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Example research essay topic: Cost Benefit Analysis J P - 2,175 words

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... healthcare payer-issued ID cards to Internet-based patient medical demographics files that can be downloaded and merged onto the complaints visit form, eliminating the need for the patient to continually fill in things like their name, address, birthdate, insurance carrier, policy numbers, telephone numbers, etc. At most the patient can edit this information retrieved from their ID cards or Internet demographic files, and simply check off the symptoms, presenting complaints or services scheduled, etc. (Kalra, p. 166) This expedites the time patients spend filling out forms and enhances their view of the efficiency of the physician practice. However, neither of these mechanisms has yet been widely used, as they represent automation usually associated with the practice management systems, and many of these systems don't accommodate either of these mechanisms, as they have not been widely used by payers or patients. This is an area of patient education and automation that would be an excellent topic for the patient and physician to discuss upon the first visit and adoption into the practice, or upon the conversion to automation upon a yearly visit thereafter. To effectively retrieve medical information, one has to effectively store it in the first place.

While that sounds simple enough, it is not -- particularly in a multi-physician practice setting. It is even more complicated if the practice is multi-specialty. Human beings are by nature non-precise in their verbal (and written) expressions, particularly when they are in a hurry (as during a busy time in the office, seeing patients). As a result, variations in physician terminology creep into the medical records. Add in an office nurse, used to using nursing terminology and there can be variations in free-form charting. For example, one doctor notes the patient has an elevated temperature, another that the patient has a fever and a third that the patient is febrile.

The nurse may chart a complaint of "temp, " and the patient writes his systems as "I feel hot. " All of these descriptions ultimately must be reduced to one code and stored in the clinical knowledgebase documenting this patient encounter. (Huff, p. 144) Only when these diverse descriptions are so resolved does it become easy to extract information from the clinical knowledgebase about all patients with the code for fever. If instead of being stored under one code, such observations are stored under several descriptors, then the caregiver must know and concatenate all synonyms for fever when querying the database longitudinally (across multiple patients) to correlate fever with some other medical condition of interest. The same is true for immunizations, diagnosis, drugs administered and other data that a practice may wish to correlate. If the electronic system is rules-based to help the practice recognize and correct oversights such as immunizations, then the rules need to know which codes to look at and correlate to trigger the physician alert that some action or intervention is required for this patient, now -- while he or she is in the office and available.

Use of PDAs (portable data assistants), such as the Palm Pilot or Compaq Ipaq, already had been adopted by 30 % of physicians. Another 23 % were interested in adopting it in the near future, while 16 % were not sure, and 31 % had no plans to use PDAs. This probably splits along age-of-physician lines, as younger doctors entering practice already have been using PDAs in med schools and consider them a familiar tool to enter practice with. Younger physicians may also be more inclined to adopt this technology than their older colleagues. (Huff, p. 170) When you look at what physicians use PDAs for, 84 % use them to manage their personal schedules, while 68 % use them to manage their professional schedule. 59 % use PDAs for accessing drug information. As physicians bring the PDA into their practices, 19 % use it for online access, 17 % for writing or entering clinical notes on patients. 8 % are using it for mobile email access while 6 % use it to transmit drug orders to pharmacies, and 2 % use it to retrieve lab results. These lower values of PDA use are more a function of missing office infrastructure and applications than the PDAs themselves.

For example, regarding PDA use for electronic prescribing, 6 % of physicians surveyed currently do so, but another 28 % are interested in doing it in the future. (Huff, p. 173) Several factors are driving this interest. First, 65 % of physicians feel that electronic prescribing will help reduce the incidence of medical errors, while 58 % feel it will help improve accuracy and legibility of orders. And 55 % associate this with fewer callbacks from pharmacists. 53 % feel this will reduce time and overhead, particularly as 50 % associate a PDA as a tool to select common drugs prescribed from "pick" lists. Almost half (47 %) say they want to be able to more readily verify the patient's approved formulary coverage. All of these factors account for the interest in using PDAs for prescription ordering, refills and management. (Huff, p. 177) Implementing an electronic medical record (EMR) is a major initiative that should be undertaken only after a thoughtful analysis of the costs and benefits involved. Unfortunately, demonstrating financial returns on an EMR often is regarded as an inexact science at best, which has caused many healthcare executives to avoid adopting this technology.

With the right approach, however, it is possible to demonstrate convincingly that the financial benefits will far outweigh the costs. To do this, it is necessary to involve representatives from operational areas throughout the organization, because they are best able to identify the potential for cost savings and additional revenue opportunities. The electronic health patient record (EPHR) long has been promoted as a means to reduce costs, provide better patient service, and dramatically improve outcomes. Despite several decades of predictions that the EPHR revolution is coming, most healthcare organizations still use paper charts and manual processes. There are many good reasons why Ephr's have not proliferated. First, the vendors' offerings only recently have begun to live up to their promises.

And as is always the case with information technology, the temptation to hold out for newer, better, and cheaper products is strong. (Graham, G. , Nugent, L. , Strouse, K, p. 23) The volatility within the healthcare information technology market also has served as strong deterrent, as potential purchasers want assurance that their vendor will be with them through implementation and beyond. Perhaps the most significant roadblock to EPHR implementation is financial. Executives are loathing to commit millions of dollars to a project unless they can be assured of positive cash flows within a reasonable period of time. Unfortunately, demonstrating this return can be challenging because many of the EPHR's benefits are either non-financial or inherently difficult to quantify. Nevertheless, it is possible to establish a sound business justification for implementing EPHR using realistic assumptions and verifiable data. (Van Ginneken, p. 209) The cost-benefit analysis indicated that anticipated benefits would far outweigh the cost of implementing and maintaining the EPHR.

