Primary care physicians play a key role in the U.S. health care delivery system.

These
providers integrate internal and external information with their clinical knowledge to
determine the patient’s treatment options. An effective ambulatory electronic health
record (EHR) is critical to supply physicians with the information they need to provide
quality care and maximize their efficiency. This case involves the decision-making
process to replace an inadequate EHR system in a primary care network owned by a
community hospital. The IT challenge reviewed in this case will be the decision-making
process that optimizes provider support for the new EHR while addressing the strategic
plan requirements of data integration, clinical application, and practice management
functionality.

Watson’s Ambulatory EHR Transition in ,$)), Watson community Association 0WcH1

board of directors decided to implementa system-wide electronic health record 0EHR1
and evaluate its clinics’ integrated EHR and Practice management system that has been
operational for four years. WcH is a ,$$-bed acute care facility that has strategically
employed primary care providers in their eight specialty clinics to facilitate access for
patients and provide a primary care patient source for specialist at the hospital.

Current Situation

The WcH specialty clinics’ current XYZ data systems integrated EHR and practice
management system was implemented based on the hospital’s meditech platform and not
on the physician needs and application functionality. Poor physician adoption and limited
support from the hospital information technology 0iT1 department has led WcH
leadership team to develop a strategic planning process to ensure the project’s success.
The planning process will closely mimic the methodology of project management use to
define the best combination of logically management processes, approaches, techniques,
methods, and technologies through effective decision making and problem solving. input
and participation by every level of WcH;s organization will be included in the planning,
decision-making, and implementation activities needed to transition to the replacement
EHR.

Plan Strengths: Important Considerations

The EHR plan included elements of project management that help ensure successful
deployment of systems that involve people, processes, and changes to the culture of an
organization. The first key factor was the inclusion of key stakeholders from each of the
affected clinical areas in the planning and decision-making process of the transition. This
process will assure the adaptation and support on the new the system that was not present
with the previous implementations. The steering committee realized that it needed to
establish an aggressive communication plan to manage multiple users and stakeholders
while providing efficient means to solicit and receive feedback throughout the project.
The communication plan provided the foundation for an objective process of the
collecting requirements and defining the project scope and objectives.

The project management methodology of establishing system requirements, planning

the work, and identifying possible vendors facilitate the completion of the request for
proposal (RFP) process. With the system requirements and objectives defined, it allowed
the acquisition team to complete the vendor review, evaluation, and selection process to
ensure that the selected system will meet those requirements and integrate well with the
current infrastructure.

Plan Improvement and Rationale

There are several other tools and techniques for collecting requirements that can be added
or replace some of the group activities.

The various groups should use formalized creative techniques such as brainstorming and
idea mapping

since they are already using a nominal group technique to rank and drill down the needs
of the organization as opposed to the individual.

These techniques help generate and collect multiple ideas related to the project
requirements and consolidate them into a single map to show conjoint ideas and
processes that can now be considered.

At this point, decisions should be made objectively by using a decision matrix that will
provide a systematic approach for establishing the criteria to evaluate and rank each idea.

The resulting requirements should be validated with the business and project objectives,
included in the vendor selection process, and monitored throughout the rest of the
implementation process.

Single Vendor for Multiple Settings?

The many advantages to maintaining a single vendor include reliability with seamless
data flow, better workflow management, single point of issue resolution and fewer
upgrades, single access point, and one contract with few vendor relationships to maintain.
But there are a few risk that an organization must weigh in their decision to maintain a
single vendor. The vendor may have an unbalanced mix of expertise in multiple HIT
systems. Upgrades in an integrated architecture may require the entire system to be
interrupted or down during the upgrade process. many managers are concern with the
"we are in" scenario of a single vendor approach and more skeptical on the system ability
to be replaced or expanded.

Conclusion

The implementation of health information technology creates many challenges for every
organization regardless of size, prominence, or level of sophistication. The process itself
requires a culture shift and evaluation of its strategic goals and objectives. The
technology will not bring those changesB people will. Watson community Association
applied sound project management methodology that involved its stakeholders at every
phase of the process. They focus on the business needs and not the individual desires
while including their most important assets -- their personnel in the change process. The
requirements were objectively developed, translated to work processes, and traced
throughout the implementation by the vendor. success can be achieved with the right
approach and change in the organizational culture.

References

Wager, K., & Lee, F. (2013) Health care information systems: A practical approach for
health care management (Third ed., pp. 6 - 6 ). San Francisco: Jossey-Bass