MHA6120 WEEK 3 DISCUSSION AND PROJECT INSTRUCTIONS

MHA6120 WEEK 3 LECTURE Page | 1

Healthcare Information Systems Architecture and Analysis

The complexities of healthcare clinical and business processes require an HIS architecture that is robust and agile and has the capacity to interwork or interoperable with other applications in the network. Moghaddasi (2018) noted that the multispecialty nature of medical services alone greatly contributes to complexities in clinical applications.

An obstetrics and gynecology service has an entirely different focus of treatment and management as opposed to medical services or anesthesiology services. In addition, applications for business or managerial processes and financial processes must have the capacity to complement and interwork with clinical applications.

Examples

Review each example to learn more.

Example 1

In order to correctly bill for the services rendered, medical coding must be supported with correct medical documentation. A mechanism from a medical coding application can flag medical documentation for specificity or an additional description.

Example 2

Physician order entry in the electronic medical record (EMR) is transmitted to the pharmacy. Once medication is dispensed for administration, the nurse administering the medication must scan the patient’s barcode and the medication barcode to verify the correct prescription and dispensed medication for administration. Once administration is completed, the nurse enters the documents administration at the EMR medication administration page. The barcode information will be transmitted to the pharmacy for billing and/or confirmation of administration.

Example 3

Medical coding is completed within forty-eight hours after the patient’s discharge. Primary and secondary diagnosis as well as all procedures are entered in the health information software, which is then captured in the patient billing software.

There are several frameworks or models of a comprehensive Information Technology (IT) architecture in the literature. Neittaanmäki (2017) suggests that the enterprise architecture (EA) model is the prescription of choice for healthcare organizations because of the following reasons:

· EA improves performance and health outcomes because of interoperability, automation, data quality, and timeliness.

· EA is capable of controlling organizational expenditure by reducing hardware purchasing, software licensing, staff training, and support cost.

· EA protects profitability by sustaining its capability.

· EA manages security and risks.

· EA encourages better planning.

Health information technology (HIT) EA in healthcare must focus on the four crucial C’s:

Four C’s of HIT Enterprise Architecture

Review each component to know more.

Connection: HIT architecture must be connected to business strategy and other key systems within and outside of the organization.

Collaboration: HIT architecture must be an outcome of multidisciplinary collaboration that will achieve critical measures of quality, patient safety, clinical, and financial outcomes.

Communication: HIT architecture must facilitate and enhance communication internally and externally.

Customers: HIT architecture must focus on customer needs and facilitate customer access.

The framework can be utilized to evaluate current HIS architecture and facilitate transition to meet the demand of both internal and external environments.

Burke (2013) noted that EA is not in the frontal lobe of healthcare leaders because it is not broadly understood. Five years later, our industry is still struggling to better understand and apply the principles and practices of EA. We need more discussions and investigations or perhaps, it is time to embrace EA in our HIS/HIT implementation and evaluation for better outcomes in our clinical and business processes. 

References:

· Burke, J. (2013). Where is enterprise architecture in healthcare? Retrieved from https://www.informationweek.com/healthcare/leadership/where-is-enterprise-architecture-in-healthcare/d/d-id/898882

· Moghaddasi, H. (2018). Important points to design hospital information system. Retrieved from https://juniperpublishers.com/jojnhc/pdf/JOJNHC.MS.ID.555680.pdf

· Neittaanmäki, P. (2017). Enterprise architecture in healthcare v2.0. Retrieved from https://www.jyu.fi/it/fi/tutkimus/julkaisut/tekes-raportteja/enterprise-architecture-in-healthcare-v2-0.pdf

HIS Acquisition and Implementation

HIS acquisition and implementation is perhaps the most challenging process in adopting an HIS. This is due to the fact that mistakes are costly and disruptive, and delays need clinical and strategic management as well as financial improvement. System acquisition process begins when a decision is made to select or replace an existing system up to the time of contract negotiation and signing (Wager, Lee, & Glaser, 2017). HIS acquisition must be in line with organizational strategic goals and objectives. It must serve a major role in translating strategic processes.

Acquisition Processes

HIS acquisition for organizational strategies must prioritize the availability of adequate resources, i.e., time, people, or funds. Wager et al. (2017) suggest the following acquisition processes:

· Establish project steering committees and appoint a project manager.

· Define project objectives and the scope of analysis.

· Screen the marketplace and review vendor profiles.

