You should construct a decision tree that includes one decision node (purchase a new EHR system) or maintain the status quo (retain the existing EHR system). There are the two EHR systems under consideration by Bright Road Health Care System, eMed and Patient Data System (PDS). For each EHR system under consideration, you, as the consultant, will be looking to determine the likelihood (probability) that the system will: fully meet the organizations needs; partially meet the organizations needs; or not meet the organizations needs. You will need to come up with the probabilities using information obtained from the scenario, as well as information gleaned from credible sources. In addition, you, as the consultant, will be expected to determine the expected outcomes (payoffs) associated with each alternative. The expected outcomes (payoffs) can be the total costs associated with each alternative, the net present value of the alternatives, the internal rate of return or modified internal rate of return, etc. Remember, all assumptions used to construct the decision tree and analyze the data should be supported.

The decision tree and other quantitative (financial) analyses used to support the recommendation should be performed using Microsoft Excel and the resulting information (findings) incorporated into the formal recommendation. The recommendation should be prepared as a Microsoft Word document, and then attached to the unit discussion thread. There is no minimum or maximum in terms of the word count; however, the response should explicitly address all required components of this discussion assignment. The document should be prepared consistent with the APA writing style (6^th edition) and reflect higher level cognitive processing (analysis, synthesis and or evaluation). The Excel spreadsheet used to perform the decision tree and other quantitative analyses should be uploaded into the unit discussion thread.

Health Care Delivery Learnscape 1: The New System The New System Introduction: Bright Road Health Care system has an outdated health records system. The Board of Directors of Bright Road is considering two new electronic health record (EHR) systems that could be implemented in all of its facilities. As a Health Care IT consultant, you will work with various team members at the corporate level to gather information and analyze the efficacy, safety/security/legal factors, cost effectiveness, and cost-benefit factors of each system. Based on this information, you will recommend which system Bright Road should implement. Your recommendation should also include a high-level implementation plan that considers system cutover and change management. Characters: 1. 2. 3. 4. 5. 6. Tanya Morales Robert Walker Kimberly O'Neill Tiffany Halpert Ken Bloom Ronald Baxter Locations: 1. 2. 3. 4. Student's Office Hospital Conference Room Chief Information Officer's Office Chief Administrative Officer's Office Health Care Delivery Learnscape 1 v3.0 October 10, 2012 1 Health Care Delivery Learnscape 1: The New System Scene 1: The New Project In this scene, the student meets with Tanya, their mentor, to learn about a new project with Bright Road Health Care Systems. The student gathers preliminary information about Bright Road's needs and expectations. Location Scene setup On-screen characters Off-screen characters Student's office The student's mentor is across the desk from the student. Tanya Morales N/A On screen text: Your colleague and mentor, Tanya, is here to discuss a new project with you. TANYA Good morning! Thank you for meeting with me. I have a really great project that I'd like you to work on. It's with Bright Road Health Care Systems. They're considering implementing a new electronic health records system. STUDENT OPTION 1 New? Are they currently keeping paper based patient records? STUDENT OPTION 2 Sounds interesting... Tell me more! STUDENT OPTION 3 Where do they want to implement it? Student can click any one of the three options to continue. TANYA RESPONSE Well, they do have an electronic system in place already. There's a terminal at all the nurses stations, but they're looking at expanding it so there's a terminal in every patient room. And the system will be centralized, so patient information will be accessible at ALL their facilities. STUDENT OPTION 1 Will the current system expand to accommodate their needs? STUDENT OPTION 2 Are they looking at getting an entirely new system? STUDENT OPTION 3 What systems have they researched? Student can click any one of the three to continue. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 2 Health Care Delivery Learnscape 1: The New System SCENE 1 TANYA RESPONSE Well, that's where they need your help. The Board of Directors has asked us to work with the Health Care System's staff members to gather information and make a recommendation. STUDENT OPTION 1 Okay. I can do that. STUDENT OPTION 2 Sure. To get started, I'll talk to his team to determine patient impact, personnel impact, facilities impact, and of course the financial impact. STUDENT OPTION 3 Great! First, I'll contact the CFO to talk about cost effectiveness. Student can click any one of the three to continue. TANYA RESPONSE 1 Alright. What's your plan? Response 1 kicks student back to options. TANYA RESPONSE 2 That sounds like a great plan! I'll send over a list of contacts for you. Response 2 moves student to next question. TANYA RESPONSE 3 Yes, cost is a big determining factor for implementation. But there are a lot of other factors that determine that. You may want to do a little research before speaking with the CFO. Response 3 kicks student back to options. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 3 Health Care Delivery Learnscape 1: The New System SCENE 1 On screen text: Shortly after Tanya leaves, you receive the email with the contacts for your project. Note: An email button flashes on screen for learner to click. EMAIL FROM TANYA You're going to enjoy this team. Here's the list of folks you'll be working with, along with their email addresses, so you can set up your meetings. If you have any questions at any time, let me know! Robert Walker, Chief Information Officer (CIO) (R_Walker@brhcs.org) Kimberly O'Neill, Chief Financial Officer (CFO) (K_Oneill @brhcs.org) Tiffany Halpert, Chief of Medical Staff (CMO) (T_Halpert @brhcs.org) Ken Bloom, Chief Nursing Officer (CNO) (K_Bloom @brhcs.org) Ronald Baxter, Chief Administrative Officer (CAO) (R_Baxter@ brhcs.org) END OF SCENE 1 Health Care Delivery Learnscape 1 v3.0 October 10, 2012 4 Health Care Delivery Learnscape 1: The New System Scene 2: Meeting with the Chief Information Officer In this scene, the student meets with Robert Walker, Bright Road's CIO, to talk about the current patient records system. Bob has also done some research on two new systems to replace the outdated current system so he has information about the new technology Bright Road is considering. Location Scene setup On-screen characters Off-screen characters CIO's Office The student is sitting across from the CIO. Robert (Bob) Walker None On screen text: First, you meet with the CIO to gather information about the current patient records system and the proposed new system. As you gather information from him, take notes about key issues you hear. STUDENT OPTION 1 It's nice to meet you Mr. Walker. As the CIO, I'm sure you have a lot of great information about the current system and new systems. Can you tell me a little bit about your role in choosing and implementing a new EHR? STUDENT OPTION 2 It's nice to meet you Mr. Walker. Can you tell me a little bit about how this project came about? STUDENT OPTION 3 It's nice to meet you Mr. Walker. As the CIO, I'm sure you have a lot of great information about the current system and new systems. Did you have a role in the decision to migrate to a new system? Student can choose any of the 3 options to continue. BOB Yes, I was the one who suggested the change. Sure, we may have systems at the nurses' centers, but I can't believe we're still writing patient information on paper charts and having to double up work by entering it into those systems. That's just silly! But anyway, I've been asked to research a couple of complete systems that might work for us. That's where you come in, an objective viewpoint. And please, call me Bob. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 5 Health Care Delivery Learnscape 1: The New System SCENE 2 STUDENT OPTION 1 Okay. First can you tell me a little bit about the system you currently have in place? STUDENT OPTION 2 Alright, Bob. What can you tell me about the system you currently have in place? STUDENT OPTION 3 Okay, Bob. I understand. What's wrong with the current system? BOB RESPONSE 1 I sure can. How much time do you have? Response 1 kicks student back to options. BOB RESPONSE 2 We call it PRS - short for the Patient Record System. It's been around for about 10 years, and it worked great when we were small. But, it's doesn't meet our needs anymore, so our staff has a lot of workarounds. Response 2 kicks student to the next question. BOB RESPONSE 3 Well, I wouldn't say there's anything wrong. It's just antiquated. Response 3 kicks student back to options STUDENT OPTION 1 You said that PRS doesn't meet your needs. Would you please elaborate? STUDENT OPTION 2 PRS doesn't meet your needs. Can you tell me more? STUDENT OPTION 3 I'd love some examples of how it's not meeting your needs. Student may click any option to continue. BOB RESPONSE 1 Well, it boils down to three main areas of deficiency. They are: Accessibility, administration, and ease of use. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 6 Health Care Delivery Learnscape 1: The New System SCENE 2 STUDENT OPTION 1 Where is your current system lacking in regards to accessibility? STUDENT OPTION 2 Administration is another tough spot? STUDENT OPTION 3 And you said Ease of Use was another issue? Student must click and listen to all options to continue. BOB RESPONSE 1 PRS is only accessible from centralized terminals throughout the Hospital, like at nurses' stations for example. It's not accessible from any of our other facilities, like our ambulatory care facilities, or even Urgent Care. So patient record keeping can be inconsistent from facility to facility. BOB RESPONSE 2 Right. Administration. It was a home-grown solution, hosted internally, and a lot of the administration tasks are manual, which means someone on my team has to do it. And it's tedious. BOB RESPONSE 3 It's not a Graphical User Interface, like so many other systems today. So, it's not intuitive for staff members to use. I can't imagine having to learn to use it! What a nightmare. STUDENT OPTION Okay, so it has some limitations. Switching gears, what can you tell me about the new systems you've been researching? BOB RESPONSE There are two of them: eMed, and Patient Data Systems. They are similar in functionality, but are installed and hosted differently. STUDENT OPTION 1 Can you tell me about eMed? STUDENT OPTION 2 What about Patient Data Systems? Student must click each option to continue. BOB RESPONSE 1 eMed is a web-based EHR system. So it's hosted in the cloud, and uses individual logins. It can be accessed from anywhere, including mobile devices. BOB RESPONSE 2 Patient Data Systems is software that would be installed on one of our servers. But if we put terminals everywhere, it can be accessed from any of them. