Analyzing Health Informatics Project Management Case Study

Health Informatics: Project Management Case Study

A major focus area, for several years now, in healthcare settings has been the support of data collection and transmission of information on patients through computer-based workflow systems deployed in such institutions. This case study is an analysis of the deployment of a healthcare workflow system (commercially available) in a hospital setting. Research findings show workflow organizational support as a strategic solution and making use of an implementation team with members having varying functional roles were critical elements not just for success, but also for creating a comprehension of data flow into and via the system due to the complex and challenging work processes. It is important to comprehend the workflow management system maturity, organizational effect of workflow, and human participation and interaction specific to workflow. With the successful deployment of workflow in the healthcare organization, the benefits and applicability of technology provides greater insight. This paper will look at the current workflow state in the institution, system issues or problems, the proposed innovation, and proposed system implementation, proposed training plan and strategy for user acceptance, proposed go-live strategy and support and the proposed on-going maintenance and support strategy.

Introduction

Workflow entails the automation of business processes. It is designed to offer support for business activity coordination to attain business goals. An integral element of workflow is collaboration. Workflow entails people and computer-based processes' interaction to facilitate the flow of work from user to user or department to department within the healthcare setting. Workflow systems ensure that work is routed in the right sequence, offers document and data access to workers and even track the execution of work processes. Workflow systems offer information flow support for health information management based on business processes like deficiency processing and management, analysis of patient charts, patient admission, patient discharge, utilization review, patient billing and record completion. The health information management department is where most workflow bits begin. The flow of patient billing, medical records and other uses of hospital resources, among other processes in need of detailed information on patients are automated through workflow systems. Collaborated computing efforts have been attributed to the workflow technology. However, the emergence of workflow and collaborative computing has been slow. Despite the essence of workflow systems in hospital settings, their development is not just sensitive to the particular development tools utilized, but also unstructured. Workflow systems are ineffective in attaining optimal productivity when their development and implementation challenges are not completely analyzed and addressed. Lack of access to workflow systems in real world settings has been defined as one of the challenges that hinder analysis of such systems. Although healthcare institutions that have implemented workflow systems have experienced tremendous growth or are expected to grow in the next decade, they still have evolving experience, expertise and knowledge in the use of this technology as their major challenges. Healthcare institutions do not share their workflow system designs, whether they consider them a success or failure. Workflow technology implementations are time-consuming and complex. As a result, data collection processes become complicated. AVENUE HEALTHCARE is having problems mapping dataflow between its two facilities and the data center facility, as well as other industries. This paper studies a workflow management system that can help overcome certain workflow issues such as mapping information flow between different facilities owned by a single institution with their main data center facility, and also how to implement it. As the Informatics Project manager, I will propose a workflow management software, specifically TAG DOC, to help solve these issues. The manager's main role will entail overseeing the new software implementation and maintenance through project management (Aalst & Hee, 2004).

The Current State

Avenue is a healthcare clinic located in the north-eastern part of the U.S. The institution is an advanced acute care facility that operates on two independent campuses, with each situated on a separate area of the city. The total number of patient beds in use in both facility campuses is 800. The average inpatient admission on a yearly basis number 42,000; outpatient diagnostic processes total 400,000; and 73,000 visits to the emergency department. The healthcare facility is a regional resource for cardiovascular medicine, cancer treatment, surgery services, burn treatment, and kidney transplantation. The facility also runs a regional trauma center. HIM (Health Information Management) resources are accessible on both the facility's campuses. However, the major department of HIM is based in a different facility that hosts the IS (Information System) and the data center. The three facilities are linked using a high speed network. The main workflow challenge experienced by Avenue is mapping information flow across the three separate facilities. Basically, the main information used is patient data with regards to diagnosis, prescriptions, admission, discharge, etc. The main system users include nurses, system administrators, pharmacists and physicians. The doctors are responsible for treating patients; nurses offer healthcare to patients undergoing treatment, such as drug administration; pharmacists provide drug prescriptions at the healthcare pharmacy; and the administrators are responsible for system management and monitoring, ensuring that it is up and running as expected, at all times (eHealth Conference et al., 2011).

