1 Within the EHR [footnoteRef:1] [1: ] [Student Name Removed] Abstract— This research paper was conducted to demonstrate the usefulness, positives, negatives and challenges associated with implementing the Electronic Health Record in a small private family practice group. Further use of research in this paper includes pieces on project implementation, government security accordance and system recommendations. INTRODUCTION Health information technology (HIT) has been revolutionized by the development of the electronic health record (EHR) and its expansion. The generalization of its use includes the transformation of paper patient charts and protected health information (PHI) into electronic forms and from there the options to revolutionize HIT began. The development of the EHR has brought a multitude of advantages and challenges with its implementation in the HIT world. Although the functions of EHR have allowed for both public and private sectors to utilize its possibilities, the private sector will be focused on in this situation. The ability for an electronic system to safely document, record, save, integrate and share with other instantly has allowed HIT to expand rapidly to all corners of the world. EHR functionalities In health information technologies, electronic health records have been identified by the Institute of Medicine as having eight core components which include the following [1]: recording patient health information and data, result management, physician order management, decision support, electronic communication and connectivity, patient support, administrative process and reporting, reporting requirements, and population health. Table 1 allows a visual representation of the core components along with other variable options available through the EHR [2]: As seen, the electronic health record is much more than digitized patient records. As the EHR has the ability to provide functions ranging from patient care through supportive administration functions and even the function of informational infrastructure guidance in order to better aid the staff of the practice in clinical and clerical office services. Integration of Practice Management System Practice management systems (PMS) have multiple levels of integration with electronic health record systems yet there are difficulties at each level. Levels of integration can range from full system communication sharing all data entered in to each system or select data pending on the organizations need for level of integration from one system to another [3]. To distinguish the two systems, practice management systems provide more clerical functions of a physician’s office such as patient billing profiles, insurance verification, appointment scheduling and sending appointment reminders [3]. Co-coordination between the two systems have become increasingly more difficult due to the evolution and development of multiple EHR products. As organizations develop new electronic h.

1. 1
Within the EHR
[footnoteRef:1] [1: ]
[Student Name Removed]
Abstract— This research paper was conducted to demonstrate
the usefulness, positives, negatives and challenges associated
with implementing the Electronic Health Record in a small
private family practice group. Further use of research in this
paper includes pieces on project implementation, government
security accordance and system recommendations.
INTRODUCTION
Health information technology (HIT) has been revolutionized by
the development of the electronic health record (EHR) and its
expansion. The generalization of its use includes the
transformation of paper patient charts and protected health
information (PHI) into electronic forms and from there the
options to revolutionize HIT began. The development of the
EHR has brought a multitude of advantages and challenges with
its implementation in the HIT world. Although the functions of
EHR have allowed for both public and private sectors to utilize
its possibilities, the private sector will be focused on in this
situation. The ability for an electronic system to safely
document, record, save, integrate and share with other instantly
has allowed HIT to expand rapidly to all corners of the world.
EHR functionalities
In health information technologies, electronic health records
have been identified by the Institute of Medicine as having
eight core components which include the following [1]:
recording patient health information and data, result
management, physician order management, decision support,
electronic communication and connectivity, patient support,
administrative process and reporting, reporting requirements,

2. and population health. Table 1 allows a visual representation of
the core components along with other variable options available
through the EHR [2]:
As seen, the electronic health record is much more
than digitized patient records. As the EHR has the ability to
provide functions ranging from patient care through supportive
administration functions and even the function of informational
infrastructure guidance in order to better aid the staff of the
practice in clinical and clerical office services.
Integration of Practice Management System
Practice management systems (PMS) have multiple levels of
integration with electronic health record systems yet there are
difficulties at each level. Levels of integration can range from
full system communication sharing all data entered in to each
system or select data pending on the organizations need for
level of integration from one system to another [3]. To
distinguish the two systems, practice management systems
provide more clerical functions of a physician’s office such as
patient billing profiles, insurance verification, appointment
scheduling and sending appointment reminders [3]. Co-
coordination between the two systems have become increasingly
more difficult due to the evolution and development of multiple
EHR products. As organizations develop new electronic health
record systems and PMS software the possibilities and extent of
integration has become challenging yet still possible.
One such successful integrations of PMS and EHR was
conducted with the organization A ViSolve Inc. A ViSolve Inc.
was able to drastically decrease duplication of data, reduced
physician effort in clerical work and decrease manual data entry
[4]. A ViSolve Inc. was able to create interoperability with the
purchasing organizations PMS and EHR systems to ensure that
each were able to have seamless communication [4]. In this
case, results from the integration allowed for improvements in
speed and quality of care within the practice, improved

