Analysis 2

Analysis of Application
Limitations. In theory, there are few limitations. Problems such as document storage and retrieval, and data entry and access have good solutions. It is the practical implementation of these solutions in the medical environment that is difficult, especially in larger and extended environments. Providing an electronic medical records solution for a mostly isolated private practice office is difficult and becomes even more so as the scale of the operations and interoperability demands increase.

At a basic level EMR systems must store simple patient information that can be neatly stored in traditional databases. In order to be even slightly practical, they must also be able to manage older paper documents. Further, they need to integrate with various other outside organizations, not least of which are government and private insurance providers. Together with useful human interfaces in complicated work flows, these requirements add complexity to the systems which is difficult to manage.

Interaction and data sharing remains a difficult problem. Standards for information storage and interchange continue to evolve. Until these standards are well developed each vendor may have unique requirements. Supporting each of these magnifies the resources required to develop and maintain these systems.

Risks. Risks for medical organizations include: ability to interact with existing internal and external systems, cooperation from staff who have little buy-in, and geographical distribution.
As an emerging technology, the benefits are poorly characterized, the implementation is usually painful and difficult, and the costs are high. Clinics and physician's offices have been operating for a long time with paper records and have developed efficient work flows within the paper records frame work. These existing paper-based work flows are exercised many times every day and have become ingrained as habits. Digital records require different work flows to which employees may or may not adopt. The digital systems may or may not be able to manage all of the requirements satisfied by the traditional systems. It may be difficult or impossible to work around problems in the digital system, where as work-a-rounds in the paper systems can be implemented in the physical world which we all know how to manipulate.

On top of such issues is the cost of these systems, which tend to be quite high. The bottom line here is: the current systems work, and generally work well; the benefits of digital systems are, at best, going to be realized slowly; and the costs are high.

Not implementing EMR systems also has risks. Government and insurance providers are requiring levels of compliance which, in some cases, are only achievable with EMR systems. Also, a medical organization risks missing out on what may soon become a competitive necessity.

Issues. As alluded to in the Risks section, change management is particularly important in the implementation of digital solutions in the medical field. Health care providers have developed strategies for working as efficiently as possible in existing paper based systems. After all, their main work is supposed to be medicine, not record keeping. Asking them to change their routine, much less, adopt an entirely new way of working, while, at the same time, practicing medicine is asking a lot. Unfortunately, for digital solution providers, this means providing efficient and usable systems that are immediately usable. At the same time, record keeping requirements are a moving target. For various reasons, including liability and insurance reimbursement, physicians are being forced to adopt EMR.

Cultural barriers can be a challenge when implementing EMR. Implementation requires an organization wide commitment. It represents a major cultural change for most medical organizations. This transformation must be the strategy of the entire organization, not just one physician or manager. The system is only valuable if staff is willing to use it. Many organizations that have moved to implement EMR with out preparing staff for the change saw quite of bit of resistance, primarily from physicians. Many of these physicians had been using paper charts and manual processes through out their entire career. EMR implementation has revised their work flow considerably.

When considering implementing EMR it is important to consider how technology savvy the staff is, including everyone from physicians, nurses to administrators. Also an important consideration is how the organization makes decisions. Are the decisions made by one or two people or does a consensus need to be reached? Do the physicians in the group value working closely with the other physicians or are they more individualistic? Will the staff be willing and able to cope with the change?

It is vitally important to thoroughly explain to staff how the implementation will make them more efficient and productive and to sell them on the strategy to transition to EMR.
Privacy is a typical concern that comes up whenever information is centralized and access to a single record could mean access to thousands [Winn 2002]. While security systems continue to improve, such concerns will likely never be entirely eliminated. Electronic record keeping has allowed for solutions that were previously impractical. For example physicians in India can be contracted to analyze medical imagery, and records administration can be performed in China. This remote access to records by outfits working in countries with privacy laws that are different from those in the US and that are subject to changing without consideration of such issues contribute to privacy concerns.

Another issue that comes up when centralizing information is data loss. As with any centralization effort, all access to the centralized resource can be disrupted by a single failure. Fortunately, these issues have been successfully addressed in various other applications. Techniques such as backing up to remote sites and distributed replicated data centers have gone a long way to solving these and related issues.

The lack of uniform and comprehensive standards for the health care IT industry is another significant issue [Winn 2002]. There are a growing number of standards, but they typically cover only specialized areas [Goedert 2007]. HIPAA, Health Insurance Provider and Accountability Act, provides a basis for building unifying records standards and is also a driving force to implement EMR. At this time compliance with HIPAA is the only EMR related practice that is required.