7324: Case Study - ELECTRONIC HEALTH RECORD - Assessment – Answer

November 21, 2018
Author : Sara Lanning

Solution Code: 1GJG

Question: Case Study

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Case Study

Case Scenario/ Task

ELECTRONIC HEALTH RECORD NEW RELEASE AND EXPANSION OF FUNCTIONALITY –

CHANGE MANAGEMENT AND STRATEGY EXECUTION PROJECT PLAN FOR THE MOUNT

PLEASANT HOSPITAL

INTRODUCTION

You are the newly appointed manager of the hospital’s clinical redesign and education unit. You have

been recently approached by the management of your hospital about the new release of the software

for electronic health records. This release will involve significant new functionality to that which is

currently provided. There will be new software, hardware required as well as a large change

management requirement.

The new functionality in particular addresses requirements for some of the key specialties including

cardiology and respiratory. New pathways are also being built into the EMR to aid with the

management of stroke, cardiology and hip fracture in line with current guidelines. The new release of

software will expand the amount of information currently shared with polyclinics and community based

service programs.

In order to ensure that the implementation of the new software release is a success, the hospital

executive want to provide funding to your unit for a project. The project funding will assist with

preparing staff education, clinical pathways and any other necessary task that you identify as

necessary.

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Solution: Case Study

PROBLEM STATEMENT

The storage and retrieval of patient information, summed up as records management, is a crucial determinant of improving patient service delivery at the hospital. The current records management operations at the hospital are paper based. This means that all patient information is stored in paper files that are stored on shelves for future retrieval. First, we must acknowledge that with such a system of managing patient records, retrieving records is a task that requires relatively more effort and time. The Mount Pleasant Hospital is a big facility that serves many patients, which means that the scale of patient records management can be overwhelming. When a returning patient comes to seek medical services at the facility, their file has to be searched among thousands of physical paper-based files that are placed on shelves. Even with advanced library management skills, the challenge of delivering fast access to information on paper-based record management systems will persist (Svärd, 2013).

It is also nearly impossible to achieve fast and efficient information exchange with relevant stakeholders. We understand that sharing of medical records within the different departments of a polyclinic, or even among different health providers can immensely help improve service delivery and patient satisfaction. If such exchange of patient information should occur, it must be done securely – patient privacy is paramount in a health service system. However, if we exchange patient records through the paper files, we face a significant risk of having the information land in the wrong hands every time such a need arises. With these considerations, we can see that Mount Pleasant Hospital is facing a problem with delivering efficient and satisfactory services to patients as a result of the challenges that arise from manual handling of records at the hospital. The problem that Mount Pleasant Hospital faces with regard to managing patient records can be described as slow, inefficient and unsecured storage and retrieval of patient records.

 

PROJECT MISSION STATEMENT

The purpose of the project is to design and develop an electronic records management system for Mount Pleasant Hospital. It will deliver a system that will be an important and central part of improving patient experience and satisfaction.

PROJECT GOALS, OBJECTIVES AND STRATEGIES

Project goal

The goal of the project is delivering an electronic records management system for Mount Pleasant Hospital.

Project objectives

The following are the objectives of the project:

  1. Define the patient records management problem at Mount Pleasant Hospital and prescribe a solution to it.
  2. Design, develop, and maintain the proposed electronic medical records system.
  3. Conduct staff training on the new system to ensure its effective use.
  4. Present the project brief and deliverables to the Executive project staff

          Project strategies

Objective 1: Define the patient records management problem at Mount Pleasant Hospital and prescribe a solution to it.

Strategies Key performance indicators Outcomes
Clearly identify what the records management situation is A clear idea of the records management situation is available A clear scope of the problem is established
Properly define the problem A specific problem statement is available Scope of problems gets well identified

Objective 2: Design, develop, and maintain the proposed electronic medical records system.

Strategies Key performance indicators Outcomes
Develop a fully functional electronic medical records system An EMR with all expected functionalities is available Improved records management at the hospital
Develop an intuitive records management interface to facilitate easy use of the system An easy-to-use interface of the system is delivered Faster records entry and retrieval

Objective 3: Conduct staff training on the new system to ensure its effective use.

