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Company Background

College Point Medical Hospital is a small rural hospital
with approximately 150 inpatient beds. The hospital opened in April, 1989. The
hospital has gone through about 5 CEOs, 2 in the last 10 years. The hospital has
about 1000 employees which includes clinical staff, administrative staff and
maintenance 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 rural
hospital, it faces a lot of struggles. Being that rural hospitals are smaller than
urban hospital and are low on funding, they tend to struggle more than well-funded
institutions. Struggling to stay afloat, the hospital attempted to update their
information systems. The system was installed to change the way they kept track
of medical records, scheduled appointments, recorded test results, schedule
operations, and patient demographics. Once the system was installed, the
medical staff and administrative staff were not trained adequately causing the
system not to function at its full potential.

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Because of the employees not knowing the system as well as
they should, they were committing a large number of medical errors. Patient
information was being confused with other patients. Patient information was
being left out in the open for anyone to see. The data was also not being
entered into the system. Being that they have to enter it into two different
systems, it was not being entered to one or the other. Which was effecting the
patient turn out. Who wants to go to a hospital that is known for making
mistakes? This was also causing a large employee turn around. Nurses and
physicians were leaving the institution due to the lack of organization,
inadequate forms of tracking and keeping patient information. Just like no one
wants to be treated at a medical center that is known for errors, no one wants
to be associated with working at a hospital that is known for being error
prone.  

Sharing of user names and passwords, created a large amount
of errors. The medical center was not able to track who was entering the wrong
information. The computer system was open for anyone to use without a sign in
and password, making it even harder to track. Staff members were also looking
up patient information that did not pertain to the job, which is a HIPPA
violation. Patient records were being printed and left in the printer. These
were not patient printers and anyone could come by and take a look a private
information.  A number of patient records
were mailed out to the wrong patients.

After the institution receive a large amount of funding by
the government for being in the most need and the appointment of new CEO, the
institution decided to revamp the already installed information systems. Retrain
employees to gain complete use of the system and its resources. By doing this
renovation, the CEO hopes to improve services. By being a more organized
institution and improving a once error prone facility to a trust worthy
hospital.

Before going live with the new system, all employees are to
be trained in a 3 week course. The understanding of the system is very
important in order for it to work to its full potential. The training of all
employees and any updates the systems needs with take an approximate 6-12
months.   Being that the hospital is not as large as other
hospitals, we are hoping to complete the process 6-8 months.

 

Business Problem

            The
problem with the information system are quite a few. The first one is large
amount of data collected and keeping it secured. Lack of security software
installation when the original system was implemented. In adequate knowledge of
the system and its need to protect the information that is collected. Hence,
the HIPPA regulations that were also not addressed appropriately to the employees
regarding the new system. The shortcomings cause a large breach of information
for the hospital. Patient data was compromised.

            Information
being entered into the system was not being secured adequately. The institution
was not following HIPPA regulations to it full capacity, at when it had to do
with electronic information. Staff members were sharing user names and
passwords. There was no real way to track who entered what, since user names
were being shared.

            Lack of
communication between their systems. College Point Medical Center had an
admission system that was working quite well for them but they had an issue
with getting both systems to communication with each other. This issue was very
time consuming because nurses and clerical staff would have to enter the
patient information twice. Some of the time the information would only get
entered once due to urgency of the patient’s needs. Possibly causing errors
when entering the data for the second time if entered at all.

            Inadequate
training of the systems to clinical staff and administrative staff. Clinic
staff was the least trained due to the fact that they had to be shown how to
use the system in between seeing patients. This occurred due to the nursing
shortage and lack of funds. The physicians only received training for the
basics, in other words, just the area they would use most. The administrated
staff was trained but not tested. Some employees trained well and understood
the system but other did not. Since the hospital could not afford more training
or testing to ensure understanding. Due to the scarcity of funding, the
institution ended the training program with hope that the employees would teach
each other. They did not provide any refresher courses. They were given a very
large manual by the company who created and installed the system but it was not
written for individuals who are not in that industry.

 

Solution

Health Information Systems resources: these include the
legislative, regulatory and planning frameworks required for a fully
functioning health information system, and the resources that are required for
such a system to be functional. Such resources involve personnel, financing,
logistics support, information and communications technology (ICT), and
coordinating mechanisms within and between the six components. Indicators a
core set of indicators and related targets is the basis for a health
information system plan and strategy. Indicators need to encompass determinants
of 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 population
surveys) and (2) institution-based data (individual records, service records
and resource records). A number of data-collection approaches and sources do
not fit into either of the above main categories but can provide important
information that may not be available elsewhere. These include occasional
health surveys, research, and information produced by community based organizations
(Jaen, 2011).

Data Management this covers all aspects of data handling
from collection, storage, quality-assurance and flow, to processing,
compilation and analysis. Information Products

Data must be transformed into
information that will become the basis for evidence and knowledge to shape
health action. Dissemination and use the value of health information is enhanced
by making it readily accessible to decision-makers and by providing incentives
for, or otherwise facilitating, information use (http://phinnetwork.org/resources/health-information-systems-his/).

