Running head: WEEK 7 ASSIGNMENT 1

Week 7 Assignment

Eduardo De Jesus Escobar

Florida National University

Management Practices for the 21st Century

MAR5829

Dr. Ernesto Gonzalez, Ph.D.

October 21, 2015

WEEK 7 ASSIGNMENT 2

Week 7 Assignment

Introduction

The continuous search for improvement of processes and offer of new products and

services in the market has led various sectors to invest ever-escalating figures in information

systems (IS) and, more broadly, in information technology (IT). According to Lunardi, Becker

and Trouble (2003), some sectors have invested significant sums as a way to account for the

competition and the commercial rivalries. Supported systems in technology are becoming a

significant component in almost all companies do, and verification of benefits related to

investment in technology is an increasingly important aspect of the process of adoption of these

systems. In the area of health, the investment in technological innovation is the rule. The typical

innovation concerns the high technology sophistication, as computed tomography, magnetic

resonance imaging, and digital x-rays. It is complex equipment that is operated by highly skilled

and dedicated professionals. The use of the equipment is the end-activity of these professionals

and does not intervene in organizational routines, and the difficulties of adoption can be

associated with the training of these professionals. Unlike this situation, innovation in

information systems, in General, poses other difficulties that can result in its rejection by users.

Typically, the use of an SI intervenes in work processes and does not constitute the end-activity

of a health professional. It is marked by Tulu, Horan and Burkhard (2005) to establish the

compatibility of working practices has a strong influence on acceptance of medical systems. The

implementation of LMR and CPOE is a big task that requires the involvement of health

professionals, IT and other IS centers. It has successfully implemented all across the hospitals

and resulted in increased performance in hospitals. This report discusses the implementation of
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this technological intervention and success and challenges associated with adopting this swift

mode of health care system i.e. LMR and CPOE (Kesner, 2009).

Discussion

1. What was the culture of PHS clinical decision making before the advent of its LMR and

CPOE of systems?

Historically, few health care organizations employ a team of network engineers highly able

to provide it services, simply because they weren't needed. Now, the entire public health system

is being digitally linked by placing a greater burden on the net than ever before. The hospitals

will have a tremendous need of experienced engineers to implement and support the increase in

volume and security requirements of EMR systems data. These engineers will need to understand

the process and business needs of medical care, beyond technology.

With the implementation of the regulations of EMR, some hospitals and clinics will

close, due to the fact that they cannot afford the resources to achieve compliance. This will result

in large mergers of hospitals, which will have huge impacts on the IT engineers, when they

attempt to combine different systems of monitoring of patients, and with no downtime. Access to

critical systems of EMR and CPOE will be required for all parts of the hospital, as well as to

affiliated organizations, using the WAN. The volume of traffic in hospital networks will continue

to increase up to new levels, with network engineers struggling to ensure that the network

infrastructure can keep pace.

The problems of application performance facing the reception at the front and rear of the

hospital or in the patient rooms will become more than just an inconvenience: they can threaten

lives. This means that engineers will need to be more than reactive troubleshooters. They must
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monitor the system proactively and take action when performance degradation occurs, before it

impacts the doctors and the patient's treatment (Kesner, 2009).

2. How has the enterprise-wide rollout of LMR and CPOE changed core health care

delivery business process?

The healthcare industry is undergoing tremendous change, due to automation of treatment

of patients, which is causing enormous impacts on organizations. The entire system that controls

the interaction between health professionals and patients is evolving dramatically, and will have

a large impact on the way a hospital does business (Butler, 2007).

Instead of tracking patients with a folder of files and Clipboard, many hospitals and

clinics have to adopt the use of electronic medical records (EMR). A fully implemented EMR

system allows the storage, retrieval and modification of electronic patient information, allowing

the departments within the healthcare organization collaborate by providing the treatment. In

hospitals and clinics, these EMR systems with federal support (in the United States and Canada)

will replace hundreds of different applications used by physicians, radiology personnel and even

hospitals ' administrations. There is tremendous pressure on it departments to implement and

support the EMR systems, allowing hospitals and clinics if the worth of incentive programs and

stimulus money (Kesner, 2009).