3. accuracy between data sharing in the two systems, increased
productivity from the clerical point of view, and a positive shift
in physician hours spent towards providing more quality of care
rather than in data entry [4]. Challenges in implementing The
ehr
Small private practices have had a larger struggle in
implementing the EHR due to differentiating factors that larger
public systems may not have had. Table 2 contains the mean
values from a previous study representing the ratings of
challenges to implementing the HER. In this sample of medical
group practices both large and small throughout the nation they
named and rated challenges and barriers to implementing the
EHR on a scale from one to five with five being the most
important [5]:
· Cost and Return on investment – Amongst the highest mean
ratings from Table 2 were the lack of resources available to
invest in an EHR along with the lack of return investments
status post implementation [5]. The loss of revenue caused from
this challenge/barrier includes the transition period from paper
to the EHR. This transition period represents the possibility for
an unseen loss of revenue during the EHR implementation
which can be substantial if incorrectly managed. In addition,
assuming the medical practice has the necessary means to
support this loss of income the possibility of not being able to
recover from the transition or recover any amounts of monetary
gain from the system has also established a challenge for
implementation [5]. Sometime implementing the EHR does not
always prove to be beneficial as small practices can become
overwhelmed by licensing fees and annual fees associated with
implementation making the investment too risky.
· Physician ability and willingness – Also referred to as the
people barrier, physicians, clinical staff and other providers
must have the willingness to alter their clinical practice to
accommodate changes [5]. If an effort is not attempted to
perform a successful transition into the EHR, then ultimately
the project will fail costing an exponential amount of money

4. and maybe even the medical groups practice. Coinciding with
this if the clinical staff does not have the capacity to adapt
quickly to the EHR then the illusion of loss on investments as
mentioned in the first barrier to implementing EHR will also
follow. Technical skills will need to be developed at an
alarming rate which can be come another liability to the small
practice if not enough training is available. advantages in using
the ehr
Table 3 lists the benefits and advantages of implementing the
EHR into private practices based off the same study previously
used in the challenge/barriers portion of the paper. This too,
contains a mean rating of the advantages provided by the EHR
[6]:
· Access to information – Both PHI and clerical information can
now be more easily accessed by individuals who require the
necessary means to view data. In this process, workflow
improvement is also a key factor in EHR implementation [6].
Improvement in workflow can now benefit provider efficiency
and in turn increase the quality of care for patient in the
practice. Providers will now have instant medical information at
the click of a button streamlining the process for conduction
searches on past medical history, allergy lists, medication lists,
and lab/radiology results.
· Prescription capabilities – Administering and refilling drug
prescriptions can now be conducted electronically which can
substantially increase the process of interactions with
pharmacies in the area. Filing claims with insurance agencies
for prescriptions is now more efficient as software within the
EHR and PMS systems are able to verify coverages
electronically. EHR implementation can further track
medication prescriptions which is another added benefit to
private family practice groups seeing how government
regulations are becoming stricter with the current opioid
epidemic in the country.
· Medical Errors – EHR implementation utilizes real time

