Company BackgroundCollege Point Medical Hospital is a small rural hospitalwith approximately 150 inpatient beds. The hospital opened in April, 1989. Thehospital has gone through about 5 CEOs, 2 in the last 10 years. The hospital hasabout 1000 employees which includes clinical staff, administrative staff andmaintenance staff. The institution had a high turn around rate for staff members.Clinical staff has not lasted longer than a year and a half. Being as ruralhospital, it faces a lot of struggles.
Being that rural hospitals are smaller thanurban hospital and are low on funding, they tend to struggle more than well-fundedinstitutions. Struggling to stay afloat, the hospital attempted to update theirinformation systems. The system was installed to change the way they kept trackof medical records, scheduled appointments, recorded test results, scheduleoperations, and patient demographics. Once the system was installed, themedical staff and administrative staff were not trained adequately causing thesystem not to function at its full potential.
Because of the employees not knowing the system as well asthey should, they were committing a large number of medical errors. Patientinformation was being confused with other patients. Patient information wasbeing left out in the open for anyone to see. The data was also not beingentered into the system. Being that they have to enter it into two differentsystems, it was not being entered to one or the other.
Which was effecting thepatient turn out. Who wants to go to a hospital that is known for makingmistakes? This was also causing a large employee turn around. Nurses andphysicians were leaving the institution due to the lack of organization,inadequate forms of tracking and keeping patient information. Just like no onewants to be treated at a medical center that is known for errors, no one wantsto be associated with working at a hospital that is known for being errorprone. Sharing of user names and passwords, created a large amountof errors.
The medical center was not able to track who was entering the wronginformation. The computer system was open for anyone to use without a sign inand password, making it even harder to track. Staff members were also lookingup patient information that did not pertain to the job, which is a HIPPAviolation. Patient records were being printed and left in the printer.
Thesewere not patient printers and anyone could come by and take a look a privateinformation. A number of patient recordswere mailed out to the wrong patients.After the institution receive a large amount of funding bythe government for being in the most need and the appointment of new CEO, theinstitution decided to revamp the already installed information systems. Retrainemployees to gain complete use of the system and its resources. By doing thisrenovation, the CEO hopes to improve services. By being a more organizedinstitution and improving a once error prone facility to a trust worthyhospital. Before going live with the new system, all employees are tobe trained in a 3 week course.
The understanding of the system is veryimportant in order for it to work to its full potential. The training of allemployees and any updates the systems needs with take an approximate 6-12months. Being that the hospital is not as large as otherhospitals, we are hoping to complete the process 6-8 months.
Business Problem Theproblem with the information system are quite a few. The first one is largeamount of data collected and keeping it secured. Lack of security softwareinstallation when the original system was implemented. In adequate knowledge ofthe system and its need to protect the information that is collected. Hence,the HIPPA regulations that were also not addressed appropriately to the employeesregarding the new system. The shortcomings cause a large breach of informationfor the hospital.
Patient data was compromised. Informationbeing entered into the system was not being secured adequately. The institutionwas not following HIPPA regulations to it full capacity, at when it had to dowith electronic information.
Staff members were sharing user names andpasswords. There was no real way to track who entered what, since user nameswere being shared. Lack ofcommunication between their systems. College Point Medical Center had anadmission system that was working quite well for them but they had an issuewith getting both systems to communication with each other.
This issue was verytime consuming because nurses and clerical staff would have to enter thepatient information twice. Some of the time the information would only getentered once due to urgency of the patient’s needs. Possibly causing errorswhen entering the data for the second time if entered at all. Inadequatetraining of the systems to clinical staff and administrative staff. Clinicstaff was the least trained due to the fact that they had to be shown how touse the system in between seeing patients.
This occurred due to the nursingshortage and lack of funds. The physicians only received training for thebasics, in other words, just the area they would use most. The administratedstaff was trained but not tested.
