HIT 102: Overview of Technology for the Medical Community Course Content

Transcription

1 Course Content The Medical Practice Client The IT Assessment Technology Requirements Technology Selections Review Quiz and Resource Links As a Healthcare IT Consultant, you are tasked with identifying and implementing the best IT infrastructure in preparation for a reliable electronic environment. You should be focused on meeting the unique needs of each practice by providing a proper assessment and thorough evaluation. Experience over time will help you to more rapidly execute these steps. However as a medical practice performs critical daily functions utilizing this technology, it is important to provide cognizant consulting for each and every new client. The Medical Practice Client Medical Practice and Clinic environments have a number of options available to them regarding IT infrastructure to execute daily operations and ultimately to support electronic records and billing systems. As with any small business it is best to establish with these sites how they plan to utilize their technology. However, medical environments are different on many levels and critical questions should be asked prior to assisting a practice down the path to best EMR infrastructure. Establishing a baseline for future discussions and narrowing the field of choices on both the hardware and software sides is an excellent beginning. First, ask these questions: 1) Will the practice select a subscription or client/server EMR/PM licensing model? 2) Have they already selected or been assigned a solution by an affiliated hospital? If so, which solution? 3) Are they migrating data from any legacy or custom solutions? 4) Do they currently own a server for any data or IT operations? 5) Do they have satellite locations? How many? Connection to-date. 6) Do all staff who require a workstation have one at this time? 7) What existing technology do they wish to maintain or evaluate for upgrade. How many units currently? Age? 8) Will the site require upgrades or replacements to peripherals and attached devices. 9) Do they have the physical space and budget to improve or install a server based network? 10) Is the current broadband onsite sufficient for either client/.server or SaaS model? 11) Do they have a wireless network in place? Is it HIPAA compliant? 12) Is there a staff member familiar with or assigned to support technology onsite? 13) Are they currently working with an IT group that is NOT versed in medical technology 14) Do they have or maintain a technology inventory of their systems onsite 15) Establish list of current user passwords and login information Once this list of questions has been answered, you may move onto the IT Assessment step.

2 THE IT ASSESSMENT A good first step is to establish a baseline of current status. What the medical community refers to as an IT Assessment [See - Generating IT Assessments - HITU 105] Executing a comprehensive assessment of current technology on the site can give the consultant: a picture of the technological proficiency of the staff a framework for upgrade and replacement needs (reviewing existing technology onsite) an inventory of specifications for vendor requirement/comparison an opportunity to identify areas of weakness in security and broadband speed a good baseline for future recommendations, planned maintenance and disaster recovery planning Once a practice has decided to investigate the costs and options associated with EMR/PM solutions, you will begin by submitting a proposal to execute an IT assessment. Once approved, you will schedule a convenient time allowing an average of 2-4 hours onsite depending upon the size and scope of the site. A solid network assessment tool is needed to establish a baseline of technical specifications. EMRapproved recommends a select group of tools depending upon the size and scope of the assessment opportunity which will be demonstrated in the tools overview. An additional manual form is used to capture non-network content. A report is then generated which must be summarized and attached to a proposal which should clearly outline necessary steps to best IT infrastructure changes to prepare for an electronic record environment. Another important early step is to discuss options with the practice regarding platform for electronic records. With hundreds of potential options on the market one quick way to narrow technology choices is to establish dedicated physical space and technical expectations for the practice. Were they planning to: buy licenses and host their own data onsite in a local server buy licenses and pay to have their data hosted by a 3 rd party purchase subscription (SaaS) licenses and pay monthly for hosting by the vendor The answer to that one question can help guide all future conversations. Once the planned platform and existing status are established the consultant can begin to consider the various technical possibilities. Certified HIT technology specialists should be familiar with the installation and implementation of the following hardware and software components as they relate to proper infrastructure. A solid understanding of EMR workflow, HIPAA compliance and IT assessments will help you to guide any ambulatory environment through and to the best available technology for them.