5. documentation and is continuously updated with each patient
visit providing the most up-to-date information for each
encounter. This provides physicians with more accurate data
when conducting medical procedures, diagnosis, and viewing
diagnostic results allowing less medical mistakes to occur.
· Reduced Expenses – A key factor for private medical groups
in hopes of achieving as much income as possible is to control
expenses. The Center for Medicaid and Medicare insurance
reimbursement rates decrease year after year and private
insurers are following with the reimbursements rates to
hospitals and private practices alike [7]. Implementation of the
EHR allows private practices to marginalize expenses by avoid
duplications and mistakes which ultimately maximizes their
profits.
Project Planning and Management
EHR implementation and the management of this project can be
successfully done through a five-step process as outlined by
Claudine Beron the Vice Chair of the Health Information and
Managements Systems Society [8]: initiate, plan, execute,
control and closing phases.
The initiation phase will consist of educating the staff about the
project while gathering their understandings of their skill set of
information technology and identifying missing skills and key
pieces required to continue to the next phase of the process [8].
The planning phase will rely heavily on the project team
selected to be responsible for the success of the rest of the
process. Here, the team will need to manage a detailed schedule
including time and cost of activities, project risks and
communication pathways for issues should they arise [8]. The
planning phase will also develop a budget for the resources
required as well as vendor selection of the EHR, confirmation
of software and hardware installation and the verification of
staff training schedules [8].
The following two stages occur almost simultaneously as
execution and control of the project are underway. Top

6. objectives in this part of project management include
conducting and managing ongoing activities such a training and
installation, measuring project milestones by performing quality
assurance checks, and identifying any risks that would likely
trigger a contingency plan prior to when they are necessary [8].
Control of the project management monitors risks and logs
issues that arise, tracks performance and completion percentage,
measures the reporting of timesheets, tacks vendor and
subcontractor reports and documents cost control [8].
The closing phase prompts the end of the project management
process and includes closing out financial obligations, signing
out vendor and subcontractor documents, finishing final reports
to executives and shareholders and conducting a project review
to determine the lessons learned through implementation of the
EHR system [8].
Technology Security Considerations
Whether in electronic or paper form, implementation of the
EHR does not change the rules of your protected health
information governed by the Health Insurance Portability and
Accountability Act (HIPAA). As spoken by Scott Withrow,
founding partner at Withrow, McQuade & Olsen LLP an expert
firm in health care law “EHRs save money, but the costs to
make EHRs as secure as paper—well, those might actually
exceed the savings of EHRs themselves” testifies that securing
EHR systems have proven to be difficult at time [9].
To prevent breaches in EHR systems, vendors and organizations
have designed their software’s and hardware’s to make the as
impeccable as possible in order to prevent breaches in PHI and
HIPAA violations. The tradeoff for security however is access
and one of the key function the EHR is to provide easy access to
information posing a difficult situation for vendors and EHR
developers. Considerations for technology security include
publishing standards and definitions of what constitutes as a
violation and can include the creation of a system of levels that
provide warnings and negative reinforcements to prevent the
violation of said standards [9]. Ensuring internal compliance

7. from all employees via signed agreements partnered with
continuous training and education on these systems can also
improve secure conditions [9]. From the software perspective,
audit recording systems and encryption software can help track
and lock accessible PHI to prevent further HIPAA violations
from unwanted breaches [9].
0. Final Recommendations base upon Data
Through extensive data analysis this practice should acquire an
EHR system that best suites smaller medical groups seeing as
there are only three physicians on staff. Based off the data
collected from Medical Group Management Association and the
Health Services Research Division at the University of
Minnesota the average upfront cost for one physician of a
smaller private practice will be over $33,000 with annual
maintenance fees of over $1,500 per month [5].
In this case of the given $150,000 for upfront expenditures
approximately $120,000 would be expected to be spent at
$40,000 per physician leaving a remainder of $30,000. This
small family practice could expect to consume most of its
annual budget leaving room for approximately $1,650 per
physician per month with only a $60,000 allowance. An
adequate recommendation for an EHR system would most likely
fall under operators of the EHR systems eClinicalWorks or
Allscripts as they cater more to smaller practices holding over
20% of the small practice market share combined compared to
the other nine top competitors [10]. Specifically noted to avoid
are EHR giants such as Cerner and Epic whom mostly provide
services to large medical and hospital groups [10].
Further recommendations would suggest to use a remotely
hosted EHR system, specifically a cloud system while avoiding
more expensive remotely hosted options such as a subsidized or
dedicated host system. Cloud based systems require minimal if
no installation during implementation, are relatively cheaper
monthly with an average of $1,100 per month and have an
outsourced IT department creating the perfect environment for a

