Richardson General Medical Center’s management is willing to acquire a new electronic system to improve internal operation, data capture, productivity, and the quality of patient care. The facility’s background needs to be analyzed to explore its current work environment and define why a new system is needed. Further, it should be discussed what the hospital should require from vendors and how it will conduct the selection process and implementation. Finally, recommendations should be proposed in terms of the next steps the facility should take on its way to improvement.
Background Information about the Facility
The facility that is seeking for implementing a new system for better patient care is Richardson General Medical Center, an acute care hospital with nearly 500 employees, 300 out of which is comprised of active medical staff members. The hospital is suitable for simultaneously providing care to 100 inpatients. More than 200 people among the staff members are nurses; the nurse-physician ratio is approximately ten to three. The hospital has existed in its present form for 30 years. The turnover of medical staff members is relatively low. Most nurses and physicians have worked together for years.
The facility is located in an area that is not densely populated. The hospital serves the needs of a particular community and does not have direct competitors, as other medical facilities in the area occupy different niches. Therefore, acute care is provided mostly by the Richardson General Medical Center. The facility does not have records of extraordinary failures or complications: the hospital has been working in a rather stable manner since its restructuring into the current from 30 years ago. However, there is a need recognized by the hospital’s management and some members of the medical staff to improve internal operation to make the care process more efficient, i.e. deliver better care or care of the same quality while spending as many or fewer resources respectively.
Current Evaluation and Analysis of the Status Quo
The facility currently uses databases for patient information and software for managing physicians’ schedules. There are several additional features in the systems, such as integration of epidemiological data, but, according to the members of the nursing staff who are in charge of running the systems, these features are not fully used. The analysis shows that the use of electronic systems in the hospital is not principally different from paper-based documentation management. Most of the information is stored in the electronic form, which makes it easy to access it and retrieve it, but advanced possibilities that can be offered by modern electronic systems are not taken into consideration.
Evaluation of the status quo has identified another important aspect of the facility’s current system: it fails to properly reflect the treatment process in a given case. When a patient is examined by the physician, all the information about prescribed treatment is inputted in the electronic system, but as the treatment goes on, physicians may make decisions about giving new drugs to the patient (or other treatment-related decisions), and these new decisions may not always be indicated in electronic records if made quickly under pressing circumstances. Sometimes, to receive full information about a certain patient’s treatment, it is needed to refer to paper records. In some cases, it might be also necessary to talk to nurses or physicians because recorded information is not fully accurate.
Driving Forces for Change: Why the System is Needed
The goal of the medical center’s management is to acquire an electronic system that would make all the internal procedures easier, more manageable, more effective, and faster. It is also acknowledged that such a system can improve the coordination of the medical staff’s work and cooperation among its members. Other possible benefits of a new system include changing the model of care in the hospital toward a more patient-centered one. Overall, the facility’s management strives for benefitting as much as possible from the modern world’s technological development and advancement.
Also, as it was previously described, the current system misses much of the important information that it should store and make accessible for the medical staff (see Current Evaluation and Analysis of the Status Quo). It is expected that a new, more advanced system will help create a data exchange environment that will comprehensively reflect everything that the medical staff might need to know for better operation and better treatment. This will allow sharing full treatment information with other facilities in case a patient receives treatment there. Another expected benefit is increasing patient satisfaction. Kazley, Diana, Ford, and Menachemi (2012) argue that the use of an electronic health record system can make a significant contribution to raising patient satisfaction by raising the quality of care delivery overall and by engaging patients in the care process particularly.
Current Work Environment and Utilization Statistics
The current work environment in the facility is generally assessed as acceptable. Many members of the medical staff have known each other and worked together for years. No major conflicts have occurred within the last year. Internal procedures are evaluated as well-established. It means that the medical staff is generally familiarized with the way the electronic system functions and does not face major complications when dealing with it. Since the current system has not been significantly modified within the last five years, the staff members are used to it. According to Goetz, Kuzel, Feng, DeShazo, and Love (2012), such a situation can be a serious challenge for implementing a new system. When procedures are well-established, bringing change is more difficult. Besides, the medical staff may be resistant to any changes in case its members do not recognize the need to shift to a new system.
The utilization statistics show that the current system is used stably, but some of its features remain widely neglected by the staff. They argue that, due to some special characteristics of their hospital, some functions of the electronic system are simply redundant. However, it can be argued that the hospital could benefit from neglected technological capabilities. At the same time, it can be argued that a shift to a new electronic system may be altogether more beneficial in the long run than trying to enhance the use of the current system. The facility’s management chose the latter, i.e. to seek a new system that will improve data processing and productivity and contribute to better patient care.
Elements for an RFP: What the Facility Wants from a Vendor
Upon completing a screening process that explored the market for possible solutions, such as electronic health record systems and similar technologies, the hospital’s management concluded that there are many different electronic systems from which the hospital could benefit. However, two major features should be taken into consideration: the hospital’s needs and the costs. When composing a request for proposal (RFP), the facility should stress what it thinks its main challenges are and what it wants to modify and improve. Of course, the budget should be indicated, too.
First of all, the medical center recognizes the need to benefit from technological progress. It wants to acquire an electronic system that would possess a wide range of functions to optimize the internal operation and the coordination of the medical staff. Therefore, the RFP should specify that vendors should address the issue of how the proposed system will improve the facility’s procedures associated with data collection, storage, and retrieval, as well as coordination of the work of nurses and physicians. Also, the RFP should require vendors to clearly explain how the proposed system will contribute to patient satisfaction and overall improvement of patient care with the considerations of the facility’s specific characteristics.
