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Initial Post [Due: Wednesday at 11:59. P.M., CT.]

According to Robert Bob Kline, Chief Information Officer, the existing system, which is called the Patient Record System (PRS), has been in operation for more than 10 years. The system worked well when the organization was smaller, but now that the system has grown through organic and inorganic growth, the current EHR isnt operating as efficiently and causing staff to find workarounds to compensate for system weaknesses. The inefficiencies boil down to three main areas: accessibility, administration, and ease of use. PRS is only accessible from centralized terminals throughout the Hospital, like at nurses stations for example. Its not accessible from any of the systems other facilities, like the ambulatory care facilities, or even Urgent Care. So, patient recordkeeping can be inconsistent from facility to facility. From an administration standpoint, the PRS was a home-grown solution, hosted internally, and many of the administration tasks are manual, which means someone on Bobs team has to do them. This can be tedious. The current system isn't a Graphical User Interface, like so many other systems today. So, its not intuitive for staff members to use.

There are two more current systems under consideration: eMed and Patient Data Systems (PDS). They are similar in functionality, but are installed and hosted differently. eMed is a web-based EHR system. So its hosted in the cloud, and uses individual logins. It can be accessed from anywhere, including mobile devices. Patient Data Systems is software that would be installed on one of our servers, but if terminals were installed everywhere, then the system could be accessed from any of them. Bob mentioned that if Bright Roads is looking to provide accessibility across different physical facilities, if they select the Patient Data System solution theyre still going to need to employ a web-based solution to connect the servers at each facility to the main server at the hospital, along an Intranet-type network. The PDS provider claims they are just finishing development on new security measures to help connect facilities; however, Bob feels that eMed is actually better prepared.

With the current system, when nurses visit a patients room, they record their observations on the physical patients chart; vitals, medications administered, notes from the patient interaction, and so forth. The charts are kept at the nurses station, and all documentation is made there. If for some reason someone - a physician or another member of the interdisciplinary team - has the record, no one else can get to it. This can be a little frustrating for the staff and contribute to delays in entering important patient information into the EHR. At some point during a nurses shift, he or she will enter the information into the terminal at the nurses station. Thats the central database where all patient data is stored. Each employee possesses unique log-in credentials, so its possible to determine who made what entries into the PRS and when those activities took place. Based on information provided by Tiffany Johnson, Chief Medical Officer, and Ken Kirk, Chief Nurse Executive, the key errors come with communication and documentation. The patient may not communicate well or the medical staff may not hear the information correctly. Also, there are errors when it comes to transferring notes from the patient chart to the electronic system . . . and this can happen just from simple typographical errors or staff members being too hasty and not double-checking their work. There are also incidents of wrong dates or times noted both in the chart and in the system.

On average, it is taking 15 minutes to document on each patient in PRS. The clinical staff (nurses and providers), on average, care for 5 patients per shift. The nurses will visit their patients between 3 or 4 times per shift for routine checks. This is consistent for the physicians except for when theyre called in. Tiffany and Ken believe it would be advantageous to have computer terminals in every patient room, since it would reduce errors and eliminate duplicate work. There is a general concern that implementing a new EHR would create a degree of anxiety amongst the nurses, physicians, and other members of the interdisciplinary team. Not all staff are technology savvy, and new policies and procedures for using the system would be developed. Furthermore, Ken and Tiffany believe the acquisition and implementation of a new EHR would be beneficial. Ken is just concerned that a transition from PRS to another system might not be without its challenges, but that is to be expected. It is agreed that implementing a more up-to-date EHR will improve documentation; improve communication; result in better care; save a LOT of time spent investigating errors; and lead to a reduction in complaints from patients. From Kens perspective, if the nurses can make patient notes once, that would be ideal as opposed to writing notes in the patient chart, and then transcribing them into the EHR later in the shift. Sometimes a patient is admitted from the ER, and the nurse didnt have time to enter notes into the system. This means someone has to call down to the ER and get the notes. A new system would enable nurses and doctors to get real-time information, which would boost the quality of care provided to the patients.

In summary, a new system would likely save personnel time, prevent human error due to handwriting or typographical mishaps, and allow for up-to-the minute information. With regards to the perceived benefits to the patients, both Tiffany and Ken are of the opinion that a new EHR will benefit the patients greatly. They believe it has the potential to reduce medication errors. Furthermore, it will benefit patients if clinical personnel can see whats been going on with the patients over time, even if theyve been seen at other facilities like Urgent Care. The time savings will mean personnel can spend more time with patients and less time entering data. It may also lessen the number of elderly patients being readmitted 30 days of discharge, which will keep the system compliant with Centers for Medicare and Medicaid Services (CMS) regulations. While most nurses will appreciate not having to write notes down, and then enter them, learning a new system can be intimidating to anyone, especially when lives depend on you being able to use the technology. The Bright Roads staff will need to be prepared to explain to the patients what theyre doing when talking to the patient and, at the same time, typing in the EHR. Even though a system like this would be more secure than folders with charts lying around, data security might be a concern to some of the patients and will keep us HIPAA compliant.