8. small private family practice [11]. This practice may also
benefit from a physician-hosted system however a
recommendation for this type is withheld because according to
the National Center for Biotechnology Innovation; vendors of
this type of system can withhold data from practices should any
issues arise and being a more expensive system, it would be
best to avoid this option [11].
Conclusion
The research conducted on this paper has certainly shed more
light as to what the Electronic Health Record has become. The
EHR is certainly much more than digital paper charts as its
functions and implication reach far beyond what its original
intentions were for.
Presented in the paper were several challenges,
advantages, and special considerations that make taking the step
toward implementing the EHR a risky but rewarding behavior
for any healthcare organizations. Tables two and three both list
the negatives and positives, accordingly, of implementing the
HER. Specifically, mentioning physician resistance and staff
capabilities as well as management costs are major cons that
were easily outmatch by key advantages of EHR: improved
access to information, reduced medical errors, reduced expenses
in the long run and most importantly improved quality of care.
Following HIPPA and governing acts of HIT are a constant
reminder that the EHR will only be able to go as far as the
government allows in order to keep PHI protect and safe from
breaches. Although not the safest system possible, the cloud
system would be the most recommended for a small private
family practice. It’s accessibility, low cost, and easy
installation suite the practice the best out of its competitors.
As for learning exercises throughout the course, modules six
and seven provide solid background information specifically for
the paper. HIT service management and electronic health
records were core objectives for this course and were certainly
helpful while conducting this research.
References

9. [1] IOM cites core functions to improve EHR systems. (2003).
Healthcare Benchmarks And Quality Improvement. Volume 10.
Number 10, pp. 118-119.
[2] P. Sinha, G. Sunder; P. Bendale, M. Mantri; A. Dande.
(2013). “Electronic Health Record: Standards, Coding Systems,
Frameworks, and Infrastructures.” The Institute of Electrical
and Electronics Engineers, Inc. Published by John Wiley &
Sons, Inc.
[3] D. Gans, B. Dowd, T. Hammons, J. Kralewski, (2005).
“Medical Groups’ Adoption of Electronic Health Records and
Information Systems,” HEALTH AFFAIRS ~ Volume 24,
Number 5 p.1323.
[4] A ViSolve Inc., “Interoperability Service: PMS and EHR A
ViSolve, Inc. Case Study” Retrieved July 27th, 2018 from
http://www.visolve.com/uploads/resources/vicareplus/PMS%20a
nd%20EHR%20Integration.pdf
[5] D. Gans, B. Dowd, T. Hammons, J. Kralewski.(2005).
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[6] D. Gans, B. Dowd, T. Hammons, J. Kralewski, (2005).
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[7] Center for Medicare and Medicaid Services. (2016).
“Comparing Reimbursement Rates.” Retrieved on July 29th,
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Education/American-Indian-Alaska-Native/AIAN/LTSS-TA-
Center/info/understand-the-reimbursement-process.html
[8] C. Beron (2013). “Readings: Implementation of Electronic
Health Records” Retrieved July 28th, 2018 from
http://openonlinecourses.com/ehr/ImplementationOfInformation
Systems.asp
[9] J. Hauenstein, & C. Sarrico, (2011). “Can EHRs and HIEs
get along with HIPAA security requirements?” Healthcare
Financial Management: Journal Of The Healthcare Financial

