EHR Improvement in Meditech Hospital

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Requirement

Question: Business Case: EHR Improvement (Stage I) in Meditech Hospital

Solution

Executive Summary

The paper is focused on improving the Electronic Health records of the chosen hospital. The American Recovery and Reinvestment Act have authorized the Centers for Medicare and Medicaid Services to provide incentives for the physicians and hospitals who are oriented towards meaningful use of electronic health record. The hospital that is under the consideration is a New York based hospital with branches located at three different locations and each of them follow the different EHR. One of them uses paper based process and another has not a certified version of the system. The project has been developed to ensure that the current system of the hospital is managed effectively and the hospital reaches the Stage I of the meaningful use of the EHR. The meaningful use has been focused due to the strong directives of the government.
The meaningful use of the EHR refers to certain outcomes that are expected from the hospitals in general. The outcomes are positive relationship and engagement with the patients and their family, improved care coordination and maintenance of privacy and security of patient health information. Moreover, it refers to the improvement in the transparency and efficiency with the hospital, empowerment of individuals, and improvement in the research data on health systems.
It has been decided that the project will be focused towards integrating the whole system into one single framework which will help in centralized data management. It will remove the duplicate data from the system and everyone will have access to all the data from one point. Moreover, the project is focused towards the development of the mobile and desktop applications which will be used by the patients to track their progress and also to register for the hospital services remotely. 
The project has considered various aspects that are required in the improvement of the system such as the activities that are required to be completed, stakeholders who will be approving the project, associated risks and their mitigation, and various other things. It is expected that the project will be a success. 
 
Part 1: The Strategic Context
The hospital is situated at three different locations. The EHR is installed at the hospitals. However, all the locations are using different EHR. One of the hospitals is involved with the paper-based system and another hospital is using the system version that is not certified. As per the ARRC, the hospitals are required to fulfill the requirements of the EHR and conduct meaningful use of the system. The meaningful uses of the EHR system mean improving the quality, safety, efficiency of the hospital services and reduce the health disparities. Moreover, it calls for engaging affirmatively with the patients and their family. It focuses on improving the care coordination and maintains the privacy and security of patient health information. The improvement in the use of EHR is expected to improve the future prospects of the hospital and also it will improve the service for the patients visiting the hospital. The major purposes are to improve the clinical outcomes, increment in the transparency and efficiency, empowerment of the individuals, and improvement in the research data on health systems. 

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1 Business Needs and Desired Outcomes 

The following sub-sections will detail on the organization’s current situation, the need of the business, and the expected outcomes.

1.1 Strategic Environment

1.1.1 Organizational Overview

The hospital that has been selected is a hypothetical hospital active in New York whose overview is mentioned below:

  • Mission: The hospital is oriented towards providing high level health services, and health education. It is dedicated towards improving the health of people of New York.

  • Strategic vision, goals, and service objectives: The hospital is destination of the top quality care for the people of New York. The company wants to help the people of New York improve their health.

  • Current activities and services: The hospital is currently taking care of few of the major health concerns, namely, cancer care, dentistry and oral surgery, emergency medicine, outpatient services, medical care, psychiatry, radiology, specialized services, surgical care, and neuroscience. 

  • Key stakeholders and clients: The stakeholders of the hospital are its customers, employees, management, shareholders, society, and the government. The local customers of the New York City are the key clients of the company. 

  • Organizational structure (high level): The image below shows the organizational structure of the organization.

  • Financial resources: The hospital is a private organization and brings in the financial resources from the customers and the shareholders who invest in the company. 

  • Human resources: The hospital has employed four people for the project as the board members who will assess the project. At present the company has numerous employees at the various levels to support the various activities. The human resource of the hospital stay generally fulfilled with the HR department. 

1.1.2 Business Need

The business that is being discussed here is a hospital which is active in New York. The hospital has three branches at three different locations. The hospital has EHR in place which is electronic health record system that ensures the hospital work oriented towards the patients and the society as a whole. Recently, American Recovery and Reinvestment Act authorized the Centers for Medicare and Medicaid Services to provide incentives for physician and hospital providers to provide “meaningful use” of an electronic health record. The incentive payments started in the year 2011. By the year 2015 it was expected that the health care providers have adopted this aspect and working effectively towards “meaningful use”. However, this hospital has not completely moved towards the same. 