Figure 1: See APPENDIX A

System Issues or Problems

Avenue has workflow issues mapping information transfer between its two facilities and the data center facility, in addition to other industries. As a result, the hospital experiences delays, interruptions, pauses, reworks, established workarounds, gaps due to omission of critical steps, and physicians perceiving processes as illogical. This leads to slower progress, decreased job satisfaction and thus lower quality care. Since the hospital handles large volumes of patient data, poor workflows lead to loss of valuable information, which in turn impedes coordination and communication between nurses and doctors, further increasing interruptions in the workflow system. The poor workflow system also leads to decreased ability to deviate from routine sequences and nurses dropping activities during busy periods. The large amounts of patient data being transferred and handoffs lead to information degradation. Interruptions break the workflow system cycle, determining what information is recorded and passed on to the next user. Due to all these system issues, it is important that Avenue healthcare institution adopts a new workflow management system that can help overcome these issues (In Berner, 2013).

Proposed Innovation

The workflow innovation proposed for Avenue healthcare is a product that is commercially available and created by a vendor of the Fortune 100 Healthcare Information Systems. It is an imaging and information management system based on a client/server technology (TAG DOC), integrating and supplementing healthcare applications. The system basis of this technology allows electronic capture, indexing, storage and retrieval of processed data (information) kept in various media and other electronic platforms from a centralized location. An online patient chart is created through the consolidation of primary or centralized patient information systems data with the information. An EPRS database also interfaces the workflow system to help track document routing, patient data query and real-time capture of patient information feeds. The innovation's workflow features allow for automation and customization of information flow within the system. Work objects, connected to each other to develop information flow via the work process, are used to construct workflow threads. 14 workflow objects are offered, as indicated in the figure 2 below.

Figure 2: See APPENDIX B

Deficiency processing and management, analysis of patient charts, utilization review, record completion, patient admission, and patient discharge are business processes that can be supported by developing threads. Release of information requests and patient accounting for billing are other processes that can be supported by the proposed innovation. The workflow map processing is controlled by a build-time agent. The processing of the workflow map occurs in a cyclical manner. The execution of the work objects by the workflow agent takes place in a pre-determined order by object type, processing the object links defined in work threads. The execution cycle starts after processing of all the links, proceeding till the termination of the workflow agent, which is scheduled to operate continuously; it is only stopped when system backups need to be performed. Generally, all system users have access to information stored in a centralized system through the internet, with system protection offered through an SSL protocol. This simplifies the workflow process, eliminating mapping issues that initially existed between the two campus facilities owned by the health institution, as well as the data center facility (Trotter & Uhlman, 2011).

Figure 3: See APPENDIX C

Proposed Implementation

The project management theory helps breakdown the implementation workload into smaller components, rendering it easier to accomplish and monitor. The whole project will take 720 hours and cost Avenue healthcare 38500 Euros. The implementation of the proposed innovation to help counteract workflow issues in Avenue hospital will undergo the following phases:

1. Initiation Phase

In this phase, the software implementation project begins. The innovation will be explored and elaborated if fit for the healthcare facility. The project feasibility will be determined and a suitable person with relevant skills and expertise assigned the role of an informatics project manager to oversee the general implementation of the workflow management software. Other parties expected to take part in the project will be determined with their respective roles. The expected results will also be determined in this phase. The informatics project manager will then write a research and development proposal for acceptance by the top management so that funding can be provided to support the project's implementation activities.

2. Definition Phase

Upon approval of the proposal, the project enters the definition phase where all the workflow management system requirements are specified. The expected outcomes, preconditions, operational requirements, functional requirements and design limitations must also be detailed in this phase. Upon approval by the informatics project manager, the project moves into the design phase.

3. Design Phase

During this phase, the innovation is customized to meet the unique needs of Avenue healthcare facility with regards to workflow issues because the software has also been developed by the vendor. Various diagrams such as workflow maps, flow charts, prototypes and other relevant diagrams are developed in this phase to help create the final diagram that will be used to configure the innovation. The design phase will be broken down into two sub-phases. This phase will take 360 hours and cost 18,500 Euros; the first phase will take 80 hours and cost 4000 Euros whereas the second phase will take 280 hours and cost 14500 Euros.

