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School
Western Governors University *
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Course
C427
Subject
Health Science
Date
Jan 9, 2024
Type
docx
Pages
8
Uploaded by MagistrateJayMaster719
C427 Technology Applications in Healthcare
Brooke Rayl
010779249
Western Governor’s University
July 9, 2023
A. PLAN - The organization should require mandatory training for all new hires that should be completed within the first week of their start date. Current employees will also be required to complete annual training and competencies to ensure that all staff are up to date with current HIPAA regulations and hospital policies. Training will consist of a presentation by management during new employee orientation for all new hires, as well as online training with a competency annually for all current employees.
ORGANIZE – New employee orientation and onboarding is managed by our Human Resources department. Their team will be responsible for communicating the education and training materials to all new hires. They will schedule time with management for a presentation during the new employee orientation day. Human Resources will also be responsible for pushing out the
online education and competency annually to ensure all staff are trained and understand the rules
and regulations surrounding HIPAA. DIRECT – Human Resources will utilize handouts, as well as interactive discussion to educate all new employees. The ongoing, annual education can be a voiced over PowerPoint or a recording of management going over current HIPAA rules and regulations, both with a quiz at the end to ensure all employees are competent. The presentation at new employee orientation will be interactive allowing for engagement from trainees as well as the ability to ask questions. CONTROL – Competencies will be completed during a new employee’s first week of employment, as well as annually for all current employees. We will continue to mandate these competencies to ensure all employees understand and follow all HIPAA rules and regulations throughout the organization. Training will be mandatory in order to continue employment at the organization. If an employee fails to comply within their designated timeframe, the employee will be placed on a temporary suspension until training has been completed in order to maintain compliance with ACHC.
a. Three types of PHI that can be shared between staff are patient’s date of birth, name, and social security number.
i. This information should only be shared in a private location away from other patients, visitors, or unnecessary staff members that are not relevant to the care of the patient. This would include treatment and exam rooms, physician offices, or other private offices where others cannot overhear discussion.
ii. Three individuals that can use and disclose this information would be physicians, clinical staff, and ancillary staff such as Laboratory and Medical Imaging staff.
b. One penalty associated with breaching patient information is a fine of up to $100 per violation and up to $25,000 per year. Another penalty is a fine that can range from $50,000 and 1 year in prison up to $250,000 and 10 years in prison for the intentional misuse of PHI.
c. In order to secure data from one working shift to another the organization will utilize unique passwords or biometrics. This would require each user to log in to the EHR with their own individual credentials. There will be a digital record of who requested or accessed what information and when. We can also limit access to certain
information based on the employee’s role within the organization. This ensures that only those employees involved in the care of the patient can access the patient’s record.
2.
a.
An internal audit of all security measures meant to protect health information will be conducted by the Information Technology (IT) department. The health IT leader will oversee the audit. This department is the most knowledgeable department in electronically securing PHI within the EHR.
b. The audit will review certain security practices. One practice will be the review of all employees, both inactive and active. We must ensure that previous employees that have been terminated from the organization have had their access to the EHR revoked. We must also review the access that all current employees have been granted. With roles and responsibilities changing from one employee to another, we will ensure only necessary permissions are given to the appropriate employees. Both lists can be reviewed by management and reconciled by the IT department. Another security practice to audit is to ensure the organization is properly disposing or storing any paperwork with PHI on it. The organization needs to follow the appropriate steps to shred documentation that needs destroyed. Any documentation that needs stored and filed should be locked away and not accessible to the general public. One more security measure to audit is ensuring employees have strong passwords that they change on a routine basis and do not share with other employees.
c. As a result of the internal security measures audit, I suggest we implement a new process of reporting all new hires/transfers/terminations to the IT department. The HR
department will send an email to the IT department stating the employee’s name, job title, manager, and access the employee will need within the EHR. This process will ensure that new hires/transfers have the appropriate access and terminated employees have been deactivated from the EHR. For paperwork and documentation to be disposed of we will have shred bins that are locked and not accessible. We will have the shredding company pick up the shred containers routinely. For any documentation
that must be kept by the organization we will keep the documentation in locked cabinets in a locked room with minimal access to the documentation. Employees will be automatically prompted to update passwords every 90 days and will adhere to strict guidelines. Employees will not be allowed to reuse passwords and will not share
passwords with others. d. i. See chart below.
ii. See chart below.
