Hospital Systems, Ancillary Services, and Physician Practices are often the focus of HIT initiatives. While these settings are key areas for HIT advancement and data acquisition, there are places within the continuum of care that often lack automation or comprehensive data management strategies, creating gaps in the longitudinal health record and both an individual and population level.

The Final Project allows you to develop a comprehensive IT strategy for one of these settings of care. This week you choose the Scenario for your Final Project from the following list. Descriptions of these settings can be found in your Learning Resources. Beginning this week, you will be building on the progressive HIT topics that culminate in your Final Project (due in Week 11). This week?s Assignment asks you to reflect on your setting of choice as you develop a Charter for the acquisition of a strategic HIT solution.

To Prepare for this Assignment:

Review the Final Project Scenarios in your Learning Resources and select a setting of care from one of these scenarios:

Long-Term Care

Critical Access Hospital

Telemedicine for Rural-Based Health Facility

Research current and specific clinical and financial management problems in these settings of care and evaluate how technology might be justified to address the most pressing challenges.

The Assignment:

Write a 3- to 4-page (excluding title and reference pages) APA style paper, addressing the following elements for the scenario that you choose. This will also be the scenario used to complete your Final Project. For this Assignment, address the elements of a project Charter used to plan the acquisition of an HIT solution for the setting of choice. The Charter should include:

Problem statement. A specific statement of the problems that you intend to address in this scenario using technology solutions.

Scope of the HIT solution to be acquired. This includes both the technical elements of the scope and the business and clinical functional elements of the scope.

Stakeholders analysis including the needs of both internal and external stakeholders. This analysis includes a summary of the business and clinical system functions that the technology should address for each of the executive stakeholders.

Risk Analysis. A specific statement of the financial, technical, legal, ethical, and operational risks involved in introducing HIT into this setting and the feasible mitigation strategies to address these risks.

You will continue the Charter in Week 4 and submit the full Charter on Day 7 of Week 4.

Note: The paper should be 3?4 pages, not including the title and reference pages. Your Assignment must be written in standard edited English. Be sure to support your work with 4?6 specific citations from this week?s Learning Resources and additional scholarly sources as appropriate. Refer to the Essential Guide to APA Style for Walden Students to ensure that your in-text citations and reference list are correct. Your Assignment should show effective application of triangulation of content and resources to show your conclusion and recommendations. See the Week 4 Assignment Rubric for additional requirements related to research and scholarly writing

Determining the (TCO) or total cost of ownership for a strategic information system investment is a critical part of the leaders' role in using technology in a transforming way. The Return on Investment Analysis depends upon reliable estimates of both the capital outlay and ongoing operational costs associated with the initiative over a period of time. This Assignment focuses on outlining both the capital and ongoing operational costs associated with a typical technology investment. You will outline the costs and, as importantly, the assumptions that you used in deriving these financial estimates.

To prepare:

Review the Pro Forma Explanation Material and HIT Program Pro Forma Template in the Learning Resources.

The Assignment:

Write a 2-page APA style paper, addressing the following elements for the scenario that you chose in Week 3. This will also be the scenario used to complete your Final Project. For this Assignment, address the financial element of the project Charter used to plan the acquisition of an HIT solution for the setting of choice. The financial analysis has two parts:

Using the HIT Pro Forma Template provided in your Learning resources, complete the anticipated capital and operating costs of the HIT solution that you are proposing in the Week 3 Assignment.

Justify the assumptions that you used in your proforma.

Submit the entire project Charter inclusive of Week 3?s materials and Week 4?s HIT Pro Forma Template and assumptions paper.

