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Business Case
For Patient Education Documentation
Solution (PEDS)
Edwin Ocasio
David Agriam
Kelly Erazo
Tina Lu
HTM 660: System Management and
Planning
Submitted to Professor Susan Leonard
November 23, 2014
Document Control
Document Information
Document Id
Document Owner
Issue Date
Last Saved Date
File Name
Information
IT Tactical Plan: PEDS
David Agriam CMIO
October 28, 2014
November 10, 2014
BusinessCase_PEDS_Project
Document History
Version
1.0
Issue Date
Nov. 8, 2014
1.1
1.2
1.2
1.2
2.0
2.1
3.0
Changes
Title Page, Document Information
Title Page, Document Information, Document Approvals,
Business Case
Cost and funding plan - David
Risk, issues, and assumptions - Tina
Benefits, goals and measurement criteria - Kelly
Update current version - Edwin
Project planning, execution and closure - David
Final edits and Executive Summary
Document Approvals
Role
Project Sponsor
Name
Signature
Date
Tina Lu - CNE
Kelly Erazo - CFO
Toktu Ulater - HRO
Table of Contents
1
Executive Summary............................................................................................ 5
Business Problem............................................................................................... 6
2.1
Environmental Analysis................................................................................. 6
2.2
Problem Analysis.......................................................................................... 8
2.2.1
Business Problem..................................................................................8
2.2.2
Business Opportunity..............................................................................8
Business Analysis............................................................................................... 9
3.1
Description.................................................................................................. 9
3.2
3.3
3.4
Feasibility.................................................................................................. 12
3.5
Risks........................................................................................................ 13
3.6
Issues....................................................................................................... 14
3.7
Assumptions.............................................................................................. 15
Implementation Approach..................................................................................16
4.1
Project Initiation......................................................................................... 16
4.2
Project Planning......................................................................................... 17
4.3
Project Execution....................................................................................... 18
4.4
Project Closure.......................................................................................... 19
Appendix......................................................................................................... 20
5.1
5.2
1 Executive Summary
Forest Regional Health Care (FRHC) promotes the concept of a system approach to
demonstrate superior performance on outcome measures and to provide the highest quality
care at consistent lowest cost. As reform, regulations, and technological advances changes
the health care market, Forest Regional was faced with responding to challenges emerging
from electronic health record (EHR) mandates and attestation of meaningful use measures.
It had developed a strategic plan that included a full suite of major Information Systems (IS)
projects to address the challenges of the current health care market.
Among those measures is the use of certified EHR technology (CEHRT) to identify patientspecific education and provide those resources to the patient. The CEHRT does not
generate or store the education materials. This objective is being met by manually extracting
the data from the EHR, providing patients with available paper-based documents, and again
manually documenting the percentage of patients receiving the resources. FRHC needs an
IS solution that can electronically extract the elements require to identify education
resources specific to a patients care. That solution can then be integrate by a certified
education provider to manage the availability of evidence-based resources specifically
targeted to each patients treatment, medication, and ancillary regiments. This solution will
now have the capability to collect and report the measures needed for attestation as they are
updated or modified.
2 Business Problem
2.1
Environmental Analysis
Forest Regional Health Care (FRHC) is dedicated to providing a culture for physician
development & relations while engaging partnership with patients and the community they
where they live. They are dedicated to enhancing employee relations in every aspect of the
business goals and objectives. Forest Regional values its ability to promote the concept of a
system approach to demonstrate superior performance on outcome measures and provide
the highest quality care at consistent lowest cost. It has developed a strategic plan that
includes a full suite of major Information Systems (IS) projects to address the challenges of
the current health care market.
As the health care market changes due to health care reform, regulations, technology
advances, and focus on low cost quality patient care, Forest Regional is faced with
responding to these challenges and the implications with rising costs and limited budgets.
The emergence of electronic health record (EHR) mandates and attesting meaningful use
requirements have added an additional strain to the operational processes of the business.
These challenges require a shift in the organizational culture not accustomed to considering
Information Technology as part of their business goals and objectives. Implementation of
health information systems for data exchanges, interoperability, and privacy are among the
business issues addresses by senior leadership. Meaning use of electronic health records
and attestation of measures and objectives must be completed to reap the benefits of the
corresponding incentives.
