The local public health department faces challenges as the state will stop maintaining its electronic medical records system. This leaves questions about how to continue maintaining medical records, raise funds for new IT services, and whether to join a private insurer's network. The department director tasks the quality director to recommend a course of action, including whether to adopt a new electronic records system and how to improve healthcare delivery and population health outcomes.

1. Running head: ELECTRONIC MEDICAL RECORDS 1
ELECTRONIC MEDICAL RECORDS 4
ELECTRONIC MEDICAL RECORDS
Student’s name:
Professor’s name:
Course title:
Date
ELECTRONIC MEDICAL RECORDS
The public 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 department is, therefore, having a hindrance in its workflow
and supporting quality healthcare. The department will soon be
unable to generate medical records about treatment gaps,
immunization status reports and pharmacy utilization reports
when the state cuts out its service. The department's revenue

2. may not be enough to cater for the services, given that most of
its revenue is generated from patients within the community
where a majority are uninsured while the others are re in
Medicaid or mediocre programs.
From the given situation some questions need to be resolved.
One is how to continue maintaining an electronic medical
record without the state's services. The other is on how to raise
revenue to cater for information technology services and
training that the will no longer be given for free. Another
question would be as for whether to join the insurer's network.
Other than the uninsured, the department seems to serve
patients who are in the insurer's Medicaid or Medicare program,
hence joining the network would probably provide quality
healthcare delivery.
To improve the population health, one of the principles to be
utilized is identifying priorities through looking at the health
trends and the burden of illness by use of the population data.
The action will allow the implementation of evidence-based
actions to which will facilitate positive health outcomes. The
current situation requires that proper management is observed to
ensure that the limited available resources cater for the
prioritized needs. Additionally, there should be created
sustainable funding method 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 department can increase its revenue by joining the insurer's
network where there will be more insured patients and stop
relying on direct patients. It can also improve financing through
cost transparency which will reduce pharmaceutical costs by
allowing drug costs negotiations by Medicare.It can also
improve its quality healthcare through maintaining healthy
healthcare systems; this means that evidence-based management
must support the delivery of evidence-based care. The primary
factor will, therefore, be information. Thus patients' real-time
data must be obtained for purposes of maintaining a smooth

3. 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 and various facilities within the department.
When all the healthcare providers work in a coordinated manner
in sharing relevant information and focusing on the same goal,
then better treatment outcomes will be achieved.
In the given case, one of the relevant healthcare delivery
principles is offering preventative and accessible quality
healthcare via insurance coverage for the whole population. The
coverage should include even those are more vulnerable to
inequalities in the healthcare. A technology relevant to the
given situation is the adoption of an Electronic Health Record
(EHR) which reduces the administrative time spent by
physicians. The saved time should be spent engaging with
patients. An evaluation of patient-centered care should be
improved and other innovative alternative care methods should
be adopted (Oleske, 2014). Lastly, healthcare delivery
principles require that the health facility integrates with the
community in other aspects as it will enhance the delivery
system.
References
Dougherty, L., & Lister, S. (Eds.). (2015). The Royal Marsden
manual of clinical nursing procedures. John Wiley & Sons.
Oleske, D. (2014). Epidemiology and the delivery of health care
services (3rd ed.). Michigan: Springer.
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.

4. 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

5. 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:
The EMR system is the only system used by the Department to
create and store medical records. Utilization of the system

6. 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.