Some employees trained well and understoodthe system but other did not. Since the hospital could not afford more trainingor testing to ensure understanding. Due to the scarcity of funding, theinstitution ended the training program with hope that the employees would teacheach other. They did not provide any refresher courses. They were given a verylarge manual by the company who created and installed the system but it was notwritten for individuals who are not in that industry. SolutionHealth Information Systems resources: these include thelegislative, regulatory and planning frameworks required for a fullyfunctioning health information system, and the resources that are required forsuch a system to be functional. Such resources involve personnel, financing,logistics support, information and communications technology (ICT), andcoordinating mechanisms within and between the six components.
Indicators acore set of indicators and related targets is the basis for a healthinformation system plan and strategy. Indicators need to encompass determinantsof health; health system inputs, outputs and outcomes; and health status (http://phinnetwork.org/resources/health-information-systems-his/).Data Sources these can be divided into two main categories;(1) population-based approaches (censuses, civil registration and populationsurveys) and (2) institution-based data (individual records, service recordsand resource records). A number of data-collection approaches and sources donot fit into either of the above main categories but can provide importantinformation that may not be available elsewhere. These include occasionalhealth surveys, research, and information produced by community based organizations(Jaen, 2011). Data Management this covers all aspects of data handlingfrom collection, storage, quality-assurance and flow, to processing,compilation and analysis. Information ProductsData must be transformed intoinformation that will become the basis for evidence and knowledge to shapehealth action.
Dissemination and use the value of health information is enhancedby making it readily accessible to decision-makers and by providing incentivesfor, or otherwise facilitating, information use (http://phinnetwork.org/resources/health-information-systems-his/).By using cloud storage computing making collecting, storingand processing data easier and cheaper. Increasingly leveraging big data todive actionable insights and improve cyber threat detection (Beesly, 2016). Themore the data grows the harder it is to keep secure. Protecting computations indistributed programming frameworks, to address this challenge recommendationsare to use authentication to establish initial trust (Beesly, 2016). Non-relational data stores such as NoSQLdatabases tend not to have robust security (Beesly, 2016). Apply encryption to protect passwords and safeguard datawhile at rest and use transport layer security for in-transit data.
To expose susceptibilitiescaused by irrelevant input validation in NoSQL, use invalid, unexpected, orrandom inputs by deploying dumb fuzzing and smart fuzzing strategies (Beesly,2016). Dumb fuzzing as the name suggests, works without having any knowledgeabout the data that it is mutating. Smartfuzzing does exactly the same thing but in a very different way. The differenceis in the way that the file is mutated when fuzzing (“Buffer overflow” 2013). HIPPA regulation require that covered entities implement administrative,physical and technical safeguards that reasonably and appropriately protect theconfidentiality, integrity and availability of the electronic Patient HealthInformation (PHI) that create, receives, maintains or transmits (https://www.medicalrecords.com/physicians/hipaa-and-medical-records).
To ensure these regulations are followed,training will be provided to all employees and must done annually. This trainingwill also take place alongside the health information systems training courses.We will beassigning staff member who need access to patient information specificprinters. To reduce the amount of access to patient information that may beforgotten after it is printed. The staff will be able to fax reports to outsidephysicians straight for the system.
There will be no need to print and thenfax, this will also reduce the amount of paper used. Any orders the patientwill need can be entered into the system and the system will communicate thatto the corresponding department. Staff members will only have access topatients in their department or physician they work with. If a department needsto schedule for another department, an over write will have to take place bysupervisor. These are just a few of the new features in the improved HIS. Outsidemedical records will be scanned in with a bar code that will place the documentin the corresponding folders, such as, lab work, radiology, surgery, outsidephysician notes and insurance. Any scans that are done at an outside facilitycan be brought in CD format, and it can be uploaded to the patient’s records.Films can also be scanned into the system, but would be encouraged to bring inCD format.
Along with theHIS training, all staff member will also be going through a HIPPA trainingcourse. To ensure all staff members are aware the regulations and follow them.An annual online course will be done by each staff member. It will be a requireneeded to access the system.
