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QUALITY IMPROVEMENT PROGRAM PAGE 1

QUALITY IMPROVEMENT PROGRAM PAGE 26

Quality Improvement Program

Cherla Randall

Colorado Technical university

Phase 1 IP

8/21/2017

When it comes to healthcare organizations wanting to increase their profitability there are many different things that they do. One of the most effective ways and most organizations introduce would be the quality improvement program. Organizations around the world have improved performance by utilizing an effective quality improvement program. With this program being used organizations can see clinical and service quality improve. Having a quality improvement program that is set in place allows organizations to obtain their goal, like increasing their probability and reducing costs. For the quality improvement program to work it has t have the basic elements that work properly in assisting the organization with their goals. Here is the list of the basic quality improvements that are in the program:

· Description of the goals of the organization, mission, and their objectives.

· Explanations and definitions of major terms and concepts.

· How the quality program is selected, monitored, and managed within the organization

· How the training will work and how the support will be for people that are taking part in the quality improvement process.

· Explanations on the quality techniques that will be used and the methodology.

· Communication plans that will be utilized and how things will be updated and communicated throughout the organization.

· The measurement will be explained along with the analysis and how it will assist with future quality improvements.

Quality Improvement Program

Literature Review

Unit 1 IP

The quality improvement program is a very important part to an organization, this is because quality improvement programs must do with the costs, trust, speed, quality, and even the value of the organization. This program has not actually spread throughout many medical center and hospitals because not many organizations in healthcare are aware of how it can be beneficial to the organization on their finical status and go beyond that to the needs of their patients and society. This makes it so that there are not many medical facilities and hospitals that have embraced the concept and idea of this quality improvement program. Within the management of healthcare facilities, they have not yet realized that there is a relation between their business management strategy, improved patient outcomes, and the achievement of optimal quality (NAVEX, 2017).

One of the major sources of financial benefits or even returns that are seen by an organization would come from them being disciplined enough to remove waste with techniques like engineering techniques. When it comes to the waste in a health care there are three major types. These types would be known as inefficiencies, overuse, and preventable harms. These are major reasons why so much of health care dollars spent are being wasted. The estimated percent is 40 percent. There are ways that you can design patient centered care so that it can be provided with negligible wasted. If the organization can drive the waste our it can reduce it and is possible when utilizing the quality improvement program. By utilizing this it will be able to help make employees engagement stronger and even build a higher reputation of high reliability and performance. If the employees are more engaged their satisfaction will increase. Employees are very important to an organization and this can help drive the financial performance within the healthcare organization. There are many people that believe that the quality improvement expenses are linked to regulatory agencies and accreditation. Because of this many people will view this as expenses with no investments or returns. The management that is in the healthcare facilities would argue that these would be costs that should happen with the process of doing business. When these costs can be avoided or even reduced so that it can make operations of healthcare organizations be more profitable. As per EIRMC known as Eastern Idaho Regional Medical Center, by implanting the quality improvement program they have been able to provide quality of health to their patients for longer periods of time and more efferently and faster. Wait times have dropped, and information is pulled up faster than before and they have information on the patients right there in each room. The patients are now able to have access to lower priced, exceptional services, and quality of care. There is authority and even accountability that has been practices throughout each different level at this hospital through health groups and their board of directors so that they can better implement, monitor, and design quality improvement programs.

This program is what will provide a formal process that will systematically and objectively monitor and even evaluate the efficiency, quality, appropriateness, effectiveness, improve returns, and care and services when utilizing this approach. With EIRMC utilizing this program and making improvements on the organizations they have been able to be known as the largest medical facility in the region, opportunities have improved, operational process have improved and he health outcome with their patients have improved. They have been able to satisfy their practitioners and providers as well as members by utilizing this program. EIRMC have been able to promote quality and accountability to their employees and affiliated health personnel and offer them quality of care and services to each of their own members. According to Navex, the experts and compliance experts, the program that is used had made the organization be able to have continuous quality improvements methodology and has been able to direct attention to certain needs of their stakeholders, patients, and community agencies.

