HCIS 140 Week 1 Technology for Electronic Health Records Example

What It Takes to Run an EHR in a Six-Provider Pediatric Practice: Hardware, Software, Networks, Hosting and the People Who Keep Them Working

[Student Name]

University of Phoenix

HCIS/140: Fundamentals of Electronic Health Records

Week 1 Assignment

[Instructor Name]

[Date]

The practice, its equipment and its costs are composites written for a model paper; national findings come from the sources listed.

A pediatric practice with four physicians, two nurse practitioners and 14 staff sees about 140 children a day in a suburban office. Every visit touches its electronic health record, from check-in to the vaccine given in the exam room to the claim sent that evening. The record itself is software, but it depends on a stack of technology and a small group of people to keep it working. This paper inventories that technology and explains what each part does.

Devices People Use

Each of the 16 exam rooms has a wall-mounted computer with a keyboard and a card reader for fast login. Front desk staff use two workstations with signature pads and insurance card scanners. Clinicians carry tablets for documenting on the move, and nurses use handheld barcode scanners to record vaccine lot numbers, which the state immunization registry requires. The billing coordinator has two monitors. In all, the practice runs 34 devices, and each one must be updated, secured and replaced about every four to five years.

The Software

The practice uses a cloud-hosted EHR: the vendor runs the software and stores the data in its own data centers, and the practice reaches it through a secure web connection. Before choosing, the office manager compared this model with a locally installed server. A local server would have given the practice more control, but it would also have required someone to maintain hardware, apply updates and run backups, work that a practice without IT staff could not do reliably. The hosted system also includes practice management functions for scheduling and billing, a patient portal and electronic prescribing.

The Network

Because the record lives in the cloud, the internet connection is as critical as electricity. The practice has a business fiber line and a separate cable line from a different provider that takes over automatically if the first fails. Inside the office, a wired network connects exam-room computers and a secured wireless network serves tablets, with a separate guest network for families so their devices never touch clinical systems.

Peripheral Devices

Label printers produce specimen labels, a document scanner turns outside records and signed forms into files attached to the chart, and a printer handles after-visit summaries for families who want paper. The vaccine refrigerators have digital thermometers that report temperatures to a monitoring service, since vaccine storage records are part of compliance.

Interfaces

The EHR exchanges data with other systems through interfaces. Laboratory orders go electronically to the regional reference laboratory and results return to the record. Vaccines given are reported automatically to the state immunization registry. Prescriptions go to pharmacies through the national e-prescribing network. Claims flow through a clearinghouse to insurers. Each interface was set up by the vendor and is monitored for errors.

Backup and Security

The vendor backs up data continuously across two data centers, but the practice keeps its own safeguards: encrypted devices, automatic screen locks, multifactor login for remote access, antivirus software and an annual security risk analysis. For downtime, the office keeps a printed next-day schedule each evening and paper forms in each room.

The People Who Keep It Working

The office manager serves as system administrator, setting up users, permissions and templates. The vendor's support desk handles software problems, and a local IT contractor, on a monthly retainer, manages devices, network and security updates. Two nurses act as superusers who help colleagues with workflows and test new versions before they go live. Without these roles, even the best software would slowly fall out of step with how the practice actually works.

A Day in the Technology

Following one visit shows how the parts work together. At 8:05 a.m. a father checks in his daughter; the front desk scans his insurance card, and the practice management module checks eligibility with the insurer in seconds through the clearinghouse. In the exam room, the medical assistant logs in with a badge tap, records the child's weight and temperature on the wall computer and scans the barcode of the flu vaccine vial, which fills in the lot number and expiration date. The physician reviews growth charts, writes the note on a tablet and sends an order for a strep test. The result posts from the in-office analyzer twenty minutes later. At checkout, a visit summary prints, the vaccine report goes to the state registry overnight and the claim leaves for the insurer that evening. Every one of those steps depends on a different piece of the stack.

Planning for Replacement and Growth

Technology ages. The practice keeps a simple inventory listing every device, its purchase date and its replacement year, so costs are spread out rather than arriving all at once. When the practice adds a seventh provider next year, the inventory shows exactly what must be bought: one more exam-room setup, a tablet, a scanner and another software license.

Why Even Small Practices Now Run on This Technology

Electronic records were rare not long ago. In a 2008 national survey, only 1.5% of U.S. hospitals had a comprehensive electronic records system (Jha et al., 2009). Federal incentive payments after 2009 accelerated adoption sharply among eligible hospitals and providers (Adler-Milstein & Jha, 2017), and today most practices, including small ones, use an EHR. The benefits include legible, accessible records and electronic ordering, while the drawbacks include cost, workflow disruption and security risk (Menachemi & Collum, 2011).

What It Costs

The practice pays about $650 per provider per month for the hosted EHR and practice management software, $900 a month for its two internet lines, $1,200 a month for the IT contractor and roughly $12,000 a year to replace devices on a rolling schedule.

Conclusion

An EHR in a small pediatric practice depends on devices in every room, hosted software, redundant internet, peripherals, interfaces, backups, security tools and a few people who know how it all fits together. Understanding that stack is the first step to understanding electronic health records.

References

Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act drove large gains in hospital electronic health record adoption. Health Affairs, 36(8), 1416-1422. https://doi.org/10.1377/hlthaff.2016.1651

Jha, A. K., DesRoches, C. M., Campbell, E. G., Donelan, K., Rao, S. R., Ferris, T. G., Shields, A., Rosenbaum, S., & Blumenthal, D. (2009). Use of electronic health records in U.S. hospitals. New England Journal of Medicine, 360(16), 1628-1638. https://doi.org/10.1056/NEJMsa0900592

Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy, 4, 47-55. https://doi.org/10.2147/RMHP.S12985