Strategies Key performance indicators Outcomes
Develop comprehensive documentation including a user manual for the system User manual and relevant documentation available Maximum use of the developed system
Develop an intuitive records management interface to facilitate easy use of the system A simple interface for entering or reading records is available Improved patient satisfaction

DELIVERABLES

At the end of the project, we will deliver a fully functional electronic medical records management system that shall comprise of hardware and software systems and trained users. With this delivery, we can expect that Mount Pleasant Hospital will convert from manual to electronic management of records immediately. Along the development of the project, we shall be submitting progressive deliverables to the executive project staff. These deliverables will be made available at the end of every sub-stage of the development. The purpose of the deliverables will be to ensure that the project is working as scheduled. The following shall be the progressive and final project deliverables:

  1. Problem statement
  2. Scope of project statement
  3. Work breakdown structure
  4. Risk analysis and contingency plan document
  5. Required project resources statement
  6. Project budget and cash flow document
  7. Staff training module/ plan/ documentation
  8. Fully functional electronic records management system

WORK BREAKDOWN STRUCTURE

Project plan section Tasks involved
Project initiation and system analysis ·         Defining problem statement

·         Defining the scope of the problem

·         Establishing the mission of the project

·         Collecting system requirements

·         Defining project goals, objectives and strategies

Requirements analysis ·         Identifying functional requirements of the system

·         Identifying non-functional requirements of the system

Stakeholder analysis ·         Identifying key project stakeholders

·         Identifying stakeholder communication requirements

Project resource requirements ·         Identifying project resource requirements

·         Estimating project budget

Risk analysis ·         Performing risk assessment

·         Developing a contingency management plan

RISK AND CONTINGENCY PLAN

As with every project, we are faced with potential risks that can arise in the course of the project and cause undesirable outcomes. A risk is an unforeseeable event which, if it occurs, will have a significant impact on the project. Project risks can be positive or negative depending on the impact that they are likely to cause on the project. If risks occur, there is a likelihood that the project may not be delivered as scheduled. Therefore there is a need to perform a risk analysis and develop a contingency plan for the identified risks. The risk analysis identifies potential risks and their impacts on the project. Efficient project risk management is an essential competency for every project manager (Gemünden & Aubry, 2015). The following are risks that are likely to occur in the project:

  1. Project delay

Project delays can result from an ill-defined scope (Hydari, 2015). An ill-defined scope can lead to significant delay of individual project tasks which is likely to affect the entire project schedule. If this risk occurs, it will cause undesirable outcomes such as an increased wage bill since project staff will work on the project for longer.

  1. Changes in scope of the project

A change in scope of the project after the project has started is a common IT project risk (Teller, Kock & Gemünden, 2014). After project development has commenced, stakeholders may start seeing new possibilities that can be delivered by the system. They can subsequently request to add features to the functionality of the system. This risk can cause the project to overrun its budget and time schedule. It can also cause the final system to become loosely integrated since some functionality of the system may have not been defined in the core of the system but only as add-ons.

  1. Key stakeholder turnover

If an indispensable stakeholder such as the system administrator leaves while the implementation is still new at Mount Pleasant Hospital, the system support staff and other system users may experience massive difficulty running the new system. If this risk occurs, patient service delivery may get worse than it was before the introduction of EMR since they will have already developed a reliance on the system.

  1. Communication overhead

Although wide consultation is highly desirable in the project, when key project staff unconsciously spend most of their time consulting, they may eventually become unable to deliver their project tasks in time.

  1. Inaccurate or conflicting expectations by users/ stakeholders

If the major stakeholders at Mount Pleasant Hospital who requested the development of the project do not have a clear understanding of how EMRs work, they might raise inaccurate expectations. If they raise inaccurate expectations, the project will be developed according to those expectations and the stakeholders may come to realize, only at the end of the project, that that is not what they wanted. At this point it might be too late to change the project.

Now that we have identified several potential risks, it would be appropriate to assess them. The table below shows the risk assessment for the above identified risks.

Table: Risk assessment

Potential risk Causes Chance Impact Contingency plan
·    Project delay Ill-defined scope, Moderate High Comprehensively define project tasks, properly define project scope
·    Changes in project scope Lack of in-depth understanding of EMR systems functionality High High Ensure that all stakeholders are broadly educated on the full functionalities of EMR systems
·    Key stakeholder turnover Various reasons Moderate High Follow well-know conventions so that final deliverable is a standard easily understandable system, Provide proper project documentation that any competent person can use to manage the system
·    Communication overhead Unclear expectations Moderate Moderate Extensively engage stakeholders and address all foreseeable issues before commencement of project
·    Inaccurate expectations Lack of in-depth understanding of EMR systems functionality Moderate High Educate the key stakeholders on what EMR systems can and cannot do

 

 

PROJECT RESOURCES REQUIRED

We will need human, financial and technical resources to successfully develop and maintain the project. The following resources will be required to deliver the final product.

Resource Quantity
Project manager 1
Project administrators 3
Other project staff 7
Computers and peripherals 20
Stationery and office supplies For 4 people
Communication equipment  

To cover hospital radius

PROJECT MANAGEMENT STRUCTURE

The project will be headed by a project manager and a team of three project administrators. There will also be other stakeholders from the hospital fraternity including senior and junior staff representatives. The project management structure, with regard to communication and coordination, will be networked as opposed to hierarchical. The following are all the likely project stakeholders.

