ITEC832 Enterprise Application Integration, Macquarie University, Australia

Electronic Medical Records

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Question 1: What management, organization, and technology factors are responsible for the difficulties in building electronic medical record systems?

Answer: 1. Technology factors - Difficulties in building electronic medical record systems

Technology Factors: The major issue from the technology perspective is different service providers involved to build the Electronic Medical Record systems. The technology services providers may develop specific services to be customized that cannot be easily interfaced or interact with other systems. In order to build the Electronic Medical Record system, the key concern is consistency and development of standards. One more big concern of technology factor is a change of speed and cost. The fast growth change in the technology is not easy to maintain resources, technology expertise and secure the Electronic Medical Record system by the small health providers. Also, the service provider of the server from the client side may affect by attacks and viruses. These types of security challenges are required various and costly resources which cannot spend on the train or hire.

Organization Factors: An organization point of view, the current Electronic Medical Record system should resist the process changes. Even though the presence of spur money, K. Laudon and J.Laudon builds up restructure in high-cost value will increase the budget in a short period and workload. In an organization level, it is difficult and resists justifying the cost and contributing to smaller practices. Moreover, the implementation period of the Electronic Medical Record system is high and it is hard to satisfy for a longer time to obtain the benefits of the online Electronic Medical Record system. The staff should resist their increased workload with careful and proper management.

Management Factors: This is necessary to address the issues of management in the Electronic Medical Record system. The very first, data nature of the Electronic Medical Record system is online should reach the government system and other health providers through the public domain. To manage the data is the real challenge in terms of providing privacy and security. Data security challenges are authenticity, availability, integrity, confidentiality, and non-reputation. The level of encryption mechanism should be in a sufficient manner while transmitting sensitive data in a protective way. The low privacy perception level could affect the quality and success of the Electronic Medical Record systems. The next issue in management factor is the distribution of patient's data and storage of data. The government should provide the cloud solution to store the data and all health care providers can access the data from the cloud. The availability of the patient's data should distribute the various hospitals and clinics. All patients' record should be accessed by other providers at any time. In small health care service providers have never possessed expertise or resources to ensure the patient's data availability.

Question 2: What stages of system-building will be the most difficult for building electronic medical record systems?

Answer: System Building - Difficult Stages of building electronic medical record systems: The purpose of the user requirements is a too costly and challenging task for each health service providers because of the user's unawareness of the actual system requirements. So, we need business analysts to fetch the information and gather the necessary workflow and requirements for the developers. We have to decide the standards that can be used and the place where the data translation will take place. Also, include the development of the Electronic Medical Record system to understand and engage with each other system on the national level. The Electronic Medical Record system contains more text contents so needed to understand how the data will be organized and segregate. So Electronic Medical Record follows a kind of indexing strategies. This can be performed machine-aide added indexing software. But before indexing the machine helped to fix taxonomy for the Electronic medical records. So, they go on with subject experts who all are familiar with medical terminology and health services to provide suggest and review on taxonomy. Koranz and Gilles accepted medical code books and its description not in the standard of medical community expectations so taxonomy for medical ought to be specific. Because of these complexities, the stages of system development are difficult. Another challenge for an application developer is to develop the client-side application and tools in consistent manner. For each provider need differently configure the system of a particular clinic. In terms of compatibility, feature stated previously by K.Laudon and J.Laudon the above issue leads to another difficult question of determining how the patient Electronic Medical Record data to be distributed among health care service providers. This can be achieved by the central government or private cloud servers that are allowing distributing across the various hospitals. The above stated options have a set of unique challenges in various features of security, retrieval or access data, privacy and taxonomy. In the implementation stage of the EMR system also face the number of challenges that are many clinics not have proper infrastructure and high-speed services to access the data in the EMR system. Another issue to build the EMR system is high availability of data which includes the backup and emergency server should be available and for the situation, if the occurrence of any loss it should be handle the data corruptions properly. At last, have to decide what security measures and methods are used when they have implemented the EMR system. The following stages will be more difficulties in system building for the electronic medical record system

• Difficulties in developing and implement the electronic medical record system.

• More risk to reach the electronic medical record system to nationwide.

• Minor issues in IT developers to maintain the health care record, health care provider and insurance companies.

• Privacy for patient medical information.

• Quality of the data

• Difficult to afford the cost and time to upgrade the electronic medical record.

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Question 3: What are the business and social benefits of digitizing medical records (to individual physicians, hospitals, insurers, patients)?

Answer: Business and social benefits of digitizing medical records: Digitalizing medical records has numerous benefits in social and business which are stated to the individual physician, hospitals, insurers, patients given below

Physician: In physician side, the digitizing medical records reduce the manual paper to search and fill the form which state that physician mainly focus on their core task to spend more time to diagnose and prescribe the medicines to cure, ailments and give treatment for patients. When increasing the speed then physicians able to work efficiently and give health care service to more patients than previous. In case we have digitalized medical records then physicians able to access the medical record directly from the EMR system immediately without refer any paper files. The digitalized medical records have full access to get the patient's medical background which is used for physician able to provide an accurate diagnosis by use of complete reference to the history of the patient. The waste of time to search and index medical records by the physician. To process the insurance claim for the patient, the company will take more time to do so the hospital has a hard time to collect their compensation from the insurance company. If medical records are not in digitalized then records will have a higher risk with errors. The major issues in not digitalized medical data are misplacement and loss of data. The government will affect to maintain and regulate the medical record when there is no standard in the record.

Hospitals: The plenty of gains in hospitals are reducing the search cost which means hospitals staffs can work more efficiently. The role of administrative can keep records and fill form would no longer significance and hospitals can mainly focus on their resources, training and recruit the professional medical experts. The importance of cost savings could not be achieved when managing the medical records in the paper. On the other hand, one more benefit of digital medical records is allowed the best control of patient data which can reduce the risk of errors and behaviour of fraudulent such as modification of patient's test results for the purpose of insurance.

Insurers: Insurers have numerous benefits to access the complete patient history which will provide enough information about patients that may not have previously. This complete information allows them to modify the product of insurance to the right individuals and also classified a proper way. The more information is used to control and manage, and mitigate the risk of fraudulent behaviour. With the help of proper management, this can lead to insurance companies to operate in a good margin and better premiums for insurance members.

Patients: The patients can find a greater benefits level of health care service and satisfaction when they visit hospitals or physicians with EMR systems. The EMR system will reduce the waiting time, queue length will be small, doctors provide accurate treatment with complete medical history. The physicians have a lower risk of missing a critical some piece of information to lead to a misdiagnosis and provide an incorrect treatment. The major benefits of digitized the medical record to provide and improve the quality of the care for example nurse could scan the patient's tags and medication which ensures the dosage level of medicines to prescribe to cure patients. By this way, we can reduce the medication errors and it will be the most common medical error and it will provide the speed up treatment also. The medical report of the patient can report to the Veterans Affairs system to process the medical claims and treatment payments instead of providing papers to verify the process.

Question 4: Diagram the "As-Is" and "To-Be" Process for ordering a pathology test for a patient being treated by his/her local doctor, if an EMR system is implemented for the To Be Process. Assume that the patient is later admitted to hospital and the hospital doctor needs the results of the pathology test urgently. Include the following actors:

• patient

• local doctor

• local pathologist

• private insurance company

• hospital doctor

• hospital pathologist

Answer: Diagram for "As-Is" and "To-Be" Process for ordering a pathology test

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