How to make EMR Adaption Easier for Small Practices

Electronic Medical Recording (EMR) systems integrate several databases in one program or into several other interrelated systems.  The system has been used for a long time, but not as an essential process in producing, maintaining, and processing electronic health records. However, licensed clinicians and staff are the critical practitioners required for the success of this healthcare system. The establishment of EMRs in hospitals will substantially benefit physicians, health care organizations, and clinical practices. Besides, these innovations will simplify the process and increase patient care quality and safety. The latest surveys have shown that only 4% of out-patient physicians have vital and well-functioning electronic records, and 13% have a transparent structure in their reports. This paper aims to illustrate how to make EMR to be adopted for small healthcare practices using networking, information technology, and data management skills.
For treatment at all healthcare services levels, the exchange of expertise and the sharing of data between patients, healthcare providers, healthcare agencies, and the economic climate are essential. For the effective diagnosis and treatment of an individual patient, the patient's medical records should be clearly defined in the system. Besides, information on patient needs, beliefs, and essential administrative information are needed for the status and availability of support services, such as staff and hospital beds.

Networking and Data Communication

Networking and data communication is an essential tool for sharing of data in a secure network or channel. The process mainly relies on data accessibility through the available network, such as a wide-area network (WAN). The data network can be viewed through a range of interconnected computer systems and terminals as a collection of databases hosting various user groups. Such a network will typically have a range of attributes. Second, databases are distributed over many machines; every database or database population supports one or more computer systems. Second, physically, but not generally, most computer systems are far apart. Third, all network computers are interconnected so that it is possible to relay information from one system to another. Each machine has software to share information between various network systems at the end of the day. Every network user can query and receive a variety of databases, evaluate and aggregate them. This research focuses on networks where a relationship parameter connecting records in one database to others is one or more common data elements.

 Databases may be connected to the data network through physical arrangements. The arrangements include telecommunications, for example, the physical transmission of magnets or disk magnets, local area networks, public networks, and contacts (Sun, Cai, Liu, Fang, & Wang, 2018). This research applies to one or more such communication networks, i.e., the word network does not mean that there needs to be electricity between computers instead of the common language used in the electrical network by trained computers. Figure 1.  EMR Data Processing Flow. Adapted from ‘Journal of Healthcare Engineering,’ by  W.Sun, Z.Cai, Y.Li, F.Liu, S.Fang, and G.Wang, 2018, Data processing and text mining technologies on electronic medical records.

Importance of Information Systems in Project Management

The use of IT offers an integrated opportunity to maximize the excellence, performance, and competence of facilities and staff while minimizing organizational overheads. This is a critical approach. Electronic Medical Records (EMRs) are considered by incorporating various information services such as test ordering, electronically administered items, decision support systems, visual imaging, and telemedicine to strengthen the clinical decision-making process. However, integrating this research into standard clinical practice would lead to a health care system that is safe and reliable. Previous studies have confirmed a wide range of EMR benefits. One of the main advantages is improved clinical quality, making it easier for patients from multiple providers to access essential health information that dramatically increases the integrity of the service and healthcare practices' efficacy (Brundin-Mather et al., 2018).
Advancement in Electronic Medical Record Technology (EMR) has enabled the replacement of some conventional functions. The application of EMR systems articulates to make a considerable difference in inpatient care. It is also necessary to consider the unintended consequences associated with the EMR if the undertaking is convincing. For instance, every new focus, such as a medical or patient paper map, can be distracting. Patients may find less personal electronic medical knowledge or fear that when a record is placed in a computer database, confidentiality may be dealt with more readily. Similarly, doctors may be concerned about the need for a machine instead of a patient or find it challenging to adapt to the latest technology.

It is helpful to note that all contact events, such as knowledge clarification, occur at a specific meeting to establish the interactions between doctors and patients, as the expectations of contact between patients and doctors often rely on actual behavior. Exposure to communication may indicate whether and how EMR influences the relationship between doctors and patients. Therefore, the Task Approach is used in this study to begin analyzing the patterns of communication of doctors using EMR (EMR) as opposed to those using only paper records. In line with this focus on measures to analyze how the EMR and the control doctor use the method and records during their respective studies, we explore the qualitative aspects of the relationship between doctor and patient.

Database Management

There are a variety of different meanings in the word database: from a doctor's paper to a significant computerized archive of Medicare beneficiary claims; computerized patient experience files that cover health care plans for the discharge of abstract databases from all healthcare facilities in a specific state; injury and cancer records kept by healthcare facilities. This research discusses secondary information systems, while databases can essentially be linked to health practitioners' primary medical records. As in the case of a health plan and public service eligibility or registry files, secondary documents are taken from source records or separate from any patient experience. They are not subject to any health center such as a hospital medical records department, expertise, or supervision of a practitioner or an individual appointed by a practitioner. Furthermore, they do not provide the prescribing physician with a primary source of information for particular cases. Secondary databases allow for the re-use, such as health care, billing, or research of the data collected to be used in a specific context.