  1. Project manager: They will be in charge of the overall project. They will appoint the project administrators and other project staff
  2. Project administrators: They will be in charge of coordinating specific units of the project such as hardware deployment, software development, software installation and user training.
  3. Other project staff: They include the technicians who will do the actual development or customisation of the software and hardware installations.
  4. Mount Pleasant Hospital management representatives: They are the clients and project initiators. They will specify the system's functional requirements.
  5. Mount Pleasant Hospital junior staff: They will be the main system users after the project is completed. They will provide the non-functional requirements of the system.
  6. BUDGET AND CASHFLOW

    Project budget

    Labour costs Project manager Project coordinators Other project staff Total
    Number of people employed 1 3 7 11
    Number of weeks employed 15 15 12 42
    Hourly rate of pay 50 50 40 140
    Hours per week employed 40 40 40 120
    Base pay 30,000 90,000 134,400 254,400
    Superannuation at 5% 1,500 4,500 6,720 12,720
    Sub total
    Professional development 200 200
    Sub total 31,500 94,500 141,320 267,320
    Payroll tax at 5% 1,575 4,725 7,066 13,336
    Total labour costs 64,575 193,725 289,706 548,006

Non-labour costs Total
Hardware equipment 470,000
Safety equipment and training 5,000
Meetings 3,000
Communication (phone and Internet connection) 4,300
Overhead costs 2,000
Stationery and office supplies 1,000
Total 485,300
   

 

Total project costs 1,033,306

NB: All costs are expressed in AUD

 

Project cashflow

  July August September October Total
No. of days in the month 31 31 30 31 123
Project total of 15 weeks (15x7=105) 31 31 30 13 105
Days in the month as a percentage total 29.5% 29.5% 28.5% 12.4%
 
Project office first 3 weeks (3x7=21) 21
  68% 0 0 0
Project manager 19,049 19,049 18,403 8,007 64,575
Project coordinators 57,148 57,148 55,211 24,021 193,725
Other project staff 85,463 85,463 82,566 35,923 289,706
Total labour budget 161,660 161,660 156,180 67,951 548,006

 

Non-labour budget July August September October Total
Hardware equipment 470,000 0 0 0 470,000
Safety equipment and training 5,000 0 0 0 5,000
Meetings 750 750 750 750 3,000
Communication (phone and Internet connection) 1,000 1,300 1000 1000 4,300
Overhead costs 2,000 0 0 0 2,000
Stationery and office supplies 500 500 0 0 1,000
Total non labour budget          

 

  July August September October Total
Total labour budget 161,660 161,660 156,180 67,951 548,006
Total non-labour budget 479,250 2,550 1,750 1,750 485,300
Total budget 640,910 164,210 157,930 69,701 1,033,306

 

COMMUNICATIONS AND REPORTING

We will be holding periodical meetings with Mount Pleasant Hospital management representatives, who are the key stakeholders. At the meetings, we will be submitting the deliverables that were earlier identified to the key stakeholders. We will accept feedback from these stakeholders but the feedback will only be used to improve the remaining sections of the project. The deliverable meetings will be composed of the project manager, all the three project administrators and at least two key stakeholders from the hospital's management. The meetings shall be based on milestones and not on time. The following  table summarizes the main communications required in the project.

Communications Stakeholders involved Frequency Medium
Presenting deliverables Project manager, administrators, management representatives Upon completion of deliverable as scheduled Boardroom meetings
Discussing milestones Project manager, administrators, management representatives Every fortnight Online collaboration, boardroom meetings
Emergency communications Any stakeholders As demand arises Boardroom meetings, email
Status updates Project manager, management representatives Every fortnight Online collaboration
Final project launch All key stakeholders, users, staff Upon completion of project Launching event

 

Appendix

Budget

The project will require a one-time financing of a sum of AUD 752,420. The project will be exclusively financed by the management of Mount Pleasant Hospital.

Item Cost estimates
Project staff salaries AUD 548,006
Hardware equipment AUD 470,000
Safety equipment and training AUD 5,000
Meetings AUD 3,000
Communication (phone and Internet connection) AUD 4,300
Overhead costs AUD 2,000
Stationery and office supplies AUD 1,000
TOTAL AUD 1,033,306

  • Budget assumptions

  1. Project plan is developed in three weeks, project is proposed to be developed in three months
  2. Average hourly rate is AUD 50 for the project manager and administrators; and AUD 40 for the other project staff
  3. Work is done on a regular shift eight hours a day, five days per week.
  4. Employer contributes 5% of pay to superannuation
  5. Saturday and Sunday are not working days

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