When it comes to the operations and the financial performance with an organization they can achieve their goals by having a work plan that they create by utilizing quality of improvement program (HRSA, 2017). The quality improvement programs that organizations do use health centers have their important information that relates to organization will, manage, and reviews that take place throughout the entire facility. Quality improvements that are created are created by executive and leaderships. For this to be approved the board of directors are the ones that must approve it. When the it has been created it must be updated on a regular basis so that it continues to make improvements. This also makes it so that the program will continue to reflect on what the organization wants and how they are improving on their returns and quality. Each department and specific areas can be reflected properly with an effective quality improvement plan this will allow you to focus in areas for a calendar year and seeing how effective the quality improvement plan is working. When creating this plan, it should not be rushed, this is something that needs to be planned with as much understanding of how the status of the organization is and where improvements need to be. Rushing this plan will only make things worse or the plan itself may fail. You must perform a current assessment of current activities of the organization. With doing this it helps the organization to see their strengths and weaknesses so they are aware of what needs to be fixed and what is working well. You can also see any barriers that are in the way (HRSA, 2017).

When it comes to the barriers there are common ones that are there when it comes to the quality improvements projects. These barriers would include: lack of good management, the quality of the management, lack of resources, the organization structure, lack of communications, technology, lack of monitoring, priorities always changing, staff always changing, and the training of all employees.

EIRMC has seen an increase in performance sense they have utilized the quality improvement plan. They have directed their attention to making sure that they are able to provide high quality and integrated care to all their patients. They do this by making sure that all their employees are well trained, they have shared objectives when providing health care services, and making sure that their programs systems are up to date and patient information is updated. Making sure that the quality of care will increase because their patients are satisfied with the services and actions that are taken with the organization. The organizations must follow the follow rule and regulations that make sure that patients are taken well care of and the quality of care is done to standards. EIRMC has created a better foundation for their health care system when it comes to their patients and committing to improving their quality of care, accountability, patient’s information, and directing their focus on their patient’s activities. EIRMC has documents that have information regarding their quality commitment that they want to improve and how they have made improvements and keep making improvements. Updating their systems to everything being online and not in paper made a huge impact on the organization they have been able to keep better track of patient’s information, it takes less time to find information on a patient, and information is updated right then and there, makes things go faster and patients must spend less time waiting sense they stopped filing paperwork and utilizing computer and file systems. The quality improvement plan for EIRMC makes their patents and the quality of improvements their priority and this helps improve quality and makes it easier to focus on their next targets and what actions need to take place. It also allows them to be monitored by the government and made sure they are to standards and that they are achieving targets by going through their quality improvement plans. Many organizations have very similar quality improvement plans and it allows them to attain better performance because they have their plans set in place and monitor them regularly.

EIRMC has directed most of their attention to the quality improvement program that they have come to develop and things are getting better for them once they decided to make some changes. It is very important to make sure that there is a good development process when making this quality of care improvement program and is very important for the organization so that they can succeed at what they are trying to do. If it is not taken seriously and taken time to plan it out you can fail, there are organizations that have not been able to be successful but using the program. There must be many stakeholders that are involved with developing this process of having an effective quality improvements program. The stake holders that need to be involved would be the clinicians, clients, patients, residents, management, and even some of the staff members. The management teams and board of directors are the ones that make sure the organizations are meeting their goals and targets that have already been set in the quality improvement program. The performance of the organization will be supported by the food quality improvement program and with this program the goals and targets are much easier to achieve and the profitability and returns get better. This development of this program should be driven by the system level priorities this would be the metrics and direct attention to integrated care across patient sectors and patient care settings. This must be prioritized because they need to come up with quality improvement programs that will touch on functional integration efforts that must do with the entire health care system. They must touch on the needs of their patients, residents, clients need to be considered when making this plan. The experience of health care is what should be a priority within the organization they want their customers, patients, stakeholders to have the best experience possible and must be incorporated in the quality improvement plan that the organization does. The ones that are designing this quality improvement program and managers need to make sure that they are coming up with new ways so that they can meet the needs of their patients and customers so they can be enhanced in a wat that EIRMC was not using before. This can happen if they a=do surveys that patients and customer can take or fill out while they are developing their quality improvement plan. Along with they should make sure that they are incorporating their other priorities and systems priorities too.