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 7 Health Care Delivery Learnscape 1: The New System SCENE 2 STUDENT OPTION 1 You said they're similar other than that. Can you give me examples? STUDENT OPTION 2 Seems to me like a web-based option would be the best. STUDENT OPTION 3 Seems to me like the installed version would be the best. Student may click any option to continue. BOB RESPONSE 1 As a matter of fact, yes I can. I have a side-by-side comparison of key factors that will affect operation and cost. It's right there on that document. Response 1 moves student to the Comparison Screen. BOB RESPONSE 2 Not necessarily. There are always security risks and possible downtime associated with web-based solutions. Response 2 kicks student back to the options. BOB RESPONSE 3 Not necessarily. That means we're still looking at internal resources for administration. Response 3 kicks student back to the options. On screen: The student can click the piece of paper to pop up a side by side comparison of the two systems. When the student clicks on portions of it, more information appears. [Asset: Comparision_Features and costs.docx - the top table with features] On-screen text: You can click each requirement to get more information. When you have the information you want, click Move On. This document will be available for future reference if you need it. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 8 Health Care Delivery Learnscape 1: The New System SCENE 2 STUDENT OPTION 1 Bob, this has been very helpful, and gives me a great foundation for the rest of my research. I may have questions for you further along in the process. STUDENT OPTION 2 Great, Bob! You sure did your homework. Can I contact you as I continue my research? STUDENT OPTION 3 Thank you so much for your time, Bob. This will help guide my discussions with other staff members. Student may click any option to continue. BOB RESPONSE I'm glad it was helpful. You can definitely reach out to me any time. An informed recommendation is a good recommendation. END OF SCENE 2 Health Care Delivery Learnscape 1 v3.0 October 10, 2012 9 Health Care Delivery Learnscape 1: The New System Scene 3: Meeting with the Chief of Medical Staff and CNO In this scene, the student meets with Tiffany and Ken to determine current patient records processes and get information about both the personnel impact and the patient impact of a new system. Location Scene setup On-screen characters Off-screen characters Hospital Conference Room Tiffany and Ken are seated at the conference table. Tiffany Halpert Ken Bloom None On screen text: After talking to the CIO, you meet with the Chief of Medical staff and the CNO. As you gather information from them, take notes about key issues you hear. STUDENT OPTION 1 Thank you for taking time out of your schedule to talk to me about an expanded EHR system. I want to have a well-rounded view of how it will impact you and your patients. STUDENT OPTION 2 Thank you for taking time out of your schedule to talk to me about a new EHR system, with terminals in every patient room. I think it will be a huge benefit for your organization. STUDENT OPTION 3 Thank you for meeting with me today. I know you are both very busy. Let's get started. TIFFANY RESPONSE 1 I'm glad. I think both Ken and I love the idea of improved technology, but we have some concerns. Response 1 moves the student to the next question. TIFFANY RESPONSE 2 Oh, you know that already, huh? Response 2 kicks student back to options. TIFFANY RESPONSE 3 We're talking about the expanded EHR system, right? Response 3 kicks student back to options. STUDENT That's exactly why we're here today. I have some questions I'd like to ask about your current processes. Then, we'll discuss how the change may impact you and your patients. Do you have any questions for me before we get started? Health Care Delivery Learnscape 1 v3.0 October 10, 2012 10 Health Care Delivery Learnscape 1: The New System SCENE 3 TIFFANY Nothing from me. Ken? KEN Not on my side; ask away! STUDENT BRANCH OPTION 1 Ask questions about processes. STUDENT BRANCH OPTION 2 Ask questions about physician and nurse impact. STUDENT BRANCH OPTION 3 Ask questions about patient impact. Note: Student can click any branch in any order, but will need to ask all sets of questions within that branch before continuing to the next branch. After all branches are complete, the student is kicked to the Scene Summary. BRANCH 1: PROCESS QUESTIONS Branch 1 Question 1 STUDENT OPTION 1 How do you currently document patient information? STUDENT OPTION 2 What is your current documentation process? STUDENT OPTION 3 What's your current process? TIFFANY RESPONSE 1 Ken, why don't you start, and I'll fill in any gaps. KEN RESPONSE 1 Sure. Well, when our nurses visit a patient's room, they note information on the patient's chart. Vitals, medication administered, notes from the patient interaction, and so forth. KEN RESPONSE 2 Well, that depends on the process. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 11 Health Care Delivery Learnscape 1: The New System SCENE 3 TIFFANY RESPONSE 3 Process for ...? Branch 1 Question 2 STUDENT OPTION 1 What happens after the nurse takes notes? STUDENT OPTION 2 What do you do with the information? STUDENT OPTION 3 Where that is charted information kept or stored? KEN RESPONSE 1 The charts are kept at the nurses' station, and all documentation is made there. If for some reason someone - a physician or another nurse - has the record, no one else can get to it. That can be frustrating! KEN RESPONSE 2 Do you mean, how do we use the information? KEN RESPONSE 3 At some point during a nurse's shift, he or she will enter the information into the terminal at the nurses' station. That's the central database where all patient data is stored. Branch 1 Question 3 STUDENT OPTION 1 How is the data entered? STUDENT OPTION 2 With regards to that data entry, does each nurse have a personal login? In other words, how does someone know