The radiology departments are eliminating the old film-based equipment and are now

using archiving and communication Systems (PACS) to store, display and transfer electronically

large digital images to any Department or organization that may need them. The clinics are

tending to the software as a service (SaaS) and remote hosting services to support these systems

of patients, rather than bear the cost of taking them to their facilities.
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Mobility continues to tend to increase in medical care because doctors employ tablets on

patients ' bedside to access the Medical order entry systems (CPOE) Computer. These requests

are reported by the network to medical staff in other departments, such as radiology, giving them

instructions for the treatment of a specific patient. After these large images are captured, they are

stored and made available for examination by the doctor, even in the patient's room

3. What challenges did the leadership of PHS need to overcome to achieve the sweeping

transformation of core processes wrought by access to a patient’s longitudinal medical

record and clinical decision support systems?

(Smith, 2013, pp. 68-69) Mentions several steps to cater change management for bringing

about CPOE/EHR to an organization these include training and motivation seminars are essential

to the development of this program, healthcare professionals need to be motivated to participate

in the designing process. This is the only way to ensure that problems that can only be identified

by people using the system are targeted and removed as much as possible. Motivation seminars

include educating the doctors about the benefits of using CPOE/EHR not only for themselves but

the patients involved. It can be believed that healthcare professionals have the will to help people

in their hearts when they are entering this field. Calling on their motivation to bring the best

solution to the patient they can be convinced to switch to this system (Butler, 2007).

Secondly a very important aspect of convincing an organization to accept CPOE/EHR as

into their system is to convince their leaders about the effectiveness of the system first. Before it

can be achieved, it is essential to perform a change readiness assessment. This includes

conducting a workshop where all the leaders of the team are invited, and a brief seminar is

conducted. Further in a post seminar session brief interviews are conducted with individual

members so that their change readiness can be evaluated. Here questions are asked about their
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understanding of the system and how it will affect their workflow as well the workflow of their

subordinates. If the leaders understand the process and can deliver a compelling argument to

their subordinates, the task of the project management team becomes easier. This also presents

the opportunity for the team leaders to assess the CPOE transition team and see if they are

competent and skilled enough to lead them through a tough time of transition.

Further PHS contacted medical insurance companies and cut a deal with them to pass on

financial benefit of improving the system through which a lower number of health hazard cases

will arise. As people enter adulthood they are less likely to accept change as they become

accustomed to the norms of their life and consider it easier to follow routine practices rather than

adapt to a new system. A financial benefit along with the promise of better healthcare is usually

sufficient for most of the healthcare professionals to transfer to a system which may seem

cumbersome at first but ultimately is beneficial for all parties involved. It can be safely assumed

that all healthcare professionals enter the field with the intent of helping out people in general in

their mind. Hence when offered a solution which not only provides better quality of healthcare

but also prevents excessive preventable financial burdens all the while providing them with a

system compiled with less overall errors they are likely to accept and welcome the change

(Kesner, 2009).

4. What circumstances contributed to the successful adoption of process change and new

information system across PHS?

It is inevitable for a group of hospitals to have doctors delocalized into private practice

clinics after hospital hours for maximizing their earnings. Further; surveys stipulate (McNamara,

Wong, Brown, & Pitt-Catsou, 2009, pp. 137-138) that adults at a mid or late stage of their
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careers are less likely to adopt change than their younger counterparts and hence offer resistance

to any new ideas. Setting up computers and large networking equipment which include

centralized data centers also carries significant costs with it and cannot be ignored when there is

a need for spreading a network over a whole city or a larger area. Additional costs are added by

logging of extra man hours required for training as training large portions of the staff will require

them to attend these sessions after their shifts are over. If small quantities of the staff are trained

it just means extra man hours being input by the training staff as they have to conduct multiple

training instead of one.

Any system that is divided into multiple levels of operations which are not completely

interlinked with each other at all levels is bound to have a multitude of redundancies. With a

manual system the chance of having this redundancies increase as it becomes increasingly

difficult to network with every component of the system and find out if there are any

unnecessary steps being taken (Kesner, 2009).

This need and circumstances made the introduction and implementation of process

change and information system across PHS.

5. What barriers existed at the time of implementation, and which barriers are remaining

after deployment ought to be a concern to PHS management?

The main trouble areas encountered by PHS during the feasibility testing included

convincing the healthcare professionals to switch to a system where they have to abandon their

current practices and switch over to CPOE. For the extent of this case study, we shall discuss the

fact that Partners HealthCare System had about a third of the doctors involved with the program

who were practicing medicine out of their offices and had no formal relation to the PHS
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program. (Kesner, 2010, p. 62) States that among the rest of the doctors who were affiliated with

PHS had a lot had their practices outside of the hospital.