These steps can be followed and carried out there are steps that can be taken and followed so that a good quality improvement program and be developed and set in place for organizations. The first step would be utilizing the organizational level data. This will determine what the current performance of the organization is or being able to come up with priority indicators. They need to make sure that all data that is necessary is gathered.

Ste two would be to review the indicators. Once they have been reviewed the ones that are relevant need to be determined. When reviewing the current performances of the organization for best priority indicators help to support this process. If for some reason management does decide that they do not want to include something as a priority for example it is working well with the organizations and does not need to be changed they need to write it down and the redon in the comment sections of their quality improvement plan and even include the indicators that are important to the program.

The third thing would be that they need to use the guidance that is provided to create this program. This would be so that they can do it correctly and succeed at what they want but they can address every system level priorities are identified and known for what improvements are needed.

The fourth step would be the process in developing the quality improvement program. This would mean that the priorities and how they want to communicate them is created. The progress report would need to be completed in this step as well so that they know what the progress is and it is communicated.

The last step would be the sign off step. This would be when it is approved by the parties that are involved, the leadership, and the board of directors.

With the quality improvement program, there are many benefits that are attributed to it. This program will have a positive effect on the improvements process and the structure, it helps with continuous improvements and the quality of those improvements, interventions, analysis, trends, and even measurements. This program also plays an important role with supporting practitioners with the initiatives. Because of this program the governing regulatory agencies have even seen benefits because of this program. The creation of services and indicators that have shown demographic and epidemiological characteristics have been easier with this program. Organizations are now able to come up with better benchmarks and designs, performances, and goals for continuous monitoring and evaluations.

Quality improvement according to Haughmon, 2017, it is the process of process management. With this program, it entails the organizations to incorporate modern quality improvement approach. This would help to have modern organizations come up with ways that they can deal with complex challenges that emerge in the market, for an example the ones that relate to managing costs and profitability.

The approaches that are involved in this are very simple and even can deal with extraordinarily powerful issues that take place. This all is based of the process management. After utilizing this program there have been many industries that have seen many changes and transformations because to the quality concepts and techniques. This use of quality improvement program has been known to be used in many health care institutions after there has been so much resistance against it knowing that it works and being able to see it work give organizations a better chance of utilizing it. With the effectiveness, it has had on the health care industry it will make other industries want to start using it with in good time. Health care is a very complex industry but it is not that much different from other industries out there. Health care does have many interlinked processes that are interlinked to make it the more complex system. It can be changed by directing attention to small interlinked processes.

With implementing the quality improvement program, it can be very beneficial and help cut on waste and be more profitable for the organization. The four steps would need to be followed and time planning and implementing this plan takes time.

EIRMC Assessment

Phase 2 IP

Eastern Idaho Regional Medical Center is the largest medical facility in the region. Eastern Idaho Regional Medical Center a joint commission-accredited, modern, 334 full-bed-hospital. Its location is in Idaho Falls, Idaho. Eastern Idaho Regional Medical center has a mission “to improve the lives of those we touch” (EIRMC, 2017).

