Electronic Health Record in Psychiatry Department

Executive Summary

The present paper is a Business Case document. It examines the opportunity for adopting new EHR at a Psychiatry Department, and two possible options are suggested for consideration: Practice Fusion EHR by Practice Fusion and PowerChart by Cerner. The Business Case considers the opportunity in the context of the business environment and proceeds to analyze the options from the point of view of their benefits, costs, feasibility, risks, and possible issues. The options are contrasted, and it is concluded that both have substantial advantages and value, and a feasibility study is recommended to make a decision since the preliminary ranking revealed a one-point difference in the scores of the two solutions. As a result, no implementation plan is provided yet.

Business Problem

Environmental Analysis

I work at a Psychiatry Department as a Mental Therapist. Our vision consists in providing best-quality care and continually striving for excellence. In the field of healthcare, this aim cannot be achieved without the successful implementation of appropriate healthcare IT, and our management takes it into account. However, as time passes, new technologies become available, and to ensure continuous development, we need a change.

Problem Analysis

Business Problem

In the present BC, the problem is regarded as an opportunity for change.

Business Opportunity

My colleagues and I are provided with Cerner Millennium Software as an EHR solution. While it is a sound system that satisfies key therapists’ and patients’ needs, it cannot be described as the perfect solution. In particular, it is not the best product of Cerner, and even though it has been updated, it is a relatively old solution, the concept of which was developed in the past century (Gold, 2011). Right at the moment, we have few complaints, mostly because we have adapted the software and feel comfortable with it, but with time, difficulties are likely to arise as a result of using the software that is growing outdated or, possibly, can already be classified as such. It is possible to interpret the situation as a problem, which can be regarded as a technology-based one.

However, we prefer a positive view, which means that we have received an impetus to search for an opportunity that will help us to get rid of the antiquated software. The opportunity exists continuously, and its positive impact would consist of improved service that is in line with our vision and mission. In particular, we hope to and expect to improve our Healthcare Cost and Utilization Project.

The business opportunity is recognized by the majority of the Department’s staff, and we have discussed appropriate solutions in informal settings. The options that have received the greatest support include the Practice Fusion EHR by Practice Fusion and PowerChart by Cerner. Both admittedly have advantages, but Practice Fusion is particularly innovative, which makes it more appealing.

Gold, S. (2011). Electronic health records: the main patient record providers. The Guardian. Web.

Available Options

Option 1 – Practice Fusion

Description

In 2012, Practice Fusion EHR (PFE) was the second most-used EHR in Psychiatry (Daviss, 2012). Practice Fusion (n.d.) provides free cloud-based EHR solutions. Initially, Practice Fusion (n.d.) was aimed at popularizing the concept, but nowadays it is growing more modernized and sophisticated.

Practice Fusion (n.d.) EHR has received multiple awards and ranks for accurateness, effectiveness, and the company’s honesty. The provider seems to be trustworthy.

Daviss, S. R. (2012). Which EHRs are psychiatrists using? Clinical Psychiatry News. Web.

Practice Fusion. (n.d.). Practice Fusion EHR. Web.

Benefits

Benefit Category Benefit Description Benefit Value
Financial
  • A free system
  • Improved profitability
$15,000 to $70,000
Unpredictable
Operational
  • Improved efficiency
  • Improved quality of service
  • Improved continuity of care
15-30%
15-30%
Reduction of discontinuity cases by 15-30%.
Customer
  • Increased satisfaction
  • Improved retention and loyalty
  • Better health outcomes
  • Customer engagement
15-30% improvement in customer survey results
15-30% retention growth
15-30% quality criteria improvement
A feature of Practice Fusion (n.d.): will not be applicable to all patients, but will allow them to control and participate in their own care to a greater extent.
Staff
  • Increased satisfaction
  • Reduced turnover
15-30% in pre- and post-testing
5-10%

Costs

Expense Category Expense Description Expense Value Expense Type
People
  • Salaries of the implementation project’s staff
  • Training for the new software usage
Depends on the number and roles of people; about $60,000 on average with significant differences for various roles.
10-15 hours
OPEX

OPEX

Physical
  • Purchase of the software
  • Maintenance costs
  • Other equipment (computers and related equipment)
Free
Depend; $80,000 annually
Owned; possibly, additional expenses
CAPEX
OPEX