Final Project Scenarios Long-Term Care Bethany Place is a 40-bed independent long-term care facility in the Pacific Northwest. They have existed for over 50 years having come from a faith-based background. With good investments and sound financial management, Bethany place has grown and is executing a capital strategic plan. They are expanding their 40-bed facility to purchase a nearby resident facility and expand into rehabilitative care, adding another 30 beds. They are approximately six months away from receiving the appropriate certificates and regulatory approvals as a rehabilitative care facility for both chronic care patients and recovery of acute head injury. The rehabilitation facility and renovations to the independent long-term care facility are scheduled to begin in the next six months and be executed over an 18-month period. Currently Bethany place has no electronic medical record. There is a third-party service that is used to scan and send automated claims to Medicare and private insurers. A local desktop IT services company was recently contracted to provide managed services to Bethany place and provides the website email and local desktop applications for staff. As part of this initiative a robust new IT network design was implemented for both Bethany place and the anticipated rehabilitation facility. The lack of an electronic health record at Bethany place has created quality issues and risk management issues particularly related to medication reconciliation with patient transfers. The board and senior leadership have asked the Bethany place management to evaluate information technology options in the form of an electronic medical record, and patient management application(s) for both Bethany place and the rehabilitation extension facility as part of executing the strategic plan. Critical Access Hospital Electronic Health Record Bedford Hospital is a 25-bed hospital in rural Pennsylvania. They have recently completed the process of being designated by CMS (Centers for Medicare and Medicaid) a CAH (critical access hospital). Prior to this designation they were part of a large academic health center but have since divested from that health center. As part of that agreement their current electronic health record contract, which is with Cerner Corporation as part of that medical center's enterprise agreement, will be expiring in 24 months. Currently all aspects of Cerner's inpatient product are implemented including documentation, orders, decision support and electronic meds administration. Cerner's registration admissions discharge scheduling and patient identification products are also part of this agreement as are the laboratory radiology and pharmacy systems. 2016 Laureate Education, Inc. Page 1 of 2 While Bedford Hospital was part of the academic center the Cerner product suite was financially supported as part of the overall corporate structure. As part of the divestiture agreement, the academic center has agreed to support Bedford's Cerner systems in total for a 24-month period, absorbing the Cerner software and enterprise hardware costs in that timeframe. Bedford Hospital is taking financial responsibility for three IT staff and day-to-day IT costs such as networks devices email and Internet costs. The CEO and CFO of Bedford Hospital have pulled together an interdisciplinary team to examine the technology options for Bedford Hospital after this 24-month period. Telemedicine for Rural-Based Health Facility Canon hospital is a 189-bed hospital in rural Texas. The hospital is approximately 100 miles and 150 miles away from two major medical centers of excellence in Texas. As the CIO of Canon Hospital, you are aware that there are capabilities to do telemedicine programs with tertiary care centers. Two of the senior medical staff in the critical care and neurology departments at Canon Hospital have approached you to investigate telemedicine capabilities related to the management of ICU patients and the emergency management of patients presenting with stroke symptoms. These medical leaders would like to ideally preserve the appropriate services for ICU patients and rehabilitative services for stroke patients in the canon hospital community. They recognize that portions of these treatment plans must include certified critical care and stroke certified providers from a tertiary care center. They have ask you to examine both the business and technical aspects of establishing telemedicine programs with one or two of the tertiary care centers who have certified specialists in critical care and stroke certified physicians who can administer TPA and other urgent stroke treatments. Currently Canon hospital is transferring over half of the ICU patients and virtually all of the patients who are presenting with stroke symptoms to these to either of these tertiary centers. There is little to no follow up on those patients with regard to treatment plans or services. In many cases, patients and caregivers are relocated for step down and rehabilitative care to facilities outside of the Canon hospital area. This creates both high level of dissatisfaction for patients and families and revenue loss for canon hospital and its associated rehabilitation facilities. 