Among those objectives is the use of certified EHR technology (CEHRT) to identify
patient-specific education resources and provide those resources to the patient. The
CEHRT does not have to generate or store the education resources or materials. This is
measure is currently being supported entirely by extracting the data from the EHR and
providing paper-based documents with limited resources. It provides patients with basic,
generalized information about treatment regiments, medications they are prescribed, and
2.2
2.2.1
Problem Analysis
Business Problem
The Centers for Medicare & Medicaid Services (CMS) included in Meaningful Use
Stage 2 and 3 objective to use certified EHR technology to identify patient-specific education
resources and provide those resources to the patient. Forest Regional and its partners are
meeting this measure by a completely manual data extraction method and paper process
with limited resources. An electronic workflow solution with digital resources will facilitate
compliance with meaningful use and provide patients with targeted education materials and
resources to manage their health. These Stage 1 objectives have now become core
measures in Stage 2, and proposed changes in Stage 3 will require patient access to patient
portals and self-management tools.
2.2.2
Business Opportunity
Improve health care quality, safety, and efficiency and reduce health disparities.
Engage patients and families in their health care.
Improve care coordination.
Improve population and public health
Ensure adequate privacy and security of personal health information.
3 Business Analysis
3.1
Description
The solution must be able to integrate and interact with the established CEHRT
system. The details of patients problem summary, medications, medical history, chronic
issues and diseases, and treatment regiments must be extracted from the patients EHR.
Evidence-based educational and training materials will be identified, delineated and
customized base on the patients disease, treatment, medication, and health management.
It must be able to seamlessly provide recommended topics and areas for training and
education base on patient profile including preference of language and media type. These
materials will be immediately available to health care staff during their encounter and after
the patients visit. Reports and statistics should be produce in accordance to CMS
guidelines to validate and verify compliance with meaningful use requirements for Stage 2
and the proposed Stage 3. Future subprojects would make available apps for smartphone
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3.2
Category
Benefit
Value
Financial
$10,000
$20,000 Per Year
$ 50,000
40 %
3 hrs.
75 %
20 %
10 %
Provision of the most up-to-date
patient education resources with
enough diversity to satisfy most if
not all patients requests will
provide a competitive edge for
the organization.
Customer
Staff
70 %
30 %
Patient access to educational
health resources increases the
patients awareness of their
conditions, diagnoses, and
preventative measures. Patients
trust and loyalty to the
organization will increase through
this extended service the
organization will provide.
30 %
Staff members will be able to
provide accurate, current, and
patient-specific educational
information to the patients. They
will also be able to direct patients
in the right path to access the
information either at the
organization or from the comfort
of their own home.
10 %
Operational
Market
3.3
Category
Value
Budgeted
11
$ 100,000 (CAPEX)
$ 75,000 (CAPEX)
$ 5,000 (CAPEX)
YES
YES
YES
$ 5,000 (OPEX)
$ 30,000 (OPEX)
$ 10,000 (OPEX)
YES
YES
YES
Marketing
Advertising / branding
Promotional materials
PR and communications
$ 1,000 (CAPEX)
$ 2,000 (CAPEX)
$ 2,000 (CAPEX)
YES
YES
YES
Organizational
Operational down-time
Short-term loss in productivity
Cultural change
$ 3,000 (OPEX)
$ 2,000 (OPEX)
Patient Educational
information will be
available mostly
electronically, through
an outside provider.
NO
NO
NO
On-going costs
$20,000 (OPEX)
YES
Funding
Source
Amount
Notes
Forest
Regional
Health Care
Capital
$250,000
People
Physical
3.4
Feasibility
Component
Rating
(1-10)
New Technology
(Cloud, SaaS, etc.)
Skilled Staff
Modified Processes
New Assets
12
3.5
Risks
Patient education, though a requirement formed out of Meaningful Use Stage 1 and
Stage 2, can be burdensome to those who dont speak English. This can be a risk when
members dont speak, read, or write in English as their primary language. Though English
will be the standard language that patients will use to seek the information they need through
the system, it would be ideal to create these same resources in the languages of the
population that Forest Health serves such as Spanish, Tagalog, Mandarin, and Cambodian.