CAPEX

Organizational
  • Temporary decrease in productivity
Up to 1 month adjustment period. OPEX

Feasibility

Component Feasibility Rating Assessment Method
New Technology 7 The review of similar organizations that have adopted the software
New Technology 8 A trial run with subsequent interviews.
New Processes 7 The review of similar organizations that have adopted the software

Risks

Risk Description Likelihood Impact Risk Mitigating Actions
Adjustment period is too long Medium; depends on the criteria Medium to high Extensive training with feedback
Staff finds flaws in the system/its implementation Medium Low to medium Planning of the project; feedback use; the use of the information to improve the software
Staff finds flaws that cannot be rectified Very low Very high Careful consideration of the option
Difficulties in adjusting the software to the needs of the department Low to medium Medium to low Project development; consultations with external specialists
Failure to adjust the software to the needs of the department Very low Very high Extensive planning of the project; continuous review and monitoring; feedback from users

Issues

Issue Description Priority Action Required to Resolve Issue
Adjustment period issues (difficulties, lowering morale, lack of motivation) High Leadership, training, and feedback
Solutions require major restructuring Medium to high A restructuring project within the current one

Assumptions

The implementation of the project may lead to some changes in the customer relations strategy due to the changes in the format of EHR and the opportunities suggested by them.

Price is not expected to increase (appear); the Practice Fusion vows to keep the product free. It is advertising-supported, though, which may dissatisfy some of the staff.

The end users are expected to participate in the project actively, in particular, out of curiosity and interest since Practice Fusion is very different from the current EHR.

Still, the end users may be confused by an EHR that is very different from the one they are used to.

Option 2 – PowerChart (Cerner)

Description

Cerner used to be the third most-used EHR provider in Psychiatry in 2012 (Daviss, 2012). Nowadays, Cerner (2016) is a very reputable company with multiple awards (including Forbes’ most innovative ones for several years) and ranks (including those for EHR quality). Cerner’s (n.d.) PowerChart is a solid EHR that offers all the necessary functions and also some additional ones (like voice dictation) that facilitate the work of a therapist. It includes Cerner (n.d.) and third-party software.

Cerner. (n.d.). Ambulatory EHR. Web.

Cerner. (2016). Company Fact Sheet. Web.

Daviss, S. R. (2012). Which EHRs are psychiatrists using? Clinical Psychiatry News. Web.

Benefits

Benefit Category Benefit Description Benefit Value
Financial
  • Improved profitability
Unpredictable
Operational
  • Improved efficiency
  • Improved quality of service
  • Improved continuity of care
20-35%
20-35%
Reduction of discontinuity cases by 20-35%
Customer
  • Increased satisfaction
  • Improved retention and loyalty
  • Better health outcomes
20-35% improvement in customer survey results
20-35% retention growth
20-35% quality criteria improvement
Staff
  • Increased satisfaction
  • Reduced turnover
20-35% in pre- and post-testing
10-15%

Costs

Expense Category Expense Description Expense Value Expense Type
People
  • Salaries of the implementation project’s staff
  • Training for the new software usage
Depends on the number and roles; about $60,000 on average.
10-15 hours
OPEX

OPEX

Physical
  • Purchase of the software
  • Maintenance costs
  • Other equipment (computers and related equipment)
Depends
Depend; $80,000 annually
Owned; possibly, additional expenses
CAPEX
OPEX

CAPEX

Organizational
  • Temporary decrease in productivity
Up to 1 month adjustment period. OPEX

Feasibility

Component Feasibility Rating Assessment Method
New Technology 8 The review of similar organizations that have adopted the software
New Technology 9 A trial run with subsequent interviews.
New Processes 8 The review of similar organizations that have adopted the software
New expenses 6 Feasibility study; comparison of the free option with this one

Risks

Risk Description Likelihood Impact Risk Mitigating Actions
Adjustment period is too long Medium to low; depends on the criteria Medium to high Extensive training with feedback
Staff finds flaws in the system/its implementation Medium Low to medium Planning of the project; feedback use; the use of the information to improve the software
Staff finds flaws that cannot be rectified Extremely low Very high Careful consideration of the option
Difficulties in adjusting the software to the needs of the department Low to medium Medium to low Project development; consultations with external specialists
Failure to adjust the software to the needs of the department Extremely low Very high Extensive planning of the project; continuous review and monitoring; feedback from users