4. Development Phase

In the development phase, the software innovation is prepared for implementation. All the materials, resources and tools needed for the implementation phase are prepared. Schedules are made, instructions given to the workers that will take part in the implementation process. When the project team is ready to begin implementation of the innovation into the facility's existing system, the design phase comes to an end.

5. Implementation/Programming Phase

The actual innovation design customization occurs in this phase. Upon completion, the system is tested to ascertain that it meets the facility's requirements as detailed earlier in the first phase and if the project goals and objectives have been attained in the obtained outcomes. The facility can request for any adjustments they deem appropriate and in line with the previously defined requirements for a system that can help overcome the workflow issues stated earlier in this paper. The implementation phase will take 200 hours, costing 11000 Euros.

6. Follow up and Closing/Testing Phase

In this phase, various activities are carried out to help bring the project to an end. User training and provision of instructions; writing a handbook or guide on the system; result maintenance; setting up of a help desk, project evaluation, project report writing; celebration of attained results; project transfer to the hospital's director or top management and breaking up of the project team, are some activities that occur during this phase. This phase will take 160 hours and cost 9000 Euros (Harvard Business Review Press, 2013).

The design, implementation and follow-up phases are the most important in this project.

Figure 4: See APPENDIX D

Figure 5: See APPENDIX E

Potential Barriers and Solutions

Use of Different Approaches to Get Tasks Done -- since project team members can have different ways of getting tasks done, it may result in them being on different pages with regards to the same project. The informatics project manager can solve this by using a standardized project management methodology to be adopted by everyone taking part in the project implementation.

Overlooking Critical Project Elements -- since everyone is busy getting tasks done to accomplish the project's goals, it becomes easy to overlook critical project aspects. This can be solved by outlining all the important tasks in the project, especially when assigning roles. Continual strategy revisits should ensure that the critical aspects are covered.

Project Ambiguity -- this can be solved by making sure that all team members understand the project scope and what is expected of them, inclusive of the strategy to be adopted by all.

Lack of Cooperation between Different Facility Departments -- a business case outlining the project plan, including resource implication, project scope, timing, goals, risks of not co-operating, etc. should help overcome this challenge.

Project Staffing -- if the facility does not have enough staff with the knowhow to enable them get into the project, the budget should cater for outsourcing of experts.

Poor Communication -- every project team member should report the progress of their tasks to a predetermined central location where those who need such information can easily have access.

Soft Project Deadline -- the project's deadline must be stipulated at the initiation stage and integrated into the project goal statement (Harvard Business Review Press, 2013).

Proposed Training Plan and Strategies for Enlisting End User, Super User and Physician Acceptance

User Acceptance Testing is the most effective proposed strategy for enlisting end user, super user and physician acceptance of the newly implemented system. UAT is when the workflow system users (nurses, doctors and administrators) get to test the software to ascertain whether it is acceptable or not. It occurs after system testing, but before it goes live or delivered as an acceptable product to the facility's top management. UAT involves three critical phases, namely: plan, design and execution. Before the plan phase begins, key acceptance criteria (the system features to be evaluated for acceptance) should be defined in terms of the innovation's functional application in the healthcare facility and a contract drawn with regards to the same. The evaluation can either be carried out by the users or the UAT team responsible for designing and implementing the innovation. In the former case, the UAT trains the users on how the system works, before they can evaluate it.

The UAT is responsible for coordinating the plan phase by ensuring that the environment, dates, users (actors), roles and responsibilities, communication protocols, analysis processes, results, templates and an entry-exit criterion are listed in the plan. During the design phase, data, administrative procedures, templates for recording test outcomes, defect logging mechanisms are developed. UAT cases can also be provided to the users. The actual system testing occurs in the execution phase after which a decision is made to accept the product or not (Barker & Cole, 2012).