A noticewill go out automatically six weeks before its due date. If it is done by theweek prior to the due date, a notice will be sent to each employee’smanager/supervisor. Supervisor must ensure the course is taken. As for theclinicians, the same process will apply only it will go to the department Chiefor Chairman. Training willtake place for end users in a phase introduction. Focusing on building theirknow-how and certainty to use the system completely in their role.
The trainingservices is an important part of the implementation of the new system. Supportservices will be provided to the end users with a working knowledge of detailsand effective use of the new information system. The organizations trainingprogram is created according to the needs of the institution. It will bespecific to the timeframes and requirements of the organization. All employeeswill be trained with unlimited training days. New employees will go through a 3week training process prior to starting in their position. In other words, theemployee will determine with they feel comfortable using the systems.
Onlinetraining manuals will be created according to the institution’s policies andprocedures. Complete online training will also be provided. An interactive testsystem incorporates platforms enhancements and modification for refreshertraining opportunities.
BenefitsThe main goal of installing a new Healthcare InformationSystem (HIS) is to prove the most outstanding support to the treatment ofpatient and concomitant administration by electronic data processing. HIS will encompass following functionalitiesthat will facilitate computerization of the treatment process that follows thepatient flow though the health care institution. Scheduling, admission of patients, keepingelectronic medical records and prescriptions. The system will also be able giveprintable documents in accordance to HIPPA regulations. A look into the historyof diagnosis and access to complete history of patient treatment.
Ensured datasecurity through assigning a set of roles for each user with specified rightson data access and actions in the system(HIS Implementation Guide, 2012).Disperseddata entry for electronic invoicing to the National Hospital Insurance Fund(NHIF) at all points where healthcare services, supplies and drugs are providedto the patient. The possibility of producing a centralized electronic invoicewith unified validation system, as was as the capacity to export gathered datain standard XML format, for possible imports in to the special software forinvoicing (HIS Implementation Guide, 2012). The expected benefits of the HIS developmentin College Point Medical Hospital are better quality of patient care,improvement of the efficiency of the hospital management, improvement ininformation quality and reduction in operating costs. Being thatuser names and passwords will no longer be shared, we can accurately know whois entering what in the system.
We are creating one user name and password forall systems, including just signing into your computer. We plan onmaking the system live within the six months. Starting with the smallest departmentas the “test run” but it will be live. We will roll out the system bydepartment. The smaller departments will be first.
By doing this we can ironany possible kinks that may come up. This way we do not have to have a completeshut down if anything goes wrong. One department at a time, will be best. Wecan roll out the system in 8 weeks trial runs per department. Expecting thatper department, we find more kinks along the way before we run the system inthe entire hospital. Technical ApproachIn order to implement strongly the new HIS, it is requiredto conduct change management process that will assist the hospital in preparingthe organization for the control of new tools and working environment. Theelements that are involved in HIS implementation through change managementprocess: social and technical factors.
The exchange among the technical andsocial elements is decided by four factors: structure, people, technology andprocesses (Cresswell, 2013). The socialfactor is more important than the technical factor. People play an importantpart in the success or failure of any change process. It is vital that thechange management include precautionary activities related to challengescorrelated with the acceptance of the system by the end user. It is importantthat risks are identified, understood and managed (Cresswell, 2013). Changes in work flow: HIS implementation has always a bangon the hospital workflows and the range of this impact relies on its intricacy. Therefore, complex work actions placedbefore the introduction of HIS should be redesigned and adjusted in order formedical staff to do their jobs effectively through the use of the system.
Somejobs will be performed faster, whereas some will consume more time, especiallywhile there is the obligation to keep both paper and electronic records (HISImplementation Guide, 2012). Staff training and technical support: initial HISimplementation is not enough for the organization to reach the necessary goals.These types of systems will not flourish properly unless the proper training isgiven to the end users. Onsite technical support and refreshers are requiredfor IT and the user to feel comfortable in using the new system (Chae, 2012). Providing an onsite technical team, that knowsthe system’s ins and outs to help the staff learn the system well. Also, atechnical team onsite will help when the system is down and the hospital’s ITdepartment is not really familiar with the system, the technical team canassist where the IT cannot.