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B. 1. Risks
Benefits
Cost – The organization will take a substantial financial hit in order to implement a new EHR
Quality of Care – The quality and continuity of care will increase with an EHR
Violations – There is increased risk for HIPAA and security violations
Increased Revenue – There will be a more
streamlined process of billing and coding ensuring that accurate charges are being billed
User Training – Failure to properly train and educate staff on the EHR could cause financial strains on the organization as well as a decrease in productivity initially
Efficiency – Once users have been properly trained and are comfortable with workflows, efficiency will increase
Data Migration – Ensuring we migrate an appropriate amount of data into the EHR as well as the time constraints and manpower to do so
Accessibility – Patient data will be easily accessible among all users within the organization
Compliance – Ensuring the organization is complaint with all CMS regulations
CPOE (Computerized Physician Order Entry) – A safer and more efficient way of
ordering ancillary services and prescriptions
a.
Four key decision makers who should give input and buy-in are as follows:
Hospital Board of Directors
– The Board of Directors is an important stakeholder in this decision since they oversee the operations and finances of the organization. They must ensure the
financial success of the organization.
CEO
– The CEO must take direction from the Board of Directors, so it is essential they work together to make the best financial decision for the organization. The CEO is responsible for more of the day-to-day operations than the Board.
CFO
– The CFO must do a financial analysis of the organization to ensure the organization can move forward with such a costly project and decide if the return will eventually outweigh the initial cost.
CIO
– The CIO will ensure the organization is compliant with all state and government rules and
regulations. The HER should provide certain safe locks to ensure compliance. The CIO must ensure the organization has all the proper equipment to maintain the system as well as the equipment a user needs to effectively carry out their job duties.
b. CMS requires the new EHR to provide access to patients in order to allow them to view, download, or transmit their health information online within 36 hours of their hospital discharge. CMS also requires the use of Computerized Provider Order Entry (CPOE) for laboratory testing, medical imaging testing, and prescription drugs. 2. There will be some hardware components the organization will need to purchase in order to run the new system. First, we will need to purchase servers that will connect the devices within the organization and allow the systems to communicate. Additionally, we will need to have desktop PCs, laptops, and document scanners in order to import paper documentation into the EHR.
a. The potential capital dollar investment for the new system could range from $5.5 million. b. Our organization has been provided information on 3 separate EHR systems: Meditech, Cerner, and Epic. Based on the information provided, Cerner tier 2 offers all the components that our organization will require. Cerner tier 2 will ensure the organization is compliant with CMS as well as all state and government rules and regulations. This also includes business office applications which consist of billing software, charging, financial reporting, and invoice creation. With Cerner tier 2 we will have one seamless system that can integrate with other software to provide the best quality of care for our patients. This is the best and most cost-effective decision for our organization.
3. The EHR will need to ensure it has the ability for CPOE as well as a patient portal in order for patients to have access to their health information. Additionally, the organization should ensure the EHR has a Clinical Decision Support System (CDSS).
a. Cerner tier 2 offers a range of security and privacy components to ensure patient data is protected and the organization is compliant with all regulatory requirements. Cerner offers role-based access controls, authentication for users, audit logging, and other privacy controls. All these features ensure that patient data is shared only with authorized individuals within the organization.
C. 1. The estimated training hours for both clinical and non-clinical staff would be 8 hours. This will ensure that all staff members have had the necessary training with a hands-on experience along with the ability to ask questions. We do not want to cut their time short and not allow enough time to train all staff members appropriately. This would cut productivity and, therefore, revenue even more than the organization originally planned for the EHR implementation.
2. a. I would recommend splitting the 8-hour training session into 4 2-hour sessions. If the staff must sit through one 8-hour session, they will become disengaged and burnt out causing them to lose their focus. It will also make it easier to continue our day-to-day
operation by splitting the training sessions into smaller segments. This would equate to 600 2-hour training sessions for 150 day-shift employees.
b. For approximately 50 night-shift employees the plan would be to carry our 200 2-hour
training sessions.
c. The training will cost around $33,600 based on an average wage of $21/hour for 8 hours of training for 200 employees.
d. The training schedule below offers morning and evening hours for Physicians to continue to see patients on a 24-hour basis. We will offer four weeks of training of 2-
hour sessions. We will keep class sizes small to ensure proper support for each physician with only 5 students per class. Saturday will be a make-up class for any physician that was unable to make it to their regularly scheduled class. With the schedule that is created below, this offers additional class times for any physician that
feels they may need additional support or training.