Issues

Issue Description Priority Action Required to Resolve Issue
Adjustment period issues (difficulties, lowering morale, lack of motivation) High Leadership, training and feedback
Solutions require major restructuring Medium to high A restructuring project within the current one
Changes in pricing Low to medium Changes in budget; mobilization of resources

Assumptions

The software is likely to have similar benefits to the previous one, but its effects are likely to be stronger due to extended functions.

PowerChart is likely to be easier to accommodate due to being similar to the software that we are using at the moment. As a result, risks are less likely, and the feasibility is greater. Also, it should be easier and, therefore, more satisfactory to use from the point of view of the end users.

Recommended Option

Option Rankings

The following ratings are based on the weighted advantages of either option against the other where 10 is “excellent” and 1 is “very bad” (most beneficial and harmful, quite cheap and very costly, very feasible and totally not feasible, and completely no risks versus most risky).

Assessment Criteria Option 1 Rating Option 2 Rating Option 3 Rating
Benefits
  • Financial
  • Operational
  • Customer
  • Staff
10
7
7
6
4
8
8
8
Costs
  • People
  • Physical
  • Organizational
10
10
9
9
6
10
Feasibility
  • New Technology
  • New Processes
  • New expenses
8
7
10
8
8
6
Risks
  • Adjustment period
  • Flaws in the system
  • Fatal flaws
  • Difficulties in adjusting
  • Failure to adjust
7
7
7
7
7
9
9
9
9
9
Total Score 119 120

Option Recommended

The options have different advantages: a free and quite functional software piece is contrasted with an extensively functional EHR system that the staff is likely to feel familiar with. The differences between the option’s rankings are minimal with the second option scoring 1 point more; it is the result of our assumption that the more functional EHR is likely to have greater positive impacts. At the same time, the first option is also expected to be beneficial, and its innovative, unusual features appeal to us. As a result, for the time being, the assessment of the options requires a feasibility study.

Test Scenarios

Introduction to the Purpose of Testing

The testing procedure is essential to ensure that the new software operates in compliance with the expected standards. As such, it is required to test all the components and determine the flaws in their functioning before the EHR system is finally implemented. Additionally, it is useful to collect the employees’ feedback on the feasibility of the new system (The Office of the National Coordinator for Health Information Technology, 2014). The paper at hand aims to describe the key components that need to be tested and provide a detailed review of the testing scenario.

Components to Be Tested

Unit

Unit testing includes examining such components of the EHR system as patient forms, menus, and templates. It is required to ensure that every component is available for the due operations. Employees should check whether all the forms and templates are properly displayed and can be printed whenever necessary (EHR System Implementation Testing, 2011).

Component

Component testing includes the verification of the particular elements of the EHR systems. As such, employees need to ensure that they can properly use such options as prescription writing, list updating, client look-up, etc. (EHR System Implementation Testing, 2011). It is critical that all these options function properly in compliance with the set standards.

System

System testing includes examining the connectivity between the components’ functioning. Otherwise stated, it is necessary to ensure that all the elements operate consistently – when a new client is registered in the client base, a separate medication list should be automatically created (EHR System Implementation Testing, 2011).

Integration Testing

Integration testing implies examining how EHR system responds to the external information flows. In other words, it is essential to ensure that its databases update in response to the new data such as demographic statistics, billing inquiries, etc. (EHR System Implementation Testing, 2011).

Testing Scenario

Develop a Testing Plan

First and foremost, it is essential to develop a consistent testing plan. As such, it is proposed that the EHR system should be tested in several dimensions. First, the test should examine the data links functioning to ensure that outputs are properly aligned with inputs. Second, it is essential to test the functioning of every separate unit of the EHR system. Finally, the testing procedure should ensure that the implemented system is compliable to other software installed. The testing plan should have a clearly set timeline and be approved by the key stakeholders.

Create a Favorable Environment

Appropriate testing environment implies the presence of all the units that need to be tested and the relevant input that will be used to test the data links (EHR System Implementation Testing, 2011). From this perspective, it is critical to ensure that the scope of the data used for testing is adequate to that that will be managed in real practice. Old data units can be used as the testing samples.

