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You will assume the role of the healthcare management executive to whom the proposal was directed. You will draft a brief executive email communication directed to all employees of the organization, in which you will explain the issue that was originally presented in the scenario, as well as the solution you will implement. Consider how you will justify your reasoning to your employees. This email message should be brief and appropriate in tone and content for the intended audience.
Specifically, your email communication must address the following critical elements:
I. Introduction: Identify yourself as a management executive and identify the issue.
II. Explanation of Factual Background
A. Explain the policy-making processes you identified above. In your explanation, be sure to explain how the processes will impact the organization. You should assume that your audience knows nothing about traditional policy-making processes.
B. Describe which methods for financing, evaluating, and improving healthcare delivery, operations, and facilities are implicated. Assume your audience needs only basic information about these methods in order to understand the reasoning for your decision.
C. Identify and briefly describe public health policy and population-health programs related to the issue. Call to attention any programs with particular relevance to the organization.
D. Discuss how the issue implicates principles of budgeting, governance, and strategic planning. Approach this discussion from the perspective of organizational employees who want to know how the issue may impact their work.
III. Next Steps and Organizational Impact
A. Explain the solution you will implement. Be direct with employees.
B. Discuss how the solution you will implement will improve population health for patients of the organization. Organizational employees may be more committed to change if there is a clear link to health improvement.
C. Describe how the solution you will implement will utilize healthcare delivery principles and technology available within the organization or using principles and technology that must be deployed in the future.
D. Discuss how your solution will use budgeting, governance, and strategic-planning principles to promote quality and organizational improvement within the organization.
Guidelines for Submission: Your executive email should be brief (1 page maximum), formatted with 12-point Times New Roman font and one-inch margins. Any citations or references that might be necessary should be formatted according to current APA guidelines.
Running head: LETTER OF PROPOSAL 1
LETTER OF PROPOSAL 2
Letter of Proposal
Name
Institution
Letter of Proposal
Executive Summary
Following the announcement by the state’s health department that it will cease from proving the Wall County Health Department with the free electronic medical record system (EMR), the health department faces the challenge of record keeping. The county’s health department will therefore have a hindrance in its workflow and supporting quality healthcare. To align to its mandate of delivering improved care services, policy making and implementation will be a key aspect. The policy-making processes will be implicated by several issues chief among being budgeting for the installation and maintenance of own EMR system. The health department has adopted EMR for ten years; hence, it is worth incurring the upfront cost for installing and operating own EMR system. Although funding is the major hindrance, one of the crucial steps that the organizations should take is to lobby subsidy funding from the federal government.
Factual Overview and Identification
The Wall County Health Department is faced with the challenge of record keeping since the state’s health department will soon cease to maintain the electronic medical record system (EMR). The county’s health department will therefore have a hindrance in its workflow and supporting quality healthcare. Notably, the county’s health department will soon be unable to generate medical records concerning treatment gaps, immunization status reports, and pharmacy utilization reports when the state cuts out its service. Remarkably, this is because the department’s revenue may not be enough to cater for the services, given that most of its revenue is generated from patients within the community where majority are uninsured while the others are in Medicaid or Medicare programs.
One of the management theory and population health improvement principles is the identification of priorities through considering the health trends and the burden of illness by use of population data. Ideally, this management approach will allow the implementation of evidence-based actions that will facilitate positive health outcomes. The impending situation mandates that proper management be observed to ensure that the limited available resources address the demands of the prioritized needs. Additionally, sustainable funding method should be developed, which rewards improvement in population healthcare and prevention (Woolf et al. 2015). Funds directed towards population healthcare should be explicitly described for prioritized healthcare intervention.