who entered the notes? STUDENT OPTION 3 So, it's like your efforts are doubled? SCENE 3 KEN RESPONSE 1 With the keyboard. KEN RESPONSE 2 Yes, there is a personal log-in for each nurse. TIFFANY RESPONSE 2 I have my own log-in as well. It's how we ensure each entry can be traced back to the person who entered it. KEN RESPONSE 3 Yeah, I guess. It's a workaround for our outdated system. Branch 1 Question 4 STUDENT OPTION 1 What types of errors does this system cause? STUDENT OPTION 2 Okay. Let's say you're a staff member entering notes for the entire shift. On average, how long does that take to enter information, per patient? STUDENT OPTION 3 On average, how long is a regular patient interactionsay one where vitals are Health Care Delivery Learnscape 1 v3.0 October 10, 2012 12 Health Care Delivery Learnscape 1: The New System checked? KEN RESPONSE 1 Well, the key errors come with communication and documentation. The patient may not communicate well or the medical staff may not hear the information correctly. Also, errors when it comes to transferring notes from the patient chart to the electronic system . . . and this can happen just from simple typographical errors or staff members being too hasty and not double-checking their work. TIFFANY RESPONSE 1 I agree with Ken. It's mostly these types of errors, or the wrong date or time noted both in the chart and in the system. KEN REPSONSE 2 That's a good question. Being the Chief Nursing Officer, I don't visit with patients much at all, since I'm more on the administrative side, but from what I've seen among the staff, I would say ten minutes per patient is a good estimate. TIFFANY RESPONSE 2 As CMO, I don't visit patients much more than Ken, but, when I have notes to enter, I'd say it usually takes me less than 5 minutes. SCENE 3 KEN REPSONSE 3 Average interaction? Probably about 15 minutes. TIFFANY RESPONSE 3 That sounds right, Ken. STUDENT OPTION 1 That actually leads me to one final question. How many patients do staff members typically care for per shift? KEN REPSONSE 1 I'd say, on average, 5. And on average, nurses visit them each 3 or 4 times per shift for regular checks. Doctors are about the same, except for when they're called in. STUDENT Excellent. Let's move on to our next set of questions. BRANCH 2: PHYSICAN AND NURSE IMPACT QUESTIONS Branch 2 Question 1 If the hospital implemented a new system that had a terminal in every room, STUDENT OPTION 1 would that make your lives easier? STUDENT OPTION 2 If the hospital implemented a new system that had a terminal in every room, how would that impact your nurses and physicians? Health Care Delivery Learnscape 1 v3.0 October 10, 2012 13 Health Care Delivery Learnscape 1: The New System STUDENT OPTION 3 If the hospital implemented a new system that had a terminal in every room, would it impact your nurses and physicians? TIFFANY RESPONSE 1 In the long run, yes. But any new system comes with hassles. KEN RESPONSE 1 Absolutely. KEN RESPONSE 2 Well, I think overall it would decrease errors and eliminate duplicate work. But it's always difficult when a new system is put in place. TIFFANY RESPONSE 3 Yes. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 14 Health Care Delivery Learnscape 1: The New System SCENE 3 KEN RESPONSE 3 Of course! Branch 2 Question 2 STUDENT OPTION 1 What are your concerns about implementing a new system? STUDENT OPTION 2 Tell me about the hassles. STUDENT OPTION 3 Would you say you'd rather not implement a new system? TIFFANY RESPONSE 1, PART 1 Well, my main thought is training. Not all of our nurses and physicians are as tech savvy as Ken and me. And we'd need to write new policies and procedures for using the system. KEN RESPONSE 1 I agree with Tiffany. I think most of our nurses will appreciate not having to write notes down, and then enter them. But learning a new system can be intimidating to anyone. Especially when lives depend on you being able to use it! TIFFANY RESPONSE 1, PART 2 One more concern - what happens when the system goes down? How do you review or document information then? KEN RESPONSE 2 New systems always bring hassle. New processes, system crashes, it can be a nightmare at first. TIFFANY RESPONSE 3 I wouldn't say that. Would you, Ken? KEN RESPONSE 3 No, please don't make assumptions. I think a technology upgrade is beneficial in a lot of ways. But it's not always easy, that's all. Branch 2 Question 3 SCENE 3 STUDENT OPTION 1 Okay, let's for a moment pretend there are no issues with a new system. What would you say then? STUDENT OPTION 2 Okay. What's the good side? STUDENT OPTION 3 Okay, now for the flip side. How do you think this type of system would improve your work? KEN RESPONSE 1 I'd say...Give us the new system! TIFFANY RESPONSE 1 Right! Can we install it tomorrow? Health Care Delivery Learnscape 1 v3.0 October 10, 2012 15 Health Care Delivery Learnscape 1: The New System Response 1 kicks student back to options. KEN RESPONSE 2 The obvious, right? Faster and better. Improved documentation, improved communication, which means we have better care. TIFFANY RESPONSE 3 Well, I think it will save a LOT of time that we spend investigating errors, and less complaints from patients to address. KEN RESPONSE 3 Yes, if my staff can make patient notes once, that would be great. Also, sometimes a patient is admitted from the ER, and the nurse didn't have time to enter notes into the system. We have to call down and get them. This new system would enable nurses and doctors to get real-time information. That would give quality of care a huge boost. STUDENT So, to summarize what I'm hearing. The new system would save you time, prevent human error due to handwriting or typographical mishaps, and allow for up-to-the minute information. Am I missing anything? KEN RESPONSE No, I'd say you nailed it. TIFFANY Definitely. STUDENT Alright, let's move on. SCENE 3 BRANCH 3: PATIENT IMPACT QUESTIONS Branch 3 Question 1 STUDENT OPTION 1 Do you think the new system will impact patients negatively? STUDENT OPTION 2 Do you think the new system will impact patients positively? STUDENT OPTION 3 What impact do you think the new system will have on your patients? KEN RESPONSE 1 I don't think so. KEN RESPONSE 2 Of course! TIFFANY RESPONSE 3 I think it will benefit our patients greatly. I can see a reduction in medication errors, for one. Also, I think it will benefit patients if we can see what's been going on with them over time, even if they've been seen at other facilities like Urgent Care. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 16 Health Care Delivery Learnscape 1: The New System KEN RESPONSE 3 I completely agree. Also, the time savings will mean we can spend more time with patients and less time entering data. And... what about the hot topic around here lately... elderly patient readmissions? I think this solution could help reduce the number of readmissions in that 30 day window, which will keep us compliant with Medicare regulations. That's a win for both the patients and us! Health Care Delivery Learnscape 1 v3.0 October 10, 2012 17 Health Care Delivery Learnscape 1: The New System SCENE 3 Branch 3 Question 2 STUDENT OPTION 1 Can you think of any way the system would impact patients negatively? STUDENT OPTION 2 Tell me about how the new system may lead to patient concerns. STUDENT OPTION 3 So, you think patients will love it? KEN RESPONSE 1 I don't think so. KEN RESPONSE 2 Well, it means change. We'll need to explain what we're doing when we're talking to them and using a computer at the same time. I agree. And I would add that even though a system like this would be more secure than folders with charts lying around, data security might be a concern to some of our patients and will keep us HIPPA-compliant. I don't know if that's exactly what we're saying. TIFFANY RESPONSE 2 TIFFANY RESPONSE 3 SCENE SUMMARY STUDENT Well, thank you both for your time and your candor. Do you have any other questions for me? KEN No, thank you for meeting with us, and good luck with your research. TIFFANY I don't have any questions, either. Thank you both! I'm off to my next meeting. END OF SCENE 3 Health Care Delivery Learnscape 1 v3.0 October 10, 2012 18 Health Care Delivery Learnscape 1: The New System Scene 4: Meeting with the Chief Administrative Officer In this scene, the student meets with the Chief Administrative Officer to gather information about the physical impact a new system will have on facilities. The student will also talk about any legal/security issues with the new system. Location Scene setup On-screen characters Off-screen characters Chief Administrative Officer's office The student is sitting across the desk from the Chief Administrative Officer. Ronald Baxter None On-screen text: Next, you meet with the Chief Administrative Officer to discuss the physical impact a new system will have on the facilities. Remember to take notes. RONALD Someone's been pretty busy, I hear! Making the rounds, huh? STUDENT OPTION 1 Yes, Ronald. And I appreciate you making the time to meet me. I'm sure you have a lot to say about the effects of a new EHR system. STUDENT OPTION 2 Yes, I've received a lot of helpful input so far. I know a new EHR system will have a big impact on your facilities, so I appreciate your input. RONALD OPTION 1 Yes, I do, but it may not be what you're expecting. I'm not panicking like everyone else about this. RONALD OPTION 2 Yes, the impact would be HUGE. I'm not sure it would be all positive, either. STUDENT OPTION 1 So, do you think a new EHR System will help or not? STUDENT OPTION 2 That's interesting. Can you tell me more? STUDENT OPTION 3 You don't seem as concerned as the others I've spoken to about the need for a new system. RONALD Well, let's just say I don't believe things are as bad right now as people think, and I'm a proud voice of reason when it comes to rushing into implementing a new system. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 19 Health Care Delivery Learnscape 1: The New System SCENE 4 STUDENT OPTION 1 You don't think operational efficiency and cost savings from error reduction would be beneficial to the hospital and your patient outcomes? STUDENT OPTION 2 The current system has been used for 10 years. That doesn't seem to be rushing. STUDENT OPTION 3 Is cost your biggest concern? RONALD RESPONSE 1 Sure, these are good things, but like I said, they may not be worth making a switch at this point. RONALD RESPONSE 2 I don't think duration has much to do with it. You don't see people pushing hard for flying cars just because the ones on wheels have been around so long! RONALD RESPONSE 3 Well, that's one of the concerns, yes, but not the biggest. STUDENT OPTION 1 Why is cost a concern? STUDENT OPTION 2 What are your biggest concerns? STUDENT OPTION 3 Did you know that the government is offering incentives for implementation electronic health records? If we can show \"Meaningful Use\" of EHR's, we are able to benefit from stimulus funds they've made available. RONALD RESPONSE 1 Do you know how much it would cost to hardwire all of the patient rooms in the hospital as well as the other facilities, like Urgent Care and ambulatory care? Not to mention how tying up our rooms like that will affect capacity? Or, if we have to install wireless routers everywhere and receivers, the initial cost and the cost of upkeep and troubleshooting are not worth the risk, in my opinion. RONALD RESPONSE 2 I would have to say, aside from the physical issues, legal and security issues are my biggest concerns. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 20 Health Care Delivery Learnscape 1: The New System SCENE 4 RONALD RESPONSE 3 Sorry, but again, just because the government is pushing something, doesn't automatically make me want to jump right in. STUDENT Okay. Since my job is to make a recommendation on the two different EHR systems currently being considered, do you mind if we talk about them separately? RONALD Certainly. I've read up on each of the proposed systems. STUDENT OPTION 1 Excellent! Can you tell me about the legal and security concerns when it comes to a hosting situation like eMed? STUDENT OPTION 2 Perfect. What are the legal and security issues related to the PDS solution? RONALD RESPONSE 1 Patient privacy is the big issue here. I don't think the technology is quite ready yet to ensure that a patient's information is completely protected across the internet. RONALD RESPONSE 2 Having the PDS solution hosted on our own server may be safer than the internet at this point, but, if there is a terminal in every patient room, we still have the risk of patient information being accessed when people other than staff are left alone in the room. And, if your answer to that is some sort of portable tablet that staff carries around with them, my answer is, no way. Those can be lost or stolen way too easily. STUDENT Each system would require secure logins with passwords that, if we wanted, could have a mandatory change requirement every month. RONALD Even passwords can be hacked easily by someone who knows what they're doing. Or information can be stolen at the server level, too. STUDENT OPTION 1 Terminals at nurses' stations are vulnerable to hacking now, aren't they? STUDENT OPTION 2 You sound a little paranoid about technology, Ronald. STUDENT OPTION 3 The server currently hosts the electronic system in place now. Don't you think a newer system would have better safeguards to offer than the one that was custom built for the hospital and requires manual updates, SCENE 4 RONALD RESPONSE 1 Yes, to a degree, and so is the server for that matter. But my point is, they're not as vulnerable as either of these two new system set-ups. RONALD RESPONSE 2 It's my job to be paranoid, thank you very much. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 21 Health Care Delivery Learnscape 1: The New System RONALD RESPONSE 3 Yes, the new system may have a better way of protecting our server, but I still think having a terminal in every patient room is just asking for trouble. STUDENT Some hospitals are using rolling carts with computers on them, and then taking them from room to room. Still, I think I understand your concerns, Ronald, and I definitely appreciate your time! RONALD No problem! Good luck to you! END OF SCENE 4 Health Care Delivery Learnscape 1 v3.0 October 10, 2012 22 Health Care Delivery Learnscape 1: The New System Scene 5: Meeting with the Chief Financial Officer In this scene, the student will meet with the CFO to discuss the financial impact of a new system. The CFO has the cost for the new systems. The student has received a lot of information from other staff members, and will also need to discuss this with the CFO, as factors in the overall cost-benefit analysis. Location Scene setup On-screen characters Off-screen characters Hospital Conference Room The CFO is in the conference room with the student, to enable figures or graphs to be shown on screen. Kimberly O'Neill None On-screen text: You meet next with the CFO of Bright Road to discuss financial implications of both systems. Taking notes here will help with writing your recommendation later! STUDENT Hi, Kimberly. It's good to see you again! KIMBERLY It's good seeing you again, too. This is an exciting project, don't you think? STUDENT OPTION 1 It's definitely got a lot of people excited, yes. STUDENT OPTION 2 Yes. What excites you most about it? STUDENT OPTION 3 I think that's a good understatement, yes! KIMBERLY Well, I for one think that a reduction in errors will pay off nicely when it comes to improving our bottom line around here, and that's always exciting. STUDENT OPTION 1 Do you think the error-reduction cost savings will outweigh the financial burden of a new system? STUDENT OPTION 2 Can I see the cost figures for both systems we're considering? KIMBERLY RESPONSE 1 Maybe we should start by looking at the figures for both systems. KIMBERLY RESPONSE 2 Sure, take a look! Health Care Delivery Learnscape 1 v3.0 October 10, 2012 23 Health Care Delivery Learnscape 1: The New System SCENE 5 On screen: A side by side Cost Comparison of the two systems is projected on the screen as a close up. When the student clicks on portions of it, more information appears. STUDENT OPTION 1 From these figures, it sure looks like eMed is the cheaper of the two solutions. STUDENT OPTION 2 At first, it looks like eMed will be more cost effective, but I think PDS might actually be more affordable. KIMBERLY Yes, with a license fee of only $900 per license and 300 doctors and nurses who will need licenses across our facilities, that total of $27,000 dollars looks a lot better than the PDS total system cost of $105,000. But, there's definitely more to consider that impacts the PDS solution affordability. STUDENT OPTION 1 Do you mean physical costs and hidden set-up costs? STUDENT OPTION 2 Are you referring to recurring costs? STUDENT OPTION 3 Do you mean security and legal considerations? Ronald Baxter thinks these are prohibitive of making any change whatsoever right now. KIMBERLY RESPONSE 1 These are definitely big considerations. IT has estimated that equipping our facilities with wireless capability to run eMed, and giving nurses and doctors portable devices will run an estimated $75,000. A new server to run the PDS system, which they tell me we'll need of course, will cost us close to $55,000. Add to this the cost of a terminal in every patient room and other places in our facilities, like labs, and you're at $135,000. Of course, the set-up cost for the PDS system will run roughly $25,000, and that's if it all goes smoothly. I'm putting a 10% buffer in there. There's no set-up cost for eMed, as you know, although there will be staff training costs; yet this will be about equal for both systems again. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 24 Health Care Delivery Learnscape 1: The New System SCENE 5 KIMBERLY RESPONSE 2 Yes! While the license fees are for eMed lower, remember, they are yearly fees. So, after 4 years only, the cost of eMed will exceed the one-time cost of the PDS system software. The data storage cost for eMed will be an additional cost, estimated at $10,000 the first year, and expected to increase by at least 8% every year based on our current data load and growth projections. PDS stores everything on our server, and an upgrade now will give us enough space to last for at least 10 more years, they're telling me. After that, of course, we'll need a bigger server. KIMBERLY RESPONSE 3 I don't necessarily agree with Ronald. First, we don't have to use mobile devices. We can still run the eMed system on terminals in each patient room. This way, you don't have the cost or the risk that a wireless network brings. There are legal and security risks and implications that come with hosting all of our patient data in the cloud. I've factored a one-time legal and technical cost of $15,000 to bring in a consultant to make sure we meet compliance. For the server-based program, security consultation is already included. STUDENT OPTION 1 This is great information. Do you have estimates for maintenance costs for each system? STUDENT OPTION 2 Yearly costs related to downtime, for each system? STUDENT OPTION 3 Any other factors I should be aware of? KIMBERLY RESPONSE 1 eMed will definitely be cheaper, since they will do all of their own maintenance. We may need to add more IT staff to help maintain all of the new terminals, and since the server will need upgrades and maintenance, with the PDS solution. KIMBERLY RESPONSE 2 I've gotten figures from Robert, our CIO, that make this issue pretty much a wash. While internet outages might be a concern, eMed still allows the user to keep working on their device, with data being uploaded to the cloud once connection is restored. You do lose that real-time information benefit at those times, but that happens just as much, he says, with our own server. Although, I think it's safe to anticipate more costs related to technical problems in the first year if we go with our own server-based solution through PDS. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 25 Health Care Delivery Learnscape 1: The New System SCENE 5 KIMBERLY RESPONSE 3 Personally, I think that technology changes so rapidly, a solution like eMed will be more cost-effective over the years to come. It seems like everything is moving to the cloud, anyway, and also, it won't cost us anything when eMed administers their own upgrades and improvements; while, with a server-based solution, we'll have administrative costs related to ongoing upgrades and improvements. Security is still the biggest drawback, though. STUDENT OPTION 1 In a perfect world, what solution would you choose? STUDENT OPTION 2 Do you really think another change is necessary at this point, or are we headed toward another possible \"MRI\" situation? KIMBERLY RESPONSE 1 In a perfect world, we wouldn't need hospitals! No, really, I may talk about glamorous things like \"the cloud\" and whatnot, but, in the end, I'd probably choose the more conservative solution. KIMBERLY RESPONSE 2 You're referring to how hospitals dished out a lot of cash for the MRI systems when they first came out, but haven't seen the benefit they thought they would, over the years? The new images are not helping the doctors in diagnosis or treatment assessment any more than the old ones. But, I don't think this is the same situation, here. The new EHR system will bring about enough improvement to operations and cost-savings to outweigh the cost in both the short-term and long-term. Plus, with all of the government incentives and attention, I think it's inevitable anyway. STUDENT Thanks for all the great information, Kimberly. I appreciate your time! KIMBERLY Any time! END OF SCENE 5 Health Care Delivery Learnscape 1 v3.0 October 10, 2012 26 Health Care Delivery Learnscape 1: The New System Scene 6: The Analysis In this scene, the student will take the information they've received from their meetings with staff and analyze the data. The mentor will ask questions to help the student organize the information. Location Scene setup On-screen characters Off-screen characters Student's Office Student is sitting at their desk Tanya Morales Robert Walker (via video call) On-screen text: Later, you meet with your mentor, Tanya, to sort through and analyze the information you've received. TANYA So, how do you feel after all of your interviews? STUDENT OPTION 1 A little overwhelmed, but I think I have enough to make a good recommendation. STUDENT OPTION 2 I'm a bit worried that I have too much conflicting information to form a solid opinion. TANYA Maybe I can help you sort through it all. Tell me, first of all, do you think a new EHR system is needed at all? STUDENT OPTION 1 Ronald Baxter thinks we're moving too fast and we should wait until the security aspects of the technology are better. STUDENT OPTION 2 Ken Bloom and Tiffany Halpert think a new system would help greatly, but are leery of the implementation and transition burdens. STUDENT OPTION 3 Kimberly, Bright Road's CFO, thinks a new system will pay off, quickly. And Robert Walker thinks the old system is antiquated and lacking in the areas of accessibility, administration and ease-of-use. TANYA Okay, but I asked what you thought. It's time for you to evaluate what you've heard and make a call on it. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 27 Health Care Delivery Learnscape 1: The New System SCENE 6 STUDENT OPTION 1 I personally agree with the people I interviewed who believe that the benefits of a new system will outweigh the risks. STUDENT OPTION 2 I think the timing is wrong and we should wait. TANYA RESPONSE 1 Okay, good. Now, which system will pose the least problems on the physical and security side, do you think? TANYA RESPONSE 2 Well, I understand, but I think you should still include a recommendation on a new system in your report to the Board. You can clearly state that you think the old system should remain in place, but, if a change were to be made, you could state which one and list the reasons why. For example, do you think the eMed solution or the Patient Data System solution would pose the least problems on the physical and security side? STUDENT OPTION 1 It seems like the eMed solution would require the least physical change, especially if mobile devices are used. But, with a wireless network comes greater security risks than the terminal access, server-based solution. STUDENT OPTION 2 I think the Patient Data System, requiring a new server with expanded storage capabilities would be more difficult to implement than the eMed, internethosted solution. TANYA Okay, what about overall benefit to patients? Which system would be better for this? On-screen text: Before you can answer, you see a phone call coming in from Robert Walker. STUDENT Excuse me, Tanya. This is Bob, our hard-working CIO. BOB (ON PHONE) Hi, sorry to call so late in the evening, but I figured you'd be fast at work on your recommendation still. And, as you know, these are my best hours to get some real work done. Health Care Delivery Learnscape 1 v3.0 October 10, 2012 28 Health Care Delivery Learnscape 1: The New System SCENE 6 STUDENT No problem, Bob. What can I do for you? BOB (ON PHONE) Actually, I just wanted to touch base with you on something we weren't able to cover in our face-to-face. You obviously know that I'm all for a new system, and we touched on how improvements are needed in the areas of accessibility, administration and ease-of-use, but I wanted to differentiate on a point between our two possible solutions. STUDENT I appreciate any additional information you can give. BOB (ON PHONE) Well, I just wanted you to know that, since we are looking to provide accessibility across different physical facilities, if we choose the Patient Data System solution we are still going to need to employ a web-based solution to connect the servers at each facility to the main server at the hospital, along an intranet-type network. STUDENT OPTION 1 So, you're saying that the eMed security concerns are not exclusive? STUDENT OPTION 2 Does the PDS solution provider offer a way to connect different facilities, with security measures already in place? BOB (ON PHONE) That's just it. The PDS provider claims they are just finishing development on new security measures to help connect facilities, but I think eMed is actually better prepared. For what it's worth, that's my opinion. Have a good night! STUDENT Thanks, Bob! You too! The call ends, and the student addresses Tanya again. STUDENT OPTION 1 Sorry about that, but that information actually helps my decision a great deal. STUDENT OPTION 2 Sorry for the interruption. You were asking about patient benefit? I think both systems are equal on this point. It's just a matter of delivery. TANYA No problem! So, do you believe Bob, in that eMed will be a more reliable patient information delivery solution when it comes to security risks? Health Care Delivery Learnscape 1 v3.0 October 10, 2012 29 Health Care Delivery Learnscape 1: The New System SCENE 6 STUDENT OPTION 1 Well, eMed must be government-approved to even be able to offer a solution in the medical arena, under the HIPAA Act, right? STUDENT OPTION 2 Yes, it just seems like the PDS provider is trying to keep from becoming obsolete when faced with the competition from a more cutting-edge company like eMed. STUDENT OPTION 3 I still don't know. I need more time to consider. TANYA RESPONSE 1 Actually, I believe both solutions are government-approved. TANYA RESPONSE 2 Is \"cutting edge\" necessarily the safe way to go when it comes to patient information security? TANYA RESPONSE 3 Well, I think you're really close, and I'm sure you'll be able to come up with the right recommendation for the Board. Remember, as a consultant, your advice is only as good as the information you receive from your team members. And, I think you've done a great job of collecting all the right information. STUDENT I hope so! Thanks for the opportunity, Tanya, and all of your help. TANYA No problem at all. Don't forget to include in your email to the Board, a high-level implementation and change-management plan based on whatever recommendation you give. Good luck! END OF SCENE 6 Health Care Delivery Learnscape 1 v3.0 October 10, 2012 30 Health Care Delivery Learnscape 1: The New System Scene 7: Making Your Recommendation In this scene, the student will craft an email to the Board of Directors, with a recommendation. The recommendation will include each aspect of the analysis, as gathered from the staff. Location Scene setup On-screen characters Off-screen characters Student's Office Student is sitting at their desk. None None On-screen text: After gathering information from key team members and sorting through it with your mentor, it's time to write your recommendation to the Board. On-screen text: Congratulations! Your recommendation to the Board has been sent! FADE OUT. End of Learnscape 1 Health Care Delivery Learnscape 1 v3.0 October 10, 2012 31