The Business Case For Investing In EHR Within A Doctor’s Practice

Overview of doctor’s practice and challenges faced in medical marketplace

Within Australia, NSW Health Department stated that the general doctor’s practices are the drivers of the Australian health care activities. The general practices are provided of complete and coordinated along with holistic care to the individuals as well as families into the communities. There is better understanding of the health, illness as well as diseases from the experiences, maintainability of the relationship among the patients and persons for gathering of knowledge. The General practitioner in Health care can able to manage healthcare uncertainty; lead and support along with coordinate the flexibility. The possible challenges into the medical marketplace are time pressure to see the patients, phone interruptions throughout the consultations, intrusion of the work into the family life, patients have difficult to manage, earned enough of money and intrusion of work on the social life.  

The best practice which is an innovation of the medical software is leader for the marketing as well as supporting the quality software product for the Australian medical practices. The EHR vendors are as follows:

BP premier: They are made for the General Practices with use of advanced technology. It is enabled to maintain the records of the electronic patient, advance into the billing appointment as well as reporting modules.

BP VIP.net: It is provided of customized supports for the installation phases, maintenance as well as consultations.

BP allied: The product is for the allied health professionals, it is easier to use as well as affordable for the customized software.

BP titanium: The product is provided of choices like the cloud based and on-premise hosted solutions with basic functionality. It is easier to use with rich features such as web base format.

The business report is based on use of Electronic Health Records (EHR) into the clinical settings is considered as patient centered healthcare delivery system. For the healthcare practices, there is an uncertainty into the cost recovery from the investments of EHR which is the major concern for the General Practices. It is recommended that EHR is the innovation enabler with providing of benefits regarding reduction of cost of healthcare, with improvement over the quality as well as safety to achieve of the patient centered healthcare. The implementation of EHR systems into the healthcare organization is complex with the physicians as well as healthcare staffs. The healthcare providers are invested into the EHR technology as they are continued to see the primary barriers into the adoption. In order to bridge gap into the implementation of EHR systems, the healthcare practices are required to arrange for the financing, then implementation process is provided of maximum incentive payout. The findings of this report are that healthcare practices are navigated into decision making processes by explanation of finance options. The paper also provides analysis of the financial and non-financial investments by use of NPV, ROI, IRR, and Breakeven Point as well as use of KPI and balance scorecard respectively. The study is based on analyzing the IT issues into the healthcare industry. The frequent issues with implementation of EHR system are incompatibility of system, ineffective data conversion because of lack of experiences, security and privacy issues, accessibility issues, network issues, unexpected cost, increased of workload because of improper training, loss of data, virus errors and manipulation of data. The study is replicated in future because of trace of trends as well as affect of the healthcare evolution. It is found that a positive ROI with EHR is achieved of cost recovery from investments of EHR.

Explanation of EHR and EHR vendor

The healthcare providers are wanted the electronic health record systems for benefiting the healthcare practices. Adoption of EHR process is not easier, but the physicians are successful to have drive. The primary recommendations are:

1. It is recommended to implement of right system into the healthcare industry so that proper health related services are provided to the staffs and patients.
2. The system should consist of human as well as electronic piece where the electronic piece is gathered of amounts of information, clinical decision supports and track the health related information.
3. They should be tracking of higher risks of the patients and keep it out of the hospital. There is huge success into the healthcare industry because of EHR system.

The secondary recommendations are:

1. The healthcare policies are increased the rate the physicians can able to use of the EHR for realization of the benefits to order duplicate of laboratory tests as well as identification of required tests.
2. Risk assessment plan is prepared to identify the risks and mitigate those risks with use of proper preventive measures.
3. There should be an implementation of database management system to collect health related information and data about the patients into the system.