Eastern Idaho Regional Medical Center is the regions health care hub and they offer specialty services that include trauma, cancer treatment, cardiovascular surgery, electrophysiology, neurosurgery, intensive care for infants, children, and adults, ground and helicopter medical rescue services. Eastern Idaho Regional Medical Center is the only hospital that is in the region that does offer perinatology services. These are for the women who have the high-risk pregnancies. They offer the neonatology services to premature and critically ill infants. They have gynecologic-oncology services that are provided by specialists. The focus on this is on ovarian, cervical, uterine and other cancers that take place in women as well as inpatient and outpatient psychiatric services. Eastern Idaho Regional Medical Center is the regional leader in hyperbaric medicine and wound care. (EIRMC, 2017).

Easter Idaho Regional Medical Center history reflects on their growth and development to the city of Idaho Falls and changing the healthcare needs of the country. The stakeholders that transferred ownership and debt to the Village Improvements Society were the ones that could establish the first hospital in Idaho falls in 1906. Then in 1910 they had begun to lease their hospital to physicians who were the ones that supplied the needed equipment to run the hospital. 1912 came around and two of the doctors could construct a 25-bed general hospital. In 1919 there was a school of nursing that was opened. The LDS church had also begun to build hospitals in Idaho Falls. There were three hospitals opened by 1923. With the LDS hospital, they had opened fourth floors where patients would occupy them and the nurses would live on the third floor. By the late 1960’s the LDS church had grown into 172 beds and the other hospitals to 120 beds. With these hospitals, they were growing the demand of healthcare in the community (Fatkin, 2017).

By 1970 the slow economic growth with the president inflation and increasing federal associated with Medicare that had made it difficult for religious organizations to provide financial expertise and support running a hospital (Tarr, 1982). In 1975 the LDS church created a non-profit corporation that was named Intermountain Health Care. Then they changed their name to Idaho Falls hospital. In 1978 the hospitals merged into one hospital and then became the largest hospital in Idaho. The residents of Bonneville county were concerned about the loss of the hospitals and that they had merged into one that they wanted to establish a competing Community Hospital. The local physicians wanted a single regional medical center so then they eventually agree to build a joint venture hospital that was managed by the HCA. In 1985 ground was broken for Eastern Idaho regional Medical Center. Eastern Idaho Regional Medical Center was finally opened in 1986. They had 1074 employees and now just were one facility and could see all their patients without having to travel to different hospitals. This is the history of how Eastern Idaho regional Medical Center came to be (Fatkin, 2017).

Eastern Idaho regional Medical Center has many different stakeholders that are part of their team. The list is as followed: Albin Rescue, Carrie Deselms, Alpine Fire Department, Jeremy Larsen, American Medical Response, Cindy Osborne, Atwood’s Family Ambulance, Del Atwood, Jr. Billings Clinic, Diana Parker, Campbell County EMS, Gregg Mentzel, Campbell County Memorial Hospital, Deb Tonn, Carbon County EMS, Candace Hofmann, Castle Rock Ambulance Service, Centennial Valley Ambulance, Andrea Kern, Cheyenne Regional Medical Center, Melissa Tschimperle, City of Torrington EMS, Darin Yates, Classic Lifeguard, April Larsen, Crook County Medical Services, Dayton Rescue Unit, Jonathan Miles, Wyoming Ambulance Service, Inc Wade Wells, Eden Valley Ambulance Service Evanston Regional Hospital, Angie Foster, Evansville Emergency Service, Matt Gacke, Fremont County Ambulance, Lauri Wempen, Glendo, Volunteer Ambulance, Elizabeth VanBuskirk, Guardian Flight, Keith Finch, and so many more. Easter Idaho Regional Medical Center has a total of 89 stakeholders that they work with (Stakeholders voting roster, 2017). The stake holders are the ones that get to vote on any changes that are made for any decision with the hospital, patients, family, and staff.

