The Metro Hospital is located in the North side of Brisbane. It is a healthcare facility that has a capacity of up to three hundred and sixty three patients given the number of beds available in the hospital. It contains various departments comprising of general surgery, general medicine, oncology, vascular, ear, nose and throat, palliative care, ophthalmology, maternity and children’s services departments. The hospital is currently at level 4 of HIMSS EMR adoption model and enjoys good links with the Division of General Practitioners. As the newly appointed Director of Informatics for the hospital, I seek to upgrade the hospital’s health care information systems and achieve the level 7 of HIMSS EMR adoption model by 2025. The following is my project proposal that outlines the kind of steps and factors to consider while transforming this hospital to a level 7 of the HIMSS EMR adoption model. Also included is the analysis of the risk factors to the project and the kind of resources to employ.
When I first take over as the Director of informatics for the Metro Hospital in Brisbane, my first analysis would include understanding how the hospital works. This implies the understanding of the data and resources that are available in this hospital (Perkins, 2010). This analysis is aimed at bringing me to speed with the proceeds of the hospital. This will ensure that I fully understand all that is involved in the dissemination of services in the hospital. The analysis will include the observation of how services are being offered to the patients, the health records that are used and their physical appearance, I will analyze the interconnectivity of the departments available in the hospital by making an observation of the performance capabilities of the available health informatics systems. Understanding how departments are interconnected is of specific importance as it guides the decision on the kind of systems that are needed in the hospital. The knowledge of the medical records used and whether they are electronic or make use of manual recordings on paper will guide on the kind of electronic medical records systems to be installed in the hospital.
Seeing that the goal of the exercise is to achieve full digital status in the hospital by 2025, my set goal in the execution of my transformation strategy will include the transformation of the hospital through a step by step proceed and upgrade in moving up the stages of the Electronic Medical Record (EMR). This involve first ensuring that the hospital is actually at the level 4 of the Electronic Medical Record by ensuring that the available health informatics systems work effectively. Two, the eradication of all paper based medical recording systems and replacing these with similar electronic systems. Three, conduct a small research on the requirements of the succeeding levels of the HIMSS EMR adoption models and later transform the hospital sequentially to level 5, then level 6 and finally to level 7 of the Electronic Medical Record. This will include the purchase of new computer systems and the installation of new and functioning systems. It will also include the expansion of the intranet web connection between the departments to ensure easy connectivity of the computer systems and the equipment used in the hospital.
The most basic and important step in the execution of any project is the division of competent strategies. Strategies help in guiding one on where to begin a task and on the kind of calculated milestones to take in order to complete the task. They also help in the eventual achievement of the set aims and project objectives (Marth, 2013). As outlined in my plan, my strategy will involve the sequential transformation of the hospital through the level 5 and level 6 of the Electronic Medical Record to finally arrive at the desired level 7. This strategy will include first, the improvement of all the available systems to make sure that they are up to date. This improvement will target the performance ability of the available systems and their capacities to ensure that they can adequately cater for the number of patients who are admitted in the hospital at a given time when the hospital is at full capacities. The second part of the strategy will be to transform the paper based medical systems into electronic health information systems and incorporate these in the already available systems and ensure system compatibility and interconnectivity. Thirdly, the purchase and installation of the full complement of the radiology Picture Archiving and Communication Systems (PACS) with fully functional cardiology PACS and document imaging systems to bring the hospital to level 5 Electronic Medical Record (EMR). Fourthly, the purchase and installation of the full physician documentation with structured templates and discrete data in several inpatient service areas, full and functional Clinical Decision Support Systems (CDSS), and the application of the Closed Loop Medication Administration to bring the hospital to the level 6 Electronic Medical Record (EMR). Finally, the complete eradication of paper charts will mark the attainment of level 7 of the Electronic Medical Record (EMR).
The set timeframes are a product of a careful analysis of the available resources in the hospital including the man power. The available resources are the key determining factors that guide on the possible time required to complete the project and on the amount and nature of the additional resources needed to be employed in the project (Berner, 2011).
|
Goal |
Start date |
Finish date |
|
Careful analysis of the hospital’s services and record procedures |
January 2017 |
June 2017 |
|
Improvement of all the available systems to make sure that they are up to date. |
July 2017 |
December 2017 |
|
Transformation of the paper based medical systems into electronic health information systems |
January 2018 |
June 2018 |
|
Purchase of and installation of full complement of the radiology PACS systems with fully functional cardiology PACS and document imaging systems |
July 2018 |
December 2018 |
|
Application of the full physician documentation with structured templates and discrete data in several inpatient care service areas |
January 2019 |
June 2-019 |
|
Purchase of and installation of the full and functional CDSS systems |
July 2019 |
December 2019 |
|
Application of the Closed Loop Medication Administration |
January 2020 |
June 2020 |
The infrastructure of the hospital refers to the available and in use electronic machinery in the hospital. This point at the type, model and make of the equipment being used in the hospital on a regular basis. This is an important factor to consider as the type of machinery being used in the hospital will determine the type of software that are to be purchased and installed in the building of the electronic health records to avoid interconnectivity issues such as incompatibility of these new systems with the old equipment being used in the hospital.