Key Attributes of Databases

By evaluating a wide variety of databases available, maintained, or acquired by HDOs, the Committee attempted to define critical characteristics. In the analysis, an example of this was given. Demographic information includes gender and ethnic origin, race, date of birth, age, marital status, address of residence, immediate family names, and other emergency details. Details may also be visible on job status and employment status, education, and a hint of socio-economic classes. Medical care details such as availability and affiliation, dual coverage, and the co-payments and deductibles required by the benefit package in question are included in administrative statistics. These data often contain costs and possibly sums charged for the services given, such as out-patient treatments or diagnostic tests. Administrative data typically refers to a single contractor with accurate provider data, including a doctor, physicist, podiatrist, psychologist, the doctor's specialty, and the nature of the organization.
Health risks and hazard awareness reflect patterns and practices, such as whether a person avoids or uses heavy tobacco and genetic and family histories, for example, whether a person has first-class family members prone to musculoskeletal disorders or cancer.

EHR Database Prototype

The below prototype shows the activities performed by a clinician mapped to EHR components for managing immunization administration.
Figure 2. EHR Database System for Managing Immunization Records

Mocking Interfaces

In the past, present, and future cognitive functioning, health issues, role, and social functioning, physical activity, emotional and mental well-being, and perception of one's health instead of one's peers, individuals themselves are usually registered (Brundin-Mather et al., 2018). Medical and qualitative quality of life assessments is widely used as a health care product. Still, this expertise from evaluators and researchers is often required by combining patients and various particular health conditions in their trials. Patient history also provides detailed knowledge of past medical conditions and events that may have been family history or injuries such as alcoholism or parental divorce and details of prior medical experiences such as hospital admissions, surgery, childbirth, live births, and the like. Again, to mix and adjust the seriousness of compelling patient treatment cases, this data can also be useful. To ensure that the forms or sections of the patient record are accurate, current medical administration is essential. These details can include health screening, diagnosis, current conditions, allergies, diagnostic or therapeutic procedures, laboratory tests, prescription drugs, and therapy, especially drug-related. The resulting projections include a broad spectrum of healthcare and mortality outcomes for various health conditions at high levels of functionality and well-being; they include health care events, such as in-house re-admission, unintended complications, and side effects. Furthermore, it is crucial to provide satisfaction metrics for care. The results assessed weeks or months after a health event and directly from patients or family members through reports are optimal, but they may be the least prevalent in these secondary data sets.

Disadvantages of Epic Database

If someone, without the user's permission and consent, has access to sensitive health information, the privacy of patients is breached by a confidentiality breach. Two recent injuries at Washington's Howard University Hospital have shown that many individuals may have poor data security. Federal prosecutors accused the hospital medical technician of breaching the Portability and Transparency Act of Health Insurance (HIPAA) on 14 May 2013. The hospital contractor had access to the patient's laptop files that had been stolen from his vehicle. The information has been locked but not encrypted, meaning that anyone worried about a password will have access to patient data without a randomly created key. By encryption, we refer to the encoding of data so that only authorized parties can read it. Usually, using the encryption key that determines how the data can be decoded, this is done. These reports sent names, addresses, social security numbers, and, in some instances, "diagnostic material" to Prime Health Care Providers Inc., according to the Hospital News Release. A good understanding is a challenge that doctors, public health officials, and federal regulators are just starting to recognize.
Epic is more interested in promoting records among Epic customers instead of using other hospital vendors. It refers to the CommonWell Health Alliance, a collaboration based on standards for sharing health information between EHR suppliers, including Cerner and Athenahealth. Epic doesn't belong to the CommonWell Party. Until recently, Epic users could share records freely with other Epic users, but a fee had to be charged by users who had chosen to share records with providers using other vendors. However, Epic revealed that non-epic EHR suppliers would not be paying a fee to share the record in April.