3 TECHNOLOGY REQUIREMENTS: Each EMR vendor maintains a list of IT requirements to support their specific solution. This list is an imperative read prior to evaluating and suggesting specific technology to any practice. Obviously the many questions answered during your initial evaluation and assessment period will weigh heavily on your recommendations and vision for that environment. However the requirements specific to the selected product will require review before creating a final quote or beginning to create the appropriate infrastructure. Several of the components will be similar form vendor to vendor though in some cases VERY specific products and even brand-names are required to operate certain solutions. ALWAYS consult the most current, vendor specific technical requirements document prior to engaging in the technology selections step. TECHNOLOGY SELECTIONS: Servers A rack or tower server may be the backbone for client/server EMR solutions and may also be used for fax-server functions and for data consolidation and backup. In addition, some sites may utilize a small server for local data synchronization even if they are subscribing to a Saas or Subscriber based remotely hosted solutions. If they are using software that operates under a client-server model, they will be required to have a server that meets that EMR vendors' minimum requirements. Servers generally fall into two categories: webbased and client-based. While web-based/virtual servers tend to be less costly, a client-based is typically more reliable. Depending upon the size of the medical environment; a simple tower style server or expandable rack or blade type may be considered. Multiple servers; separating data from operational software and fax functions may be required by larger certified vendors. This protects the data and permits faster and more efficient operations. SERVER BACKUP: If accessing data from a local or virtual site server - dependency on that server is extremely high, so it is critical that this equipment is carefully selected and configured to meet strict vendor guidelines. Backup solutions are also critical and should be discussed at length with the client. A dual local and online/remote solution (permitting redundancy protection) is recommended. Secure Networks The network in a practice environment may connect a server to independent workstations, one computer to another, all units to the Internet and ultimately to the EMR data and system software. All medical environments will need a reliable internet service provider and a high-quality secure wireless network if planning to use utilize any wireless technology such as Tablet PCs, Laptops, Pads or PDAs. In some cases where physicians are planning to do a significant amount of interactive communication with patients and across the network with sensitive data additional protections such as enhanced security solutions may be employed. A comprehensive understanding of security and privacy issues related to electronic medical data is imperative for the HIT consultant. Please reference EMR University lesson 109 for additional detail and links on this topic as well as the security documents within this curriculum.

4 Wireless Tablets, Slates and Pads Wireless Tablets offer the most mobility in the office. Their transportability and light weight make them a popular option, allowing doctors to document at the point of encounter as they would with paper records. This is not to say that they are always the best choice as there are a number of details to consider such as battery life, cost and moderate durability. Most tablets offer a touch panel and digital pen option. Permitting the practitioner to digitally sign notes, tap menus and use handwriting recognition for other functions. Medical style Slate Tablets generally have handles, built-in scanner capability and other medically specific features. They are extremely durable (many vendors drop them on the ground to demonstrate their toughness). They are also built with digital pen and touch screens and often charge in docking bays for extended battery life. Another contender in the tablet market is the smaller, lighter Pad units. ipad and Android as well as Windows and other cellular platforms are introducing various handheld products and APPS designed to work seamlessly with many of the major certified ambulatory EMR's. These units are smaller and lighter than the standard EMR Medical Slate or Tablet, but are intended to provide some of the same features and functionality at a lighter weight and lower cost. Some will fit perfectly into the pocket of a lab coat. One of the benefits of this solution is the portability. Many incorporate the use of cellular internet functionality,. Allowing medical personal the freedom to access tools while in transit to and from the practice (particularly helpful in emergency situations). Standard Workstations, Displays and All-in-One Desktops Workstations, desktops and slim clients can be used in conjunction with tablet PCs and laptops or on their own in each treatment room. Because the standard workstation is a relatively uncomplicated and inexpensive technology, many offices choose them for their cost efficiency. Workstations are often an ideal option if an office which has many providers but few treatment rooms, thus the office is not required to equip each provider/assistant with a personal tablet PC or laptop. Workstations can be housed in powered medical carts to permit greater mobility in the exam rooms and around the practice and can be paired with medical touch screens at higher resolutions for greater flexibility and functionality. All-in-one Desktop units can save space and are reasonably priced. AIO s house all components interior to the monitor as opposed to requiring a separate tower and display. Some even have touch screen capability, similar to the digitized tablet but at a lower expense to the practice and often have built-in wireless capability..

5 Medical and Touch Panel Displays (Monitors and Digital Signage) In growing numbers medical environments utilizing workstations for cost efficiency are opting to pair them with medical grade displays. Either for their higher resolution (for use with radiology equipment or scans) or for their wash-ability to reduce germs and help promote a more antimicrobial environment. They are generally custom built with brand name display units overlaid with washable and touch capable veneers. Functional while wearing surgical gloves and designed to withstand medical environment challenges. These displays may cost a bit more but are often well worth the added expense. They last longer and provide a cleaner solution. Standard Laptops Standard laptops, since they are lower in cost, may be an ideal solution for nurses and assistants who require some mobility but who do not require the full touch tablet functionality. Laptops can also be placed on non-powered rolling carts providing convenient mobile access while permitting the user to have their hands free. Low-end laptops however are not a good selection for practices as they often do not meet minimum specifications by the vendors for operational use of the EMR software. Careful selection and recommendation it traditional laptops and desktops is necessary to ensure compatibility. Scanners, ID Scanners and Printers Imaging devices, mainly workgroup and ID scanners help make the transition between paper and electronic documents easier. Workgroup scanners for the medial practice must be TWAIN compliant, should have robust PPM scan capability and be capable of relatively high volumes. Despite the move to electronic functionality medical practices still are required to do a fair amount of scanning into the e-record. At least one high volume workgroup scanner should be a part of ALL new EMR practice assessments. Medical ID Scanners can be used with MANY of the major certified solutions to automatically scan Driver License and insurance information directly into the patient record. Eliminating the need to manually type information at each new or updated documentation phase of check-in. Several even permit the population of the ID photo into the record for quick patient identification. Allowing practice staff to spend more time focused on patient care. Less time addressing tedious clerical duties. Most EMR vendors also suggest at least one reliable high-volume laser printer in each practice. Again, some paper (at this stage of electronic transition) will be produced. Multi-function devices that have all print, fax and scan capabilities are cost-effective options where limited scanning will be done. They make excellent additional scanners and can double for secondary printers as well.

