around twenty states allow physical examinations via Telehealth tools (Mukherjee & Sharma, 2015). The last but not least barrier is Credentialing. The process of telemedicine credentialing can be very complicated like in healthcare centers which work from a hub and spoke model (Kahn, 2015). Which of these areas do you think would be the easiest to transition into telemedicine? As per my opinion, behavioral health is the easiest to transition into telemedicine. To understand this we must understand the area of behavioral health; It includes the well-being of mental health such as depression or anxiety and other mental health-related issues. There is a critical requirement of better mental health care, and the public has also become open to telemedicine that has made the behavioral health a comfortable area to transition into telemedicine. Other things that made it easiest option are: There is a shortage of psychiatrists in the U.S., and that is a huge problem, in this kind of treatment there is no need to go for physical examination, most of the times psychiatrists have to take sessions that can be possible with the use of Telepsychiatry such as tech software to video chat with patients online. So this way a psychiatrist in another state can now treat a patient living in a rural shortage area or another state (Mukherjee & Sharma, 2015). One of the most significant advantages that make telemedicine an easy option is that now patients are convalescing at home, mobile-challenged patients can have easy consultation from the psychiatry, if they have a way to connect to the internet, telepsychiatry enables them to access treatment (Fuhrman & Lilly, 2015). While the public has become open towards the treatment of behavioral health these days, but still there is a stigma problem for some patients. In this process, the patient should not fight social stigma and can ensure their privacy because therapy appointments can be made from home. Which would be the hardest? Why? As per my opinion radiology is the hardest to transition into telemedicine.T o understand this we must understand the area of radiology, it includes the specialty related to the use of radiation for the diagnosis and treatment of diseases, such as X-rays and ultrasound: consists of the diagnosis and treatment of diseases of the heart and vascular system (Mukherjee & Sharma, 2015). Teleradiology concerned with the practice of a radiologist such as medical images when the patient is not physically present in the location and images is generated. There is expensive technology required to use this facility such as mobile imaging, urgent care facilities. It is costly to get a Teleradiologist on-site. Cost of equipment involved and installation is very high and make it a hard option in this area (Ndlovu, Littman-Quinn, Park, Dikai & Kovarik, 2014). Privacy issues are also a problem: Use of Teleradiology led to the risks to patient privacy and confidentiality, and there are many studies which have emphasized the legal and ethical aspects of Teleradiology. 2. To bring Telemedicine to the Grand hospital within 18 months the first steps I will take are: Constructing a well-designed Strategic plan with Strategic goals Mission Vision Forming a Committee. Concentrating on Five project goals and methods. Searching for the best possible vendor for the facilities information system. Whom would you involve in the planning process and why? CEO CFO 2 top physicians 2 top radiologists 2 top psychiatrists, about 3 RNs or nurses Facility administrator, The office manager of each department 3. The first step that I will take is to determine whom I should ask which might involve interviewing the entire company pyramid. In that case, I would start with the senior level management where I might find the needs of the senior management vary significantly with that of the front line managers. I will also develop the questions to ask which will differ from one worker to the other. Lastly, I will have to tabulate the results after gathering all the results (Lilly et al., 2014). Which parameters or system requirements would be most important to include in the needs assessment and why? Some of the parameters to be considered are an external environment that the company exists within, the weaknesses and strengths of the Company. However, the frame factors should also be considered in this assessment (Weinstein et al., 2014). Conclusion In conclusion, the Grand hospital has to work hard and find new and innovative ways that cut costs and overcome the physician shortages especially within the field of radiology, intensive care and behavioral health along with improving the patient care outcomes. Accordingly, Telemedicine reduces the hospital readmission rates. Therefore, there is an efficient post-operation follow-up since the orthopedic surgeons usually spot-check the surgical wound in less than thirty seconds. References Eadie, L., Heaney, D., Dowie, L., Glynn, L., Casey, M., Hayes, P., & Alrutz, K. (2014). Implementing Transnational Telemedicine Solutions. In teemed 2014: The Sixth International Conference on eHealth, Telemedicine, and Social Medicine. Fuhrman, S. A., & Lilly, C. M. (2015). ICU telemedicine solutions. Clinics in chest medicine, 36(3), 401-407. Gagnon, M. (2016). Telemedicine: the value challenge. Plastic and reconstructive surgery, 137(2), 496e-497e. Kahn, J. M. (2015). Virtual visits—confronting the challenges of telemedicine. N Engl J Med, 372(18), 1684-1685. Lilly, C. M., Zubrow, M. T., Kempner, K. M., Reynolds, H. N., Subramanian, S., Eriksson, E. A., & Cowboy, E. R. (2014). Critical care telemedicine: evolution and state of the art. Critical care medicine, 42(11), 2429-2436. Mukherjee, A., & Sharma, M. (2015). Potential Support of Telemedicine for Lung Cancer Eradication in India. International Journal of Scientific and Research Publications, 99. Ndlovu, K., Littman-Quinn, R., Park, E., Dikai, Z., & Kovarik, C. L. (2014). Scaling up a mobile telemedicine solution in Botswana: keys to sustainability. Frontiers in public health, 2, 275. Weinstein, R. S., Lopez, A. M., Joseph, B. A., Erps, K. A., Holcomb, M., Barker, G. P., & Krupinski, E. A. (2014). Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers. The American journal of medicine, 127(3), 183-187.

HITT 1211 Health Information Systems

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