2016 Laureate Education, Inc. Page 2 of 2 Week 4 Assignment Rubric CATEGORY Charter: Plan the acquisition (30 points possible) Risk Analysis (30 points possible) EXCELLENT - above expectations The Charter shows depth, breath, triangulation, and clarity in critical thinking when addressing the problem statement, scope of the HIT solution, and stakeholder analysis. GOOD - met expectations FAIR - below expectations The Charter fully addresses the problem statement, scope of the HIT solution, and stakeholder analysis. The Charter lacks depth, breath, triangulation, and clarity in critical thinking when addressing the problem statement, scope of the HIT solution, and stakeholder analysis. (27-30 points) (24-26 points) The risk analysis shows depth, breath, triangulation, and clarity in critical thinking concerning the risk and mitigation strategies to address the risk. The risk analysis fully addresses the risk and mitigation strategies to address the risk. Triangulation was attempted but not fully addressed. Triangulation was attempted but not fully addressed. (27-30 points) POOR - significantly below expectations or missing The charter does not address (zero points) or poorly addresses the problem statement, scope of the HIT solution, and stakeholder analysis. (21-23 points ) (0-20 points) The risk analysis lacks depth, breath, triangulation and clarity in critical thinking concerning the risk and mitigation strategies to address the risk. The risk analysis does not address (zero points) or poorly the risk and mitigation strategies to address the risk. (0-20 points) (21-23 points ) (24-26 points) Writing (15 points possible) The paper is well organized, uses scholarly tone, contains original writing and proper paraphrasing, follows APA style, contains very few or no writing and/or spelling errors, and is fully consistent with graduate level writing style. The work is supported by the Learning Resources and more than three additional scholarly sources. The paper is mostly consistent with graduate level writing style and may have some spelling, APA, and writing errors. The paper is somewhat consistent with graduate level writing style and may have some spelling, APA, and writing errors. The paper is well below graduate level writing style expectations for organization, scholarly tone, APA style, and writing, or shows heavy reliance on quoting. The work is supported by the Learning Resources and at least three additional scholarly sources. The work is supported by the Learning Resources and less than three additional scholarly sources. The work is not supported by the Learning Resources or additional scholarly sources. The paper is 3-4 pages plus a title and a reference page. The paper is not 3-4 pages plus a title and a reference page. The paper is not 3-4 pages plus a title and a reference page. (12-13 points) (10-11 points) (0-9 points) The paper is 3-4 pages plus a title and a reference page. (13-15 points) 2016 Laureate Education, Inc. Page 1 of 1 HIT Program Pro Forma Template Scope of Technology Implemenation: Software Licensing Terms: FY '01 Capital Costs (one time costs that can be depreciated) Consulting Services Vendor or Third Party Implementation Salaries Database Software Hardware CostsServers & Devices Network CostsAdditional Network Needed Licensed SoftwareVendor & Third Party Software Capital Totals Operating Costs (annual recurring costs) Software Maintenance/Support Hardware Maintenance/Support Physician Salary Support Support/Post Production Salaries (IT & Other) Travel/Training Other Operating Totals Grand Totals (Capital & Operating) FY - Fiscal Year FY '02 $0 $0 $0 $0 $0 FY '03 FY '04 FY '05 Totals $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Pro Forma Explanation Material There are two types of costs to consider planning the HIT program pro forma. These two types of costs are capital costs and operating costs. While the accounting definition of these costs varies depending upon the organization, the general definition of these costs are capital costs (being one-time expenses) and operational costs (being ongoing or reoccurring cost of the program). The HIT Program Pro Forma Template provides the opportunity to estimate both capital and operating costs for an HIT program. The following information is a description of each line item on the HIT Program Pro Forma Template. Keep in mind that as you are working through these costs on a year-by-year basis that you are working diligently with teams of stakeholders to best estimates these costs. Therefore, your cost estimates will be generally more accurate for the first fiscal year and second fiscal year of the program and be more vague as the fiscal years of the