i. Week 1
Sunda
y
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
7-
9am
X
5 Providers
5 Providers
5 Providers
5 Providers
5 Providers
Make-up Class
6-
8pm
X
5 Providers
5 Providers
5 Providers
5 Providers
5 Providers
Make-up Class
Week 2
Sunda
y
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
6-
8am
X
5 Providers
5 Providers
5 Providers
5 Providers
5 Providers
Make-up Class
7-
9pm
X
5 Providers
5 Providers
5 Providers
5 Providers
5 Providers
Make-up Class
Week 3
Sunda
y
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
7-
9am
X
5 Providers
5 Providers
5 Providers
5 Providers
5 Providers
Make-up Class
5-
7pm
X
5 Providers
5 Providers
5 Providers
5 Providers
5 Providers
Make-up Class
Week 4
Sunda
y
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
7-
9am
X
5 Providers
5 Providers
5 Providers
5 Providers
5 Providers
Make-up Class
7-
X
5 Providers
5 Providers
5 Providers
5 Providers
5 Providers
Make-up Class
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9pm
3. A train-the-trainer program will be implemented in order to facilitate the training prior to implementation, as well as assist in workflow questions and troubleshooting both during and after implementation. Managers will nominate top performers in their area that can lead classes and develop workflows with educational material. These Subject Matter Experts (SMEs) will attend an additional 8-hour class to gain further knowledge of the system. Our organization will ensure that Cerner will provide the necessary education and training for these SMEs. They will be provided additional educational material. The SMEs will be the point of contact for all other employees that have questions or need help. If they are unable to answer those questions, the SMEs will be given additional contacts to reference so that they can obtain the answer for the staff member. The SMEs will help develop workflows and lead training sessions to ensure staff are trained to the workflows.
4. A transition plan will help us go from paper to a new EHR in a more seamless manner. We will start by developing testing scripts of workflows and test these in a testing or mock environment. We will have the trainees run through these test scripts and pass the scripts off to the appropriate departments to finish their piece of the testing scripts. This will help educate and train as well as work out any issues or bugs within the EHR. We will need to ensure that our paper charts or legacy system are still easily accessible for a time in case data did not get migrated over appropriately or anything is missing. We will continue to have support available for all shifts during the first 2-3 weeks if implementation. The organization will set up a phone line for any emergent issues that need fixed promptly and have an IT support staff answering help desk calls and submitting support requests.
a. The SMEs will create competencies for employees to complete upon finishing their training. This will ensure that the employee is deemed competent in their relevant workflows. They will continue to have annual competencies to ensure the employees have not developed workarounds or found their own “efficient” way of doing something. This would be a cause of concern as sometimes cutting out steps of a workflow do not always mean more efficient and can sometimes cause greater downstream effects.
b. I would recommend starting the transition period at 12am on a Sunday. This would be a slower time for patient care, and we could start gradually with the nightshift. We could work out any issues or bugs identified during this time and be ready to start rolling things out for the day shift on Monday morning.
i. Three leaders that should be onsite for the transition are the CIO, CNO, and SMEs
for the departments operating during the transition.
ii. The CIO and their team should be onsite in order to direct questions and concerns.
They will need to ensure the transition is going smoothly and help mitigate any issues that may arise. The CNO will need to be present to help with workflows as staff will still likely have questions that will arise. SMEs for the departments operating during the transition will need to be present in order to answer questions and work alongside the staff. This will ease nerves for the other staff members as they have a peer to reach out to if any issues or questions shall arise.
5. To reward the team for successfully learning and implementing a new EHR I would first get the entire staff t-shirts. This would not only allow patients to comment on this and let them know that we appreciate their patience as we work through this transition but also allows the team to “dress down” for the day. We will make them a little more comfortable by doing so. I also recommend offering a free breakfast to get started for the day. A water bottle will also help keep them hydrated during their busy time of running around and working so hard.
a. A committee will be formed who will collaborate with administration to determine a budget and gather the quote of how much each item will cost. The committee should include management from the cafeteria, marketing team, administration, HR, the IT department, and administration. They can arrange the free breakfast for the go-live date and ensure each staff member has their t-shirt and water bottle for the day as well. It will be a token of our appreciation for their effort and hard work.