When we think of the staff capacity we are looking at the human resource employed in the hospital and their career qualifications and skills they possess with regards to health informatics. The qualification of the staff and the level of skills that they portray is an important consideration in building electronic health records as it will guide on the kind of software to use in the systems and the level of complexity of the system since it is this same staff that will be operating the electronic health records (Bieber et al, 2010). The IT qualifications of the staff will also direct the decision of whether or not there is need for prior training before the installation and use of the software and the system in the building of the electronic health records (Wegener and Woodman, 2004).
A hospital’s physical environment refers to the position of the work stations and the proceeds of the work flow. This is an aspect of consideration since the building of the electronic health records should not disrupt the work flow in the hospital but should be centered on the work stations to ensure continuity of work in the hospital and quick recovery of the electronic data. The physical environment also guides the position of the satellite area or the hospital’s internet hub to ensure that it is equidistance from most if not all of the departments of the hospital that do require internet and intranet connection to ensure concrete interconnectivity and effective and fast transmission of data (Aremo et al, 2004).
My strategy will involve the application of and the installation of the electronic health information systems, complement radiology Picture Archiving and Communication Systems (PACS), document imaging systems, physician documentation systems, Clinical Decision Support Systems (CDSS), and the closed loop medication administration systems. The application of the electronic health information systems requires the building of the electronic health records that go beyond the standard data collected in a provider’s office. These systems will include a wide range of information on the patient that will guide the health provider’s workflow while making it automatic and streamline (HealthIT.gov).
The complement radiology Picture Archiving and Communication System (PACS) is critical in ensuring continuity of workflow in the radiology department as it oversees the proper storage and electronic transmission of patient data and radiology results from the radiology department to the physicians’ PCs and handsets (McEnery, 2013).
The document imaging systems are part of the document management systems that are designed to help with the transition to electronic systems as they convert paper based files to digital images that can be processed, stored and transmitted using the electronic systems (Joanna, 2017).
The physician documentation systems will comprise of computer-assisted physician documentation which will ensure that each patient receives quality and complete clinical history (nuance.com, 2017).
Clinical Decision Support System (CDSS) is a system that will help the physicians in the hospital make informed and concrete decisions regarding the health interventions that will best help a patient (Rouse, 2017).
Lastly, the system that I will install to help achieve my goal using my strategy is the Closed-Loop Medication Administration system. This system will help complete the Closed-Loop Medication Management System that oversees the effective and timely prescription of drugs, ordering and supply of these drugs and enhance patient safety in the drug administration process (Integrated Health Information System (IHIS), 2017).
For this project, the resources that I would employ would include: time, human resources, and capital.
Time as a resource includes the exclusive dedication of a period of time to adequately work on one aspect that is of importance in the milestones that will be taken in an attempt to achieve the bigger picture. This will require strictly adhering to the pre-determined time frames to ensure that the work is effectively and efficiently done on time. The timeframes are also there to ensure that the hospital capital is not too stretched as to make the institution run bankrupt.
Human resources in this project refer to the technical team required to work on the project and see to it that the goals are attained. These individuals will carry out the purchase, transportation, installation, and eventually the execution of the complete system checkup and interconnectivity. The human workforce will include a team of close to twenty individuals with competent skills in the respective fields.
Capital is one of the most important resources in any project. Its availability and quantity will direct on the quality of equipment acquired by the hospital, the size of the work force and the consequent quality of work and time taken to achieve the goals (Seth, 2016). The capital could be acquired from the proceeds of the payment made by the patients to the hospital and from other contribution made to oversee the development of the hospital.
In the governance of the project, I would employ a fully dynamic duty roaster that will be in accordance with the time frames pre-determined in the planning of the project. The duty roasters will be to guide on who is to take on what assignment as many things have to be done in a very short period of time. This roaster is meant to be dynamic in nature to accommodate any changes in the shifts of the hospital employees and to cater for any setbacks in the proceeds of the project.
I would also employ the aspect of delegation. This will reduce my work load and oversee the execution of a task by a team managed by a supervisor. Delegation helps in breaking down the proceeds of any work to ensure that they are completed in time (Remley and Herlihy, 2012) and no one team player is overloaded with too much work. Delegation will also oversee the dedication to a specific task to ensure that it will be completed in time and in good quality. This will ensure that the project is done in time and achieved with excellent quality.
I would finally make use of team conferences at the beginning, in the middle and at the end of a task to help monitor the proceeds of the milestones taken to achieve the goals of the project. These conferences will be used to bring the team to speed with what they are expected to do during the period. This will ensure that everyone is aware of their expectations in that task. It will also act as a forum to delegate the aspects of the task to different team members and properly document what is to be done by every team member. At the end of the task, it will provide a complete assessment of how the work was done and hence act as a means to instill accountability among the team members.
