HCA620 Hospital Systems Electronic Medical Record (EMR)

HCA620 Hospital Systems Electronic Medical Record (EMR)

Executive Summary

“Time is of the essence.” Centers for Medicare and Medicaid Services (CMS) mandated Electronic Medical Record (EMR) Incentive Program enforcement began last year, 2015.  This means for eligible health care providers that failed to comply with CMS’s reimbursement penalty is in effect.  HCA620 hospital systems understand the timing and criticality of the EMR implementation from both patient care and regulatory perspectives.  This project team, composed of Noelle Powell and Jean Hung, prepared an EMR implementation plan for the leadership team to effectively complete EMR deployment in the following 8-12 months of 2016.  Detailed timeline and project milestone is presented in section 8 of the implementation plan. 

Beyond governmental mandate, EMR implementation proved to offer solid economic benefits.  Based on information obtained from American Heart Association (AHA), the average EMR deployment cost in 2014 for a 200 bed healthcare system, was between $2.9 million to $4.1 million (AHA, 2015).  The average Return on Investment (ROI) based on 5 year study is approximately 25.8% (see Implementation/Operational plan for costing information). Preliminary

Our research of EMR deployment indicated the use of turn-key solution to be advantageous particularly for smaller hospital system, in where the in-house IT resources may be limited.  The turn-key solution offers experience and know-how to this complex undertaking.  Most turn-key services provide software and hardware selection and costing, deployment personnel, data reconciliation and integration, system turn-up and testing, user training and on-going application maintenance and support.  Preceding the Request for Proposal (RFP) process, management buy-in will be secured for the turn-key solution. 

Finally, our research indicated that the community served, e.g., inner-city demography, has limited access and requirement to Patient Health Record (PHR). Therefore, the planned EMR deployment will follow a phased approach.  Hospital deployment will be introduced first, followed by network of clinics and offering of PHR for public access will be the final phase. 

Goals/Objectives

The objective of this document is to present the overall EMR implementation strategy for HCA620 hospital systems.  The planning and recommendation set forth in this documentation are critical and timely to successful transition of EMR for the hospital systems.

Management Team

The HCA620 Hospital Corporation is located in Any-City, USA.  The hospital system was started by thirty Primary Care Physicians (PCPs).  HCA620 Hospital Corporation is a privately owned and operated, not-for-profit hospital system. The hospital systems includes a 200-bed hospital and 4 clinics operating the same community.  It includes one hospital and four clinics dispersed throughout the service area.  This document represents the EMR implementation plan for the hospital system.  It addressed eight areas of the implementations which include:

1. Current Environment Assessment:  cultural, literacy and language concerns
2. Selection of the vendor for the EMR software
3. Hardware and Real Estate-Related Cost Estimates
4. Integration with any current electronic data sources (imaging, laboratory, dictation, billing, quality software systems)
5. Staffing for design, implementation, training, future support
6. Staff training
7. Physician training
8. Timelines for design, implementation, testing, training

Implementation/Operational Plan

Current Environment Assessment:  Cultural, and Language Concerns

            According to the Office of the National Coordinator (ONC), for Health Information Technology,  the “assessment phase is foundational to all other EHR implementation steps, and involves determining if the practice is ready to make the change from paper records to electronic health records (EHRs), or to upgrade their current system to a new certified version”.  HCA620 is a smaller hospital system operating in the inner city.  The demographics of patient base is a mixed racial and ethnic population.  Approximately 60% of the residents are minorities and live below the poverty line.  A major portion of the residents are foreign born and whose language preference is other than English.  Majority of the residents live in apartments and are in close proximity.  Most of the patients of HCA620 hospital’s system have either private or state funded insurances. 

HCA620 hospital was at one time a city-owned hospital due to lack of funding was slated for closure.  A group of thirty dedicated medical doctors who have practices in the area came together and purchased the failing hospital from the city.  15 years ago, HCA620 hospital was reborn.  In keeping the goal of the founding doctors, the hospital was there to serve the community however, funding from billing and documentation from insurance and governmental sources continued to be a problem.  Although most of the patient’s records, were “computerized”, the records are remain separated by health provider’s locations and by practice. In effect, the same patient record can appear in several different databases, e.g., one record in the MD’s office and another one in the hospital’s radiology department.  The only way to transfer the patient information is either by fax or physical transport.  The problem is exacerbated by the language confusion.  Often there are multiple identifiers for the same patient due to misspelling of name and date of birth.  All these resulting in delay in diagnosis and missed revenue.

The management team at HCA620 understands the need for EMR implementation for the hospital and its 4 satellite clinics.  Through the management savvy of the board members, the hospital system was granted collateralized loan by the Inner City governance board to proceed with the hospital-wide E………

Selection of the vendor for the EMR software

Based on our research of industry statistics, for a smaller hospital system like HCA620, economy of scale favors a “turn-key” EMR implementation solution (AHS, 2016).  Using the RFP process approved by CMS, the project team will present to hospital’s Board of Directors, EMR vendor implementation proposal and cost estimates (see project schedule and milestone for details) based on turn-key solution.  This solution is adopted to reduce EMR turn-up time and personnel resources.  The project team recommended outsourcing of Information Technology (IT) portion of software and hardware support which includes initial software and hardware sourcing, testing and turn-up through on-going system hosting and maintenance.  Staff training and network and on-site application support will remain with HCA620 in-house staff. The proposed RFP procedures are compliant to current

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