To integrate this scattered mass of healthcare professionals into a singular system

required not only convincing but sufficient IT infrastructure and networking prowess. Among

the many different healthcare professionals who were affiliated with PHS but were running their

personal clinics as well a multitude of platforms were used for data logging. The project team

responsible for bringing CPOE/EHR to PHS had to consider this factor while designing the

system so that the existing platforms could be modified and networked into one system.

The healthcare professionals were welcoming to an IT based data entry system, however,

a significant portion had qualms about switching; having to perform data entry by healthcare

professionals during initial meetings with the patients was seen as disruptive and overly

cumbersome. There was also a significant cost of installing CPOE system at a healthcare

professional’s clinic and the “anti-kickback legislation” prevented any subsidizing of system

integration by PHS. (Kesner, 2009)

6. What are the implications of PHS transformation in the following areas:

1. The selection, training and performance management of PHS personnel.

This will expedite the performance of PHS personnel. However a heavy training program

will be needed to make the professionals learn and operate the electronic system

2. Collaboration among PHS personnel.

The transformation leads to high success rate with increased collaboration and

improved data sharing among healthcare professionals for successfully achieving the goals.

3. Ongoing quality management and measurement.

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First and foremost measuring success is a measure of improve in service quality for the

patients of PHS, this can simply be measured by the average wait time of patients during entry

and discharge to the hospital or clinic as well as quantifying the drop in bad prescriptions or

therapies recommended to them by accident or due to lack of information available. The data

provided by the statistical analysis becomes crucial at this point; it is of utmost importance that

the data is as error free as possible. Correct information about the expenditure on healthcare,

patient wait and discharge times and most essentially the success rate of medicinal procedures

and prescriptions is required to determine truly if the system has been implemented successfully.

4. The allocation of IT resources.

A large team of IT professionals was required to integrate the entire system of 6000 plus

medical professionals into one centralized system. A Large quantity of data was being generated

on daily basis and hence required not only constant sorting but filtration as well. This data came

not only from the patient visits but voluntary data submission by the patients from home. One

major concern with data generation at this scale is the potential of security lapse (Butler, 2007).

7. What are the challenges faced by PHS in implementing an enterprise-wide electronic

medical records system?

PHS had a preliminary stage of EHR system in place they called it Longitudinal Medical

Record (LMR), this system mimicked EHR and was aimed at producing similar results, however

since it was not forced to be followed by all constituent members of PHS it had limited

functionality. Once PHS decided to implement the CPOE system, it managed to extend its

existing LMR system, modifying it and bringing about improvements so that it may be

incorporated into the entire network of people connected to PHS. The biggest challenge was
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centralizing the patient record system so that all the different formats that were being used by the

healthcare professionals could be brought under one unified database.

All the IT projects had business sponsors and project managers, this personnel ensured

that the correct solution within the time limits and budgeted funds was reached. They guided the

projects by focusing of project needs and quantifying deliverables, so that target achievement

became a reality. It is important for the IT team to have adequate resources for their process

implementation; this requires dedicated trainers who are professionals in their job. A technician

or a software developer is just that, if they have great communication and training skills it can be

considered an bonus. However, it takes a professional trainer to be able to ascertain the amount

of information being provided to the trainees is not too much, to provide them the information in

a friendly and encouraging environment and that they will be able to store that amount of

information (Butler, 2007).

It is also essential for training material to be developed beforehand and be updated along

with the changes in the system. Web resources for self-training and self-help, guides and

individual coaching as required are some of the tools necessary for this program. Also required,

before training begins, is an adequate space for training the people involved. If such a space is

not available within the hospital premises it is suggested to hold the training sessions in training

rooms available outside it. Following the progress of the trainees through results being generated

in the system or otherwise is also an essential aspect of the training.

A large team of IT professionals was required to integrate the entire system of 6000 plus

medical professionals into one centralized system. A Large quantity of data was being generated

on daily basis and hence required not only constant sorting but filtration as well. This data came
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not only from the patient visits but voluntary data submission by the patients from home. One

major concern with data generation at this scale is the potential of security lapse (Kesner, 2009).

8. What are the challenges faced in establishing a decision support system to assist health

care providers in trading their patients?