project go out into subsequent years. For this reason, the HIT program pro forma is updated often, based on new information and changes in the program environment. Capital costs generally consist of the following categories: consultative services, implementation salaries, database software, hardware costs, network costs, and other licensed software costs. The following is a description of the meaning of each of these line item categories on the HIT Program Pro Forma Template. Keep in mind that if your organization organizes capital costs in a different way or asks you to capitalize costs under your program that fall outside of these categories you can add additional rows to your program pro forma file. Consulting services vendor or third-party: Often the help of external consultants from either the HIT vendor or another third-party are used in order to implement systems. Often, these costs are significant at the early stages of a project and are capitalized by an organization. It is possible, as the program progresses, that the chief financial officer of the organization may ask that these costs be moved into operating expenses. A solid understanding of the scope of the project and the project plan enables organizations to have an idea of how to estimate consulting costs. Most accounting rules do not allow organizations to capitalize travel associated with consultants. Thus, these costs will typically only involve the hourly rate paid to the consulting company for the consultants. Implementation salaries: Often, chief financial officers of an organization will allow or prefer that internal staff salaries that are associated with implementing the program to be capitalized with the program. This is an internal decision; it is permitted by General Accounting Principles. If the organization prefers that this be the case, planners work with leaders in the organization to estimate a blended rate for different kinds of staff who are working on the implementation and estimate their hours to come up with the implementation salaries cost estimate. 2016 Laureate Education, Inc. Page 1 of 4 Database software: Often organizations purchase software from vendors and have to pay separate software licenses for the database product that runs the vendor applications. For example, if a site purchases an electronic health record from Cerner Corporation they may need to buy associated Oracle licenses for its use. These details need to be clarified with the vendor and HIT staff. If this is the case, this line item is included to record the usually significant licensing costs associated with licensing a database. If this database cost is estimated at the \"per user\" rate then the program planner must provide an estimate of the number of users who will be on the system every year and multiply by that per user cost to get this line item estimate. Hardware costs, servers, and devices: There are many types of devices required to implement different kinds of solutions in the healthcare environment. If any of these devices are purchased by the organization as a depreciable asset then these costs should be noted as capital costs. This may include, but would not be limited to, desktops, laptops, printers, scanners, thumbprint login devices, and other peripherals. Network costs: Senior network engineering staff work with project and program planners to determine what kind of network requirements are necessary to run planned solutions in the healthcare environment. Network assessment should be conducted to ensure that the expected service that is assumed as part of the program is aligned with current network capabilities. Additional network hardware and or bandwidth may need to be purchased in order to execute the program. These costs should be estimated as closely as possible for the entire program and updated as information progresses. Licensed software-vendor and third-party software: Often HIT program solutions in healthcare involve significant capital purchases from vendor suppliers. Depending upon the terms of the contract with these vendors these costs may be loaded into early years of the project or they may be paid out in increments over the life of the program and associated with milestones. The planner who is executing the pro forma must include the cost of all licensed software including any kinds of software products that are needed to run other software products or desktops and servers. Operational costs generally consist of the following categories: Software maintenance and support, hardware maintenance and support, physician salary support, postproduction support salaries, travel training, and other. The following is a description of each of these operational cost items. Keep in mind that these operational costs may reside in different organizational budget throughout the organization. Having said that, often senior leaders want to see all of the capital and operational costs associated with an HIT program in one place in order to manage these significant investments. 