Extended Cases does not account for the requirement to leave no blanks in the transcription. Work slows down even more. At this point, the backlog has grown and Maria must outsource some of the transcription work to catch up. She finds a vendor who promises great turnaround time, excellent quality, and competitive pricing. To engage with the vendor, Maria develops a business associate agreement (BAA). She also ensures the vendor can access the hospital's IT system. When the BAA is ap- proved and signed by all parties and IT establishes a virtual private network (VPN), the vendor begins work. Soon, it becomes clear that the vendor is able to meet quality and turnaround time standards for the workload at a much lower cost than the on-site staff. The chief financial officer (CFO) met with Maria and indicated that a decision had been made to outsource all transcription services beginning in one month. 1. Using Kotter's change management process steps, propose a better way Maria could have handled the initial transcription staff consolidation. 2. Present one factor that was key to the transcription staff merger's failure. Support your opinion. 3. Predict how this change process may have evolved differently if Maria had previous experience as a director. 4. Theorize how Maria could have used Gloria and the other lead transcriptionists to achieve the desired results in a more advantageous manner. 5. Develop a BAA for the transcription services. Provide insight as to why a BAA is necessary. 6. Propose three security elements that should be implemented as part of the VPN and elaborate on each. Resources Amatayakul, M. 2017. Health IT and EHRs Principles and Practice. 6th ed. Chicago: AHIMA. Gordon L. 2020. Leadership. Chapter 19 in Health Information Technology An Applied Approach, 6th ed. N. B. Sayles and L. Gordon, eds. Chicago: AHIMA. Rinehart-Thompson, L. A. 2018. Introduction to Health Information Privacy and Security, 2nd ed. Chicago: AHIMA. Rinehart-Thompson, L. A. 2017. HIPAA Privacy Rule Part I. Chapter 10 in Fundamentals of Law for Health Informatics and Information Management, 3rd ed. M. S. Brodnik, L. A. Rinehart-Thompson, and R. B. Reynolds, eds. Chicago: AHIMA. Shaw P. L. and D. Carter. 2019. Quality and Performance Improvement in Healthcare: A Tool for Programmed Learning, 7th ed. Chicago: AHIMA.Chapter 7 7.4 Merging and outsourcing transcription services Competency Il.1 Competency 11.2 6 Competency V.2 6 6 Competency VI.1 6 Competency VI.2 B G 6 6 Competency VI.3 Maria is the new director of HIM at Beechwood City Hospital. This is her first director position. When she started work, she was directed to consolidate the on-site transcription staff across the radiology, pathology, and HIM departments. A consultant determined that cross-training staff, implementing industry leading productivity standards for line count, and offering an incentive for achieving goals beyond the productivity standard would save the hospital over $150,000 per year. Currently, each of the department transcription groups has its own lead transcriptionist and each has a different dictation system. Consolidating the services will result in one lead position and create substantial savings. Additionally, the consultant found that based on the lines of dicta- tion in all the departments and the industry leading productivity standards, the organization has more transcriptionists than necessary. Merging the transcription services into one central service and increasing productivity would mean terminating a minimum of four full-time transcription- ists, which would create additional cost savings. Finally, consolidating all transcription under one system will net an annual savings of $250,000 in software licenses and maintenance. Maria is reluctant to inform the transcription staff about the impending job losses for fear that many of the transcriptionists may be nervous enough to look for positions elsewhere, leaving the hospital in a bind. She begins the process by informing all the transcriptionists of the consolida- tion and puts Gloria, her HIM lead transcriptionist, in charge of the combined team. Without sharing any of the rationale for her changes, Maria has the other two transcriptionists who were leads begin cross training the staff in their specialties. She does not change their job status since they are performing the cross training, so no cost savings are realized. Gloria is put in charge of training radiologists and pathologists on the HIM dictation system. Staff are slow to adapt to the differences in transcribing reports for radiology and pathology, so productivity decreases. Physicians complain about reports not being available in a timely man- ner. Meanwhile, training the radiologists and pathologists on the HIM system is also slow. Those departments' physicians do not understand why there is a change, and Gloria cannot answer their questions. Many of them continue to use the legacy system to dictate. When Maria tries to implement the new productivity standards, the transcriptionists complain that the new requirement of 1,500 lines per day with 65-characters per line (including spaces)