Q&A: Computer-based records are more than paperless
By Margret Amatayakul, MBA, RHIA, FHIMSS President, Margret\A Consulting Schaumburg, IL
Last September, I presented a tutorial at the 72nd National Convention and Exhibit of the American Health Information Management Association on the role of the health information manager in computer-based patient record (CPR) projects. The following Q&A covers what health information management (HIM) professionals should consider before undertaking CPR projects.
Q: What was the purpose of your tutorial?
A: The objectives of the presentation were to provide health information management professionals tools to help them do CPR projects. The three-hour tutorial covered subjects including:
- How do you get involved in the CPR steering committee and who should the members be?
- What is a CPR?
- How do you develop a migration path?
- How do you select your vendors?
I also talked about process redesign, the information technology infrastructure, and a framework for conducting an in-depth analysis.
Q: Does everyone agree on the definition of a computer-based patient record?
A: No. Some people just think a computer-based patient record means going paperless. Others think it means trying to get physicians to do order entry, but that hasn’t been satisfactory. The ambulatory environment is different.
Q: Are one-size-fits-all CPRs available?
A: I don’t believe that a computer-based patient record is something you buy off the shelf. I believe it is a theory of information systems, policies, and procedures that you put together to form a whole package.
Q: Where do HIM professionals begin in this process?
A: To achieve the state of having a computer-based patient record, you need to start by defining current clinical applications and any financial and administrative applications that relate. Describe current networking capabilities. Then plot out what you want to achieve with a computer-based patient record. You need to define what that means in your own organization.
Q: What strategies do HIM professionals need to address?
A: There are a lot of issues that need to be addressed:
- What is the vision for your CPR?
- What is your functional strategy? Are you going to look at functions that are strictly for communication or is it going to be decision support, knowledge management?
- What is your technical strategy? Are you going to go with the latest and greatest technology? Are you going to keep your mainframe and add to it? Are you going to throw out everything and buy new?
- What about your acquisition strategy? How are you going to buy [the technology]? Are you going to buy, lease, or use an ASP? How are you going to implement it — all at one time or phase it in?
- what is your operations and maintenance strategy?
Q: How should HIM professionals build a migration path?
A: You have to know what the environment is and where you want it to go. Then you can chunk it off into phases, such as:
- What applications do you have today? Therefore, over the course of the next several years or phases or however you define them, what applications do you have to add?
- What do you have to do your database? Do you have to buy a repository? Are you going to buy data mining tools?
- What do you need to do with your network?
Q: Have providers made much progress in the CPR process?
A: A majority of providers have identified that CPR is an ultimate goal. Many of them have started on migration path, whether they have formalized it. I don’t think they are very far [in the process]. There are some key hurdles that organizations have not been able to get over. There may be a vendor who wants to sell an integrated system and will tell a [provider] to buy everything from ABC company. But the provider might say, "ABC doesn’t do this and this, which I really want." Unfortunately, no one company has the answer to everything. No one company has the ambulatory product, the hospital-based product, etc. The organization needs to determine, too, if it is going to choose [one component] or some sort of combination.
Some providers have a lot in place. They are in a good position to start focusing on the clinical information. It has to do with readiness on the part of users.
Q: What specifically is the role of the HIM professional in CPR projects?
A: We are the only health professionals that are explicitly trained in the flow of health information throughout our organizations. While we may not have all of the technical background, we make excellent liaisons between the clinical folks and the technical folks, the IS/IT people. Involvement of the HIM professional should be encouraged.
(Editor’s note: Amatayakul also addresses this topic in her book, Supporting the Computer-based Patient Record: A Practical Guide for Health Information Management Professionals, available from the American Health Information Management Association in Chicago.)
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