Midwest Regional Hospital (fictional) is a 500-bed general medical and surgical facility with 25,000 admissions and 7,500 annual inpatient and 17,500 outpatient surgeries annually. Its emergency room has 52,000 visits each year. It is a non- profit hospital that treats both adult and child patients. Over 1,200 nurses, technicians, doctors, and physicians practice at the hospital. An electronic health record (EHR) is an electronic version of a patient's medical history that is maintained by the provider over time and may include all of the key administrative clinical data relevant to that person's care, including demo- graphics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR automates access to this information, and the more sophisticated versions of EHR software can also produce an online "digital chart" that displays up-to-date patient information in real time, complete with decision support tools for physicians and nurses. One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one healthcare organization, including laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics. Midwest Hospital was an early pioneer in the adoption of EHR software, implementing the technology in 2004. Unfortunately, the vendor that Midwest selected has not been able to keep up with evolving regulatory requirements and the changing needs of its healthcare clients. Its software is fast becoming obsolete, and it is rumored that the firm will soon eliminate support of its software. You have been hired as a consultant to lead a project to replace the original software with software from one of the current leading EHR software providers Allscripts, Cerner Corporation, or Epic Systems Corporation.

Critical Thinking Questions

1. The hospital administrators have made it clear to you that the software vendor must be chosen and the software installed as soon as possible. What measures do you feel comfortable taking to accelerate the process without raising the risk of choosing the wrong software or having a rough system start-up?

2. A safety-critical system is one whose failure or misuse may cause human injury or death. Given that an EHR system can be considered to be such a sys- tem, which tasks associated with software implementation deserve special attention?