Reference no: EM133307032

Assignment: In June 2015, our organization implemented a new electronic health record (EHR) using a so-called big bang approach,whereby, overnight, the previous EHR was replaced. All new computer applications, functionalities, and data from the old system were converted andtransferred to the new system simultaneously. In contrast to a phased approach where implementation is sequenced over time, this approach requires clinicians to migrate rapidly to new workflows and processes. Although both approaches present risks, we decided that a big bang approach would be safest.

Two months after transitioning to the new EHR, patient S, who had breast cancer, experienced a delay in care as a result of breakdowns in communication among her clinical team. Samantha Anderson is a 38-year-old woman with a history of stage IIIA, high-risk breast cancer who completed treatment in July 2015. During treatment, she communicated frequently with her care team, which included a medical oncologist (MD), physician assistant (PA), program nurse (RN), and office administrator.

In August, Samantha Anderson contacted her care team using the secure patient portal of the new EHR. She described exacerbations of chronic asthma symptoms. The office administrator received the message and directed it to the PA for follow-up. The PA responded to Samantha Anderson with instructions to follow up with her primary care physician and to contact the office if symptoms worsened or did not improve. With a push of a button, the communication with Samantha Anderson was added to her EHR; however, other members of her care team were not informed of this interaction. Samantha Anderson chose not to follow up with her primary care physician. Additionally, she was not trained on how to use the patient portal and was not aware that her communication had become part of her permanent record.

One week later, patient S's symptoms had not improved. She called her MD's office complaining of shortness of breath, dyspnea on exertion, and a "feeling of something in her lungs." Because of her history of high-risk disease and prior treatment with potentially cardiotoxic agents, the MD used the EHR to order a chest computed tomography scan and echocardiogram to rule out disease progression or cardiac toxicity from prior therapy. Using the new EHR communication tool to send messages to specific predetermined pools of individuals, the MD sent a message to the office administrator, the PA, and the RN, to inform them of the conversation and to have the tests and follow-up appointment scheduled. However, the office administrator did not see the message for several days. This lapse was caused by the administrator's lack of familiarity with the communication tool, the inordinate volume of messages she was receiving because she now received every message written to any individual in her pool, and her inability to determine which messages were time sensitive or clinically urgent.

When the office administrator eventually saw the message, she made several unsuccessful attempts to reach Samantha Anderson before going on vacation. Furthermore, she had not been trained on how to set the out-of-office notification in the new EHR to alert her colleagues for coverage. Sensing that the team was not working together as it had been previously, the PA checked the status of the tests the following day and discovered that they had not been scheduled. She messaged the office administrator, expecting the out-of-office system to direct

the communication to the covering administrator, as she had been trained that it would. However, no forwarding step occurred, the information was not conveyed, and the tests remained unscheduled. Five days later, the patient called again and spoke with the RN. Recognizing the delay, the RN transferred Samantha Anderson to the office administrator, who had returned from vacation. The tests and MD appointment were scheduled for the following week. In total, 23 days elapsed from when Samantha Anderson initially paged her oncologist to when she was seen for an office visit with the test results. This was an unacceptable delay (Fig 1). Fortunately, the patient did not experience medical harm, but the confidence that she could trust her team to respond to her needs in a timely manner was threatened, as was the confidence that team members had, before the EHR implementation, that their communication methods could be relied upon to keep each other informed and responsive to patient needs

Questions:
1. Evaluate the EHR changeover process in this case study and state how this could be implemented properly and also outline the various steps that should have been followed during such a project - be sure to identify all the stages of implementing an EHR and link that to this case study in your write-up.

2. Considering the "broken trust" what actions will you recommend for the hospital to take to restore its reputation?

3. Perform and detailed SWOT analysis on this project.