Running Head: EMR in a Rehabilitation Setting

EMR in a Rehabilitation Setting

Patricia Beemer
CAHS 300
Ferris State University
May 2, 2014










EMR in a Rehabilitation Setting

Health care facilities are in need of developing a plan to include an electronic medical
record (EMR) system. There may be multiple barriers and challenges involved in this transition.
The planning stage of this is crucial for facilities to continue functioning at an efficient and
productive level. Barriers to this may be influenced by the type of facility, few resources,
limited budget, minimal time frame for system to be implemented, and ability for physicians and
staff to adjust to new charting system. Challenges may include lack of cooperation by physicians
and staff, transitioning from paper charting to electronic charting, developing new report systems
and inaccurate charting due to input errors.
When choosing a system to work with, the type of facility using the system should be
taken into consideration by all involved. The system currently used within my rehabilitation
hospital is Cerner. Cerner has a good reputation and is used by many hospitals in the area. After
the implementation of this program, however, it showed many indications that this particular
version was not the most user friendly system for a rehab setting.
Cerner was the first, and among a growing list of companies in the industry, to obtain
full accreditation from the Direct Trusted Agent Accreditation Program (DTAAP) offered in
partnership by DirectTrust and the Electronic Healthcare Network Accreditation Commission
(EHNAC), further highlighting our commitment to uphold industry-established best practices for
privacy and security, and fostering confidence for continued innovation around broad use of
these national Direct standards. (Heeren, 2013)
Within the past year using the Cerner system, there have been different integrations and
modifications between Cerner staff and the hospital itself to provide better flow of information
and to provide a more user friendly system for staff.
EMR in a Rehabilitation Setting
Multiple training sessions have been provided to staff in order to optimize time to chart
assessments for patients and to input correct orders. Even with this training, there have been a
great number of issues with this system in relation to a rehabilitation hospital instead of an acute
care hospital. With these issues coming to the surface, there have been opportunities presented
to integrate and interface with other systems.
One of the areas interfaced are with new vital machines. These new machines are able to
communicate with Cerner and information is uploaded into the patient chart in real time. This
decreases the chance of inaccurate or missed charting. It also allows for nurses and physicians to
have immediate ability to view information from remote computers providing a higher quality of
patient care.
In preparation to start this interface process, the Information Technology department
spent a great deal of time researching and meeting with the companies to provide training and
developing a plan for implementation. When considering adoption of a system such as this
integration/interface system, it is extremely important to not only consider the cost of the
program itself, but also the amount of funding needed to provide training to all involved.
Cerner is currently being used for EMR purposes, but may also deploy Cerner electronic
health record (EHR) systems in the future. (Groen, 2013) In referring to the discussion posting
from week five in CAHS 300, a comparison was made between EMR and EHR as follows:
According to Garrett and Seidman, electronic medical records (EMR) are a digital version of a
patients chart. The EMR is to be used within the facility and does not follow the patient. The
EMR allows a facility to track information over a time, monitors needs for patient follow up, and
monitors and improves the patient care overall. (Garrett-Siedman, 2011) Garrett and Seidman
state that electronic health records represents the ability to easily share medial information
EMR in a Rehabilitation Setting
among stakeholders and to have a patients information to follow him or her through the various
modalities of care engaged by that individual. (Garrett-Seidman, 2011) A patient also has the
ability to access their information.
With todays ever changing ways in health care and new developments in technology, it
is crucial to stay up to date with changes to compete with healthcare facilities and all they have
to offer. Patients are becoming more involved in their healthcare and are finding it important to
have access to their medical records for review and understanding. Facilities offering this option
to patients may have a higher population because they are up to date with technology. A patient
who has the capability of receiving medical information to a smart phone or computer may
choose to go to a physician who can offer that option rather than go to a physician who does not
have that benefit available. Smart phones have multiple apps to download to assist in monitoring
blood pressure, blood sugars and provide teaching on a plethora of diagnosis. (Burke, 2013)
Information Technology plays an important part in not only the implementation of a
system, but they also need to follow up to develop a way to create reports containing information
requested by the facility. Creating and following up on reports is a step that a facility must
incorporate in their plan in order to make sure correct payment is received for patient care. One
of the differences between a rehabilitation hospital and an acute care hospital is that
rehabilitation hospitals document Function Independence Measures (FIM) in order to receive
reimbursement. The amount of reimbursement is based off from these numbers. It is because of
the particular Cerner program our facility chose which was geared more toward an acute care
setting that a great deal of upgrades and changes to the system has had to be made. This
oversight resulted in a great deal of reimbursement lost and many hours of work for staff
members from many different disciplines throughout the facility. Hebda and Czar state,
EMR in a Rehabilitation Setting
Developing methods to measure and evaluate beyond system functionality leaves open
opportunities. Selecting a system which has the criteria to meet organizational goals is only the
first step. (Hebda, pg. 167)
The Information Technology team has been able to work with Cerner to make
modifications to the system to better meet the needs of rehabilitation documentation. FIM scores
now have the capability of being charted in Cerner and a report was developed to run the
numbers for reimbursement. The vital machines and glucometers are now interfaced with Cerner
so time and money is saved with the new process.
Reflecting on the implementation of this system within our facility, it seems as though
more time should have been spent in the beginning choosing the best information system for a
rehabilitation hospital. Hebda and Czar state The selection and implementation of an
information system occur through a well-defined process called the life cycle of an information
system. (Hebda, pg. 168) The four stages include an assessment, system selection,
implementation, and maintenance. (Hebda, 2013)
The maintenance phase will now be continued and a great deal of attention needs to be
paid to the updates and changes within the system. Training will then have to continue with staff
to keep them educated to ensure proper documentation for our patients resulting in the
reimbursement for services continuing at the rate earned.
Healthcare facilities are finding a need to research ways of functioning with budget cuts.
The systems put in place for a facility have the potential to save a great deal of time resulting in
money saved. There is also an opportunity to reach the maximum reimbursement level with
thorough and accurate documentation. This puts a high priority on the development and
EMR in a Rehabilitation Setting
continued maintenance within the Information Technology department to reach the maximum
potential for a facility.
Throughout the research for an information system, it has been my conclusion that it is of
extreme importance to follow the life cycle and to complete a thorough assessment of the system
prior to making a decision. Had the facility spent more time and effort on this initial phase,
many dollars would have been saved. As a result of the lack of time spent on the assessment, a
great deal of time and money was spent to try to recover from a poor choice of a system.








EMR in a Rehabilitation Setting
References
Burke, L. & Weill, B. (2013). Information technology for the health professions (4th ed.). Upper
Saddle River, NJ: Pearson/Prentice Hall.
Garrett, P., & Seidman, J.PhD (2011). EMR vs HER---What is the Difference? Retrieved from
http://www.healthit.gov on April 20, 2014.
Groen, P., Maduro, R. 2013. VistA rivals and Cerner in major deployments of EHR
systems. Open Health News. Retrieved from :
http://www.openhealthnews.com/hotnews/vista-rivals-epic-and-cerner-
major-deployments-ehr-systems on April 20, 2014
Hebda, T. L. & Czar, P. (2013). Handbook of informatics for nurses and healthcare
professionals (5th ed.). Upper Saddle River, NJ: Pearson.
Heeren, A. 2013. Cerner supports Blue Button + to engage individuals for better
health. Retrieved from:
http://www.cerner.com/blog/cerner_supports_blue_button_plus/ on April
20, 2014.