2016 Laureate Education, Inc. Page 2 of 4 Software maintenance support: The software that is being licensed in the capital area will need to be supported on an ongoing basis. Often those support costs \"kick in\" after a license is paid and the software has been installed for a year. Solutions vary in how they are priced and sold to organizations. It is important for the organizational planner to understand when those software maintenance and support fees \"kick in\" in the lifecycle of a program. Hardware maintenance and support: Similar to software, when hardware is purchased whether it be servers running in a data center or desktop computers or printers, there are often support fees associated with keeping those hardware products up and running and supported on an ongoing basis. Sometimes organizations don't even purchase hardware. They may \"lease\" hardware products such as desktops. If this were the case, then the estimated leasing fees for those desktops per year would be inserted in this part of the program pro forma. Physician salary support: Sometimes, but not always, organizations make a financial commitment to cover internal salary costs of physicians when they are working on significant program efforts. Organizations do this because they want to have the ability to pull those physicians out of clinical service for a period of time and have them focus on an HIT program. If this is the case, this is the place where those salary estimates would be inserted. Keep in mind that any time you are estimating salaries in a pro forma, whether it be capital or operating, you most likely will work with leadership to determine a \"blended\" salary rate for an average personnel cost and use that rate in your pro forma. Also, keep in mind that a typical salary year is budgeted at 2,080 hours per year per full-time individual. Support and postproduction salaries: Similarly, this line item is used to record any and all other salaries needed to support the program on an ongoing basis. This line item requires significant work in that one has to understand all of the different individuals, skill sets, and compensation levels of those individuals that go into supporting the technology that is being implemented. Sometimes individual efforts are budgeted at a full-time effort for an entire year; other times portions of people's time is budgeted on these programs from a support perspective. Travel training: Accounting rules prevent two itemstravel and training costs from being recorded as capital expenses. Salaries associated with training people on new HIT systems and any travel associated with training or implementation staffs must be recorded as operating costs. Training may include training of IT staff as well as training of end-users. Other: Many other types of costs may come into play when planning a program. For example, there may be outside legal costs incurred, or there may be marketing costs involved if a program includes patient facing applications that 2016 Laureate Education, Inc. Page 3 of 4 require a marketing campaign. Any other capital or operating costs should be included in the pro forma and aggregated for each year to understand a total program cost. 2016 Laureate Education, Inc. Page 4 of 4 Running header: TELEMEDICINE FOR RURAL HEALTH FACILITY TELEMEDICINE FOR RURAL HEALTH FACILITY Student's Name: Institution: 1 TELEMEDICINE FOR RURAL HEALTH FACILITY 2 Introduction The nature of care in modern health is extraordinarily impacted by the sort of innovation that is utilized as a part of the distinctive fields of telemedicine. Telemedicine innovation regularly is a way to bolster or provide care or is utilized as a fundamental measure in advanced medical care in conjunction with different advancements. Telemedicine utilizes systems of PCs, camcorders and phone contacts to connect patients with doctors or other medicinal experts. Telehealth has been hailed as a particular state of the art approach to give quality and improved care to individuals living in remote places (Yap, 2015). Under telemedicine framework, since patients and their doctor can interact with distant specialists, they can use diagnostics that they might not have ordinarily gained access to. The innovative extent of telemedicine may extend from a specific store-and-forward innovation to a two-way TV framework or a full teleconsultation system. Week three Problem statement: Canon hospital is currently serving an extensive area. However, the facility's efforts are hampered by the lack of efficient telemedicine infrastructure. The resulting inefficiency has adversely impacted service delivery in its neurology and critical care divisions. To make matter even worse, the facility has not been able to make follow-ups. As one measures to avoid the recurrence of such unfortunate events in the future, Canon hospital intends to introduce a rehabilitation program for stroke patients