By using cloud storage computing making collecting, storing
and processing data easier and cheaper. Increasingly leveraging big data to
dive actionable insights and improve cyber threat detection (Beesly, 2016). The
more the data grows the harder it is to keep secure. Protecting computations in
distributed programming frameworks, to address this challenge recommendations
are to use authentication to establish initial trust (Beesly, 2016).  Non-relational data stores such as NoSQL
databases tend not to have robust security (Beesly, 2016).

Apply encryption to protect passwords and safeguard data
while at rest and use transport layer security for in-transit data. To expose susceptibilities
caused by irrelevant input validation in NoSQL, use invalid, unexpected, or
random inputs by deploying dumb fuzzing and smart fuzzing strategies (Beesly,
2016). Dumb fuzzing as the name suggests, works without having any knowledge
about the data that it is mutating.  Smart
fuzzing does exactly the same thing but in a very different way. The difference
is 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 the
confidentiality, integrity and availability of the electronic Patient Health
Information (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 training
will also take place alongside the health information systems training courses.

We will be
assigning staff member who need access to patient information specific
printers. To reduce the amount of access to patient information that may be
forgotten after it is printed. The staff will be able to fax reports to outside
physicians straight for the system. There will be no need to print and then
fax, this will also reduce the amount of paper used. Any orders the patient
will need can be entered into the system and the system will communicate that
to the corresponding department. Staff members will only have access to
patients in their department or physician they work with. If a department needs
to schedule for another department, an over write will have to take place by
supervisor. These are just a few of the new features in the improved HIS.

Outside
medical records will be scanned in with a bar code that will place the document
in the corresponding folders, such as, lab work, radiology, surgery, outside
physician notes and insurance. Any scans that are done at an outside facility
can 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 in
CD format.

Along with the
HIS training, all staff member will also be going through a HIPPA training
course. 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 require
needed to access the system.  A notice
will go out automatically six weeks before its due date. If it is done by the
week prior to the due date, a notice will be sent to each employee’s
manager/supervisor. Supervisor must ensure the course is taken. As for the
clinicians, the same process will apply only it will go to the department Chief
or Chairman.

Training will
take place for end users in a phase introduction. Focusing on building their
know-how and certainty to use the system completely in their role. The training
services is an important part of the implementation of the new system. Support
services will be provided to the end users with a working knowledge of details
and effective use of the new information system. The organizations training
program is created according to the needs of the institution. It will be
specific to the timeframes and requirements of the organization. All employees
will be trained with unlimited training days. New employees will go through a 3
week training process prior to starting in their position. In other words, the
employee will determine with they feel comfortable using the systems. Online
training manuals will be created according to the institution’s policies and
procedures. Complete online training will also be provided. An interactive test
system incorporates platforms enhancements and modification for refresher
training opportunities.

 

Benefits

The main goal of installing a new Healthcare Information
System (HIS) is to prove the most outstanding support to the treatment of
patient and concomitant administration by electronic data processing.  HIS will encompass following functionalities
that will facilitate computerization of the treatment process that follows the
patient flow though the health care institution.  Scheduling, admission of patients, keeping
electronic medical records and prescriptions. The system will also be able give
printable documents in accordance to HIPPA regulations. A look into the history
of diagnosis and access to complete history of patient treatment. Ensured data
security through assigning a set of roles for each user with specified rights
on data access and actions in the system
(HIS Implementation Guide, 2012).

Dispersed
data entry for electronic invoicing to the National Hospital Insurance Fund
(NHIF) at all points where healthcare services, supplies and drugs are provided
to the patient. The possibility of producing a centralized electronic invoice
with unified validation system, as was as the capacity to export gathered data
in standard XML format, for possible imports in to the special software for
invoicing (HIS Implementation Guide, 2012).  The expected benefits of the HIS development
in College Point Medical Hospital are better quality of patient care,
improvement of the efficiency of the hospital management, improvement in
information quality and reduction in operating costs.

Being that
user names and passwords will no longer be shared, we can accurately know who
is entering what in the system. We are creating one user name and password for
all systems, including just signing into your computer.

We plan on
making the system live within the six months. Starting with the smallest department
as the “test run” but it will be live. We will roll out the system by
department. The smaller departments will be first. By doing this we can iron
any possible kinks that may come up. This way we do not have to have a complete
shut down if anything goes wrong. One department at a time, will be best. We
can roll out the system in 8 weeks trial runs per department. Expecting that
per department, we find more kinks along the way before we run the system in
the entire hospital.

 

Technical Approach

In order to implement strongly the new HIS, it is required
to conduct change management process that will assist the hospital in preparing
the organization for the control of new tools and working environment. The
elements that are involved in HIS implementation through change management
process: social and technical factors. The exchange among the technical and
social elements is decided by four factors: structure, people, technology and
processes (Cresswell, 2013).  The social
factor is more important than the technical factor. People play an important
part in the success or failure of any change process. It is vital that the
change management include precautionary activities related to challenges
correlated with the acceptance of the system by the end user. It is important
that risks are identified, understood and managed (Cresswell, 2013). 