The Chief Administrative Officer, Ronald Rider, isnt convinced that Bright Roads needs to purchase another EHR. Ronald doesnt believe things are as bad right now as people think, so hes proud to be the voice of reason when it comes to rushing into implementing a new system. He acknowledges that a new system might improve operational efficiency and generate cost savings from error reduction, which would, in turn, benefit the hospital and improve patient outcomes. With that said, he isnt convinced they would be worth making a switch at this point. Ronald is concerned about the cost to hardwire all of the patient rooms in the hospital as well as the other facilities, like Urgent Care and ambulatory care. Furthermore, if they have to install wireless routers everywhere and receivers, the initial cost and the cost of upkeep and troubleshooting are not worth the risk, in his opinion. Aside from the physical issues, the legal and security issues are his greatest concern. Patient privacy is the big issue at Bright Roads. Ronald doesnt think the technology is quite ready yet to ensure that a patients information is completely protected across the Internet. Having the PDS solution hosted on the systems own server may be safer than the Internet at this point, but, if there is a terminal in every patient room, the system is still at risk of patient information being accessed when people other than staff are left alone in the room. If the staff were to use some sort of portable tablet that could easily be lost or stolen and potentially compromise protected health information. Each system would require secure logins with passwords that, if wanted, could have a mandatory change requirement every month.

According to Kimberly Kindle, the Chief Financial Officer, she believes a reduction in errors will pay off nicely when it comes to improving Bright Roads bottom line performance. Kimberly has completed some financial analyses of eMed and PDS. At first, it looks like eMed will be more cost effective, but PDS might actually be more affordable. With a license fee of only $90 per license and 300 doctors and nurses who will need licenses across the Bright Roads facilities that total of $27,000 dollars looks a lot better than the PDS total system cost of $105,000. But, theres definitely more to consider that impacts the PDS solution affordability. While legal and security concerns need to be taken into consideration, the IT Department has estimated that equipping the facilities with wireless capability to run eMed, and giving nurses and doctors portable devices will run an estimated $75,000. A new server to run the PDS system, which IT says theyll need, will cost the system close to $55,000. Add to this the cost of a terminal in every patient room and other places in the facilities, like labs, and youre at $135,000. Of course, the set-up cost for the PDS system will run roughly $25,000, and thats if all goes smoothly. Kimberly factored in a 10% buffer. Theres no set-up cost for eMed, although there will be staff training costs; yet this will be about equal for both systems. While the licensing fees for eMed are lower, remember, they are yearly fees. So, after 4 years only, the cost of eMed will exceed the one-time cost of the PDS system software.

The data storage cost for eMed will be an additional cost, estimated at $10,000 the first year, and expected to increase by at least 8% every year based on our current data load and growth projections. PDS stores everything on Bright Roads server, and an upgrade now will give Bright Road enough space to last for at least 10 more years. After that, of course, the system will need to invest in a bigger server. Kimberly doesnt necessarily agree with Ronald. First, they dont have to use mobile devices. Bright Roads can still run the eMed system on terminals in each patient room. This way, we dont have the cost or the risk that a wireless network brings. There are legal and security risks and implications that come with hosting all of their patient data in the cloud. Kimberly factored a one-time legal and technical cost of $15,000 to bring in a consultant to make sure Bright Road meets compliance standards. For the server-based program, security consultation is already included. eMed will definitely be cheaper, since they will do all of their own maintenance. Bight Road may need to add more IT staff to help maintain all of the new terminals, and since the server will need upgrades and maintenance with the PDS solution. Kimberly received figures from Bob, the CIO, that make this issue pretty much a wash.

While Internet outages might be a concern, eMed still allows the user to keep working on their device, with data being uploaded to the cloud once connection is restored. Bright Roads will lose that real-time information benefit at those times, but that happens just as much, Bob says, with their own server. According to Kimberly, she thinks its safe to anticipate more costs related to technical problems in the first year if they go with their own server-based solution through PDS. She believes that technology changes so rapidly, a solution like eMed will be more cost-effective over the years to come. It seems like everything is moving to the cloud, anyway, and also, it wont cost the system anything when eMed administers their own upgrades and improvements; while, with a server-based solution, theyll have administrative costs related to ongoing upgrades and improvements. Security is still the biggest drawback, though. Kimberly commented that a new EHR system will bring about enough improvement to operations and cost-savings to outweigh the cost in both the short-term and long-term. Plus, with all of the government incentives and attention, she believe the need to switch to a new EHR is inevitable.

For this assignment, you're assuming the persona of the Health Care IT Consultant, in the case study entitled: Productivity Analysis & Recommendation.

Based on the information provided in this case and upon a careful review of the available literature, the student will assume the role of a Health Care IT consultant whose firm has been contracted to assess the met and unmet needs of the system, the functionality of the EHR systems under consideration, determine how well each system will meet the needs of the organization, and then recommend a course of action. As the consultant, the student will work with various team members, at the corporate level, to gather relevant information and analyze the efficacy, safety/security/legal factors, cost effectiveness, and cost-benefit factors of two possible new systems to help the organization (via the Board) decide whether or not to implement one of the two systems. A formal recommendation will be submitted to the Tanya Tucker, Chairman and Chief Executive Officer, on which of the two systems, if either, should be acquired with supporting rationale. The Board has requested that the recommendation include, but not be limited to, a decision tree analysis of the options, including maintaining the status quo. This recommendation should be logically presented, well-supported, and thoroughly vetted.