Another risk for non-usage of the new patient education system at Forest Health is
medical jargon or terminology. It is recognized that being diagnosed with a disease and
maintaining ones health are hard enough with medical jargon that only highly esteemed
health care professionals can understand. Patient education access should be in a
language that is easy for all members of all educational levels to understand.
Finally, access to technology is all important. What benefit can be derived from an
evidence-based patient education system when it is not accessible to popular technological
gadgets of today? Forest Health should have its patient education system available to
members on any technological device they prefer, whether it be their smartphone, tablet or
personal computer at home. There must always be other contingencies for patients that
cannot either afford these devices or the technology to access the resources. The resources
must be relevant and current while providing the patient with the tools and resources to
participate in their own health care.
In order to prove the business case of this project, issues and assumptions will be
addressed so that it can be recorded and tracked once the project is approved with an
infusion of capital from the board. A formal risk assessment had been undertaken and the
following is the result of that assessment and the mitigating actions have been defined so
that costs for this project shall not escalate more taking into account the issues and
assumptions that have been defined through the risk assessment.
13
Description
Likelihood
Impact
Language barriers
Low
Very High
Patient education
technology solution
is unable to deliver
required results
Medium
High
Patient education
not available in all
technological
formats.
Medium
Medium
Patient education
written in easy to
understand
language for
members to
understand
Medium
Very High
3.6
Mitigating Actions
Issues
The issues that have come up in patient education are many, but a few have been
selected that stand out due to its importance and impact on the project. Those few issues
are shown below and prioritized based on its importance on the patient education project.
The IT committee is requesting capital funds set aside for this technological upgrade for the
organization and patients to increase physician and patient interaction, while providing a
resource for patients and physicians to use when information is needed regarding their
medical condition. A process for vendor selection is in place as it will be needed to find out
which information system will be best suited for health care workers based on their daily
work flow without impacting or changing much of the tasks that they are used to doing.
Adherence to health care regulatory law, in the form of Meaningful Use 2 under Patient
Education is a high priority considering that it will be started first before anything else is
implemented. This is done so that the organization has legal clearance to move forward and
implement the changes needed to propel the organization forward into the 21st century.
Patient education in other languages as recognized by the organization, which are Spanish,
Tagalog, Mandarin and Cambodian is on a lower priority since the organization currently
functions best in English. Upon consultation with other medical centers nearby that currently
14
Description
Priority
Resolution Actions
Medium
High
Medium
High
Consultation with IT
language interpreters and
vendor recommendations
Low
3.7
Assumptions
The following is a list of major assumptions associated with the adoption of this option:
There will be no legislative, business strategy, or policy changes during this project as
adherence to federal health care law and hospital policies and procedures will be reviewed,
observed, and enforced.
It is understood that the current prices of materials and services will not increase during the
course of this project.
Additional human resources will be available from the corresponding business units to
support this project. Vendor consultation and interaction and guidance from other medical
centers in the area will be available to help the project to its completion.
15
All staff personnel as well as patients accessing the patient education information online are
able to navigate the various media options. In some cases, these materials or resources will
be available:
o
someone in person who will assist them with accessing the online website.
o
4 Implementation Approach
4.1
Project Initiation
Forest Health has realized that this challenge will require a successful change
management or development program to create an awareness or understanding of the need
to change. The success of this endeavor depends on the support of senior leadership,
providers, health care staff, and our patients. Though the outcome of the project is required
to meet a business requirement and compliance measure, it does make any less critical than
other projects or programs that have inherent risk and implications. The awareness of
change will be promulgated through planned or structured communication. The project
manager and the project team will convey to each FRHC employee the business reasons for
the project, the key challenges that the project raises for each health care professional, and
the benefits resulting from overcoming such challenges. A selected set of patients that may
benefit from the implementation of the solution may be invited to provide a base for the
testing phases of the new program.
