Acquisition of IT Solutions

Description of the Problem

The problem is the inefficiency, complex, and time consuming nature of paper medical records that are used to document patient information. The Patient Admission Department obtains personal information from patients, which is documented before they are allowed to see the physician. Currently, the hospital manages documentation of patient information using paper-based medical records, which are complex and time consuming.

Business Activities and Processes Affected by the Problem

Documentation of patient data; billing; physician-patient relationship.

Actual Performance (e.g., current baseline)

At present, patient documentation process involves recording patient data, peer communication, patient care and other activities. This process requires an average of 30 minutes to complete. Therefore, the process reduces the dedicated time spent on patient consultation and care by nearly 10%.

Target Performance

An achievable target is for patient documentation process to require an average of 10 minutes per patient. There will be an improvement in physician-patient relationship, from a 75% patient satisfaction rating to a targeted rating of 90%. This will help improve the quality of care and billing processes.

Performance Gap

Since the hospital averages 20 patient visits each day, the performance gaps total approximately 10 labor hours per month. This results in an overall 25% decline in productivity.

Organizational KPIs Affected

Return on investments; physician-patient relationship; patient satisfaction ratings.

Principal Stakeholders

Chief Executive Officer; Patient Admission Department; Physicians

Tentative Solution Strategy

Investigate the viability of establishing an easy-to-use, efficient, and commercially-available electronic health record (EHR) that will automate the process documentation of patient information. The system should improve billing processes, patient care delivery processes, management of patient data, and peer communication (exchange of patient data among physicians for better decision-making).

Acquisition Need Confirmation

We/I confirm that this issue can be addressed through the acquisition of IT services (and IT products as needed) from a contractor selected in open competition.

Activity 2 – Requirements Development

OBJECTIVE OF THE REQUIREMENTS

Reduce the amount of time required to document patient data and to improve the management of patient information, as stated in the Performance Gap document.

REQUIREMENTS CATEGORY

REQUIREMENTS DEFINITION

1. Stakeholder Considerations that Need to be Reflected in the Solution

Chief Executive Officer seeks increased return on investments and an increase in overall productivity. The Patient Admission Department seeks improvements in the management of patient information. Physicians seek for improved patient care and satisfaction.

2. Factors to Take Into Account Related to the Business Environment (including legal factors, regulations, competition, and business cycles)

Competitors have the capabilities described here since they currently use electronic health records for documentation of patient data.

3. New Capabilities and/or Functionality Required by a Solution (including requirements for ease of use, quality, interoperability, and data sharing)

An electronic health record is required to lessen the time taken by the Patient Admission Department in recording or managing patient information. As a software solution, EHR will help enhance billing and physician-patient relationship.

Must be able to store and support speedy retrieval of patient data, improve peer communication, and enhance billing processes. Must enhance data sharing among clinicians at the facility. The solution must be easy to use, scalable, fast and reliable, and function across platforms. Must operate with existing technology systems.

4. Existing Business Process Shortfalls (why current business process and/or systems cannot meet the needs or be changed to meet the needs)

Current paper-based medical records are cumbersome and time-consuming to prepare. In addition, it takes time to retrieve and share patient data among clinicians. It is error prone, lacks backups, and is likely to create an adverse medical event.

5. Cost Limitations (may be stated in terms of preferred cost range; may specify a maximum cost; cost figures need to include associated overhead costs; may be specified as an annual limit or life cycle limit or both)

The average cost of implementing an electronic health record is $162,000 with additional maintenance of nearly $85,000 in the first year (Quinn, 2016). As a result the total cost of implementation, training, and overhead is expected to range between $170,000 - $240,000.

6. Other Limitations or Constraints (e.g. availability of key personnel, such as subject matter experts, training methods, and time available for training; limitations related to maintenance or to external support)

Since the targeted individuals are hospital personnel, they are readily available for training to use the system. On-the-job training will be used to promote seamless switch from current paper-based records to EHR. The cost of maintenance would be nearly $85,000 in the first year.