10. Management Association. Volume 65. Number 2, pp. 86-90.
[10] Medical Economics. “Top 10 Most popular EHR systems
for small practices” Retrieved on July 29th, 2018 from
http://www.medicaleconomics.com/modern-medicine-feature-
articles/top-10-most-popular-ehr-systems-small-practices
[11] D. Neal. (2011). “Choosing and Electronic Health Records
System: Professional Liability Considerations” Innovations in
Clinical Neuroscience. 2011 Jun; Volume 8. Number 6, pp. 43–
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1
[footnoteRef:1] [1: ]
Title of the Term Project {Title 24 point Times New Roman}
<Your full name> {11 point Times New Roman}
Abstract— {9 point Times New Roman, Bold} Abstract should
not exceed 100 words. Just summarize your work in less than
100 words.
INTRODUCTION
Write a captivating introduction to your term paper. This should
be engaging and insightful yet concise. The introduction should
setup your paper and prepare your reader for the rest of the
content.
EHR Functionalities
Answer question 1 of the project statement in this section. You
can add a table of functionalities if you find it necessary.
Integration of Practice Management System
Answer question 2 of the project statement here. It may be
helpful to read about the existing Practice Management Systems
and challenges in integrating them with new systems. You may
use resources available through UCF library for resources (if
required).challenges in implementing the ehr
List the critical challenges in implementing an EHR using bullet
points and write a paragraph on each of them.advantages in

11. using the ehr
List the advantages in implementing the EHR using bullet
points and write a paragraph for each of them.
Project Planning and Management
Explain the project planning and management techniques and
considerations you would employ to ensure the implementation
is successful.Technology Security Considerations
Explain the technology security considerations and how HIPAA
governs their implementation.
0. Final Recommendation based upon Data
Make a recommendation on the type of EHR system this
practice should adopt and support your decision using data.
Conclusion
Write about the things that you learned doing this exercise.
Also, include any parts/modules of this course that may have
helped you do this term project. Keep in mind that the
references must be inserted in the text using numbers (example:
[1]). The following section explains how you could list them.
References
[1] G. O. Young, “Synthetic structure of industrial plastics
(Book style with paper title and editor),” in Plastics, 2nd
ed. vol. 3, J. Peters, Ed. New York: McGraw-Hill, 1964, pp.
15–64.
[2] W.-K. Chen, Linear Networks and Systems (Book style).
Belmont, CA: Wadsworth, 1993, pp. 123–135.
[3] H. Poor, An Introduction to Signal Detection and
Estimation. New York: Springer-Verlag, 1985, ch. 4.
[4] B. Smith, “An approach to graphs of linear forms
(Unpublished work style),” unpublished.
[5] E. H. Miller, “A note on reflector arrays (Periodical style—
Accepted for publication),” IEEE Trans. Antennas Propagat., to
be published.
[6] J. Wang, “Fundamentals of erbium-doped fiber amplifiers
arrays (Periodical style—Submitted for publication),” IEEE J.

12. Quantum Electron., submitted for publication.
[7] C. J. Kaufman, Rocky Mountain Research Lab., Boulder,
CO, private communication, May 1995.
[8] Y. Yorozu, M. Hirano, K. Oka, and Y. Tagawa, “Electron
spectroscopy studies on magneto-optical media and plastic
substrate interfaces (Translation Journals style),” IEEE Transl.
J. Magn.Jpn., vol. 2, Aug. 1987, pp. 740–741 [Dig. 9th Annu.
Conf. Magnetics Japan, 1982, p. 301].
[9] M. Young, The Techincal Writers Handbook. Mill Valley,
CA: University Science, 1989.
[10] J. U. Duncombe, “Infrared navigation—Part I: An
assessment of feasibility (Periodical style),” IEEE Trans.
Electron Devices, vol. ED-11, pp. 34–39, Jan. 1959.
[11] S. Chen, B. Mulgrew, and P. M. Grant, “A clustering
technique for digital communications channel equalization using
radial basis function networks,” IEEE Trans. Neural Networks,
vol. 4, pp. 570–578, Jul. 1993.
[12] R. W. Lucky, “Automatic equalization for digital
communication,” Bell Syst. Tech. J., vol. 44, no. 4, pp. 547–
588, Apr. 1965.
[13] S. P. Bingulac, “On the compatibility of adaptive
controllers (Published Conference Proceedings style),” in Proc.
4th Annu. Allerton Conf. Circuits and Systems Theory, New
York, 1994, pp. 8–16.