Changes in work flow: HIS implementation has always a bang
on the hospital workflows and the range of this impact relies on its intricacy.
 Therefore, complex work actions placed
before the introduction of HIS should be redesigned and adjusted in order for
medical staff to do their jobs effectively through the use of the system. Some
jobs will be performed faster, whereas some will consume more time, especially
while there is the obligation to keep both paper and electronic records (HIS
Implementation Guide, 2012).

Staff training and technical support: initial HIS
implementation is not enough for the organization to reach the necessary goals.
These types of systems will not flourish properly unless the proper training is
given to the end users. Onsite technical support and refreshers are required
for IT and the user to feel comfortable in using the new system (Chae, 2012).  Providing an onsite technical team, that knows
the system’s ins and outs to help the staff learn the system well. Also, a
technical team onsite will help when the system is down and the hospital’s IT
department is not really familiar with the system, the technical team can
assist where the IT cannot.

 

Implementation
Plan

Although the implementation plan will be a long process and
require a lot of training, we will try our best to get it up and running as
quickly as possible. HIS implementation will be carried out by the team
prepared for the hospital staff (end-user) training and configuration of HIS according
to the hospital needs (Jaen, 2011).  Project
team will submit, in timely manner, the list of necessary data, code lists and
information that hospital has to provide to the Project at the very beginning
of the HIS implementation (2011).  The
total duration of the planned HIS implementation process takes usually six to
twelve months.  

The HIS implementation will be conducted through following
phases, in accordance with the best practices: (1) HIS installation and initial
training, (2) practical HIS training – test environment, (3) support for HIS
production environment, depending on the size of the institution, (4) subsequent
training for the additional HIS functionalities related to Electronic Health
Record, conducted upon HIS implementation.  All phases are susceptible to change, in
accordance with the number of end users and actual situation in particular
hospital (HIS implementation guide).

            Patient
scheduling and the patient records will all speak with each other. Comments can
be 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 section
will 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 physician
will received and email stating results are available. This will also show up
in the patient’s consultation notes.

Since it will take three to four months to go live, we will
be using the remainder months for running small departments first. We will
attempt 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 the
next department. We will include HIPPA regulation course as part of running the
system live. Everyone must have completed the course prior to going live with
the system.

By implementing this plan, the HIS will help the hospital
run more efficiently. Having access to the correct patient information and the
most updated information will help the clinicians provide better service to
their patients. It is very important that clinicians and administrative staff
be trained to know the ins and outs of the system. Granted this will take a
sometime but in the long run it will work out for the best.

 

Summary

The HIS
implementation describes how the information system will be installed and how
training will take place.  The plan
contains a brief review of the problem, a brief description of the major tasks
involved in the implementation, the overall resources needed to support the implementation
effort.  The plan is developed during the
resign phase and is updated during the installation phase; the final version is
provided in the integration and test phase and is used for guidance during the
implementation phase. Before running the system live, we will make sure the
staff is fully trained on HIPPA regulations. This will be a requirement for the
use of HIS, with an annual refresher course.  

The HIS system will
communicate a number of information between the clinical and the administrative
part of the system. Patient scheduling will be connected to the patient orders.
Physicians, nurses and administrative staff will be able to see all past
appointments. Staff members will only be able to access medical records that
pertain to their specific job. Anything or than that, must be approved by a
supervisor with a physician or nurse’s order.

The system will be
able to track everything from what computer the person log-in, to time, date
and person. No more sharing of user names and passwords. The computers and
printer must be patient information accessible or the staff member will not be
able to access any patient information. This will keep patient information safe
from exposure to any misuse of personal information.

We will start in
the smallest department as a test run. Then we will run it for about 4 weeks
and iron out any kinks that may occur. Then we will move to the next
department. While seeing how the system runs, we will see if we can start to
run more than one department at a time. The HIS should be up and running in the
whole hospital by 8th month of the process.

 

Conclusion

 In this paper, it is
described how the implementation of HIS in a healthcare organization is a
process. The organization is affected by the coming of new technology. With the
implementation of this new system, we believe it will increase the value of
services and increase revenue. The HIS system will make the institute organized
and provided better service and reduce errors. College Point Medical Hospital
will benefit extremely from the systems upgrade.  Once this system is up and running and the
staff members are fully trained, the hospital will be running in a more efficient
manner. The institution will be more organized. The medical records of patient
will be easily accessible. Test results will be all in one place, easy to find
and can be printed or faxed it needed. The staff will have the access to their
patients records all in one place.  The
clinical and administrative staff will be much happier with the organization.
Therefore, provide better service to their patients. By providing better
service, revenue will increase. With the hospital producing better service and
more income, they can have money for renovations, more qualified staff members.

 

 

 

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