The health department can increase its revenue by joining the insurer’s network to ensure that there are more insured patients, which would reduce the overreliance of revenue obtained from direct patients. It can also improve financing through cost transparency which will reduce pharmaceutical costs by allowing drug costs negotiations by Medicare. Moreover, the health department can improve its healthcare quality through maintaining healthy healthcare systems; this means that evidence-based management must support the delivery of evidence-based care. For this reason, patients’ real-time data must be obtained for the purposes of maintaining a smooth workflow. Information will lead to making better decisions which will have a direct impact on better health outcomes. An integrated healthcare system will also be vital in improving healthcare delivery within the healthcare department facilities. When all the healthcare providers work in a coordinated manner through sharing relevant information and focusing on the same goal, better treatment outcomes will be achieved.
Analysis
The first policy-making process implicated by the issue is identification or setting of the problem. The process is implicated in the case scenario because the health facility is required to identify what problem it faces due to the state withdrawing its assistance. The problem identification policy is one that arises from the need to provide quality services or to comply with certain laws (Birkland, 2014). For example, identifying that the hospital is faced with the challenge of maintaining medical recorded is a policy-making process which comes from the need to provide quality healthcare. The other policy-making process influenced by the issue is the formulation of the policy process. Since the situation facing the hospital is challenging, then there is need to formulate policies that can help solve the situation. The policy formulation process implicated by the case requires that policies be made that will directly solve the problem. Another policy-making process that is implicated is adopting the formulated policy (Drummond et al. 2015). The hospital is challenged in many ways ranging from increasing revenue, improving population healthcare, training of personnel, and record maintenance. Therefore, the situation implicates that the health care must adopt the formulated policies so that it can solve its problems.
Policies and population health programs are crucial public health programs. One of the population health programs related to the case scenario is health education. There is a close relationship between health and education. Population health education is a critical determinant of the public health outcomes. There is need to promote health education programs which bridge the education gap between low and high-income earners, and minority and majority populations (Nash et al. 2015). Population health education policies are implemented through the collaboration of health practitioners and public health policymakers. Population health is related to the case scenario since the health department serves members of the public on different levels; ranging from children to the aged. Importantly, health education is fundamental to improving health outcomes and patients health. For this reason, health education could help the hospital cut down the expenses spent in treating patients since they improve personal health care.
Another population health program related to the case scenario is the integration of clinical networks. The integration of healthcare services is a growing health strategy aimed at promoting the adoption of evidence-based practice that improves delivery of healthcare. Ideally, this approach offer a shift from the traditional hierarchical healthcare organization structure to a better model which incorporated the engagement of physicians in the development of improved healthcare models. The situation presented in the case scenario relates to the program since Wall County Health Department is seeking to cut down costs while improving its healthcare provision. Joining a network of other health providers will boost the quality of services offered.
The financial health of an organization is affected by its budgeting principles. A health organization will fail in service delivery if sound budgeting principles are not applied. The scenario facing the health department requires that the institution underestimate its income and overestimate its expenses. The situation implicates the budgeting principle because of contingency expenses. Another way to look at how the scenario has implicated the budgeting principle is through finding out whether the hospital had set aside some funds for unprecedented events such as being cut out from free services by the state. Another principle of budgeting implicated by the scenario is teamwork and consultation. In budgeting, working as a team is a fundamental concept.
The presented issues demand that the Wall county health department utilizes this principle in planning its budget since it is faced with a difficult task of managing limited funds and thus consultations will be immensely needed. Managing budgets requires that tasks are split to persons with great expertise in the field. Following this principle will make the budgeting process slow, but the outcome will be more accurate. Another implicated principle is corporate strategic planning principle. The corporate principle is incorporated because it deals with the overall performance of the organization. Given the challenges facing the health department, this principle must be in play when looking at how to improve the quality of healthcare.
Recommended Solutions
Since their introduction, Electronic medical records (EMRs) have been perceived to possess the potential to advance the general health of the society. However, the major setbacks with the utilization of EMRs are the costs and challenges associated with the implementation of the systems. According to Hayes (2015), the cost of implementing an EMR system is quite high and could cost about $163, 765 for a single physician. Hayes (2015) research highlights that by 2015, the Center for Medicare and Medicaid Services had spent over $30 billion funding the implementation and utilization of EMR systems in about 468,000 care providers. Although the implementation and maintenance of EMR systems are high, there are several benefits associated with such systems. For instance, they result in minimal medical errors, improved patient care management, reduced costs, and increased productivity (Fottler, Khatri, and Savage, 2010).