Easter Idaho Regional Medical Center culture of their organization is lived by their values for their customers and patients. It’s called I am EIRMC. This guides interaction with patients, visitors, and other colleagues. This was created by employees across all areas of their hospital. They start with Accountability. Their culture is to act like an owner, pull their weight, be accountable for what they do and say, the problems are heir until they are solved, and they will hold other accountable. The next one is Integrity. Each employee will be open, honest, and appropriate in all communications. They will take mail to the correct address and not talking about it with anyone on their way. They will follow through on all their commitments no matter how big they are, and they will speak up sharing their idea and concerns that they have. Then they have Quality. This is when they anticipate the needs of patients that they serve, they will crave new knowledge and experiences, their work will make a difference by doing their very best, when identifying problems, they will identify solutions, they will always look to turn good enough into even better. Then they follow respect. This is when they will have positive attitude at work, they will be on time, patients and physicians are why they have a job and they will never be an inconvenience of distraction. They will always make the time and spend the time with them that they need. They will show humility for their role they play in the lives of others, they will respect everyone around them, and everyone will know that they care. Then they follow loyalty. This is when they will build teamwork by being a good team member, they will be loyal to their leaders, and they will be an ambassador for Eastern Idaho Regional Medical Center. Finally, they follow enjoyment. This is when humor and laughter will be a part of their work daily but not at the discomfort or expense of others, they will greet, smile, and welcome each person that is encountered, and they will make sure that their smile is heard in their voice.

Eastern Idaho Regional Medical Center wants to improve their quality improvements. They want to change their system from manual to electronic. This will benefit the company so that they can get information on patients faster and more efficient. As per EIRMC known as Eastern Idaho Regional Medical Center, by implanting the quality improvement program they have been able to provide quality of health to their patients for longer periods of time and more efferently and faster. Wait times have dropped, and information is pulled up faster than before and they have information on the patients right there in each room. The patients are now able to have access to lower priced, exceptional services, and quality of care. There is authority and even accountability that has been practices throughout each different level at this hospital through health groups and their board of directors so that they can better implement, monitor, and design quality improvement programs.

They can scan wrist bands of their patients to pull up their information so they can save their time on having to go through files manually and take more time from their patients. They can get things done faster and more efficient that they ever have before. “The Joint Commission has evolved to where policies are the foundation of your organization and your practice is what surveyors look at. I’d say 5 to 10 years ago, it was an absolute requirement (of the Joint Commission) that you had your policies in place. It’s still an absolute to have your policies in place, but additionally now you are expected to practice what you preach and use your policies to drive your practice. These new requirements make it more important than ever to have your policies easily accessible, well-organized, and not in conflict with one another, which is really hard to do in a manual process” (Navex, 2017). By changing their system, they can reduce their costs, improve efficiency, and have more time for their patients. Can improve in the areas that they need to.

EIRMC	Hospital score	Best hospital score	Average hospital score
Training to improve safety	40	40	37.43
Effective leadership	110.77	120.00	115.47
Enough qualified nurses	82.35	100.00	96.48
Specialty trained doctors	100.00	100.00	42.98
Communication with doctors	3	5	2.98
Communication with nurses	3	5	3.27

As you can see from the above chart Easter Idaho Regional Medical Center has areas where they need to improve on. By changing their systems over to electronic they will be able to have more time to communicate efficiently and have better access to all the different notes and comments that were set in place by others instead of trying to find information manually and taking long to get information that needs to be communicated.

Annual Investment by State Idaho
Hospitals	2
Number of beds	484
employees	2,031
payroll	143,560,263
Capital investments	13,344,462
Total state investments	164,978,315
Uncompensated Care	21,600,345

Enrollment in local colleges, 2005

Strengths	Weaknesses	Opportunities	Threats
Largest regional Hospital	ER wait times	More efficient	Other hospitals being built
334 beds	Communications	Electronic records	Employee turn over
Multiple services	Filing system	Better training	Not enough training
Trauma service

A SWOT analysis had been made for Eastern Idaho Regional Medical Center. By changing their system to electronic it can help them benefit and be more efficient in their work place. They can keep better track of patient information, medications that are given, communication between nurses and doctors, and even filing system will be accessed faster and easier than before. The weakness would be it is time consuming at first transferring file over to electronic, but gives them the opportunity to be more efficient. They have the threat of other hospitals already switched over and the threat of commuters crashing with information.