Each venture has its own risks and the major risks foreseen in this project include; time management issues, the problem of insufficient funds and the possible complete disruption of the workflow in the hospital with possible loss of patient data in the transition.
The transition to a newer and fully electronic environment might cause the disruption of workflow in the hospital in the first few weeks. This will be so as the staff strives to accommodate the change in the sequence and series of steps required to document and retrieve patients’ data from the electronic system. This might cause unnecessary traffic in the systems that will delay the proceeds of services offered in the hospital. Also, the transition to new electronic system in place of the old manual systems might cause loss of important patient data as their might be no other backups available for the manual systems.
This possesses the biggest risk to the project. This is because a lot of the aspects involved in the transition require capital. This includes the purchase of the important system softwares and the wages for the workforce involved. The lack of funds might delay the time in which the project gets done as it dictates the amount of workforce employed to take part in the project and also, the time when the system softwares will be purchased.
The time taken to fully complete a task in the project also possess a great risk to the set goal that is to get the hospital at level 7 of HIMSS EMR Adoption Model by 2025. Time is a great risk factor as most of the proceeds of the project are dependent on other variables that will result in a great series of delays in case the starting aspect of a task is delayed. For example, if the purchase of the systems’ softwares and their delivery to the hospital is delayed then the subsequent installation time will be delayed as well. This aspect cannot be controlled easily as it relies mostly on other extrinsic factors.
The health care models adopted by Queensland and Australia have competent and comprehensive healthcare support systems. These systems have been created in a way to enable their service users’ ease of access to the information contained in the systems. My strategy is in line with this model as it will enhance the convenience of accessing patient information from the systems used in the hospital and hence facilitate easy and fast dissemination of healthcare services to the hospital’s clients.
Conclusion
This transformational proposal, therefore, outlines the best possible strategy that will help move the Metro Hospital from its current level 4 of HIMSS EMR adoption model to the ultimate level 7 of HIMSS EMR adoption model. The proposal outlines the analysis to be taken prior to the initiation of the transformation, the strategies to be used in the transformation and their time frames, the technical factors to be considered in the transformation, the kind of systems that will be used to support the project, the resources that will employed in the project, the risk factors to the project, and the project management techniques to be employed.
References
Aremo, A. G., Aeolian, M., Irrechukwu, J., and Olugbenle,T, T. (2004). Critical Success Factors in Establishing the Electronic Health Record. The Experience of Chevron Texaco Hospital, Lagos, Nigeria. Retrieved from https://library.ahima.org/doc?oid=57882#.WSWD1cmnwWE Accessed on 24th May 2017
Berner, E. S. (2011). Clinical Decision Support Systems. New York: Springer Science + Business Media, LLC. 3-22
Bieber, E. J., Walker, J. M., and Richards, F. (2010). Implementing an Electronic Health Record System. New York: Springer-Verlag London Limited
Joanna, S. (2017). 7 Document Imaging System Capabilities Your Office Needs. Retrieved from https://www.laserfiche.com/ecmblog/7-document-imaging-system-capabilities-your-office-cant-live-without/ Accessed on 28th May 2017
HealthIT.gov. (2017). What is an Electronic Health Record (EHR)? Retrieved from https://www.healthit.gov/providers-professionals/faqs/what-electronic-health-record-ehr Accessed on 24th May 2017
Integrated Health Information Systems (IHIS). (2017). Closed Loop Medication Management System. Retrieved from https://www.ihis.com.sg/Project_Showcase/Healthcare_Systems/Pages/CLMM.aspx Accessed on 28th May 2017
McEnery, K. W. (2013). IT Reference Guide for the Practicing Radiologist: Radiology Information Systems and Electronic Medical Records. The American College of Radiology.
Marth, E. H. (2013). Standard Methods for the Examination of Dairy Products. 14th Ed. New Jersey: American Public Health Association.
Nuance. (2017). Improve Clinical Documentation with Computer-Assisted Physician Documentation (CAPD). Retrieved from https://www.nuance.com/healthcare/clintegrity/documentation-improvement/computer-assisted-physician-documentation.html Accessed on 28th May 2017
Perkins, H. (2010). The Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors and Clinicians. Sydney: Jossey-Bass
Remley, T. P., and Herlihy, B. (2012). Ethical, Legal, and Professional Issues in Counseling. New Jersey: Pearson Merrill Prentice Hall
Rouse, M. (2017). Clinical Decision Support System (CDSS). Retrieved from https://searchhealthit.techtarget.com/definition/clinical-decision-support-system-CDSS Accessed on 28th May 2017
Seth, T. (2016). Capital: Meaning, Characteristics, Function, and Importance of Capital. Retrieved from https://www.economicsdiscussion.net/articles/capital-meaning-characteristics-function-and-importance-of-capital/1541 Accessed on 28th May 2017
Wegener, J and Woodman, A. J. (2017). Critical Success Factor in Establishing the Electronic Health Record: The Experience of St. Michael’s Hospital, Canada. Retrieved from https://library.ahima.org/doc?oid=59674#.WSV6f8mnwWE Accessed on 24th May 2017
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