Question

The ABC Home Health Agency is a nonprofit, Medicare-certified organization established in the mid-1950s in a small Midwestern city. It is accredited by the Accreditation Commission for Health Care, Inc. The agency offers a continuum of preventive and therapeutic services that have an individual, family, and community focus. Clinicians provide services to patients ranging in age from infants to elders. The agency employs supervisory, administrative, IT, and support staff, as well as 45 clinicians: 25 nurses, 10 home care aides, 5 homemakers, 3 physical therapists, 1 occupational therapist, and 1 social worker. Staff members are on call 24 hours a day. ABC Home Health Agency services include (1) skilled home
health and hospice; (2) home care aide and homemaker; (3) private duty, including nursing, personal care, and respite care; (4) wellness, flu, and immunization clinics; (5) school health; (6) jail health; and (7) durable medical equipment. There are two hospitals with about 100 beds and 15 physicians
within the service area. The Agency has a good working relationship with both hospitals and the physicians. Many patients followed by the Agency have been referred from these services. Last year the Agency provided 20,345 home visits. The Agency has used an automated billing, statistical, and
financial management information system for 15 years. Clinicians enter all patient data using an unstructured, narrative, automated software system. The previous director, who has just retired, did not believe that the cost was justified to implement an EHR capable of capturing discreet clinical data to support tracking patientspecific assessment information, identifying the specifics of care, and generating outcome measures. You have just been hired as the new director. The board of directors asks you to investigate purchasing an EHR and submit your recommendations to them.

1. Should you introduce the clinicians to standardized terminologies and involve them in discussions about EHRs before contacting potential software vendors? Or should you contact vendors, select the best software, and tell the clinicians what you selected?
2. What steps would you need to complete before reporting to the board of directors?
3. What strategies will likely increase your chances of success? What strategies will increase your chances of failure?

Answer 1

Answer 1 : Introducing the clinicians to standardized terminologies and involving them in discussions about Electronic Health Record (EHR) would be more beneficial before contacting potential vendors. Since the clinicians will be the one who will be practically involved with EHR and their suggestions would give an insight on how it may leverage or effect the quality of health service provided. They may also be able to provide suggestions on which software may be a good choice. Moreover involving the clinicians will help in maintaining a good working relationship with them.

Answer 2: As a director my primary responsibility is that the Agency,s goals are met. Hence before reaching to a decision whether to purchase an EHR or not, the steps that need to be followed are-

- Proper planning on why, how and what need to be done.

- Assessment of the need of EHR.

- As mentioned above, a discussion with the clinicians would be beneficial as it would give an insight on how the introduction of EHR may be helpful to patients and the health care providers

- Listing out all the advantages and also the demerits of an EHR.

- Budget estimation of introducing the EHR in all the services within ABC Home Health Agency

- Contacting vendors, selecting the best software

- Analyzing the efficacy of the software

- Cost-Benefit analysis

- Proper analysis of the data collected

- Making the report

Answer 3: The strategies that are likely to increase my chances of success are-

- Proper analysis of the advantages and disadvantages of Electronic Health Record.

- Having a clear picture on how the EHR would benefit the Agency in achieving its goal of providing high quality preventive and therapeutic services that have an individual, family, and community focus.

- Having a proper understanding on how EHR will help in organizing the health service provided in a structured manner and also strengthen the referral to both the hospitals.

- Proper Planning on how and when the EHR would be implemented and how all the staff will be trained on its use before its implementation.

The strategies that are likely to increase my chances of failure are-

- Collecting Incomplete information

- Ignoring the relationship the Agency hold with both the hospitals and the physicians.

- Training all the staff before introduction of EHR may pose a challenge.

- Ineffectiveness in handling he challenges that may occur during the gap in Implementing the EHR software and it's use .