This project will benefit the organization in three ways. First, they will have better communications. When each doctor sees a patient and or a nurse they can sign on leave notes for each person who has access to that patient and can see it where ever they are logged on to the computer. This making it so that no communication is left un said and everyone is on the same page and know who they need to ask questions to if they do have any.

Second it will help to lower costs. This will help so that they do not have to manually find information and file information and take more time trying to look for the information that they need on a patient. They will save money from not having to use paper all the time.

Finally, the third thing they can benefit from is being more efficient. By changing to electronically they can safe more time and spend more time with their patients giving them the care that they need and being more efficient on their diagnosis. This making patient happier and get their concerns answered and more likely to return and refer new patients to them giving them more benefits for profits.

Some of the risks that can take place would be training employees on the new technology that will be used, employee turnover rates, and the cost of changing it over. Navex will help EIRMC get what they need to better benefit the organizations. Because of this program the governing regulatory agencies have even seen benefits because of this program. The creation of services and indicators that have shown demographic and epidemiological characteristics have been easier with this program. Organizations are now able to come up with better benchmarks and designs, performances, and goals for continuous monitoring and evaluations.

By doing this change it benefits the company and can be undertaken by state and federal regulations. It meets the regulations on the HIPPA policies and privacy that will keep patient information safe and secure. This may cause some starks and antikickback when they first do it until they are familiar with the new technology. That can be a risk that the company faces but after the first audit the program will pay for itself. No matter what changes you do there are always going to be some kickbacks until things are done correctly but it helps with improvements that the organization can take.

Eastern Idaho Regional Medical Center has many resource available to help, they have granters and sponsors that help them achieve the goals that they want. It would not be possible without them. Some of their granters and sponsors are A-1 Collections, American Cancer Society, Cintas, Health Care Management, Health Facility Authority, Health Resources and Services Administration, U.S. Department of Health and Human Services (DHHS), Health Stream, Idaho Department of Health and Welfare, Medical Management, MEM data, Office for the Advancement of Telehealth, DHHS, Perspectives Imaging, Portneuf Healthcare Foundation, Rocky Mountain EAP, SoyJoy, Spacelabs Healthcare, State Office of Rural Health, Sterol Med, Thermo Fisher Scientific, United Dairymen of Idaho, USDA, and Wyoming Dairy Council (The Hospital Corporate, 2017).

So, you can see how Eastern Idaho Regional Medical Center Came about and it history. You can see that there needs to be quality improvements made and they need to improve their electronic system to better manage their patient information’s, communications, and effectiveness.

Project Plan

Unit 3 IP

Problem statement

The principle reason as to why it is necessary to change over to electronic health systems is to raise the standards of care provision and be more efficient when taking care of our patients. Having a manual filing system take more time away from our patients and is more time consuming to find files and information on our patients. By changing over to electronic filing system, we will be able to have access to patient information right in the room where the patient is allowing us to give the patient faster and more proficient care that they need. It will allow us to know what other doctors have done and tested for when logged into patient’s profile making it easier when things are busy and have better communication on what is going on with the patient. Some potential consequences would be the computers go down or the system has errors in it, technology is not up to date when trying to utilize the system, and information was imported incorrectly. If these problems are not solved it could cause many issues t to arise but the potential problems are ones that are able to be solved and if they are not then you still have your original files stored away that you can go back and look at if needed, or you would have to get more information from the patient and start over which would just take longer.

There are many measurable goal and objective when switching to electronic health systems. The goals will provide direction to this project. These goals are attainable and have been taken into consideration would be the best ones to look at first.

Goal 1: Importing all files into the electronic filing system

Objective a: Get all patient files into the electronic filing system. This will take time and should be done within one year because there are so many patients at the hospital that all information needs to be imported correctly and in a reasonable amount of time to get things transferred and moving more efficiently.