The EHR is most important achievements of the IT into the healthcare domain. The business environment of the healthcare industry is analyzed by use of the SWOT analysis in implementation of EHR. The highest priority into the strategic analysis is related to timely as well as quick access to the health related information. Lack of hardware as well as infrastructures are important weaknesses (Ginter, 2018). In order to have potential to share of information are accessed to different health related data is significant opportunity of EHR system. In order to collect of information for performing of SWOT analysis, EHR implementation is done for this study. SWOT analysis of EHR implementation is as follows:

Strengths	Weaknesses
Ø There is power management of changes into the system Ø It has ability to personalize of objects such as interface (Boulware et al., 2016). Ø There is higher availability along with support for the full time. Ø There are higher accessibility and security.	Ø There are non-existent of the system documentation. Ø There are confusing graphical interfaces. Ø There are insufficient educational as well as training for the healthcare professionals (Sallis, Owen, & Fisher, 2015). Ø There is old usage of computers and the implementation process becomes slow.
Opportunities	Threats
Ø There is ability to integrate with other applications. Ø There is ability to provide of healthcare related information via use of internet. Ø The implementation process has ability to expand as well as sustain of new health related services (Gholami et al., 2015). Ø The projections are more proper along with usable interfaces.	Ø There is higher level of competitions from other healthcare related systems. Ø There is expansion of the software industry for the health marketplace (Wager, Lee, & Glaser, 2017). Ø There is higher market pressure. Ø There are economical and financial crisis and there are financial constraints.

Mission statement behind implementation of EHR is that the health care providers are implemented of EHR by providing of higher quality, personalized technical assistance, improvement over the quality of the healthcare for the patients and help to achieve of higher quality health related data as well as information (Zhang et al., 2017). The general practices are used of 60-85 percent of the implementation of computer system such as EHR.

The proposed business process model of EHR system has some following characteristics such as:

Dynamic model: It consists of various managerial, human as well a technological readiness levels.  

Integrated model: EHR as well as ERP are the similar systems as per the objectives as well as structures. It is being assumed that the system is shared of common factors which affect success along with implementation of EHR (Krumholz, 2014).

Process model: There are pre-implementation phase where the decision makers are chosen to go into the project (Lewis et al., 2016). Implementation of EHR software is complex, where monitoring as well as feedback processes are periodically through entire stage of the project to get desired results.

The current and future state of practice related to implementation of EHR is as follows:

1. There is adoption as well as optimization of the clinical decision support systems.
2. There are engagement of the clinician and optimization and identification of the data required (Brownson, Colditz, & Proctor, 2017).
3. There is incorporation of the additional EHR data like social determinants of the heath along with patient reported data.
4. There is transferrable knowledge across effective EHR tools and governance structures (Dietz et al., 2015).
5. There are standardized outcomes measures into implementation of EHR for support of interoperability.

Requirements of safe as well as higher quality care along with productivity of healthcare systems are known as constrain conditions which are expected to distribute as well as specialized the healthcare services (Catarinucci et al., 2015). The healthcare services are provided of independent of the time, distribution of the resources as well as localization into collaborative way such as eHealth. EHR is being implemented into the system that consists of set of components such as create, use, store as well as retrieve of the proposed system. EHR system along with its standards is defined to have assessed with reference to the structure of the EHR (Atun et al., 2015). The healthcare information system is evaluated to reflect on relationship among the user of system, technology as well as medical environments. EHR system will help the healthcare professionals for improvement of efficiency, effectiveness as well as reduction of the medical errors. Adoption of EHR leads to better quality, effective healthcare which contains of sensitive health related data for the individual patients.        

Key recommendations

Financial cost:

Implementation of healthcare system
Hardware	$         15,000.00
Software	$              750.00
Development team salaries	$           7,690.00
Training	$           1,000.00
Total Development Cost	$         24,440.00
Hardware	$         12,000.00
Software	$              107.00
Operational Labor	$         12,000.00
Total Operational Cost	$         24,107.00
Approximate salary savings	$       120,000.00
Reduced operating cost	$         50,000.00
Total Benefit	$       170,000.00
Discount Rate Used	5.00%

Calculation of NPV, ROI and breakeven point:

				Year of Project
		0	1	2	3	4	5	TOTALS
Economic Benefit		$0.00	$ 170,000.00	$ 170,000.00	$    170,000.00	$  170,000.00	$    170,000.00
Discount Rate		1.0000	0.9524	0.9070	0.8638	0.8227	0.7835
PV of Benefits		$0.00	$161,904.76	$154,195.01	$146,852.39	$139,859.42	$133,199.45
NPV of all BENEFITS		$0.00	$ 161,904.76	$ 316,099.77	$    462,952.16	$  602,811.59	$    736,011.03	$     736,011.03
One-Time COSTS		$   (24,440.00)
Recurring Costs		$0.00	$  (24,107.00)	$  (24,107.00)	$     (24,107.00)	$  (24,107.00)	$     (24,107.00)
Discount Rate		1.0000	0.9524	0.9070	0.8638	0.8227	0.7835
PV of Recurring Costs		$0.00	$  (22,959.05)	$  (21,865.76)	$     (20,824.53)	$  (19,832.89)	$     (18,888.47)
NPV of all COSTS		$   (24,440.00)	$  (47,399.05)	$  (69,264.81)	$     (90,089.34)	$ (109,922.23)	$   (128,810.69)	$    (128,810.69)
Overall NPV								$     607,200.34
Overall ROI
Break-even Analysis
Yearly NPV Cash FLOW		$   (24,440.00)	$ 138,945.71	$ 132,329.25	$    126,027.86	$  120,026.53	$    114,310.98
Overall NPV Cash FLOW		$   (24,440.00)	$ 114,505.71	$ 246,834.97	$    372,862.82	$  492,889.36	$    607,200.34
IRR		6%

There are three KPIs which provide impacts on the business performance of healthcare industry such as:

Customer satisfaction survey scores: A survey is done on the customers to identify the benefits of EHR system on the healthcare industry (Betancourt et al., 2016). The survey helps to improve over the quality, improve of customer satisfaction and improve of delivery processes.

Kind of patient’s complaints: The patient’s complaints are recorded to improve the accuracy of the healthcare services.

Customer retention rate: It defines percentage of the customers that the healthcare industry is lost over period of time (Zingg et al., 2015).

Following are the risks into the implementation of the EHR are as follows:

Planning failures: While implementation of the proposed system, the healthcare organization should failed to plan a proper implementation process so that there are required to implement of sophisticated software options which are emerged into the organization (White, Dudley-Brown, & Terhaar, 2016).

Stakeholder hesitation: Most of the patients are combined about the physician focused more on conversation into progress. The project stakeholders are hesitated to support into the implementation process. Therefore, lack of support from the stakeholder’s side causes delay into the project (Raghupathi & Raghupathi, 2014)

Financial exposure and delay ROI: Investigation of the EHR solutions are not allowed for customization of the business practices. It is not resulted into spending of money on solution that is not accomplished of favorable outcomes.

Privacy and security issues: There is lack of secured and data protection pose to serious risks for the healthcare providers. The health related records are valuable to the cyber criminals as compared to personal credit card data (Pollitt & Bouckaert, 2017).

Due to implementation of EHR, the patient safety are succeed to extent with the healthcare organizations recognized requirements and developed to implement of organizational changes. EHR has capability to exchange of the health related information electronically which helps to provide of higher quality along with safer care of the patients into the healthcare industry (Sandberg et al., 2015). The system makes changes into the organization by providing of better management of care for the patients and providing of better healthcare. The system also provides of up-to-date and complete data related to the patients. It enables to access to patient’s records more coordinated. There are organizational changes due to improvement over the patient’s as well as provider interaction as well as communication. It helps to enable and promote of complete documentation (Wager, Lee, & Glaser, 2017). It reduces the paperwork into the healthcare services.   

The investors agreed that implementation of healthcare system intends to protect the patients, which harms by restriction of innovations. Due to implementation of proposed system, there is development of the digital health, move forward with the larger scale initiatives, and increase into investment as well as innovational support. Implementation of new system into the healthcare organization provides better opportunities into the business as well as healthcare providers by focusing to implement of digital transformation (Andrews et al., 2015).

Project governance and oversight: Governance of the IT applications as well as resources is critical towards the improvement of patient care and success of delivering the healthcare organizations. The project governance achieves of implementation of EHR across the system into inpatient as well as ambulatory arenas. The IT governance throughout the implementation of EHR is based on the centralized model (Richards, Iademarco, & Anderson, 2014). Into this structure, the teams are encouraged to take of decisions at lower level when it is possible. The project governance as well as insight ensure of the project and manage, stay on the track as well as achieve of intended outcomes.

Risk management: The risk management is beneficial for the organization when it comes to implement of the EHR system into the healthcare industry. The challenges which are faced by the administrators are consisted of patient safety, potential medical errors, existing as well as future healthcare policies along with legislation impacts the field of the healthcare system (Fleiszer et al., 2015).   

