Assignment Introduction
According to Margret A., “a functional needs assessment describes the key capabilities or application requirements for achieving benefits of the EHR as the organization has envisioned it.” Aside from the required EHR functionality laid out by the federal government in the Meaningful Use standards, there may be other needs identified by the healthcare organization. Margret A. also addresses the technical infrastructure needed to support the EHR. She states, “Current EHR technology is by no means simple in its technical infrastructure but should appear simple to the user. Information technology and systems infrastructure refer to how hardware and software work together to deliver EHR functionality to users.” In this assignment, you will be developing a plan for addressing only the functional needs of a home care agency and then completing an objective, side-by-side comparison of the vendors on key differentiators or needs.
Below is a scenario for you to follow for this assignment. You are put in the position of an HIM Director who is being asked to serve as the project manager for the investigation, acquisition, and eventual purchase of software to facilitate and help coordinate the Home Health care portion of a hospital.
It is imperative that you read chapters 1 and 7 in Margret A.’s text in order to fully understand what must be considered in a needs assessment and to understand the Systems Development Life Cycle. As identified in Table 7.2 in the text, there are both primary and secondary uses of an EHR system. For purposes of this assignment, I would like you to focus on the primary uses of an EHR system for this scenario involving home care.
This assignment will require you to research home care in order to gain an understanding of their information infrastructure needs (functional needs, data requirements, and technical capabilities). Here is an older article to get you started.
Assignment Scenario
Case Study Setting/Scenario
The scenario involves the selection of a software package by a medium-size regional hospital for use in the Home Health segment of their organization. The hospital (to be referred to in this monograph by a fictitious name, General Hospital) is located in the central portion of a southern state in the USA, within 30 minutes of the state capital. Its constituents reside in the largest SMSA (standard metropolitan statistical area) in the state and consist of both rural, suburban, and city residents. The 149-bed facility is a state-of-the-art institution, as 91% of their 23 quality measures are better than the national average (“Where to Find Care”, 2010). Services offered include Emergency Department, Hospice, Intensive Care Unit (ICU), Obstetrics, Open Heart Surgery, and Pediatrics. Additional components of General Hospital consist of an Imaging Center, a Rehabilitation Hospital, Four Primary Care Clinics, a Health and Fitness Center (one of the largest in the nation with more than 70,000 square feet and 7,000 members), a Wound Healing Center, regional Therapy Centers, and Home Care (the focal point of this study).
There are more than 120 physicians on the active medical staff, over 1,400 employees and in excess of 100 volunteers (“General Hospital”, 2010). In short, it is representative of many similar patient care facilities around the nation and the world. As such, it provides a rich environment for the investigation of using the SDLC in a 21st century health care institution.
Home Health and Study Overview
Home Health, or Home Care, is the portion of health care that is carried out at the patient’s home or residence. It is a participatory arrangement that eliminates the need for constant trips to the hospital for routine procedures. For example, patients take their own blood pressure (or heart rate, glucose level, etc.) using a device hooked up near their bed at home. The results are transmitted to the hospital (or in this case, the Home Health facility near General Hospital) electronically and are immediately processed, inspected, and monitored by attending staff.
In addition, there is a Lifeline feature available to elderly or other homebound individuals. The unit includes a button worn on a necklace or bracelet that the patient can push should they need assistance (“Home Health”, 2010). Periodically, clinicians (e.g., nurses, physical therapists, etc.) will visit the patient in their home to monitor their progress and perform routine inspections and maintenance on the technology.
You are the HIM Director and have been asked by hospital administration to serve as the project manager for this endeavor and have been charged with investigating the acquisition, and eventual purchase, of software to facilitate and help coordinate the Home Health care portion of their business.
THE SDLC IN ACTION
The HIM Director identified early on that this project would indeed follow the stages of the traditional SDLC. We would follow many, but not all, of the SDLC steps in lockstep fashion. The overall task was an adaptation of the SDLC (i.e., a software acquisition project) as opposed to a software development project involving all the stages. It is important to see that the core ideas of the SDLC can be adapted to fit a “buy” (rather than “make”) situation. The systematic approach is adaptable, which makes the knowledge more valuable.
Analysis
Problem Definition
The first step in the Systems Development Life Cycle is the Problem Definition component of the Analysis phase. One would be hard-pressed to offer a solution to a problem that was not fully defined. The Home Health portion of General Hospital had been reorganized as a separate, subsidiary unit located near the main hospital in its own standalone facility. Furthermore, the software they were using was at least seven years old and could simply not keep up with all the changes in billing practices and Medicare requirements and payments. The current system was not scalable to the growing needs and transformation within the environment. Thus, in addition to specific desirable criteria of the chosen software (described in the following section), the HIM Director’s explicit purpose in helping General was twofold: 1) to modernize their operations with current technology; and 2) to provide the best patient care available to their clients in the Home Health arena.