The project team may include providers, medical support staff, ancillary services
personnel, and representation from the patient affairs business unit in charge of patient
education. Nurse educators, patient safety and quality improvement department may be
brought as consultants during various phases of the project. The mandatory members will
16
4.2
Project Planning
Planning will take place in parallel and in conjunction with other projects within the
EHR program being managed by PMO. This method will allow for maximum availability and
optimal use of scarce human resources needed to facilitate the implementation of the
various new IT systems. The project plan will take into consideration other phases of similar
projects and coordinate efforts beneficial to both parties. Plans for processes that do not
involve interaction with the CEHRT will proceed uninhibited by other project or program. The
plans for the implementation phase will be coordinate with the health care to identify patient
populations that would benefit most from the outcomes of the solution. This will include justin-time training for affected departments and divisions. The plan for the evaluation phase will
include tracking patient progress and the submission of attestation data to CMS. This plan
will stay in affect for as long as necessary to determine that it can support the volume of
patients required by CMS and the companys strategic goals.
Various aspects will be assigned to smaller steering committees from each of the
clinics who will report to the larger steering committees in the hospital to facilitate ease of
implementation, communication, and review of the system once it has been in place. The
new system will be in place for 90 days before conducting any official review of the system,
its workflow, online education resources, site navigation, and retrieval each patients problem
summary, medications, medical history, chronic issues and diseases, and treatment
regiments. The deployment plan includes a rigorous review of education materials and
resources that will be available to the most vulnerable population in the FRHC system and
can affect their safety and health outcomes.
17
4.3
Project Execution
There will be three distinct project phases to complete the build phase of the project.
The first phase will take place in conjunction with other projects within the EHR program
being managed by PMO. This method will allow the team to interact with other project
teams to optimize use of scarce human resources needed to complete the analysis and
functional requirements for this solution. The will take advantage of EHR subject matter
experts. This phase will take into consideration other phases of similar projects and
coordinate efforts beneficial to both parties.
The second phase can start in parallel since it does not any involve interaction with the
CEHRT, and can proceed uninhibited by other projects or programs. During this phase the
project team will be working with the education providers to select best platform to host the
solution. This process will include staff from patient relations, nurse educators, safety
managers, and quality and process improvement team members. The provider must be able
to supply appropriate evidence-based materials and resources to meet the CMS measures
and comply with all patient education and safety regulations. Then, once phase one is
completed, a final decision can be made on the implementation phase.
The last phase with put into effect the implementation plan in coordination with the
health care team to help identify patient populations that would benefit most from the
outcomes of the solution. This will include just-in-time training for affected departmental and
division personnel. The plan includes an evaluation phase to tracking patient progress and
the submission of attestation data to CMS. This phase includes a rigorous review of
education materials and resources that will be available to the most vulnerable population in
the FRHC system and can affect their safety and health outcomes. This plan will stay in
affect for as long as necessary to determine that it can support the volume of patients
required by CMS and the companys strategic goals.
18
4.4
Project Closure
Once the project has attained full implementation status, the system will be delivered to
the clinics and hospitals. Vendor specialists will be on hand to answer any questions
regarding the system and guide health care workers through the anticipated quirks that the
system may have in its first 120 days of full operation. Health IT staff will be on hand to
assist as well, but will be reallocated to their former areas in the organization, whether it was
one of the clinics or a hospital. A full Post Implementation Review meeting will be set up at
120 days after the implementation of the new system to review the good, the bad, the best
and the ugly of working with the new system and coordinating ways to improve the system.
Procurement will be closed and all project documents will be added to the project
information system along with the completed version of the lessons learned.
19
5 Appendix
5.1
Measure
Exclusion
Attestation Requirements:
NUMERATOR / DENOMINATOR
20
5.2
Measure
Exclusion
Attestation Requirements:
DENOMINATOR / NUMERATOR / THRESHOLD / EXCLUSION
DENOMINATOR: Number of unique patients with office visits seen by the EP during
the EHR reporting period.
NUMERATOR: Number of patients in the denominator who were provided patientspecific education resources identified by the Certified EHR Technology.
THRESHOLD: The resulting percentage must be more than 10 percent in order for
an EP to meet this measure.
EXCLUSION: Any EP who has no office visits during the EHR reporting period.
21