However data cleanup will be required for clearer results, certain patients may have

responded very well to a procedure, but a group of patients with preexisting allergies or health

conditions can react to the same procedure in negative ways. A healthcare expert in that field can

then determine the accuracy of the procedure and the data that may be neglected or provided as a

precaution when implementing those medicinal procedures. For this purpose, it is essential that a

panel of healthcare experts is available with the statistical analysis team for their expert opinion

on the data found. If they find that the results being presented by the analysis are unlikely to

occur, they can order further research and analysis with preset conditions to see if the results can

be reproduced. This is an opportune time for the hospital to consider its existing set of criteria

concerning pharmacy and procedures if they find any shortfalls in the system they can be

identified and removed with the support of statistical analysis and a committee dedicated to

finding the best workflow pattern (Kesner, 2009).

9. From a project management perspective, which system deployment success factors are in

place and which factors appear to be absent?

The risks include a fear by the clerk/help desk level of employees that they would lose

their jobs, CPOE/EHR looks to automate the processes that this workforce is generally

performing. If the employees are not counseled about the process and reassigned new areas of
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work they are likely to cause negative sentiments about the system in their area of influence as

they will see the system as their replacement. It is essential to perform a change readiness

assessment before proceeding with system implementation so that there is a smooth transition

from one system to the other without any reaction from the people involved.

10. Does the IS unit's approach to the architectural design of the solution mitigate project risk

and contribute to a successful outcome? If so, explain how. If not, identify what is needed

to improve the situation.

By far the biggest risk involved in this process was the possibility of rejection from the

healthcare professionals for following this program if they failed to see a direct benefit to them

from using it. A secondary risk was healthcare professionals accepting suggestions from the

system without considering additional risks that the software had not calculated. This could

result in an actual increase in readmission rates which would reduce not only the quality of

healthcare being provided but also devalue the software from its benefits. Further there is always

a need of bypasses in the system for emergency cases and this could result in bypassing

occurring during instances of non-emergency which would make the installation of this system

ineffectual.

Some of the risks played out during the Cedars-Sinai CPOE implementation C. Connolly

claims in her article (2005, p. 148) that this was not a failure of the system but the failure of the

software being unable to deliver a user friendly intuitive interface that the physicians and nurses

could understand. Multiple orders were required to be placed by the doctors before the nurses

could get the information across to them. There was insufficient training and the administration

tried to convert too much of the system at once instead of compartmentalizing the process. These
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are all red flags in the world of CPOE/EHR as every one of these steps brings along with it its

own problems (Kesner, 2009).

11. Is there anything noteworthy in the IS unit's use of research and development centers? Do

these centers contribute to the initial success or to the ongoing value of the LMR/CPOE

investment?

For successful completion of this project, PHS required support from IS centers and

entire healthcare professional’s team to not only adopt the program but to help in the initiation

and programming phase for an improved result. It also sought the help of a professional IT and

networking team who could help it in setting up the systems required to implement a project on

such a huge scale. However it is essential to make the process grow instead of dumping the

whole system on the healthcare facility. By starting small problems that were not identified

during the system workflow redesign phase will crop up and can be eliminated as they come.

Introducing new tools a few at a time and integrating small portions of the hospital into the

system is the way to go as it prevents a massive communication and training storm which will

disrupt the process flow of the facility. By doing all this IS centers help in contributing to initial

success of LMR/CPOE (Kesner, 2009).

What are the operational IT and MIS challenges posed by the systems now in place for

the following groups:

PHS Management

If an IT organization of medical care does not make the necessary changes to the support

of EMR and CPOE, she will not survive the next few years. In many hospitals, implementing the
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EMR system internally will require a review on network infrastructure, on data warehouse and

application servers. Instead of taking this massive expenditure, some hospitals are considering

the use of hybrid or private cloud services to host the EMR system. Regardless of how the

service is hosted, scan data patients and make them safe and accessible to health care providers is

a huge task. Affiliated organizations outside the hospital will need to have access to patient data?

How you will share this data without violating the compliance with safety regulations? The

infrastructure is ready for a huge increase in traffic load? If a hospital or clinic is suffering

performance problems, this will have an impact on the ability of physicians to provide patient

treatment efficiently, which can make patients look for another location, which results in a loss

of income for the hospital.

PHS Health Care Practitioners

In part, the hospitals have long been at the forefront in the use of tablets and other

wireless devices. However, since these are used by doctors and nurses to drive EMR, CPOE

systems and basic care to patients, the increase in the volume of data and security requirements

will overload the wireless infrastructure, leading her to her limits of throughput and coverage.