For the past ten years, the Wall County Health Department has been using the EMR system offered and maintained by the States Department of Health and Human Services (DHHS). Wall County Health Department has been paying a nominal fee for using the DHHS EMR system. However, following a severe budget cut, DHHS has signaled that it will terminate the maintenance of the EMR system within the next 120 days. After the scheduled termination, the users will manage to access the EMR system for only 12 months. In light of this, the main challenge facing the Wall County Health Department is on whether to install and maintain its EMR system or go back to the conventional medical records storage. For this reason, this proposal aims to recommend the installation of an EMR system by the care facility.
The goal of any healthcare facility is to provide improved care to the patients sustainably. EMRs were implemented to increase the quality of healthcare delivery and patients outcomes. Since the introduction of EMRs, many healthcare facilities across the US have shown their interest in their adoption and use (Suresh and Stanton, 2016). For the past ten years, Wall County Health Department has entirely relied on EMR system to create and store medical records. Moreover, the care facility has depended on the system to generate pharmacy utilization, immunization, and treatment reports. For these reasons, Wall County Health Department should install, implement, and maintain its EMR system following the termination of the EMR system provided and maintained by DHHS to align with its mission. Although implementation of EMR is expensive, its long-term benefits are worth the upfront costs incurred. Such benefits include effective cure option at low costs, health expenditure reduction at the national level, provision of effective primary health care measures, and predictive medicine. Ideally, the combination of this benefits results in a healthier society. It is worth realizing that these benefits cannot be realized without the patient, the federal governments, and providers sustaining substantial initial costs for both implementation and maintenance (Hayes (2015).
The main reason why the care facility has not implemented and maintained its EMR system is that of cost-saving purposes. Notably, apart from the nominal fee, it pays for the EMR system provided by DHHS, the care facility major spending are on operation overheads, and care providers’ salaries in its four locations where it offers care services in the County. The healthcare facility receives most of its revenue from the money it collects from providing direct behavioral and physical health services to patients. Other funding is from the County general fund and grant programs. According to Hayes (2015), the cost of implementing and maintaining an EMR system is approximately $65,000 after factoring in federal subsidies.
Although this is still a considerable cost, the facility can manage to sustain it given that most of the care providers who require an EMR system are those involved in physical intervention care delivery with the facility locations. Moreover, the policymakers at the federal level are responsible for providing subsidies to a facility of Wall County Health Department nature, which implies that upfront costs incurred can equally be minimized (Joshi, 2017). The rationality for implementing the EMR system is equally supported by the facility’s desire to join the network of Medicaid Management Care and Medicare Advantage Insurer. Although the Insurer offers the highest rates, it tends to reduce them when facilities fail to improve their population health outcomes. Ideally, implementing an EMR system would result in sustained improved healthcare outcomes.
Conclusion
The issue of record keeping implicates the policy-making process. Ideally, the problem identification process is of implication since the county’s health department is required to identify the challenges it will encounter following the state’s service withdrawal. Formulation of applicable policies will equally have implication to the situation. Notably, policies will have to be enacted to solve the problem. The formulation of policies entails discussions with the relevant stakeholders, which have impacts on the operation of the care facilities following the implementation of policies. Policies and education health programs are crucial for promoting the delivery of health care. For instance, health education is an essential aspect that relates to delivery of health care because it results in better public health outcomes; hence, the significance of health education programs. Integration of clinical network is another vital health program that enhances the delivery of health care. Notably, evidence-based practice has proved to be an important approach for implementing the transformation from the traditional hierarchical healthcare organization structure to a better model which incorporated the engagement of physicians. The financing of the health care usually has an impact on the budgeting principle since the principles have to be modified to align to the funding requirements for organizational success. The management approaches are relevant to the issue under consideration since the county’s health department is required to implement them in planning its budget because of the limited funds. In its mandate to improve the care delivery, the health department has adopted EMR for ten years; hence, it is worth incurring the upfront cost for installing and operating own EMR system. Although funding is the major hindrance, one of the crucial steps that the organizations should take is to lobby subsidy funding from the federal government.
