This 1996 Act was part of a Civil Rights concern that as information became more electronically disseminated, it would lead to misuse of that information (U.S. Department of Health and Human Services, 2010). Certainly, one of the benefits of electronic information is that on one hand it is available to a larger number of people, but it is also verifiable on who views that information at what time. This protection, though, is part of the ethics of individual rights. It has, however, affected scholarly research and the ability to perform retrospective, chart-based research and evaluations. One study, in fact, said that HIPAA managed rules led to a 73% decrease in patient accrual, triple the time recruiting patients, and tripling (at least) of mean recruiting costs (Wold and Bennett, 2005). However, despite the few incidents in which the regulation of this information is detrimental, most civil rights advocates praise the legislation -- believing that each individual should control access to not only their bodies, but information about their bodies and conditions as well.
Too much security and a lockdown of information, and the benefits of immediate access to information and patient benefit will be lost. Too little security and there is an increased potential of fraud. Patients however, have far more trust that healthcare providers will keep their information save, secure, and private for particular use than they do with banks, governmental institutions, employers, or even credit card companies (Shinkman, 2012).
Accuracy
One of the selling points for ERM is that data tends to be more accurate because it is entered only once. This, of course, forces the person doing the initial entry to be even more aware of the issues surrounding the data, but also has some issues relating to privacy concerns. Accuracy of the information is completely dependent upon two major paradigms: the initial set up of the system and the quality and expertise (training) of input personnel. Adopting a four-part program will solve the initial concerns about accuracy, and focusing on appropriate training (see below) will alleviate some of the worry on the second issue. However, a continuous and rigorous training program will be necessary when there are new hires; people have been out of the office for vacations, etc., when there are system upgrades, and the like. Part 1 ensures initial data accuracy for the system; Part 2, the training, Part 3, network implementation and testing of accuracy of information; and Part 4, Ensuring appropriate equipment so that there are no hardware or software issues that cause inaccuracies, down-time, calculation mistakes, etc.
Part 1 - Conversion of existing patient records -- Preloading is one of the most essential steps to convert medical records (patient histories) into the new system. This creates a standard record with minimal information, but that can be added to once the structure is complete. We will begin by entering the patient's name and vital demographic information (point of contact, insurance information, etc.). Then move to past medical history, problem list, medication history, and allergy history. It is important to use ICD-9 codes as much as possible, and for this reason, it might be advisable to hire temporary help to load data; individuals with nursing experience and/or insurance data entry so they are familiar with the correct codes and terminology. Each chart on the active list (can be 12-24 months) should be completely preloaded prior to using for charting (live use). It is important to hire the right people for this crucial step -- anyone not comfortable with technology will have a difficult time.
Part 2 - Once the preloading is done, it will be time to customize the HER based on the provider of the hardware/software. This should be done with an implementation team consisting of the Medical Office Manager, 1-2 nurses, and the data entry staff, a physician if at all possible, or the MOM trains the physician later. The provider source customization training should take 1-2 days, and would be most effective if the office was shut down for a day -- preloading finished and QC'd (Quality Control) by Thursday, training on Friday and Saturday, live on Monday. If not possible, then training in a conference room on Friday with minimal interruptions. If the training is offsite, then as many of the implementation team as possible should attend. It may take a full day to customize some of the options per office, and any technical support should be there to ensure that modems, printers, etc. are all working. This might need to be done on a Sunday, if the office wishes to go live Monday. Finally, if at all possible, the first few days of going...
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