A precursor to the Analysis stage, often mentioned in textbooks (e.g., Valacich, George, and Hoffer, 2009) and of great importance in a practical setting, is the Feasibility Study. This preface to the beginning of the Analysis phase is oftentimes broken down into three areas of feasibility:
Technical (Do we have the necessary resources and infrastructure to support the software if it is acquired?)
Economic (Do we have the financial resources to pay for it, including support and maintenance?)
Operational (Do we have properly trained individuals who can operate and use the software?).
Fortunately, these questions had all been answered in the affirmative before the project started. The Director of Information Technology at General Hospital budgeted $250,000 for procurement (thus meeting the criteria for economic feasibility); General’s IT infrastructure was more than adequate and up to date with regard to supporting the new software (technical feasibility); and support staff and potential end users were well trained and enthusiastic about adopting the new technology (operational feasibility). Given that the Feasibility Study portion of the SDLC was complete, the HIM Director endeavored forthwith into the project details.
Requirements Analysis
In the Requirements Analysis portion of the Analysis stage, great care is taken to ensure that the proposed system meets the objectives put forth by management. To that end, the HIM Director met with the various stakeholders (i.e., the Director of the Home Care facility and potential end-users) to map out the requirements needed from the new system. Copious notes were taken at these meetings, and a conscientious effort to synthesize all of the information was done. Several key requirements are described here:
MEDITECH Compatible: This was the first, and one of the most important requirements, at least from a technological viewpoint. MEDITECH (Medical Information Technology, Inc.) has been a leading software vendor in the health care informatics industry for 40 years (“About Meditech”, 2009). It is the flagship product used at General Hospital and is described as the number one health care vendor in the United States with approximately 25% market share (“International News”, 2006). All Meditech platforms are certified EMR/EHR systems (“Meditech News”, 2012). “With an Electronic Health Record, a patient’s record follows her electronically. From the physician’s office, to the hospital, to her home-based care, and to any other place she receives health services, and she and her doctors can access all of this information and communicate with a smartphone or computer” (“The New Meditech”, 2012). Because of its strategic importance to General, and its overall large footprint in the entire infrastructure and day-to-day operations, it was imperative that the new software would be Meditech-compatible.
Point of Care Documentation: Electronic medical record (EMR) point-of-care (POC) documentation in patients’ rooms is used in the hospital. POC documentation reduces inefficiencies, decreases the probability of errors, promotes information transfer, and encourages the caregiver to be at the bedside or, in the case of home care, on the receiving end of the transmission.
OASIS Analyzer: OASIS is a system developed by the Centers for Medicare & Medicaid Services (CMS), formerly an agency of the U.S. Department of Health and Human Services, as part of the required home care assessment for reimbursing health care providers. OASIS combines 20 data elements to measure case-mix across 3 domains–clinical severity, functional status and utilization factors (“Medical Dictionary”, 2010). This module allows staff to work more intelligently, allowing them to easily analyze outcomes data in an effort to move toward improved clinical and financial results (“Butte Home Health”, 2009). Given its strategic link to Medicare and Medicaid reimbursement, OASIS Analyzer was a “must have” feature of the new software.
Physician Portal: The chosen software package must have an entryway for the attending, resident, or primary caregiver physician to interact with the system in a seamless fashion. Such a gateway will facilitate efficient patient care by enabling the physician to have immediate access to critical patient data and history.
Other “Must Haves” of the New Software: Special billing and accounts receivable modules tailored to Home Health; real-time reports and built-in digital dashboards to provide business intelligence (e.g., OASIS Analyzer); schedule optimization; and last, but certainly not least, the system must be user friendly.
Desirable, But Not Absolutely Necessary Features: Security (advanced, beyond the normal user identification and password type); trial period available (i.e., could General try it out for a limited time before fully committing to the contract?).
Other Items of interest During the Analysis Phase: Several other issues were important in this phase:
Is the proposed solution a Home Health-only product, or is it part of a larger, perhaps enterprise-wide system?
Are there other modules available (e.g., financial, clinical, hospice; applications to synchronize the system with a smartphone or other mobile device such as an ipad?
Is there a web demo available to view online; or, even better, is there an opportunity to participate in a live, hands-on demonstration of the software under real or simulated conditions? A site visit to another home care agency using the software?
Design
As previously noted, for this particular case study of software selection, the HIM Director did not have to proceed through each step of the SDLC since the software products already existed. Thus, the vendors have already carried out the Design stage of the SDLC. In a similar vein, the coding, testing, and debugging of program modules had to be performed by each vendor candidate.