Execute Testing and Retesting

According to the initially designed project Gantt Chart, the testing phase will last 40 days. As such, a week will be allowed for each type of testing: unit, component, system, and integration. Employees will be required to fix the examination flow and report all the system inconsistencies and functional errors. All the errors should be analyzed and further eliminated. When the critical flaws are fixed, it is recommended to carry out a retesting procedure.

Testing Procedure

As it was previously determined, unit-based testing is chosen as a testing scenario. It means that all tests will be conducted on the basis of individual units, which are not connected one to another (The Office of the National Coordinator for Health Information Technology, 2014). In order to guarantee accurate results of testing procedures, it is essential to pay significant attention to inputs and outputs of unit-based tests as well as processes that will be involved in testing procedures.

Test Inputs

In case of unit-based testing scenario, individual data is the primary input. The whole procedure will be made up of several independent tests. Input data is the primary difference between the tests. Some of the test inputs will include medication list, problem list, laboratory results, procedures list of patients as well as performance statistics of a hospital unit. It is critical to guarantee that all input data refers to a single environment in order to obtain adequate and accurate outputs (Galorath, n.d.).

Test Outputs

Inputs and outputs are dependent variables, as outputs are direct results of tests determined by the quality and accuracy of initially used data (inputs). The objective of the testing procedure is to assess the effectiveness of the proposed electronic health record system and find out whether its implementation would contribute to improving the quality of provided medical care services (The Office of the National Coordinator for Health Information Technology, 2013).

The expected outputs are a patient’s reaction to medication and procedures as well as the changes in hospital performance. As the patients are tested every 15 minutes, the idea is to discover whether this examination is carried out properly and the implementation of the new EHR system is connected to the decrease in medical errors and improvement of patient care, i.e. performance of a healthcare unit. During this testing scenario, the central planned output is a proper generation of relevant information once it is requested by a healthcare professional. For instance, showing an accurate list of medications and procedures is desirable if a nurse requests these details.

Processes

In order to guarantee the success of the proposed testing scenario, it is essential to follow a detailed plan of actions. That said, this scenario is a set of predetermined processes. The first process is the identification of input data, i.e. all information, which would be estimated. These details were specific in the inputs section. The second process is entering data. Here, it is paramount to guarantee accuracy and avoiding mistakes.

The third phase is conducting the unit-based tests. Outputs analysis is the next process. This one is connected to studying test results with the aim of identifying errors if any and determining the level of the EHR effectiveness. It means that this stage is related to comparing obtained results to planned or desirable figures, i.e. benchmarks. Drawing conclusions is the final process included in the test scenario. It is connected to speculations on the productivity of the proposed software.

At the same time, it is essential to point to the fact that in case if any errors were identified during the analysis process, conducting additional tests and retesting are recommended. It means that some final processes (for instance, output analysis) will be repeated until no errors in EHR operation and data input are detected and results are satisfactory.

EHR System Implementation Testing. (2011). Web.

Galorath, D. (n.d.). Software reuse and commercial off-the-shelf software. Web.

The Office of the National Coordinator for Health Information Technology. (2013). 2014 edition test scenarios. Web.

The Office of the National Coordinator for Health Information Technology. (2014). Test scenario procedure for encounter: Interoperability intake. Web.

Implementation Approach

In this section, describe the general approach needed to implement the recommended solution and derive the business benefits described in this document.

Project Initiation

Outline the method for defining the project, forming the project team, and establishing the project office.

Project Planning

Define the overall planning process to ensure that the project phases, activities, and tasks proceed in a coordinated fashion.

Project Execution

Identify the generic phases and activities required to build the physical deliverables for customer approval.

Project Closure

List the generic steps necessary to release the completed deliverables to the business, close the project office, reallocate staff, and perform a Post-Implementation Review of the project.

Project Management

Briefly describe how the following aspects of the project will be managed:

  • Time management
  • Cost management
  • Quality management
  • Change management
  • Risk management
  • Issue management
  • Procurement management
  • Communications management
  • Acceptance management ©

Appendix

Supporting Documentation

See the feasibility study

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