to bolster follow-ups. However, this is not enough; the facility must introduce a robust telemedicine infrastructure that includes the implementation of electronic stethoscopes as well as instituting strong telephone connectivity with its tertiary center as well as to facilitate the booking of appointment with its patients. TELEMEDICINE FOR RURAL HEALTH FACILITY 3 Therefore, in order to improve service delivery, the facility must implement an effective teleconsultation, electronic stethoscopes framework, increased telephony connectivity to improve referral to tertiary centers as well as bolster medical follow-ups. The scope of the IT solution: implementing an effective telemedicine framework is very demanding in terms of technical and clinical requirements. The staff needs to be trained in order for them to be able to handle the new technological aspects (Yap, 2015). For instance, a couple of the electronic stethoscopes available are referred to as digitizing stethoscopes since they change over the sound to an advanced sign. Such stethoscopes can transmit serialized sound information that can partake progressively or in synchronized forms. As such, trained staffs who know how to read such signals are able to interpret the data. Since Canon hospital does not have this equipment ready in place, the facility will have to procure the hardware and software components from local HIT vendors. For instance, teleconsultation framework is facilitated by using emerging trends such as teleconferencing. As such, the facility must procure computers to support this process as well as establish a robust network that will power faster and secure communication with the tertiary critical care centers and the patients. The facility must also establish a central server. This will serve the facility and its environs. The server will receive signals from the remote patient devices and transmit it to relevant divisions within the facility. However, in order to facilitate an efficient and smooth functioning, patching must be applied to the serves on a continues basis. As such, it demands that the facility must hire the services of IT expert whose responsibility is to carry out system maintenance (Cook & Do, 2014). TELEMEDICINE FOR RURAL HEALTH FACILITY 4 Stakeholder analysis: Effective acquisition entails involving the various interested parties in the change process. The Canon medicinal services framework is an interlocked system of patients, doctors, managers, controllers and different partners. A huge change affecting one segment will reshape the whole framework. Patients' view of the progressions will to a large degree rely on upon how they affect their consideration, their specialist, and their paycheck. Translating and demystifying the progressions for buyers will seem a continuous interchanges challenge. The new technology will increase doctor patient interaction in the sense that the doctor will be able to book an appointment with the patients with much ease. Given the fact that the facility is serving a wide area, some of the patients will have to travel longer to reach the facility. However, under the proposed framework, patients who are far from the facility can just book an appointment with a specialist and the doctor will be able to attend to the patients at his or her home setting (Yap, 2015). Correspondence with tertiary will improve thus boosting the referral rates to these facilities. Telemedicine seeks to improve the quality of healthcare. The reputation of stakeholders and the facility will improve due to higher referral rates, enhanced appointment booking system, and the provision of quality health care. As a result, the hospital's management will enjoy outright benefits that will result from the improved profits (Yap, 2015). When client understand the facility is interested in addressing their needs, they will develop higher loyalty for the facility. As such, Canon hospital is likely to benefit from its bases of a loyal customer who believes that the Canon hospital understands their needs, and it is willing to act on them in the most efficient way. TELEMEDICINE FOR RURAL HEALTH FACILITY 5 Risk Analysis: acquiring this system will cost the facility to the tune of $8.7 million. It is projected that Canon hospital will incur a total capital and operational expense of $3415000 and $5300000 respectively. This means that the facility will have to spend $8715000 during the first five years as indicated in the pro forma below. Although the initiative might seem expensive, it will be profitable in the long run. Adopting the initiative is in line with Canon's mission and vision that seeks to establish the facility as the leading health care provider in the entire rural Texas. From a technical perspective, the facility will benefit from the implementation of a robust telemedicine infrastructure that will see the hospital improve the delivery of its services. The rate of missed or canceled appointment that results out of poor patient/ doctor correspondence will reduce drastically. Generally, the benefits associated with the implementation of this new HIT outweigh the anticipated risk.