Pediatric Informatics: Computer Applications in Child Health (Health ...

230 M.M. Simonian
to patients affected by breaches? What are liability issues? Depending on the type
of information compromised the technology vendor may help identify individuals
affected (audit trails), and policy will be necessary to establish whether telephone,
e-mail, paper or fax will be used to communicate to any potential harmed patients.
16.4.6.2 System and Data Integrity and Availability
What happens when the system (hardware or software) becomes nonfunctional and
what is the ability of the user to replace or repair it in a timely way? Some repairs
may be quick and simple (rebooting a server), some may be facilitated by online
help (telephone, online, or network control) and others may require live service and
time. Practices may require onsite backup replacements for hardware (extra printers,
workstations) and ready access to expertise when needed. Some downtime is
necessary for upgrades and backups and should be planned to minimize its impact
(nighttime backups).
How will downtime data be handled? How will data captured on paper and pencil
be recovered for electronic use? When data integrity is compromised, how will
final authority be assured (human review, electronic backup, or a combination)?
16.5 Conclusion
Adoption of health IT for small practices is a big investment that is easier to
navigate than previously. New opportunities exist for practices to incorporate
electronic health records into their practices without large initial costs, but with
some tradeoffs.
16.6 Case Study: A Solo Practitioner’s Experience
in EMR Adoption
In my one doctor practice with two support staff, workflow efficiency was the number
one criteria when adopting an electronic medical record (EMR) and integrated practice
management software (PMS). After moving to a new location with anticipation of
greater patient numbers, I needed to be able to retrieve patient information and generate
documentation with minimal additional operational costs and staff time.
As the primary financial decision maker, I chose to bring in about $25,000
through a home equity line (which was tax deductible) at relative low interest
rates (4–5%). About $17,000 went into software and the remainder into hardware.
The capital access allowed me to buy software licenses, associated additional