Resource: Healthy Care Community ProfileThis week you continue your work on the HCC HIT system upgrade project by drafting several components of your project team's security plan to prevent and manage

DEISGN PROPOSAL 12

Healthy Care Community HIT Design Proposal

Michelle Smith

University of Phoenix

October 27, 2019

“The Healthy Care Community (HCC) mission with almost excellence and compassion in providing disease and injury care to the community and individuals in their communities" (Jones 2017). Healthy Care Community operates two acute care clinics at 20 miles to accomplish this mission. Recently, the aging IT infrastructure of the Healthy Care Community has hampered its effectiveness. This has been shown by the failure to implement the Digital Bedside Monitoring System (DBMS). Although the problem has been solved through an all-round review, HCC's management has enabled the IT department to update its IT infrastructure to its entirety in line with HCC's project strategies.

Healthy Care Community’s Current Architecture

Safe Care Community's Healthy information technology (HIT), currently consists of generic HIT systems which can be classified into one of three broad categories: medical, non-clinical and vital business HIT systems. The HCC Data Center and the two Hospital Locations, HCC West and HCC South, were split between these structures into the three sites. HCC currently owns all its infrastructure and the IT department of HCC is responsible for every aspect of its maintenance. That part of this project should work together, so that HCC can provide the most efficient treatment to its community, at competitive prices, whilst at the same time optimizing its profits.

Clinical Functions

Clinical functions can also be viewed as specific functions of the health discipline and as supporting information technology structures. In the acute health care hospital disciplines, health services such as radiology, cardiology, clinical diagnostics and emergency rooms are different. The disciplines are similar. These are the disciplines and departments in a hospital which provide the hospital patients with direct health care services. The Healthy Care Community Profile (HIT350 r3 HCC Profile.doc), Healthy Care Community clinical functions are ' Radiology, Cardiology, Laboratory, Network Oversight and Customer Service ' (Patients will not be referred to as the clients in this document, though it is preferred in the healthcare industry to avoid confusion with the information technology terms customer / server computing). (Jones, 2017).

Non-Clinical Functions

Non-clinical roles consist of facilities and divisions that provide patients with not direct health care but support those services by means of indirect, but not less important, means such as the registration and scheduling of patient services and financial operations such as billing, management of medical information and the management of materials. Direct health programs would be unable to operate without such tasks and the data systems that support them. The nonclinical roles of the Healthy Care community include, "Patient Billing, Patient Tracking, Patients Scheduling, Patient Monitoring, Materia Management, Bed Capacity Management, and Health Information Management" in the Healthy Care Community Profile report (HIT350 r3 HCC Profile.doc). (Jones, 2017).

Critical Enterprise HIT Systems

The critical Healthy Care Community Impact systems are "Electronic Health Record (EHR)/Electronic Medical Record (EMR), Clinical Decision Support (CDS), Patient Registration System (PRS), and Patient Pollution System" (Jones, 2017). The Healthy Care Community Profile report (HIT350 r3 HCC Profile.doc). The programs are used by medical or non-clinical staff but are categorized as important to the daily operations of the organization because they directly affect the payment of the Organization for all services to its clients. The HITECH Act of 2009, which was passed as part of the 2009 United States Recovery and Reinvestment Act, mandates all covering providers to prove that EHR / EMR systems are used to their fullest extent to continue to be eligible for reimbursement from Medicare. Medicare requirements are adopted by most insurance providers and federal Medicaid services. The EHR / EMR program is thus as important for accounting as it for medical records, and the identification of patients is necessary for the entry of new customers, creating new revenue stream avenues.

Locations

The IT service of HCC retains its servers in its data center for operations of the systems mentioned above. Healthy Care East and Healthy Care West have most of these services at every site for customer-side systems. The Medical Record Number servers are a significant exception. "While hospitals share other programs, each hospital has its own medical record (MRN) database, as shown by the Safe Care Group Profile. There is no common MRN between two hospitals for patients. "(Jones, 2017). When introducing a Virtual Nest Monitor Program, it proved a near-fatal flaw in overall system layout.

The Digital Bedside Monitor System Incident

A new Digital Bedside Monitoring System (DBMS) has recently been introduced by HCC. This system monitors and records in real time patient data such as signs of life (temperature, heart rate, rhythm, breath, blood pressure) and interfaces with the PACS system. One day, workers at both locations found a flaw when the system went online. The device reported data that were not consistent with the person currently in bed. The root cause was found after the investigation. HCC West and HCC East have their own MRN servers at both sites. This means that the HCC West patient had the same MRN as HCC East patient and the DBMS registered the HCC East patient data and data for HCC West, and vice versa.

Medical Record Numbers (MRNs)

For many reasons, this problem is alarming. First and foremost, had the staff not noticed the DBMS information was inaccurate, patient harm was possible, and the inadequate information was provided by less diligent staff. Medication could have been issued without any health requirements that could result in a real medical emergency to increase or decrease heart rate, blood pressure, breathing, and correct arrhythmias. This puts the business at risk of possible malpractice and serious criminal and financial penalties in addition to the potential for patient damages. Further compound the problem, reading the Healthy Care Community Profile, it is obvious that this issue has already been found in other shared systems, as Jones says, "To do so, the MRN-feed-in patient registration system (PRS) uses an extra field in its database that prepends a digit for the MRN further show which of the two hospitals the patient has. This transformation of the software is important for ensuring a consistent patient identity. (Jones, 2017).

