Planning and implementation of electronic medical record system through in a local health district

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Introduction

There has been considerable increase in the implementation of electronic medical health records in hospitals around the globe. They hold a great potential by improvisation of patient safety and care quality being provided by the medical professionals. As specified by a report on Data Standards for Patient safety by the Institute of Medicine, the basic components of the electronic medical health record systems include, but are not limited to: longitudinal collection and management of health information electronically; making immediate access to these electronic records possible for the authorized users at both individual as well as population levels; improvisation of care quality by providing decision support and knowledge provision; and, providing appropriate support for efficient delivery of health care (Institute of Medicine (US) Committee on Data Standards for Patient Safety, 2003; Kukafka et al., 2007; Simon et al., 2005).

There are several important factors contributing towards the ever-increasing need of electronic medical records among medical groups as well as hospitals. One of the most prominent among these is the ever-growing complexity of the medical organizations. Also, this complexity itself can be attributed to a variety of factors that have been steeply emerged especially during the past two decades such as: continuous efforts by medical organizations in reducing and controlling the costs of patients’ care; an increase in the time demanded by patients due to affliction with chronic diseases and hence augmented workload on the relevant staff. Moreover, to achieve better management of patient care, it is necessary to share clinical information between primary care medical staff and specialist medical physicians as well as their practices which can be achieved quite efficiently using electronic systems of medical records (Hillestad et al., 2005; Miller & Sim, 2004; Simon et al., 2005).

The most robust evidence about the value of using electronic medical record keeping comes from studies which have specifically focused on the its two vital components namely computer physician order entry and computerized decision support systems. According to one study focused on the later of these mentioned components, an improved performance of physicians was found upon encouragement to use electronic system (Balas et al., 2000). Similarly, another study investigated the effects of computer-aided dosing, reminder systems for preventive care, and achievement of quality assurance via computer-assisted decision support systems and found a significant reduction of errors in the clinical data (D. L. Hunt et al., 1998; Dereck L. Hunt et al., 1998). 

Due to lack of the technical expertise in hospitals, it is often challenging to carry out the successful implementation of the of the electronic health record system. This urges the need for the development of appropriate strategies by healthcare management teams for enactment of information technology for electronic health records (EHR) processing. In this design, nursing leaders and managers consist of the target population in the development of a ‘change plan’ for applying HER system in a hospital having capacity of two hundred beds. The implementation of the plan will take six months where the computer hardware and systems will be available within the first two months. Furthermore, the HER plan will be build and executed on a 3 step Lewin’s change theory as a basis to formulate theoretical framework (Mehrolhassani & Emami, 2013).

Plan of change according to Lewin’s model

For the analysis of the currently given situation for change plan in shifting the nursing practices towards electronic system, the most important thing which has to be done on priority basis is the characterization of the entire situation and that too should include the entire context instead of mere isolated essentials. For the identification of the driving and restraining forces to come in the way of a plan, it is imperative to determine the psychological air of the working staff which holds an indispensable importance in the scenario to come. A good and thorough understanding of the making of project decisions as well as the governing principles of the individual units can also make the change plan implementation easy and effective. Moreover, due to the autonomy of the rules made to facilitate the changes, an awareness of the decision making factors will help the processes of unfreezing, moving and refreezing (Bozak, 2003).

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