1.1.3 Drivers for Change

There are various internal and external drivers which are the basic reason behind the change in the hospital’s current EHR. The internal drivers of the change are mentioned below:

  • Hospital Management: The hospital management has the understanding that the EHR system should improve and proper incentives should be provided to the physicians. Moreover, the proper use of the improved system will be towards the customers or patients data which can be utilized to either improve the service further or to earn further monetary gains. 

  • Employee Needs: The employees within the hospital will have improved skill to manage the larger number of patients. Moreover, they will learn new skills which will be beneficial for them. As it has been stated in the case that one of the hospital is using the manual process, which is way beyond the current desired system. 

  • Financial Growth: It can be clearly stated that if the hospital gains operational efficiency then it will be able to cater to more patients in the coming days. The increased efficiency to cater to more patients will automatically convert into the improved financial income for the hospital. 

Some of the external drivers for change are as follows:

  • Government Department: As per the case, the government department is pushing the use of improved EHR which is bound to improve the serviceability of the hospitals. This is oriented towards helping the society receive improved facility. It can be stated from the case that the government brought this element in 2011 and now it is a mandatory step that must be accepted by the hospitals. The government regulation is the major force behind the change.

  • Patient Demand: The patients coming at the hospitals prefer better serviceability from the hospital. It has been observed that the hospital staffs face issue in regenerating the historical record of the patients which becomes challenging for the patients and physicians alike. Therefore, an improved technological change is mandatory to improve this aspect. 

  • Shareholder Demand: The individuals who have invested money on the hospital as shareholder is sure to expect right amount of return on their investment. This is only possible when there will be more patients at the hospitals which is possible only when the hospital has great service. Therefore, the pressure from the shareholders can be considered as one of the aspect. 

1.1.4 Business Outcomes

Though some of the desired outcomes have been briefed in the beginning, mentioned below is the desired outcomes from the project:

  1. - Improving the quality, safety, efficiency of the hospital services

  2. - Reduce the health disparities

  3. - Engaging positively with the patients and their families

  4. - Improving the coordination

  5. - Maintain the privacy and security of patient health information

  6. - Improvement in the use of EHR

  7. - Improve the service for the patients visiting the hospital

  8. - Improve clinical outcomes

  9. - Increment in the transparency and efficiency

  10. - Empowerment of individuals

  11. - Improvement in the research data on health systems

1.2 Strategic Fit

As stated earlier that the mission of the organization is to provide high level health services to the patients and become an organization that takes care of the people of the New York. The investment which is being suggested will improve the way organization’s operational activities are being conducted. The hospital will be able to conduct better research on patients’ data and provide better health services to the patients. Therefore, it can be stated that the investment is in complete harmony with the organization’s mission, vision, and strategic plan.

1.3 Detailed Description of the Business Need

1.3.1 Problem/Opportunity Statement

The hospital is currently facing the issue in effectively managing the patient information and past records. Moreover, it is unable to manage the incentive programs of the physicians. Moreover, the electronic health record is not being managed effectively. However, the company has the opportunity to use the one year time it has been allowed to improve the EHR system within the hospital to gain the same level of confidence in the eye of the government and trust among the public. 

1.3.2 Prioritized Requirements

There are some key requirements that need to be fulfilled if the organization wants to improve the service. Mentioned below are the requirements that need to be considered:

  • Integrating the two data centers into one so that there will not be any data duplicates around the system. 

  • Improving the security of the current data centers so that the external threats cannot hamper the stored sensitive data

  • Training the staffs to ensure that no security holes occur when the systems are being used

  • Integrating all the administrative systems into one channel so that designated person can have the access to all the information from one access point.

  • Implementation of hospital website and mobile application integrated with the data center so that the lives of physicians and patients become easy.

1.3.3 Assumptions

Mentioned below are the assumptions related to the project:

  1. - It is assumed that the management will be coordinating positively with the system improvements

  2. - The heads of all the departments will provide enough information necessary to implement the new system effectively

  3. - No one on the project team will be leaving the project in the middle of the activity

  4. - The budget allocated and the time provided is enough for the implementation of the system.

1.3.4 Constraints

There are some constraints that should be considered as it is likely to impact the project activity and completion:

  1. - The time period provided for the project is fixed and there is no extension on the project. 12 months has been provided and all the activities need to be completed within the same.

  2. - The budget would be the second likely constraint which will be difficult to manage.