References
Birkland, T. A. (2014). An introduction to the policy process: Theories, concepts and models of public policy making. Routledge.
Nash, D. B., Fabius, R. J., Clarke, J. L., & Skoufalos, A. (Eds.). (2015). Population Health. Jones & Bartlett Publishers.
Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes. Oxford University
Press.
Woolf, S. H., Purnell, J. Q., Simon, S. M., Zimmerman, E. B., Camberos, G. J., Haley, A., & Fields, R. P. (2015). Translating evidence into population health improvement: strategies and barriers. Annual review of public health, 36, 463-482.
Fottler, M. D., Khatri, N., & Savage, G. T. (2010). Strategic human resource management in health care. Bingley: Emerald.
Hayes, T. (2015). Are Electronic Medical Records Worth the Costs of Implementation? Retrieved 11 January 2018, from https://www.americanactionforum.org/research/are-electronic-medical-records-worth-the-costs-of-implementation/
Joshi, A. (2017). POPULATION HEALTH INFORMATICS: Driving evidence-based solutions into practice. Sudbury: Jones & Bartlett Learning.
Suresh, S. & Stanton, B. (2016). Quality of care and information technology. Philadelphia,
Pennsylvania: Elsevier
PHE 610 Electronic Medical Records and Quality Improvement
Wall County is in the State of Drake. Wall County (the “County”) has a local public health department, Wall County Health Department (the “Department”) that
offers a variety of services, including primary care and outpatient behavioral health services for children and adults. The County serves predominantly uninsured,
Medicaid, and Medicare patients in multiple locations around the County. Wall County is a mix of urban and rural areas. In many communities within the County,
the Department is sole provider of physical and behavioral health services.
The Department receives the bulk of its revenue from providing direct physical and behavioral health services. Some additional revenue flows to the Department
from the County’s general fund and by way of small grant programs to support environmental health and nurse home visiting activities. The Department’s budget
year aligns with the County’s budget year and runs July 1 through June 30. The Department’s largest expenses are provider salaries and operating overhead in
each of the four locations where the Department offers services throughout the County.
Drake’s largest Medicaid managed care and Medicare Advantage insurer (the “Insurer”) has approached the Department about joining the Insurer’s network. The
Department has learned from other entities in the Insurer’s network across the State of Drake that network payment rates typically exceed those rates offered by
other payers. However, the Insurer has a history of decreasing payment rates over time for those network providers that do not manage their populations to
improve health outcomes and decrease emergency department utilization. At this time, the Department has not made a decision about whether to join the
Insurer’s network.
For the past 10 years, the Department has paid a nominal fee to use the statewide electronic medical record (“EMR”) system provided and maintained by the
State Department of Health and Human Services (“DHHS”). The EMR system allows the Department to generate limited reports for its providers, including:
Treatment gap lists and risk
Pharmacy utilization reports
Immunization status reports
The EMR system is the only system used by the Department to create and store medical records. Utilization of the system varies widely by provider and by
location, but in general, utilization of the EMR system is lower among behavioral health providers than among physical health providers. Some Department
locations in the County have trained providers on workflows to navigate the EMR system and other locations have not.
Five days ago, on January 2, DHHS notified the Department that it will cease maintaining the EMR system in the next 120 days. DHHS explained that EMR system
users will be allowed to access the EMR system for up to 12 months after maintenance termination, but no user support or security patches will be available
during that time period. Unfortunately, DHHS has experienced a round of severe budget cuts that have limited its ability to respond to questions about the EMR
system or related service requests; DHHS will not offer any information technology support or technology training for the Department.
You are the director of quality for the department. Your supervisor, the director of public health for the department (with the backing of the Board of County
Commissioners), has directed you to brief her on the issue and recommend a course of action. Specifically, the director of public health has asked you to create a
policy proposal for her review.