7. Safety & Privacy Requirements (any requirements beyond those currently being used by the organization for non-critical and non-sensitive applications)

Since the implementation of EHR will involve switching from the paper-based medical records, the hospital will need to set-up an IT infrastructure to support the new system. A computerized system comprising computers with a processor of at least 2.5GHz, 2GB of RAM, and an internet speed of at least 3 Mb/s is required. The system should support Chrome, Safari, or Microsoft Edge browsers. A comprehensive network security system is also required to safeguard the EHR.

8. Number to be Implemented (e.g. specify the number of places the solution will need to be implemented and whether they are at different geographical locations)

The solution must be provided for the Patient Admission Department, hospital wards/units, and at CEO’s office within the facility.

9. Schedule (explain any schedule constraint, whether for financial or non-financial reasons – e.g. if the solution be in place as of a certain date, specify the date and why)

Acquire and implement the solution within the next six months February 8, 2022 – August 8, 2022.

10. Other Requirements Not Specified Above (e.g. any related to vendors, consultants, partnerships with other entities, unique user interface requirements, documentation needs, special certification requirements)

Requires external/vendor support, especially within the first year of implementation. The implementation process would involve unit and functional testing, system testing, integrated testing, and performance and stress testing (Aguirre et al., 2019). Vendor must provide assurance of regular support and fast response to any emerging issues.

Activity 3 – Identifying Alternatives

OBJECTIVE:

Reduce the amount of time required to document patient data and to improve the management of patient information.

Name of Solution Alternative

Summary Description of Solution That Meets the Stated Requirements

Alternative Solution #1:

Cloud-based Electronic Health Record

A web-native EHR solution in which patient data is stored on external servers and accessed via the web. It requires only a computer with Internet connection capabilities. This system eliminates the need for the facility to maintain an internal server(s), develop redundancy and resiliency protocol, and monitor backup procedures in efforts to ensure reliable access to data and promote continuity of service (O’Connor, 2015).

Alternative Solution #2:

Client-server Electronic Health Record

A system requiring in-house storage of patient data. This system requires the facility to maintain internal servers and install hardware and software in the various hospital units including the Patient Admission Department and physician’s office. The facility regularly monitors backup procedures and creates redundancy and resiliency protocol for the system.

Alternative Solution #3:

Remotely-hosted EHR system

A system in which the responsibility of maintaining patient data is shifted from the facility/physician to a third-party. While the physician/facility collects patient data, a third-party is responsible for storage and management of the data. The facility stores patient data on a vendor’s servers. However, the facility handles data backup, maintenance, and security issues.

Alternative Solution #4:

Subsidized EHR system

A remotely-based electronic health record in which a facility collaborates with another in maintaining patient records. The facility leverages the capability of its partner to create and maintain an electronic health record. The partner facility controls and manages the data collected by the primary facility (Tharpe, 2020). Data storage and maintenance is handled by the partner facility.

IT Acquisition Confirmation

Each alternative solution described above requires the acquisition of IT services from an external IT service provider selected in open competition.

Activity 4 – Screening Alternatives

Alternative Solution

Responsiveness to Requirements

Feasibility (Capable of Being Successful)

Enterprise Architecture

Risks and Constraints

Affordability

New Opportunities

Rank Order

Alternative Solution #1:

Cloud-based Electronic Health Record

Can meet all requirements

Feasible

Supports; no conflict

Cloud-provider dependence; privacy concerns; fewer options for customization

Affordable initial cost and $100 a month subscription fee (Jason, 2020)

None beyond meeting current objectives

Alternative Solution #2:

Client-server Electronic Health Record

Can meet all requirements

Probably feasible

Supports; no conflict

Increased workflow burdens due to the need to maintain internal servers; costly to maintain; hardware and software requirements

Likely highest initial installation and maintenance costs

None beyond current objectives

Alternative Solution #3:

Remotely-hosted EHR system

Potentially could meet all requirements

Feasible

Depends on the capability of the host facility

May have data privacy risks

Likely greater initial cost, but affordable

On-going partnership could be source of new opportunities

Alternative Solution #4:

Subsidized EHR system

Can meet all requirements

Probably feasible

Depends on the capability of the host facility

Potential antitrust, privacy, and ownership issues

Affordable

Host my offer new opportunities

Activity 5 – Work Breakdown Structure

WBS for Alternative #1: Cloud-based Electronic Health RecordCreating a selection team