  3. - The third likely constraint can be the availability of right human resource on the projet.

1.3.5 Dependencies

Mentioned below are some of the dependencies that have been identified in relation to the project which concerns with the business need, requirements or solutions:
- The current system cannot be left alone while bringing in the improvements.
- The current system has to be maintained properly while moving towards the Stage I
- The improvement phase will take place only after the approval of the top management.

1.4 Scope

1.4.1 Boundaries

Mentioned below are the premises within which the project manager will be handling the whole project:

  1. - The project manager will ensure that the current system is being maintained effectively

  2. - The project manager will be implementing the project as per the requirements that are integrating the system in such a manner that it all the outcomes are reached.

  3. - The project manager will not be looking for the funders if the project faces financial challenges.

  4. - The project manager will be oriented towards managing the activities within the team.

  5. - The project manager will try to finish the project within the stated time frame and the alloted budget.

1.4.2 Stakeholder Analysis

Describe each stakeholder type, their specific roles, and the effects of the investment on the stakeholders and their role in the project.
Mentioned below are the stakeholders who will be concerned with the project progress in some way or the other along with their roles and the impacts of investment on them:

  1. -    Hospital Management: The hospital management is the top stakeholder for the project who will be providing right fund to the project. They will be concerned that the investment reaches the right fruition. The hospital management will be approving the various activities that will be conducted in the project.

  2. -    Project Manager and the Project Team: These stakeholders will be directly associated with the project activity as they will be conducting the activity themselves. Therefore, the failure or success of the project depends on them. The proper investment in the project will help them conduct the activity smoothly. 

  3. -    System users: These are the employees of the hospital who will be using the newly improved system. They will be helping the project manager in ensuring that the improvements made in the system are in accordance with their needs and requirements. 

  4. -    Clients (Patients): The individuals who will be finally impacted by the system are the patients who will be visiting the hospitals. The implemented system will help them get better service. The mobile application and the website will receive feedback from these users to improve it further. 

Part 2: Management and Capacity

The sections head help in understanding the investment fit of the project within the organization’s broader governance structure. Moreover, the management of the project, its outcomes, risk assessment and mitigation, change management and implementation, and performance assessment will be studied. 

2 Managing the Investment

The management of the investment will be conducted as per the following sections.

2.1 Governance and Oversight

The governance structure of the organization is straight and simple. The hospital is currently following the poor operational activity despite the presence of various technological equipments. It is the responsibility of the project manager to implement the new system. The new system will improve the efficiency of the staffs working at various levels. Moreover, it will improve the data integration capability. It will help the hospital management in bringing transparency within the whole structure which will eventually improve the governance structure of the whole organization.

2.2 Project Management Strategy

Mentioned below is the methodology to manage the project during its life cycle and through post implementation:
Initiation: The project initiation will take place by analyzing the feasibility of the project. The next would be to appoint the team and define the place where the meetings will take place (i.e. a project office).

  • Planning: The step will be concerned with the preparation of the project plan in which the various project resources, finances, and quality plan will be developed. Moreover, acceptance plan and communications plan will be prepared in this step.

  • Execution: This step is concerned with actually building the project based on the defined deliverables and controlling the scope, costs and associated risks. 

  • Closure: This will be the final phase of this project where the project will be wind-down. The deliverables will be handed to the management and all the associated bills will be paid out. Moreover, the approval of the management will be taken that the project has been completed. 

  • Training: After the project closure the staffs will be trained on the new improved system and get their feedback on thing they learned.

2.2.1 Project Review Strategy

Mentioned below are the methods and processes to report the project’s progress and the way progress will be communicated to the project team, project sponsor, and other stakeholders:

  1. -    The project team will be updated about the project progress through daily meetings. This meeting will also be concerned with taking their feedbacks on the progress made so far.

  2. -    The project sponsor will be communicated about the project progress, handled risks, and the financials on monthly basis.

  3. -    The other stakeholders such as the employees will be informed on fifteenth of each month through emails.

  4. -    All these communication activities will be handled by the communication manager appointed for the project who will be working under the guidance of the project manager.

2.3 Outcome Management Strategy

Mentioned below are the steps that will be followed while managing the outcome of project in relation to the overall project:

  • 1.    The first step would be assessing the mission and objectives of the organization (done earlier).

  • 2.    The second step would be to identify the outcomes of the project (as defined earlier).