· Determine system goals.

· Determine and prioritize system requirements. 

· Develop and distribute a request for proposal (RFP) or a request for information (RFI).

· Explore other options such as leasing, hiring system designer, or building in-house.

· Evaluate vendor proposals.

· Conduct cost-benefit analysis.

· Prepare a summary report and recommendation.

· Conduct contract negotiations. 

HIS implementation commences after the signing of the contract. Network components such as hardware, software, talent, and other key requirements are then acquired and prepared for implementation. Wager et al. (2017) noted that the fundamentals to implementation are as follows:

· Organize the implementation team and identify a system champion.

· Clearly define the project scope and goals.

· Identify the accountability for successful completion of the project.

· Establish and institute a project plan.

HIS implementation is the most complex and massive undertaking for a healthcare organization, from workstation installation, building of database, network testing and evaluation, user training, data conversion, and writing of procedures are some of the many tasks to be completed. It is important to note that implementation is costly and, therefore, must be completed on time with minimal disruption of clinical and business processes. In addition, implementation must also address and consider organizational culture, politics, and external environment such as licensure, accreditation, and regulatory agencies (Wager et al., 2017). 

Reference:

· Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: A practical approach for health care management (4th ed.). San Francisco, CA: Jossey-Bass

Additional Materials

From your course textbook, Information Systems for Healthcare Management, review the following chapters:

·  Connecting the Strategic Dots: Does HIT Matter?

· Systems Selection and Contract Management

From the Internet, review the following:

· Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: A practical approach for health care management (4th ed.). San Francisco, CA: Jossey-Bass

· Wilt, D. (2017, January 19). HealthShare Exchange. Information systems acquisition development and maintenance security policy. Retrieved from https://www.healthshareexchange.org/sites/default/files/pdf/information_systems_acquisition_development_maintenance_security_policy_1-19-2017.pdf

System Selection and Contract Management

HIS selection is a very crucial step in implementing an application that will achieve organizational strategies or service needs. The primary reason for careful system selection is the cost that could be detrimental to the organization. Backer’s Health IT and CIO Report, (2018) noted that the electronic health record (EHR) implementation of Mayo Clinic costs over a billion dollar. An evidence-based careful system selection process recommended by Glandon, Smaltz, and Slovenky (2013) will assist new and experienced healthcare administrator/managers to properly manage the selection process. First, objectives must be defined and clarified. Second, formation of the system selection governance structure, and processes. It is very important to note that a stakeholder/user be involved in the selection governance structure. Third, establishment of a system selection plan. Fourth, understand the marketplace, then narrow the field, and finally, contract negotiation (Glandon et al., 2013).

The system selection process ends with contract management. It would be wise to use the same selection governance to be involved in framing and negotiating contracts; this team may function as the contract management team. In addition, it is beneficial to include a hospital business or a purchasing adviser and hospital legal adviser in the process (Wager, Lee, & Glaser, 2017). The contract management team must frame a contract-negotiating strategy on key issues such as pricing, licensing, implementation resources, training, interface, support services, financial liability for exceeding implementation time, customization, confidentiality, change management, workflow redesign, etc. (Glandon et al., 2013; Wager et al., 2017). The goal of contract negotiation is to reach a fair and equitable agreement with clear expectations for implementation and support during and after implementation. It is also important to ensure that there is legal and financial protection articulated on behalf of the organization. Respect and collaboration between the vendor and the purchaser during contract negotiation is an ideal relationship that will support a successful acquisition and implementation of an HIS (Glandon et al., 2013).

References:

· Becker's Health IT and CIO Report. (2018, May 16). Unpacking hospitals' EHR implementation costs: What's behind the million-dollar price tags? Retrieved from https://www.beckershospitalreview.com/healthcare-information-technology/unpacking-hospitals-ehr-implementation-costs-what-s-behind-the-million-dollar-price-tags.html

· Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: A practical approach for health care management (4th ed.). San Francisco, CA: Jossey-Bass

Additional Materials

From the Internet, review the following:

· Becker's Health IT and CIO Report. (2018, May 16). Unpacking hospitals' EHR implementation costs: What's behind the million-dollar price tags? Retrieved from https://www.beckershospitalreview.com/healthcare-information-technology/unpacking-hospitals-ehr-implementation-costs-what-s-behind-the-million-dollar-price-tags.html

· Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: A practical approach for health care management (4th ed.). San Francisco, CA: Jossey-Bass