Internet versus Intranet Difference

The Internet is used simultaneously to connect a variety of networks to computers. It is a public network, which ensures that anyone can use the Internet. It provides users on the Internet with an infinite amount of information and a range of users. According to Moussa (2016), the Internet is a global infrastructure that links different electrical devices worldwide using the TCP / IP protocol suite. The Internet is a network of interconnected computers that is worldwide. A network of public, private, and commercial networks, including networks, banking, academia, business, and government, is the Internet. The Internet is a form of network and is referred to as a network. It is a private network, meaning that there is no access to the intranet for other users. There are a small number of intranet users, and their users are given a limited amount of information.
The IT networks use Internet protocols and network communication to access and exchange information and communicate with employees. An intranet is a private computer network. It has the same types of client servers that operate on the TCP / IP protocol suite, similar to the Internet. With the support of a browser, company details can be accessed. Without the need for special software, it could also run on the client's machines. The Internet is a network created by connecting a vast number of networks of computers not managed by someone else. To be governed by it, no government needs anyone to enter the country. In addition to other protocols, including FTP, HTTP, and SMTP, the Internet Key Driver used in the connected network is the TCP / IP protocol.

References

Brundin-Mather, R., Soo, A., Zuege, D. J., Niven, D. J., Fiest, K., Doig, C. J., & Stelfox, H. T. (2018). Secondary EMR data for quality improvement and research: a comparison of manual and electronic data collection from an integrated critical care electronic medical record system. Journal of Critical Care, 47, 295-301.
Moussa, M. (2016). Internet, Intranets, and Extranets in Organizations: An Integrative Literature Review. SIU Journal of Management, 6(1), 1-39.
Sun, W., Cai, Z., Li, Y., Liu, F., Fang, S., & Wang, G. (2018). Data processing and text mining technologies on electronic medical records: a review. Journal of Healthcare Engineering, 2018.

Still Alice by Lisa Genova: Case Management Review

 

Still Alice by Lisa GHenova: Case Management Review

Introduction

            Management of the client’s psychological needs is a critical practice that should be adequately addressed to achieve desired mental health. However, therapy needs amongst the clients accompanied by a host of socioeconomic factors could constrain service delivery. In this case, caregivers are caught in the epicenter of which ideal practice should be employed to guarantee their clients quality services. The book Still Alice by Lisa Genova lends itself to the topic as a compelling case to review in the appraisal of processes involved in managing diverse client situations. The book presents Alice's case, the main female character who suffers from early-onset Alzheimer's disease, and the family struggles to provide the support that should be best sufficed with family-centered intervention.

Issues to Review

The causes

           Researchers have not yet agreed on the real causes of early-onset Alzheimer's. It is only suspected that two proteins get damaged, killing the nerve cells in the end. One of the damaged proteins develops into plagues while the other forms tangle (Kandimalla et al., 2016). These two features are noticeable almost in every person at the aging stage. In the beginning, plagues and tangles damage memory areas that are within the brain. In the long-run, the entire brain is attacked. 

Etiology

           On-set Alzheimer's is caused by old age and hereditary factors. Aging people are vulnerable to memory lapse and are most likely to suffer from on-set Alzheimer’s. In other cases, hereditary factors could be the cause of the condition. In this case, it can be noticeable in people aged as early as 30 (Bird, 2018). 

Interventions that have tried and failed

           On-set Alzheimer's is a condition that affects the health well-being of the patient. To combat the disease, doctors have tried to use pharmacological interventions such as Aricept, razadyne, Exelon, and namenda (Hung & Fu, 2017). However, these drugs are only meant to slow down the rate of memory lapses. In addition, psychotherapy interventions are deemed the best strategy to deal with related mental conditions, have been employed, but failed. The psychotherapy approach has been unable to correct the on-set Alzheimer's disease Alice is experiencing. The failure in psychotherapy is to manage adequately the condition due to the absence of widely defined guidelines for nurse psychotherapists.

The role of the family in providing care

           Family members play a critical role in helping the patient cope with any health-related issue, particularly mental condition. For instance, as inferred to the case, Alice's family members are concerned about on-set Alzheimer's disease she is experiencing (Genova, n.d). However, whether they are doing all it takes to offer Alice full support alongside nurse psychotherapy remains unclear. As such, nurse psychotherapists should explain to Alice's members that they are responsible for helping their mother manage the condition.

Initial Assessment

Alzheimer's condition can be assessed in many ways. Observation and interview approaches are regarded as the appropriate approach. For instance, as revealed in the case, Alice has on-set Alzheimer's signs. These signs can be seen as she appears to carry out her daily activities and forgets about herself. Interviewing Alice by asking her simple questions, struggles to find appropriate answers. A nurse psychiatrist should structure these two approaches before commencing on a treatment plan action to help Alice manage the condition. 

CM theory, models, how do these fit with your client?