This is especially the case when large medical imaging such as MRIs and x-rays are accessed

from the patient's room. With the influx of patients, such as iPads and smartphones,

organizations will need to consider how they can provide guest access and, at the same time,

keep the bandwidth for critical equipment from the hospital.

Health care practitioners and allied agencies (such as insurance companies and state and

federal agencies) who must interact with PHS.

The PHS IS organization.

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The Initial task of setting up the central data acquisition and storage system can take

approximately up to 6 months, however this may be entirely dependent on the existing IT

resources available to the project team, further decision supporting systems can be expected to be

up and running 5 months from project startup. The systems that evaluate successful practices and

learns from the current ones is expected to have an additional lead time of 6 months, however

seeing as it is an ever improving system it can be seen as an open ended process (Kesner,2009).

What are the total cost of ownership (TCO) implications of the overall LMR/CPOE

investment?

For initial phases of the system, an estimate of the expenditure required for the project is

made, this includes the IT hardware including the examination of existing resources and the

requirement for more resources as well as upgrading the existing resources as seen fit. It also

includes estimating the expenditure on training and motivation seminars which are essential to

the project success and the inclusion of additional man hours required for this training. It also

includes hiring any new IT or training related employees to conduct the proceedings. A big step

in the financial aspect of CPOE/EHR implementation is also acquiring the required financial

resources by convincing the leadership of the healthcare facility, and this can only be achieved

by convincing them of the positive aspects of the system. It is essential for the organization to

have a change ready leadership before these steps are taken as the shift to CPOE/EHR carries a

big cost along with it which may make it difficult for the project team to convince the leadership

if they are already not considering the solution as positive (Kesner, 2009).

If the system is successfully installed it is not only an improvement in healthcare service

provided to the people but it offers financial benefits to all parties involved. Through meetings

with medical insurance companies PHS negotiated improved earnings for the health care
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professionals as a better system will less incidents resulted in less insurance payouts. It also

provides cheaper medical procedures and medicine to the patients by analyzing the medicinal

and procedural trends and cutting the research times of new medicines and procedures among a

varied group of patients, this improves the overall satisfaction level of customers attracting

people to gain healthcare from that organization bringing in more patients and financial earnings.

However, the project had the potential of failing if it faced significant disinterest from

healthcare professionals, i.e. if they could not be convinced to switch over to this system. This is

a very realistic possibility if proper training and motivation seminars are not provided before and

during system implementation. Initially, the system may look like it is asking the healthcare

professionals to do the jobs of clerks as well as dispensing quality healthcare. The system may

increase the time, difficulty and amount of information a doctor has to input into it to perform

tasks that they previously performed manually, but it saves time by reducing the number of

clarification calls performed to ensure the correct test or medicine is being provided to the

patient. It may also look like it is taking the jobs of clerks out of the equation and rendering them

jobless. However through proper guidance and reassignment of duties the workforce can be

utilized in other areas and not lose their effectiveness in the system. In this scenario without

proper guidance and training the total cost of infrastructure, training, motivational seminars, and

all IT and networking personnel involved will fall on the parent group of hospitals that will see a

rise in healthcare costs at their facilities.

To perceive all financial matters the data required includes calculating the total drop in

erroneous prescriptions and medical procedures. An estimate of medical insurance payments

avoided and paid out to the healthcare professionals. And a complete data set of all the
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expenditure made on the project including employee salaries, networking equipment, over time

logged and training and motivation seminars.

This data may be gathered by having strict data entry protocol for all transactions

occurring within the hospital and clinics and offices of healthcare professionals. It also requires

regular statistical data analysis to provide number and figures containing average drop of

accidents correlating to the system installed. As well as having an organized bookkeeping

protocol during project implementation and related activities.

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Conclusion

Overall it can be stipulated that CPOE/EHR brings benefit to any organization that

decides to participate in the transition, the improvement in the quality of healthcare it brings to

an institution as well as the financial benefits that all parties can reap from it speak for itself. It

can be argued that CPOE/EHR is the leader of information management in healthcare, as it uses

the modern resources of IT and networking and utilizes the statistical tools available to perform

functions that were being done manually and were hence riddled with error. Its greatest

achievement, in bringing down the cost of medical research, may yet not be seen clearly by the

public in general and may not even be perceivable, but it does not doubt the future of healthcare

(Butler, 2007).
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Connolly, C. (2005, March 21). Cedars-Sinai Doctors Cling to Pen and Paper. Retrieved

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