Assignment Instructions
Planning Phase of SDLC
1. Let’s take a step back in the SDLC to Analysis. The Requirements Analysis section of the case scenario identified needs that the administration/leadership desires. Create a plan that addresses how you, as the project manager, are going to conduct a functional needs assessment to address clinical staff, revenue cycle staff/management, and end-user needs. Please review Chapter 7 in the Margret A. text for guidance. Your plan must address:
a. You are charged with ensuring input is gathered from all staff and departments for functional requirements. From a project management standpoint, how will you ensure clinical staff buy-in, revenue cycle staff/management, and end-user buy-in? Explain “how” you will accomplish this. Be specific and support your plan with supporting documentation from your personal research or the Margret A. text.
b. How you will identify the internal and external information needs of the home health agency. Again, explain “how” you will accomplish this. What is the best way to do this based on your research and/or course reading? Be specific and support your plan with supporting documentation from your personal research or the Margret A. text.
2. Using what you learned through your research and through your functional needs assessment with clinical staff, revenue cycle staff/management, and end-user, utilize the table below to identify the “Key Differentiators or Needs” of your organization.
**Your instructor has entered some examples of types of information and how to fill out the table.**
a. Many EHR products will include many of the same functions, especially if they are certified, and only using the responses to the Request for Proposal (RFP) can be very difficult to narrow the field of vendors to the few you actually want to conduct further due diligence with as you move into the acquisition phase of the SDLC. The complete response to the RFP ensures that all functionality is addressed in your ultimate contract with the vendor of choice, but it is overwhelming for narrowing the field. Using a table, like the one below, can help you complete an objective, side-by-side comparison of the vendors on key selection differentiators or needs.
b. Identify a set of key differentiators or needs and record them on the tool. The key differentiators should be unique to the nature of home care. There should be between 15 and 20 key differentiators.
**It is important to consider what makes home care unique, compared to a hospital or primary care clinic and the types of functionality, technology, implementation/ongoing support and vendor characteristic needs. After you identify the key differentiators, take a look over all of them and ask yourself – How are these differentiators different from a primary care clinic? If they are all in alignment with what a general practice would need, then you need to do more research on home health care.**
Key Differentiators or Needs
Due Diligence
Vendor A
Vendor B
I. Comprehensive functionality
Patient portal
I, ii., iii.
4
3
II. Technology
Compatible w/ tablets
Drawing tools
Interfaces
III. Implementation/ongoing support
On-site training
24/7 help desk support
IV. Vendor characteristics
Certified EHR
Good Reputation
d. For each of the key differentiators/needs, identify the form or forms of due diligence that will reveal the best information for each of the key differentiators. The due diligence tells me how you will go about evaluating whether the vendor can provide you with the key differentiator and/or meet the need. In the column titled “Due Diligence” identify which of the following you would use to make that determination. You may use one or multiple forms of due diligence for each key differentiator or need.
i. The RFP
ii. An EHR demonstration
iii. A site visit to another organization using that EHR product/vendor
iv. Conduct a reference check
v. Conduct a corporate check
Acquisition/Design and Development Phase of SDLC
1. Perform market research for home care to understand the EHR products that are available.
a. Identify 2 EHR vendors for home care and enter the names of the vendors in the table above, replacing the words “Vendor A” and “Vendor B.”
b. Based on your market research and the information you can obtain from the vendor website, rate the vendor on each key differentiator/need. Use the rating scale below.
Rating Scale:
0 = product does not address and no indication that it will
1 = product does not incorporate today but appears very likely to be available in near future
2 = product is marginal and lacking in some but not all aspects of the differentiator
3 = product is satisfactory
4 = product fully meets or even exceeds the differentiator
2. Conclude with a short statement (2 to 3 sentences) on which vendor would be selected and your rationale for their selection
Assignment Deliverables
1. A plan that addresses how you are going to conduct a functional needs assessment for your organization’s home care service line.
2. A completed table that identifies the following:
a. 15 – 20 key differentiators/needs
b. Forms of due diligence that will be used for each differentiator/need
c. Identification of two EHR vendors for your specialty/sector of health care
d. Rating of both vendors for each key differentiator/need
e. Vendor selection statement
Format: Follow correct APA Style and include all required components.
The plan should be in essay format, 2-3 pages in length, double-spaced, and 12 point/Times New Roman font.
The plan should be followed by the completed table and the vendor selection statement should follow the table.
Please include your plan, table, and vendor selection statement on the same Word document.
Reference
This assignment case study has been developed based on the following.
McMurtrey, M. (2013). A case study of the application of the systems development life cycle
(SDLC) in 21st century health care: Something old, something new? Journal of the
Southern Association of Information Systems, 1(1). http://dx.doi.org/10.3998/
jsais.11880084.0001.103