       The psychological health needs of patients are varying and complicated. Because of this reason, a nurse psychiatrist should tactically approach the case. A tactical approach will need a case manager to use a scientific case management framework and concepts. While referring to Genova case management, she explained in a structure that encompasses nine steps that should be used by case managers to guarantee quality psychological services (n.d). The effective psychiatric process's nine steps include screening, assessing, stratifying risk, planning, implementing, following-up, transitioning, communicating post-transition, and evaluating (Genova, n.d). Whichever the condition a client could be diagnosed with, the nine steps framework approach is deemed ideal. However, while these steps are suitable for psychiatrists, there are notable gaps in knowledge execution and delivery of services amongst case managers. These gaps in service delivery are attributable to the use of different concepts. For example, a psychosocial concept comprises knowledge touching on cultures, clients, social networks, and support teams play to enhance the client's health (Emery et. al, 2019).

On the other hand, rehabilitation concepts are comprised of knowledge that touches on the client's occupational and physical health functioning (Frankel, Gelman & Pastor, 2018). As such, a case manager who uses either of these concepts will reveal an alteration in knowledge service delivery. Whichever way, the tactical approach case management, which requires a case manager to use scientific framework and concepts are ideal. For instance, the scientific framework provided steps for a high-level case management process ideal for managing related mental conditions such as Alice Alzheimer's case. It is worth noting that psychosocial and rehabilitation concepts provided many options for a case manager to choose from to develop an ideal treatment plan. In particular, major depression requires a treatment plan that has a combination of both the two concepts postulated in this paper. 

Signs of onset Alzheimer’s

           Signs of onset Alzheimer's vary depending on the psychological response of the patient. For instance, in Alice's case review, she presents the following symptoms; foremost, she loses her memory and cannot remember simple things about her life. Also, she cannot trace her home, located a few meters away from where she lectures. Loss of appetite is also another sign and is evidenced in Alice when she loses weight.  

Guideline Questions

      A nurse psychiatrist must ask his/her client questions to gather information, which should be used to implement a treatment plan. Some of the most probable questions include; how often have you felt depressed, down, or hopeless in the past two weeks? A client who expresses to having felt down for more than half the days or daily for over the past two weeks is a clear indication of onset Alzheimer's. Have you had suicidal thoughts? How is your sleep? How is your energy? Do you opt to stay at home or prefer to go out to do new things? Do you have any relatives who had been diagnosed with onset Alzheimer's? Do you have a family? How many children do you have?

Conclusion

      In conclusion, this paper sought to review Still Alice, where Alice is the main female character. The book reveals that she has early-onset Alzheimer's disease and whom the family struggles to provide the support that should be best sufficed with family-centered intervention. In this regard, Genova advised that a nurse psychiatrist should employ a nine-step framework to guide a client through the treatment plan (n.d). However, the fact that nurse psychiatrists have employed the nine-step framework has some noticeable changes that constrain their service delivery. These changes have been mainly attributable to the use of psychosocial and rehabilitation concepts strategies. These two concepts provided many options for case managers to choose from to develop an ideal treatment plan. As a result, some nurse psychiatrists do not adequately stick to the two concepts' guidelines, thus compromising service delivery. Therefore, nurse psychiatrists should adhere to the framework and concept guidelines to enhance their service delivery. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Bird, T. D. (2018). Alzheimer disease overview. In GeneReviews®[Internet]. University of Washington, Seattle.

            https://www.ncbi.nlm.nih.gov/books/NBK1161/

Emery Trindade, P. G., Santos, R. L., Lacerda, I. B., Johannessen, A., & Nascimento Dourado, M. C. (2019). Awareness of disease in Alzheimer’s disease: what do patients realize about their own condition?. Aging & mental health, 23(10), 1292-1299.

https://www.tandfonline.com/doi/abs/10.1080/13607863.2018.1488945

Frankel, A. J., Gelman, S. R., & Pastor, D. K. (2018). Case management: An introduction to concepts and skills. Oxford University Press.

http://www.amazon.com › Case-Management-Third-Introduction-Concepts

Genova., L. (n.d). Still Alice: Case management review. Retrieved on 7^th, august, 2020 from < https://cmbodyofknowledge.com/content/introduction-case-management-body-knowledge>

Hung, S. Y., & Fu, W. M. (2017). Drug candidates in clinical trials for Alzheimer’s disease. Journal of biomedical science, 24(1), 47.

            https://link.springer.com/article/10.1186/s12929-017-0355-7

Kandimalla, R., Manczak, M., Fry, D., Suneetha, Y., Sesaki, H., & Reddy, P. H. (2016). Reduced dynamin-related protein 1 protects against phosphorylated Tau-induced mitochondrial dysfunction and synaptic damage in Alzheimer’s disease. Human molecular genetics, 25(22), 4881-4897.

            https://academic.oup.com/hmg/article/25/22/4881/2525916