Objective b: Making sure all information is correct when patients are seen. When a patient is being seen ask and make sure that all information is correct and if it is not correct the information while you are with the patient and they are there to verify what needs to be fixed. This should not take too much time and should be done within a half hour with the patient before giving medication or given medical care. The people who check in the patient should be getting this information so that nurses and doctors are prepared and ready to start treating the patients.

Goal 2: Making sure all employees are trained on the system and are up to date on how the electronic filing system works.

Objective a: This should be done before all files have been imported into the electronic filing system. All employees must know how to work the system and have access to the system so that they are able to know how to use and import information that is needed. The training should go into depth and employees should know the system within dix months and ready to start utilizing the system once files have been imported. This will make thing run more efficiently and faster once the system is up and ready to use and employees will already know how to utilize it.

Objective b: Making sure all employees know how things work and what they should be doing with the electronic filing system. Make sure the training is completed and each employee can go through the system with a manager so they are aware that everything is going to be done correctly and every patient is taken care of and getting the care that they need. Training should be done once a month and every time the system updates so that employees know about all updates and changed that are made for the system.

Resources that would be required for this change will be put into place to help make the change from manual filing to electronic systems much easier. This give us time to conduct things that need to be done and make sure that we are on the right track of meeting our goals.

Human resources would be the manpower that will be helping with this project. They need to be willing to help, motivated, and making sure all regulations are being followed and all patient information is being secured and protected. This project is part of their job and will continue getting paid and are in the budget that is already set for the employees and their pays. They will continue to keep doing their jobs and making sure all employees are working together to help keep their patients information taken care of and following regulations to provide patients with the best care and trust.

Financial would be a resource that is specifically for this project. The community and vendors will be helping with financially affording the change to electronic funds. There are grants that can be used to stay up to standards and the government give the hospital money each year to support the needs of the hospital. This is in the budget so that the change can be made.

1. Select an electronic system that will support the business process.

a. Have change orders created

b. Submit orders for review

c. Document decisions

d. Report on the status

e. Assess implementation of change orders when approved

2. Document company’s intent

a. Certify intentions to use electronic filing system

3. Document company’s standard operating procedures

4. Document employees understanding of electronic filing systems

a. Electronic signatures

b. Patients formation

c. Communication

5. Electronic system meets security and FDA regulations

6. Making the switch

7. Move from paper to electronic

a. Document existing change process and map to electronic system

b. Document intent

c. Create a SOP standard operating procedures

i. Supremacy of electronic or paper documentation

ii. Use of electronic signature

iii. Employee access

d. Document employee understanding and acceptance of policies and procedures on electronic filing system.

e. Data security and user accounts

When communicating while implementing this project it is very important. We need to function and work together as a team to make things run smoothly and efficiently. There needs to be communication that is being done from the top to the bottom. There must be managers that mandate with follow ups to make sure the executions are being done and correctly done. Questions need to be answered even if they must be answered clear from the top. Meetings must take place to communicate what needs to be done and by what times and how they should be done and then managers need to explain to their employees and make sure that things are done.

There are direct and indirect stakeholders that are part of this project. Direct stakeholders would be the government and creditors. The indirect would be the community. They play a huge part in getting this project done and completed.

So, making this change and completing this project by each step is very important. Each step plays a role in making sure things are completed and we know where we stand on our goals and objectives. Don’t forget about the budgeting either it is a must to know what needs done.

Central costs	Year one	Year two	Year three

Labor	220,000	226,600	233,398
Consulting Project management Training support Data Center Hardware Software license and fees Storage and backup Telecommunications Application software Annual maintenance fees Hosting fees Data warehouse costs Integration	12,500 17,000 18,750 37,465 157,505 156,000 11,500 37,500	157,500 156,000 1,500	157,500 156,000 1,500
Total cumulative	668,215 668,215	541,600 1,209,815	548,398 1,758,213

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