[Don14] Therefore, the facility should consider implementing the Telehealth project. Week four HIT Program Pro Forma Template Scope of Technology Implementation: Software Licensing Terms: Capital Costs (one time costs that can be depreciated) Consulting Services Vendor or Third Party Implementation Salaries Database Software Hardware CostsServers & Devices Network CostsAdditional Network Needed Licensed SoftwareVendor & Third Party FY '01 FY '02 FY '03 FY '04 $ 10,000.00 $ 200,000.00 $ 300,000.00 $ 200,000.00 $ 300,000.00 $ $ 10,000.00 $ 10,000.00 $150,000.00 $100,000.00 $200,000.00 $150,000.00 $150,000.00 $100,000.00 $250,000.00 $ 85,000.00 $200,000.00 $ $ 10,000.00 $ 80,000.00 $ 100,000.00 $ 80,000.00 $ 100,000.00 $ TELEMEDICINE FOR RURAL HEALTH FACILITY 6 Software Capital Totals Operating Costs (annual recurring costs) Software Maintenance/Support Hardware Maintenance/Support Physician Salary Support Support/Post Production Salaries (IT & Other) Travel/Training Other Operating Totals Grand Totals (Capital & Operating) FY - Fiscal Year 100,000.00 $1,110,000 $ 50,000.00 $ 10,000.00 $ 600,000.00 $ 100,000.00 $ 20,000.00 $ 100,000.00 $880,000 $1,990,000 $845,000 $ 60,000.00 $ 20,000.00 70,000.00 $630,000 65,000.00 $435,000 $ 65,000.00 $ 30,000.00 $ 68,000.00 $ 40,000.00 $ 650,000.00 $ 400,000.00 $ 20,000.00 $ 100,000.00 $1,170,000 $1,605,000 $600,000.00 $650,000.00 $200,000.00 $ 20,000.00 $300,000.00 $ 20,000.00 $100,000.00 $920,000 $1,765,000 $100,000.00 $1,070,000 $1,700,000 In order to maintain a positive accounting practice, accountants must be able to make certain accounting assumptions. Without these assumptions, experts warn that firms will not be able to make predictions that are quantifiable in the long run (Bragg, 2007). As such, with assumptions, Canon will be able to predict of the HIT is worth adopting or not. The key assumptions seek to state how Canon hospital operates. As such, they provide fundamental structures on how the facility will record the particulars in the pro forma. In the event that these assumptions are not to be treated as the absolute truth, then the figures in the pro forma need to be adjusted to fit into the assumptions as outlined below. The same accounting method has to be used throughout the entire evaluation process. Consistency assumption seeks to maintain uniformity during accounting practice. If consistency assumption is no maintained, then the financial functions in the pro forma are fluctuating. As such, it is not a good accounting practice to prepare financial statements that are not uniform (Bragg, 2007). TELEMEDICINE FOR RURAL HEALTH FACILITY 7 Treating Canon as an economic entity is another fundamental assumption made here. This assumption seeks to state those transactions that belong to Canon as well as its owners. In good accounting practice, it is not appropriate to mix the two. A financial statement such as a pro forma will only feature those transactions that belong to the business alone. These transactions are in financial terms. Another assumption made is the reliability assumption. In this regard, all the figures regarded in the pro forma are treated as reliable transactions. A reliable transaction refers to those expensed that are justifiable in the long run. If reliability assumption is not factored in, then it means that the accounting procedures adopted by the facility artificially accelerate profitability by bolstering revenue in the short run. The period assumption is another fundamental assumption. The capital and expense figures are recorded over a consistent and uniform period.[Ken16] However, it is anticipated that capital expenses will decrease as time progresses. To the contrary, expense, on the other hand, will be increasing on an annual basis. Other miscellaneous assumptions include; Consulting Services Vendor or Third Party, traveling fee and other expenses are constant throughout the fiscal year. The rest of the capital expenses except Consulting Services Vendor or Third Party Fee reduce progressively. All expenses except for travel and another miscellaneous fee will be increasing progressively. b TELEMEDICINE FOR RURAL HEALTH FACILITY 8 References Bragg, S. (2007). Management accounting best practices. Hoboken, N.J.: John Wiley & Sons. Cook, S. & Do, Q. (2014). MBSE-Supported System Acquisition. INSIGHT, 17(4), 40-42. http://dx.doi.org/10.1002/inst.201417440 Yap, J. (2015). Coherency and Completeness in TeleHealth / Coherencia e Integridad en \"TeleHealth.\"Int J Integr Care, 15(8). http://dx.doi.org/10.5334/ijic.2401 Caldwell, D. H. (2014 ). U.S. health law and policy, 2001 : a guide to... by Donald H Caldwell . Chicago: Health Forum. Drude, K. P. (2016). Career paths in telemental health. Switzerland: Springer. TELEMEDICINE FOR RURAL HEALTH FACILITY 9