Healthy Care Community (HCC) is upgrading its Health Information Technology (HIT) system and you are participating in the project. You will submit weekly milestone assignments in Weeks One, Two, Three, and Four. In Week Five, you will submit a proposal of your upgrade recommendations. Use this profile as a reference and resource.
Healthy Care Community is made up of two acute care hospitals, located 20 miles apart.
To enable the community and the individuals within to enjoy maximum health by providing illness and injury care with the utmost excellence and compassion.
Healthy Care Community plans to execute and achieve its mission through the four following strategies.
Patient satisfaction is the foundational strategy by which Healthy Care Community will attain its mission. It encompasses patient outcomes, compliance scores, patient and visitor experiences within the hospital, and the community’s perception of Healthy Care Community as a corporate neighbor and community member.
Providing excellent care requires money. Healthy Care Community seeks to maximize revenue wherever ethically possible through a strategy that captures, retains, and grows revenue.
Maximization of Operational Efficiencies
Maximizing operational efficiencies helps Healthy Care Community get the most value out of each dollar of revenue. Efficient operations also directly affect the patient experience and overall patient and visitor satisfaction.
Gain of Positive Returns on Capital Investments
Ensuring that new initiatives show a tangible return on investment (ROI).
Healthy Care Community has identified the following objectives to support their mission and strategies:
· Make the pharmacy a revenue-generating business line
· Increase prescription capture rates
· Leverage assets and resources to centralize and automate processes
· Leverage the electronic medical record (EMR) system with an improved pharmacy, revenue cycle, and EMR integration
· Reduce the Total Cost of Ownership (TCO) with respect to the IT infrastructure and HIT systems
· Improve the security of HIT systems to protect the confidentiality, integrity, and availability of the HCC data, assets, and systems
· Improve compliance with regulatory requirements, such as HIPAA, FDA, and DEA
· Maintain Specialty Pharmacy Accreditation through improved integration of the pharmacy’s workflow and integrated point of sale (POS) system
Healthy Care Community IT Initiatives
The Healthy Care Community IT department has several initiatives to support the organization’s strategies and objectives. These initiatives encouraged HCC leadership to approve a HIT system upgrade. This upgrade is now a full project, along with the others noted below.
The current HIT system has not had a comprehensive overview in several years. The focus of the upgrades has been on keeping the individual components functioning and communicating with each other. The IT Director obtained authorization to review and upgrade the overall HIT system.
The director laid out the high-level plan and tasks to his staff as follows:
· Describe the system requirements of the other initiatives described in this section.
· Track and report several issues that have negatively affected patient satisfaction and compliance.
· Identify the issues that negatively affect timely revenue recognition and create barriers to operational efficiency. The identified issues include:
· Narrowing margins and escalating costs
· Total Cost of Ownership (TCO) for the IT infrastructure continues to increase
· Increasing costs for supporting local servers
· Insufficient manpower to manage the servers; lack of skilled resources for server operations and management
· Identify the gaps in the security posture and recommend mitigation actions to protect the confidentiality, integrity, and availability of HCC’s data and assets.
IT leadership believes fiscal and operational efficiencies could be gained using cloud-based application services. While team members will research available cloud-based services that would work well for their organization, the HIT system upgrade would need to include technical considerations for using such services.
Digital Bedside Monitoring System Performance Issues
Healthy Care Community recently implemented a new digital bedside monitoring system (DBMS). It is interfaced with the HIT system components as shown in the diagram. The digital bedside monitoring system measures the patient’s vitals which interfaces with the Electronic Health Records (EHR) and the Picture Archiving and Communication System (PACS).
Upon the first day of operational use in both hospital locations, the nurses noticed that what the DBMS and PACS displayed on their screens did not match the actual patient that they are caring for in the physical bed.
It appears that DBMS is mixing up patients between the two hospitals. While the hospitals share many systems, each hospital has its own Medical Record Number (MRN) database. There is not a unique MRN for patients between the two hospitals.
To get around this, the Patient Registration System (PRS), which feeds the MRN to non-EHR systems, uses an extra field in its database that prepends a digit to the MRN to indicate which of the two hospitals the patient is admitted. This interface conversion is required to ensure that there is a unique patient identifier.
Pharmacy Medication Synchronization Initiative
Healthy Care Community plans to implement a cloud-based solution for synchronizing medications per regulatory requirements. The upgraded HIT system will enable the successful implementation of the new process and application, as well as meet the established business objectives.