Target measures: There is improvement of the patient experiences of the healthcare, improvement of the heath of the populations as well as reduction per capital cost of the healthcare industry (Stefko, Gavurova, & Korony, 2016). The healthcare industry measures the outcomes for various reasons such as reveal of areas where the interventions can improve the healthcare, identification of variations of the care, providing of evidences about thee interventions for the patients under the circumstances and compare of the effectiveness of different treatments as well as procedures.

The EHR improves quality of the healthcare services and it is cost effective. The advanced technologies are introduced of hazards; therefore safety of the system information into the healthcare industry is a big challenge. Secure of the EHR by means of encrypted password is one of the solutions towards the ethical issues of the system. The ethical issues linked to EHR confronts of health professional (Walston, 2014). There are four major ethical and social implications related to implementation of EHR are as follows:

Privacy and confidentiality: There are right of the individual to keep the information from being disclosed to others. The claim of the individuals is that information of the patient is released only to the permission of patients (Stefko, Gavurova, & Korony, 2016). The patients are unable to do as age, mental incapacity about the decisions about sharing of information are made by the legal representative. The information is shared as result of clinical interactions which is taken as confidential and protected (Hyun et al., 2017). The information from identifying of patients is ascertained. Only the authorized person can able to access to the confidential data as well as information.

Security breaches: The security breaches are threatening the privacy of the patients as the confidential health information is available to others without consent of the individual along with their authorization (McNeil, Frey, & Embrechts, 2015). When the data as well as information of patients are unencrypted, then anyone can able to guess the password and can able to access to the patient’s files without random generated keys.

System implementation: The healthcare organization can encounter the challenges into EHR implementation due to the challenges resulted into wastage of resources, loss of the confidence by the patients as well as issues related to safety of patients. Improper design of the EHR system leads to system failure so that the system will not work properly into the healthcare organization. The organization as well as healthcare institutions are made improvements into the clinical engagements (Bromiley et al., 2015). The implementation process failed due to underestimate importance of the one as well as more clinician to serve of the healthcare providers into the clinic. The disruption throughout EHR implementation is negatively impacts the quality of the healthcare as well as endangers the safety of the patients along with the financial losses.

Data inaccuracies: There are integrity assured that there are inaccurate data which are not changed. EHR is served to improve the safety of the patients by reduction of the errors into the healthcare, reduction of the health disparities in addition to improvement of the health into the organization (Pritchard & PMP, 2014). There are concerns regarding the accuracy along with reliability of the data which are entered into the electronic records. There are losses as well as destruction of data throughout the data transfer which raised concerns regards to the data accuracy base as the decisions of patient care are being based. There are grow into problems due to the medical identify theft.   

Risk matrix:

Type of risks	Impact	Probability	Risk level	Mitigation plan
Privacy and confidentiality	Moderate	Moderate	Medium	The claim of the individuals is that information of the patient is released only to the permission of patients.
Security breaches	Minor	Moderate	Medium	By the process of encryption, the system users can able to encode information in a way that only authorized person can able to read the message (Andrews et al., 2015).
System implementation	Moderate	Unlikely	Medium	Proper implementation plan is done so that it would help to implement of proper healthcare system to provide of better quality of the healthcare as well as endangers the safety of the patients along with prevention of the financial losses (Pollitt & Bouckaert, 2017).
Data inaccuracies	Trivial	Unlikely	Low	The accuracy of data is kept properly so that proper confidential healthcare data are occurred throughout the transfer of data.

The implementation of EHR is not always save the healthcare providers time that allow spending time with the each of the patients and then seeing the patients. The electronic medical records are being limited by both security as well as privacy concerns. There is also lack of coordination among the healthcare providers as well as patients (Boulware et al., 2016). Each of the hospital has unique portal entry into the database and there are various ways of navigation. The physician are working into the single database will have proficient into the system. The healthcare professionals are working at various hospitals will carry of the passwords along with navigation clues. The records are being limited by both security as well as privacy concerns. The system will not reduce the cost and it will not streamline the healthcare delivery. Transfer of the records into the system is an obstacle will become a risk for the business organization (Wager, Lee, & Glaser, 2017). The EHR system always providing of confidential data as well as information to the patients related. Sometimes, due to lack of accuracy as well as authentication processes, the system is not implemented properly and there are many risks of privacy as well as security of the data.

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