Gathering requirements

Research potential vendors and submitting RFI and RFP

Cloud-based Electronic Health Record

Labor Hours: 400

Cost: $5,000

Other Resources

Cost: $2,000

Requirements Gathering

Labor Hours: 50

Cost: $500

Other Resources

Cost: $200

Planning Phase

Labor Hours: 100

Cost: $1,000

Other Resources

Cost: $500

Testing & Transition Phase

Labor Hours: 250

Cost: $3,500

Other Resources

Cost: $1,300

Evaluation of RFI and RFP responses

Ranking vendors and creating a shortlist

Vendor demonstrations and selection

Solution testing

Training

Go-live preparation

Implementation and evaluation

WBS for Alternative #2: Client-server Electronic Health RecordCreating a selection team

Gathering requirements

Research potential vendors Submitting RFI and RFP

Evaluation of RFI and RFP responses

Vendor ranking and demonstrations

Client-server Electronic Health Record

Labor Hours: 680

Cost: $175,000

Other Resources

Cost: $85,000

Design Phase

Labor Hours: 100

Cost: $20,000

Other Resources

Cost: $2,000

Planning Phase

Labor Hours: 200

Cost: $85,000

Other Resources

Cost: $3,000

Testing & Implementation Phase

Labor Hours: 380

Cost: $125,500

Other Resources

Cost: $24,500

Purchasing hardware and software requirements

User training

Pilot testing

Go-live preparation

Incremental implementation

Full implementation

Monitoring and evaluation

WBS for Alternative #3: Remotely-based EHR System

Creating a selection team

Gathering requirements

Research on potential third-party

Remotely-based EHR system

Labor Hours: 300

Cost: $65,000

Other Resources

Cost: $5,000

Requirements Identification

Labor Hours: 50

Cost: $2,000

Other Resources

Cost: $1,000

Third-Party Selection & Testing

Labor Hours: 100

Cost: $17,000

Other Resources

Cost: $2,000

Implementation

Labor Hours: 150

Cost: $40,000

Other Resources

Cost: $3,000

Third-party identification

Request for RFI and RFP

Third-party selection & contracting

Go-live preparation

Implementation

Monitoring and evaluation

WBS for Alternative #4: Subsidized EHR SystemCreating a selection team

Gathering requirements

Research on potential host facility

Subsidized EHR system

Labor Hours: 300

Cost: $43,000

Other Resources

Cost: $2,000

Requirements Identification

Labor Hours: 50

Cost: $2,000

Other Resources

Cost: $500

Third-Party Selection & Testing

Labor Hours: 100

Cost: $17,500

Other Resources

Cost: $2,000

Implementation

Labor Hours: 150

Cost: $20,000

Other Resources

Cost: $3,000

Host facility identification

Request for RFI and RFP

Host facility selection & contracting

Go-live preparation

Implementation

Monitoring and evaluation

Activity 6 – Risk Analysis of Alternative Solutions

Alternative Solution #1 (Tentative Solution Rank Order #1):

Identify a web-native EHR solution in which patient data is stored on external servers and accessed via the web. No need to maintain internal servers.

Risk Category

Probability

Impact if Occurs

Mitigation Strategy

Approximate Risk Exposure

Risk Priority

Organizational Risk

Potential user resistance

$2,000 - $5,000

Frequent updates to users; involvement of users in all stages

$1,400 - $2,000

M

Information Security and Privacy Risk

Potential loss of control of data maintenance

$10,000 - $50,000

Identify potential privacy concerns and establish strict measures to prevent them from occurring

$1,500 - $3,000

M2

Complexity Risk

Potential limited options for customization

Thorough review of vendor solutions before adoption; ongoing collaboration with the vendor

$500 - $1,000

L

Infrastructure Risk

Probable interoperability challenges

$2,000 - $10,000

Provide training; extensive scrutiny of vendor solutions before adoption

$300 - $800

L

External Risk

Poor performance

Review vendor past performance

$100 - $300

L

Average Probability

Total Approximate Risk Exposure

$3,800 - $7,100

Alternative Solution #2 (Tentative Solution Rank Order #4):

Establish an in-house electronic health records; handle data storage and collection internally; monitor backup procedures; create redundancy and resiliency protocol for the system.