critical thinking 13

 
Replacing an EHR System
Evaluate the healthcare information system acquisition process as if you were preparing to initiate those activities. From the case study “Replacing an EHR System” on pages 147-148, use this study as a background for developing the hypothetical project scope, vendor selection process, determine the system goals and requirements, discuss the RFP process, vendor evaluation process including the evaluation criteria and a cost-benefit analysis. Discuss project management tools that will help you accomplish this task and conduct a risk analysis of what can go wrong during a healthcare information system acquisition.
Outline:

Introduction
Project Steering Committee

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Scope
System Requirements

Request for Proposal (RFP)
Vendor Proposals
Cost-benefit Analysis
Recommendations
Conclusion

the case study
 Valley Practice provides patient care services at three locations, all within a fifteen-mile radius, and serves nearly one hundred thousand patients. Valley Practice is owned and operated by seven physicians; each physician has an equal partnership. In addition to the physicians, the practice employs nine nurses, fifteen support staff members, a business offi cer manager, an accountant, and a chief executive offi cer (CEO). During a two-day strategic planning session, the physicians and management team created a mission, vision, and set of strategic goals for Valley Practice. The mission of the facility is to serve as the primary care “medical home” of individuals within the community, regardless of the patients’ ability to pay. Valley Practice wishes to be recognized as a “high-tech, high-touch” practice that provides high-quality, cost- effective patient care using evidence-based standards of care. Consistent with its mission, one of the practice’s strategic goals is to replace its legacy EHR with an EHR system that adheres to industry standards for security and interoperability and that fosters patient engagement, with the long-term goal of supporting health fi tness applications.  
 Dr. John Marcus, the lead physician at Valley Practice, asked Dr. Julie Brown, the newest partner in the group, to lead the EHR project initiative. Dr. Brown joined the practice two years ago after completing an internal medicine residency at an academic medical center that had a fully integrated EHR system available in the hospital and its ambulatory care clinics. Of all the physicians at Valley Practice, Dr. Brown has had the most experience using EHR applications via portable devices. She has been a vocal advocate for migrating to a new EHR and believes it is essential to enabling the facility to achieve its strategic goals. Dr. Brown agreed to chair the project steering committee. She invited other key individuals to serve on the committee, including Dr. Renee Ward, a senior physician in the practice; Mr. James Rowls, the CEO; Ms. Mary Matthews, RN, a nurse; and Ms. Sandy Raymond, the business offi cer manager. After the project steering committee was formed, Dr. Marcus met with the committee to outline its charge and deliverables. Dr. Marcus expressed his appreciation to Dr. Brown and all of the members of the committee for their willingness to participate in this important initiative. He assured them that they had his full support and the support of the entire physician team.  
 Dr. Marcus reviewed with the committee the mission, vision, and strategic goals of the practice as well as the committee’s charge. The committee was asked to fully investigate and recommend the top three EHR products available in the vendor community. He stressed his desire that the committee members would focus on EHR vendors that have experience and a solid track record in implementing systems in physician practices similar to theirs and that have Office of the National Coordinator for Health Information Technology (ONC)–certified EHR products. He is intrigued with the idea of cloud-based EHR systems provided they can ensure safety, security, and confidentiality of data; are reliable and scalable; and have the capacity to convert data easily from the current system into the new system. The vendor must also be willing to sign a business associates’ agreement ensuring compliance with HIPAA security and privacy regulations. Dr. Marcus is also interested in exploring what opportunities are available for health information exchange within the region. He envisions that the practice will likely partner with specialists, hospitals, and other key stakeholders in the community to provide coordinated care across the continuum under value-based reimbursement models. Under the leadership of Dr. Brown, the members of the project steering committee established five project goals and the methods they would use to guide their activities. Ms. Moore, the consultant, assisted them in clearly defining these goals and discussing the various options for moving forward. They agreed to consider EHR products only from those vendors that had five or more years of experience in the industry and had a solid track record of implementations (which they defined as having done twenty-five or more). Dr. Ward, Mr. Rowls, and Ms. Matthews assumed leadership roles in verifying and prioritizing the requirements expressed by the various user groups.  
 The five project goals were based on Valley Practice’s strategic goals. These project goals were circulated for discussion and approved by the CEO and the physician partners. Once the goals were agreed on, the project steering committee appointed a small task group of committee members to carry out the process of defining system functionality and requirements. Because staff time was limited, the task group conducted three separate focus groups during the lunch period—one with the nurses, one with the support staff members, and a third with the physicians. Ms. Moore, the  consultant, conducted the focus groups, using a semi-structured nominal group technique. Concurrently with the requirements definition phase of the project, Mr. Rowls and Dr. Brown, with assistance from Ms. Moore, screened the EHR vendor marketplace. They reviewed the literature, consulted with colleagues in the state medical association, and surveyed practices in the state that they knew used state-of-the-art EHR systems. Mr. Rowls made a few phone calls to chief information offi cers (CIOs) in surrounding hospitals who had experience with ambulatory care EHR to get their advice. This initial screening resulted in the identification of eight EHR vendors whose products and services seemed to meet Valley Practice’s needs. Given the fairly manageable number of vendors, Ms. Moore suggested that the project steering committee use a short-form RFP. This form had been developed by her consulting firm and had been used successfully .

 
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