EHR Implementation Plan for a Rural Hospital: IT Acquisition

Problem Definition and Performance Gap

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

The following areas are directly affected: documentation of patient data, billing, and the physician-patient relationship.

At present, the patient documentation process involves recording patient data, peer communication, patient care coordination, and related activities. This process requires an average of 30 minutes to complete per patient, reducing the time dedicated to patient consultation and care by nearly 10%.

An achievable target is for the patient documentation process to require an average of 10 minutes per patient. This improvement is expected to raise the physician-patient satisfaction rating from its current 75% to a targeted 90%, thereby improving the overall quality of care and billing processes.

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.

Return on investment, physician-patient relationship quality, and patient satisfaction ratings are the primary KPIs affected.

Chief Executive Officer, Patient Admission Department, and Physicians.

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

This issue can be addressed through the acquisition of IT services (and IT products as needed) from a contractor selected through open competition.

Requirements Development

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

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

Competing facilities already possess the capabilities described here, as they currently use electronic health records for documentation of patient data. This creates a competitive disadvantage for the hospital if the transition to EHR is not made promptly.

An electronic health record is required to reduce the time the Patient Admission Department spends recording and managing patient information. As a software solution, the EHR will also enhance billing and improve the physician-patient relationship.

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

Current paper-based medical records are cumbersome and time-consuming to prepare. Retrieving and sharing patient data among clinicians is slow. The paper-based system is error-prone, lacks backup mechanisms, and creates conditions likely to produce adverse medical events.

The average cost of implementing an electronic health record is $162,000, with additional maintenance costs 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 and $240,000.

Since the targeted users are hospital personnel, they are readily available for training. On-the-job training will be used to promote a seamless transition from paper-based records to the EHR. The cost of maintenance is estimated at nearly $85,000 in the first year.

Because the implementation of EHR involves a switch from paper-based records, the hospital will need to establish an IT infrastructure to support the new system. The required infrastructure includes computers with a processor of at least 2.5 GHz, 2 GB of RAM, and an internet connection speed of at least 3 Mb/s. The system must support Chrome, Safari, or Microsoft Edge browsers. A comprehensive network security system is also required to safeguard the EHR and protect patient data.

The solution must be implemented in the Patient Admission Department, hospital wards and units, and the CEO's office within the facility.

The target is to acquire and implement the solution within six months: February 8, 2022 – August 8, 2022.

External vendor support is required, especially within the first year of implementation. The implementation process will involve unit and functional testing, system testing, integrated testing, and performance and stress testing (Aguirre et al., 2019). The vendor must provide assurance of regular support and a fast response to any emerging issues.

Identifying and Screening Alternative EHR Solutions

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

A web-native EHR solution in which patient data is stored on external servers and accessed via the internet. It requires only a computer with internet connectivity. This system eliminates the need for the facility to maintain internal servers, develop redundancy and resiliency protocols, and monitor backup procedures — all while ensuring reliable access to data and continuity of service (O'Connor, 2015).

A system requiring in-house storage of patient data. This solution requires the facility to maintain internal servers and install hardware and software across various hospital units, including the Patient Admission Department and physicians' offices. The facility would also be responsible for monitoring backup procedures and creating redundancy and resiliency protocols for the system.

A system in which responsibility for maintaining patient data is shifted from the facility to a third party. While the facility collects patient data, a third party handles storage and management. The facility stores patient data on the vendor's servers, but the facility retains responsibility for data backup, maintenance, and security oversight.

A remotely-based electronic health record in which the facility collaborates with a partner facility to maintain patient records. The facility leverages the partner's existing infrastructure and capabilities to create and maintain the EHR. The partner facility controls and manages the data collected by the primary facility (Tharpe, 2020), and handles data storage and maintenance.

Each alternative was evaluated across six criteria: responsiveness to requirements, feasibility, enterprise architecture fit, risks and constraints, affordability, and new opportunities. The results are summarized below.

Alternative #1 (Cloud-based EHR) — Rank: 1. Can meet all requirements. Feasible. Supports existing enterprise architecture with no conflict. Key risks include cloud-provider dependence, privacy concerns, and fewer customization options. Affordable, with an initial cost and a $100/month subscription fee (Jason, 2020). No opportunities beyond current objectives.

Alternative #2 (Client-server EHR) — Rank: 4. Can meet all requirements. Probably feasible. Supports existing enterprise architecture with no conflict. Key risks include increased workflow burdens from maintaining internal servers and high hardware and software requirements. Likely the highest initial installation and maintenance costs. No new opportunities beyond current objectives.

Alternative #3 (Remotely-hosted EHR) — Rank: 2. Potentially could meet all requirements. Feasible. Enterprise architecture compatibility depends on the capability of the host facility. May carry data privacy risks. Likely greater initial cost, but affordable. An ongoing partnership could be a source of new opportunities.

Alternative #4 (Subsidized EHR) — Rank: 3. Can meet all requirements. Probably feasible. Enterprise architecture compatibility depends on the capability of the host facility. Carries potential antitrust, privacy, and ownership risks. Affordable. The host facility may offer new business opportunities.

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