  • 3.    The third step would be the selection of right indicator for the outcome. Some of the indicators that have been identified are budget movement, time utilization, work as per the defined project timeline, and the effective utilization of the resources.

  • 4.    The fourth step is concerned with the collection of the right data for the measurement. This will be done through the reports submitted by the project manager on the monthly basis. 

  • 5.    The fifth step is concerned with the assessment of the report and searching any deviation from the defined plan. If there is any deviation then strong plan of action should be prepared to regain the speed and maintain the budget. 

2.4 Risk Management Strategy

The risks within the project will be managed by below mentioned strategies:

  1. -    Assessing the risks that are likely to occur in the project implementation

  2. -    Then preparing the plan for the known risks and leaving some space for the risks that are unknown to the project manager

  3. -    The risks associated with the time and budget will be managed by working effectively with the developed plan and ensuring that the proper check is kept on the activities.

  4. -    The risks with the communication mismanagement will be handled by ensuring that the messages are sent at the right time to the concerned stakeholders and the feedbacks are taken so that no confusion creep in.

2.5 Change Management Strategy

The change management for the project will be utilizing the Kotter’s 8-Step Change Model:

  • 1.    Creating Urgency: Employees will be informed that the change is vital and urgent

  • 2.    Forming Coalition: Groups will be formed with the likeminded who are oriented towards change

  • 3.    Creating Vision for Change: A vision for change will be created which to improve the lives of employees and patients.

  • 4.    Communicating the Vision: The vision will be communicated through mails and messages (often).

  • 5.    Removing Obstacles: Challenges will be identified and handled like those employees who do not want the change.

  • 6.    Creating Short-term wins: Conducting implementation in phases and showing the success.

  • 7.    Building on the change: Taking the phase implementation ahead throughout the hospital

  • 8.    Anchoring the change: Ensuring that the people accept and start using the improved system.

2.6 Performance Measurement Strategy

The performance of the team member at the project level will be maintained by providing them various incentives and motivational counselling. Moreover, the performance of the team members will be assessed based on the completion of the assigned activities as per the defined timeline and the allotted budget. 

Part 3: Analysis and Recommendation

The sections ahead will focus on the various alternatives within the project and the methods to be applied to reach there.

3 Preliminary Options Analysis

The sub-sections ahead will try to short out the various alternatives that are available and the selection of the viable ones from the list.

3.1 Evaluation Criteria

Mentioned below are the criteria that have been defined for the analysis of the options:

  1. -    The selected alternative should not take more than one year to complete the project.

  2. -    The selected alternative should not exceed the allotted budget for the project activity.

  3. -    The alternative must achieve all the outcomes and requirements in the beginning.

  4. -    Lesser Risks

  5. -    Timely delivery

3.2 List the Possible Options

Mentioned below are the alternative options that have been identified for the project:

  1. Outsourcing: The project activities can be outsourced to the third party who have year of experience in handling such projects.

  2. In House Development: The in house IT department can undertake this activity.

  3. In house team with the Outsourced team: This will be the hybrid model where some individuals from the organization will be working in coordination with the outsourced team.

3.2.1 The Status Quo

One possible situation can be display of lack of financial resources that cannot be procured in any manner. This is the only option that can work for the organization which can be shown through the financial reports. However, if there is no such case, then it would be mandatory for the hospital to go ahead with the project. 

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3.2.2 Describing Each Option

  • Outsourcing: The in house team have never conducted such changes in the system before and therefore the outsourcing can reduce the risk of failure. The major disadvantage is that the external party will be open to access the secure information. Moreover, the management will not have control on the performance of the employees of the outsourced companies. Along with that, it not sure whether the external individuals will fit in the culture of the organization.

  • In house development: The major advantage is that the in house IT department has the complete understanding of the organizational operations and thus they will be able to meet the requirements. However, as the company’s in house team has no experience in such activities, therefore it is the possibility that the project might fail.

  • In house team with the Outsourced team: On one hand where the in house team can provide knowledge about the whole organization, on the other, the outsourced company will be able to provide right method to implement the system. This hybrid model can complement each other and can get things done. However, one major challenge would be to bringing in both team of different work culture together.

3.2.3 Strategic Alignment

The current business architecture allows the organization to choose the selected methods above. The organization can afford to move ahead with the alternatives justified. The departments are active within the organization in isolation to some extent which allows the organization to begin the process phase wise and complete the whole activity. 

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