The EPHR was projected to produce tangible financial benefits in a variety of operational areas. In a paper-based system, laboratory and radiology orders require manual procedures for placing the order at the clinic / hospital unit and in processing the order at the ancillary service site. With the EPHR, orders would be placed by the physician at the workstation and automatically transmitted to the appropriate ancillary department. This procedure would eliminate the need for clinic, hospital, and ancillary staff to clarify, transcribe, and manually enter orders into the ancillary department's information system. The EPHR would provide immediate feedback if a physician attempts to order a medication that is clinically contraindicated or improperly dosed and would eliminate many of the adverse drug events related to illegible drug orders.

In addition, the EPHR contains logic to help physicians adhere to formularies and select the most cost-effective medications for the patient's condition, resulting in significant savings. Finally, the elimination of manual procedures involved with placing medication orders would reduce the need for pharmacy staff in the same manner as previously described for laboratory and radiology. Much of the information that is dictated and manually transcribed is redundant, such as social and past medical history, allergies, current medical conditions, and medications. Because the EPHR would make this information readily available, transcription would not be needed each time a physician dictated, thereby reducing transcription costs.

The team determined, however, that during the transition to on-line documentation, transcription costs temporarily would increase. (Baretto, S. , Warren, J, p. 174) Considerable effort is spent creating, filing, searching for, and transporting charts. The EPHR would eliminate these activities, resulting in reduced staffing in the health IS department, clinics, and hospital units. Eliminating paper charts would reduce office-supplies expense. The EPHR would interface with the billing system, so that whenever a service was performed and documented, the charge would be generated automatically without a need for paper charge slips. In addition, the technology would help ensure that providers document all billable services and that these services would be coded correctly, thereby helping the organization avoid lost revenue. Although it is impossible to quantify the extent of these missed revenue opportunities, some healthcare organizations have estimated them at 10 percent of total charges -- an amount the team felt was realistic.

Nevertheless, the team conservatively estimated that interfacing the EPHR with the billing system would improve charge capture by only 2 percent. (Huff, p. 236) Before any team can identify the benefits of an EPHR, it first needs to understand its capabilities. Therefore, any organization attempting to analyze the benefits of EPHR technology should educate team members at the outset about the technology through product demonstrations, site visits, and other presentations. Keep the analysis objective and close to home. Healthcare organizations that conduct this type of analysis often are tempted to focus on savings from things such as less expensive but equally effective clinical protocols, or enhancing clinical outcomes to reduce future costs dramatically. In fact, many academic studies attempt to quantify these benefits and generally show tremendous potential for saving money. However, most organizations cannot easily produce the detailed information regarding patient mix, clinical costs, and other factors needed to replicate such an analysis.

Therefore, the analysis will gravitate naturally toward those areas for which data are already available, such as the ones described in this article. The numbers do not tell the whole story. The hospital or clinic represents an ideal environment for demonstrating an EPHR's economic value because the organization encompasses both inpatient and outpatient services and employs a single group of physicians to provide patient care. In outpatient-only settings, such as a medical group, the smaller size of the organization and the reduced scope of the EPHR benefits may make the economic advantages of an EPHR less obvious. The same also may apply to an inpatient-only environment, which often will have the additional challenge of persuading a disparate collection of non employed physicians to use the system. (Baretto, S. , Warren, J, p. 229) The benefits sometimes can be difficult to evaluate in a cost-benefit analysis, but their strategic importance cannot be overestimated.

Organizations that lag behind their competition in adopting EPHR technology will have difficulty catching up and eventually will lose patients. An even more pressing concern is the issue of physician recruitment and retention. Increasingly, clinical information technology is becoming a major factor in attracting top-quality physicians who have trained on, and have come to expect, Ephr's. The benefits are not automatic. A cost-benefit study will benefit a healthcare organization only if it follows through with a focused effort to realize the projected benefits. Implementation of an EPHR requires a strong, organization wide commitment.

An EPHR is valuable only if users are willing to change the way they do business so that the technology works for them. Physicians who are used to having an administrative staff person transcribe medication orders, for example, may resist performing this function themselves at the workstation. Depending upon the organization's culture, overcoming this resistance may not be feasible. Bibliography: Baretto, S. , Warren, J. (2002).

Coordination of Inter-organizational Healthcare Processes via Specialization of Internet-Based Object Life Cycles. United States: Institute of Electrical and Electronics Engineers, Inc. Clayton P. D.

Integrated Advanced Medical Information Systems (IAIMS): Payoffs and Problems. Methods of Information in Medicine, 2003; 33: 351 - 357. Graham, G. , Nugent, L. , Strouse, K. Information Everywhere: How the EHR Transformed Care at VHA. Journal of AHIMA, 74: 3, March 2003, pp. 20 - 24. Huff S.

M. (2001). The Next Generation: A New Client-Server Architecture. Washington: Heinley&Belfus. Kalra, D. (2002).

CEN/TC 251 Task Force 13606: Electronic Health Record Communication Proposed Scope and Technical Approach. Sweden: CEN Health Informatics European Committee on Standardization. Van Ginneken, A. M. (1999). A Powerful Macro-model for the Computer Patient Record.

Washington: Heinley&Belfus. Wickramasinghe, N. , Mills, Gail L. (2002). E-Knowledge in Health Care: A Strategic Imperative. United States: Institute of Electrical and Electronics Engineers, Inc. , 2002


Free research essays on topics related to: cost benefit analysis, j p, internet based, information technology, physicians

Research essay sample on Cost Benefit Analysis J P

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