ImplementationPlanAlthough the implementation plan will be a long process andrequire a lot of training, we will try our best to get it up and running asquickly as possible. HIS implementation will be carried out by the teamprepared for the hospital staff (end-user) training and configuration of HIS accordingto the hospital needs (Jaen, 2011). Projectteam will submit, in timely manner, the list of necessary data, code lists andinformation that hospital has to provide to the Project at the very beginningof the HIS implementation (2011).
Thetotal duration of the planned HIS implementation process takes usually six totwelve months. The HIS implementation will be conducted through followingphases, in accordance with the best practices: (1) HIS installation and initialtraining, (2) practical HIS training – test environment, (3) support for HISproduction environment, depending on the size of the institution, (4) subsequenttraining for the additional HIS functionalities related to Electronic HealthRecord, conducted upon HIS implementation. All phases are susceptible to change, inaccordance with the number of end users and actual situation in particularhospital (HIS implementation guide). Patientscheduling and the patient records will all speak with each other.
Comments canbe entered to help other office staff know what is going on with the patient.For example, when and order is place for blood work, in the scheduling sectionwill be a part where it will state that the patient is having blood done.Another example will be when blood results are done the nurse and physicianwill received and email stating results are available. This will also show upin the patient’s consultation notes.Since it will take three to four months to go live, we willbe using the remainder months for running small departments first. We willattempt to run the system for the first 4 weeks in the smallest department.Depending on how well that turns out we will decide if and when to move to thenext department.
We will include HIPPA regulation course as part of running thesystem live. Everyone must have completed the course prior to going live withthe system.By implementing this plan, the HIS will help the hospitalrun more efficiently. Having access to the correct patient information and themost updated information will help the clinicians provide better service totheir patients. It is very important that clinicians and administrative staffbe trained to know the ins and outs of the system. Granted this will take asometime but in the long run it will work out for the best.
SummaryThe HISimplementation describes how the information system will be installed and howtraining will take place. The plancontains a brief review of the problem, a brief description of the major tasksinvolved in the implementation, the overall resources needed to support the implementationeffort. The plan is developed during theresign phase and is updated during the installation phase; the final version isprovided in the integration and test phase and is used for guidance during theimplementation phase.
Before running the system live, we will make sure thestaff is fully trained on HIPPA regulations. This will be a requirement for theuse of HIS, with an annual refresher course. The HIS system willcommunicate a number of information between the clinical and the administrativepart of the system. Patient scheduling will be connected to the patient orders.Physicians, nurses and administrative staff will be able to see all pastappointments.
Staff members will only be able to access medical records thatpertain to their specific job. Anything or than that, must be approved by asupervisor with a physician or nurse’s order. The system will beable to track everything from what computer the person log-in, to time, dateand person. No more sharing of user names and passwords. The computers andprinter must be patient information accessible or the staff member will not beable to access any patient information.
This will keep patient information safefrom exposure to any misuse of personal information. We will start inthe smallest department as a test run. Then we will run it for about 4 weeksand iron out any kinks that may occur. Then we will move to the nextdepartment. While seeing how the system runs, we will see if we can start torun more than one department at a time. The HIS should be up and running in thewhole hospital by 8th month of the process.
Conclusion In this paper, it isdescribed how the implementation of HIS in a healthcare organization is aprocess. The organization is affected by the coming of new technology. With theimplementation of this new system, we believe it will increase the value ofservices and increase revenue. The HIS system will make the institute organizedand provided better service and reduce errors. College Point Medical Hospitalwill benefit extremely from the systems upgrade. Once this system is up and running and thestaff members are fully trained, the hospital will be running in a more efficientmanner.
The institution will be more organized. The medical records of patientwill be easily accessible. Test results will be all in one place, easy to findand can be printed or faxed it needed. The staff will have the access to theirpatients records all in one place.
Theclinical and administrative staff will be much happier with the organization.Therefore, provide better service to their patients. By providing betterservice, revenue will increase. With the hospital producing better service andmore income, they can have money for renovations, more qualified staff members.