6 For the initial implementation phase, high speed /very high volume scanners can often be rented to handle the heavy scanning of initial patient records into the medical record system. Most EMR vendors recommend at least one print-only networkable laser printer be available for heavy print duties and at least one scan-only workgroup scanner for daily scanning tasks. Antimicrobial Accessories The rapid increase in cross contamination infections is the most critical issue facing healthcare today. Direct contact medical equipment, input devices and other hard to clean surfaces pose a significant challenge to infection control efforts in the medical practice. A recent University of Arizona study reported that computer keyboards, for example, harbor up to 400 times more microbial bacteria thant the average toilet seat. Therefore, encouraging practices to upgrade or swap direct contact items such as keyboards, mice and monitors with antimicrobial equivalents is an excellent way to improve the technical environment while also expanding your value as a consultant to that practice. Several vendors design and supply these accessories. EMRapproved selects them exclusively for our accessories and medical touch display lines. Medical Devices Medical devices which connect to EMR technology will save time and reduce opportunities for transcription errors. Common devices that can interface with an EMR include ECG machines, holter recorders, digital scales and vital sign monitors. An interface for these devices may be required by the EMR vendor at additional cost. See our Medical Device buyer guide for more information about purchasing EMR medical devices. Radiology equipment and services can also be linked with the EMR system. Additional information regarding radiology (PACS) solutions will be available through the EMRapproved PACS directory beginning in September of Mobility Carts, Mounts and Tools As mentioned in prior summaries carts are an excellent tool to provide a practice or clinic with added flexibility for their workstations and medical devices. They are ergonomically designed allowing both sit or stand operation. Not only do they provide mobility but permit the use of single workstations in multiple locations in the office. Saving both money and overall space. Carts are designed powered (to host standard workstations) or non-powered to support laptops and other medical devices which operate using their own long-life battery.

7 EMR Companions Products and Services There are a number of different hardware and software products available to help facilitate ease of use for many EMR solutions. These products and services can greatly increase time and cost efficiency, while providing expanded patient care and payment collection services. Voice Recognition Software One popular timesaver is voice recognition technology, which allows physicians to immediately and easily edit each patient's chart by speaking into a headset, microphone or dictation machine. It converts talk-to-text. Many of the certified EMR's even permit the voice activation software to assist them in navigating menus within in their software. Some are built directly into the EMR; others may be attached and configured to work with both navigation and text input. Patient Check-in Payment Capture Another product that many practices find invaluable is a patient check-in and payment-capture service. This service provides practices with: Portals for patients to fill out electronic intake forms Verification of demographic information and insurance eligibility in real-time Collection of balances and co-pays immediately via credit card All patient information is then securely stored for easy access. With an additional interface many can import that data directly into select EMR patient billing records. Some are tablet based like the unit shown here. Other solutions are provided by the bank and involve small payment verification devices and still others may be linked services available via patient portals and the EMR system itself. Check with the specific vendor selected for this project to review the various options and benefits of each. Large Scale Scanning and Data Conversion Services: Whether the practice is moving from a paper or legacy system environment, manual or staff entry of data can be cumbersome and time consuming. Often a practice will look for an outside service company to provide either high-speed scanning of paper documents into the new EMR system or to convert legacy EMR system data including demographics, charts, labs and test results into the new system.

8 Review Quiz and Resource Directory The REVIEW QUIZ for each course will help you to prepare for the final exam. Use your participant login code to take each review quiz. You are welcome to take each quiz multiple times to help you prepare. It is recommended that you take each quiz once at the end of the lesson and all of them again just prior to taking the final exam. Click button below to take the quiz for this lesson. The RESOURCE DIRECTORY for the HITU University Program includes links to HIT Samples, Templates and Contracts which may be reviewed and/or modified for your HIT business. It also includes a directory of helpful online links and resources to help with client counseling and additional self-education in the EMR/HIT market. Finally, a link to the HITU Marketing Toolkit is provided to assist with your medical community marketing and outreach efforts. If you have any questions regarding this selection of resources, you may contact our program team at (800) ext #33. Educational Content Copyright 2011