Note: The Healthy Care Community Medication Synchronization Project Overview document provides additional information. This is a separate document provided in this course.
Challenges with the Pharmacy IT System
· Changing regulatory requirements
· Rising drug costs
· Decreasing drug reimbursements and complex medication reimbursement processes
Healthy Care Community will compare two cloud-based pharmacy medication synchronization service providers (vendors) and select the most appropriate vendor based on criteria established for HCC’s needs and best practices. The vendors have functional, performance, and security information on their websites to help with the final selection of a vendor.
The IT and security staff will need to define the hardware/software technical specifications, performance parameters, and security requirements to compare the vendors.
Electronic Medical Record (EMR) Upgrade Initiative
The Healthy Care Community EMR is outdated and is causing performance issues. The board of directors agree that the IT department is to implement a new solution that meets these high-level requirements:
· Use either a cloud-based or open source solution to reduce overhead and costs in accordance with the HCC established objectives (see above)
· The solution must be Office of National Coordinator (ONC) certified
· Design with fully integrated electronic health records and all functional services (i.e., radiology, laboratory, and patient monitoring)
· Interoperable with Windows® and Mac OS X® systems
· Meet security requirements, including but not limited to:
· Ability to encrypt patient documents
· Support for per-user, role-based access controls
· Ensure secured remote access into the EMR solution
After extensive research, requirements definition, and design, the board of directors approved the implementation of OpenEMR. The IT department is tasked with implementing and testing OpenEMR.
Healthy Care Community operates with one Electronic Health Records (EHR) system, Patient Registration System (PRS), and one billing/revenue system. The Community consists of the standard HIT system components; some of which are shown in Figure 1.
Healthy Care Community Functions
Health Care Community has the following standard suite of hospital functions within the facilities:
· Clinical Functions
· Bedside Monitoring
· Infusion Management
· Emergency Department
· Labor and Delivery
· Critical/Urgent Care (Internal and External)
· Physician Offices (Internal and External)
· Non-Clinical Functions (Business/Finance/Registration)
· Patient Billing
· Patient Registration
· Patient Scheduling
· Materials Management
· Bed Capacity Management
· Health Information Management
· Critical Enterprise HIT Systems (These are the heart of the HIT system components)
· Electronic Health Record (EHR)/Electronic Medical Record (EMR)
· Clinical Decision Support (CDS)
· Patient Registration System
· Patient Billing System
The IT Infrastructure must be optimized to support the HIT systems throughout the environment. The CIO and CISO will collaborate to develop and maintain short- and long-term strategic plans to ensure the IT network infrastructure capacity meets existing and future requirements, which include:
· Anticipating HCC’s networking and HIT system needs are designed and implemented to meet the mission, strategies, and objectives
· Foreseeing new capabilities for current and future HIT systems
· Leveraging new technologies to assist with the integration and improvements of HIT systems and work flows
· Designing, implementing, and maintaining HCC’s medical grade business and clinical network to ensure HIT systems are operating in a secure and stable environment with a goal of 99.99% network reliability
· Anticipating and designing bandwidth and security requirements
· Conducting frequent network traffic and capacity studies
· Planning and implementing IT network infrastructure security measures
· Work with senior leadership and HIT system owners to protect sensitive data
· Recommending products, services, protocols, and standards in support of the IT network infrastructure and HIT system development efforts
· Interacting with vendors to secure infrastructure-specific and HIT system products and services
· Conducting feasibility studies for various upgrade projects, improvements, and other conversions
· Developing installation plans to support implementation of new or upgraded HIT system projects
· Providing highly-skilled technical assistance in network and server planning, engineering, and architecture
· Providing resolution for network and/or server problems
· Creating and maintaining troubleshooting guidelines and associated support documentation on problem identification, fault isolation, estimation of effort hours required to complete problem resolution, and systems restoration in the event of a critical system failure
· Providing troubleshooting and/or disaster recovery services and other technical documentation
Protecting the confidentiality, integrity, and availability of a business’ data and assets is fundamental to ensuring business objectives are met. HCC has not met all the security standards in accordance with the HIPAA security rule.
The IT department and security professionals must identify and review the security gaps to determine mitigation actions through the hardware and software technical, administrative, and operational security controls to reduce the risks associated with those gaps.
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