The focus of the patient's database can be considered the MRN. It should be a unique identifier for each patient in order not to misallocate information for one patient. With an address given by then President George W. Bush in 2004 and his establishment, by Executive Order, of the Office of the National Coordinator of Health Information Technology in the Department of Health and Human Services, the need for specific MRNs and for individual electronic health / medical records was brought to national attention. HCC could be evidence of incompetent incompetence for failing to apply the same procedures to the new DBMS, if a malicious client had suffered, by applying a workaround on this problem on existing systems as shown by the SRP process prepending an additional digit on MRNs in shared systems. The solution to the problem was to connect the DBMS to the PRS api.

New Architecture Proposal

Following the HCC leadership incident in the DBMS, it was agreed that it was time to complete an upgrade to the HIT whole system and the OpenEMR project and other key parameters were approved as the basis. These parameters are to ensure compliance with the relevant rules, including HIPAA, by improving and maintaining system security, transforming the pharmacy into a revenue generation transaction, and ensuring future operational efficiencies, for a simplicity and cost decreased Cloud solution. Following review of the existing HCC systems, OpenEMR investigation and a careful examination of HCC leadership parameters, the following proposals will be put forward as outlined in the Healthy Care Community Profile document.

OpenEMR in the Cloud

This code has been revealed to follow nearly all the parameters set out in the Healthy Care Group Profile report through the OpenEMR website and its official Wiki and Forums. The GNU General Public License software is free of charge as open source Software. This would reduce any licensing fees. It is a full EHR with ONC approval. It may be installed and run on any cPannel and LAMP stack (Linux, Apache, MySQL, and PHP) framework officially, but with little adjustment it is possible to run OpenEMR any system that supports PHP. It would be run from a server, like any other website, on the client computer. The Amazon AWS provides a complete OpenEMR full-stack solution from $140 a month. It could be done from a server in the HCC Data Centre. This would stop HCC from getting the hardware and software on their server and managing them. The HCC network quality could also be enhanced by autoscaling AWS bandwidth. This kit complies with HIPAA positions that can easily be customized to suit specific needs. It also provides data backup and retrieval.

OpenEMR has all modules provided by the current system, including many other Medical, Non-Clinical and important business features. With the open source nature of software, community developers are constantly adding additional features to new releases and the source code is freely available for review to ensure compliance. In line with HCC's wish to turn the internal pharmacy into a business revenue line, the pharmacy unit supports not only prescription collection, but also has dispensing assistance, drug and regulatory data. OpenEMR also provides a website for patients. In this way clinicians can access information and documentation without going to hospital and then connect with clinicians and verify prescriptions. In line with one of the HCC goals, this leads to an improvement in overall patient satisfaction.

Previous iterations of patient data and information were revealed and many HIPAA breaches were raised. Concerns had been raised. The ones are patched. Those. Interoperability with Microsoft Windows, Mac OS and many mobile operating systems as a cloud-based solution does not present a problem. Each computer supporting a modern web browser will serve as a workstation for users. This can include existing workstations on the client side of HCC. Because workstations must be replaced, low-country choices like Wyse Thin Clients or Chromebooks (Chrome OS for enhanced security with Enterprise level) can be explored.

The new system can be deployed alongside the existing system with the help of the cloud-based solution while patients admitted to the existing system remain operational. The proposed system would allow new patients and former patients admitted under a new treatment series. This would encourage both locations to use the same system, generating different MRNs for the whole organization. The current system could be withdrawn from the board, only leaving the new cloud system running, in a near seamless transition after the last patient in the old system has been discharged, and all patient data backed up.

Conclusion

HIT systems can be a tough and costly process. It is necessary not only to address technical aspects, but also to comply with regulations governing the healthcare sector. When these systems must combine other physical locations, this can be made even harder. Luckily, with enough preparation and developments in cloud computing, cost-effective solutions to these problems are overcome.

References

McCormick, K. A., Gugerty, B., & Mattison, J. E. (2018). Healthcare Information Technology Exam Guide for CHTS and CAHIMS Certifications. Retrieved 10 June 2019, from The University of Phoenix eBook Collection database.

Jones, L. (2017). Healthy Care Community Profile (HIT350_r3_HCC.doc) (3rd ed.). Retrieved 10 June 2019, from The University of Phoenix eBook Collection database.

HITECH Act Enforcement Interim Final Rule. (2009). HHS.gov. Retrieved 10 June 2019, from https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html

What is a Primary Key? - Definition from Techopedia. (2019). Techopedia.com. Retrieved 10 June 2019, from https://www.techopedia.com/definition/5547/primary-key

10 years after the revolution. (2014). Modern Healthcare. Retrieved 10 June 2019, from https://www.modernhealthcare.com/article/20140405/MAGAZINE/304059980/10-years-after-the-revolution

OpenEMR. (2019). Open-emr.org. Retrieved 10 June 2019, from https://www.open-emr.org/

OpenEMR Features - OpenEMR Project Wiki. (2019). Open-emr.org. Retrieved 10 June 2019, from https://www.open-emr.org/wiki/index.php/OpenEMR_Features#Prescriptions

Pharmacy Dispensary Module - OpenEMR Project Wiki. (2019). Open-emr.org. Retrieved 10 June 2019, from https://www.open-emr.org/wiki/index.php/Pharmacy_Dispensary_Module

Technical Aspects of OpenEMR - OpenEMR Project Wiki. (2019). Open-emr.org. Retrieved 10 June 2019, from https://www.open-emr.org/wiki/index.php/Technical_Aspects_of_OpenEMR

AWS Cloud Packages Comparison - OpenEMR Project Wiki. (2019). Open-emr.org. Retrieved 10 June 2019, from https://www.open-emr.org/wiki/index.php/AWS_Cloud_Packages_Comparison