Committees and the Selection Process
The Richardson General Medical Center will establish a Systems Selection Committee that will include representatives of the Development Office, Financial Office, Board, and medical staff, including physicians and nurses. Changes in the Committee’s composition are possible upon request from the hospital’s top management. The Committee will announce a call for proposals from the hospital’s departments as well as proposals from vendors directly. The expected content of proposals will be specified in the RFP (see Elements for an RFP: What the Facility Wants from a Vendor).
The Selection Committee is also responsible for developing evaluation criteria for the proposals. Suggested criteria are the proposed system’s potential for optimizing the hospital’s internal operation, the system’s safety, its potential contribution to patient satisfaction, cost-effectiveness (how the hospital will benefit from the system in terms of finances in the long run), reliability, and costs. Evaluation should also take into account whether or not a particular proposal will assess risks and complications associated with adopting the system. Based on the criteria, the Selection Committee will choose one of the proposed systems for purchase and implementation and provide the authors of other proposals with feedback and recommendations that can help them submit a proposal next time that will be accepted.
Implementation: Pilot Studies
The system chosen for purchase and implementation is an Emergency Department Information System (EDIS). Many vendors are proposing different types of it in a wide range of various functions. The essence of an EDIS is that it provides a comprehensive platform for the patient, health, and medical records, physician and nurse documentation, and other kinds of information processing aimed at optimizing the facility’s operation. Implementation will include delivering and installing the software (hardware modifications or additions might be necessary), testing, technical support, and staff training.
What the system does is integrating the facility’s records, including patient information, physician and nurse information, scheduling, and treatment information, into a manageable electronic form. Farley et al. (2013) point out the there are two major considerations when assessing an EDIS: safety and quality. Safety refers to the system’s protection from unauthorized access and modification or retrieval of data. This is a pivotal consideration as it ensures patients’ privacy and confidentiality and guarantees that no third parties can interfere with the treatment process. The system’s quality refers to its thoroughness of design and low risks of failures.
Used properly, the EDIS will effectively coordinate the work of the medical staff, their interactions with patients, and the course of treatment. Pilot studies will take place after the staff training and will include partial elimination of the old system (with subsequent full elimination) and transition to the new one.
Evaluation of the System: Success Factors
The main obstacle for implementing the new EDIS is the staff’s attitude and possible resistance. This risk is inherent in all facilities that already have well-established procedural practices (see Current Work Environment and Utilization Statistics). That is why a major success factor will be the staff’s positive response to the system upon its trial. According to a qualitative study by Park, Lee, and Chen (2012), many physicians recognize the benefits of electronic health record systems and acknowledge that such systems make their work more efficient. Similarly, among nurses, it was found that, given that a nursing information system they switch to is user-friendly, most of them soon realize that it makes their work easier (Sockolow, Rogers, Bowles, Hand, & George, 2014). Employees working with the new system will be asked to submit their feedback, and employee satisfaction will be a major success factor.
Another success factor is patient satisfaction. If the results of patients’ evaluations show that their satisfaction with care grows, it will be considered a success. Other evaluation criteria will include cost-effectiveness and financial benefits, i.e. whether or not the system helps the facility save money. Bar-Dayan et al. (2013) found that electronic health record systems can help save money only if used properly and efficiently, i.e. without neglecting the full scope of their capabilities. This is only possible if the medical staff members are willing to use the new system and adopt a positive attitude toward it.
A new electronic system for better patient care does not only optimize a facility’s operation. It improves coordination and productivity, thus enabling further improvement. It can be expected that a new integrated EDIS will reveal disadvantages, flaws, or outdated features of the way the medical staff currently operates in Richardson General Medical Center. As a result, the hospital’s management might find it necessary to change the model of care delivery. For example, some modifications can be brought to the way nurses work, i.e. the nursing care model can be changed. Therefore, once the use of the new system is adjusted and normalized, it is recommended to consider whether health care providers’ patterns or work comply with the modern electronic system. If some incompliance is detected, it could be a reason to revise the organization of the medical staff members’ work.
It has been discussed that the purposes of purchasing and implementing a new electronic system should be defined as optimizing the internal operation of Richardson General Medical Center and contributing to improved patient care and patient satisfaction. These purposes should be crucial elements of the RFP, the main criteria in the selection process, and major success factors in evaluating the system upon launching it. Medical staff members’ resistance to change is expected to be a possible obstacle in implementing the system. At the same time, staff satisfaction is the main criterion for assessing the system’s success. The new EDIS is anticipated to improve the quality of care provided by the facility and possibly modify the model of the medical staff’s work toward more efficient and effective care.
Bar-Dayan, Y., Saed, H., Boaz, M., Misch, Y., Shahar, T., Husiascky, I., & Blumenfeld, O. (2013). Using electronic health records to save money. Journal of the American Medical Informatics Association, 20(1), 17-20.
Farley, H. L., Baumlin, K. M., Hamedani, A. G., Cheung, D. S., Edwards, M. R., Fuller, D. C.,…& Nielson, J. (2013). Quality and safety implications of emergency department information systems. Annals of Emergency Medicine, 62(4), 399-407.
Goetz, G. D., Kuzel, A. J., Feng, L. B., DeShazo, J. P., & Love, L. E. (2012). EHRs in primary care practices: Benefits, challenges, and successful strategies. The American Journal of Managed Care, 18(2), 48-54.
Kazley, A. S., Diana, M. L., Ford, E. W., & Menachemi, N. (2012). Is electronic health record use associated with patient satisfaction in hospitals? Health Care Management Review, 37(1), 23-30.
Park, S. Y., Lee, S. Y., & Chen, Y. (2012). The effects of EMR deployment on doctors’ work practices: A qualitative study in the emergency department of a teaching hospital. International Journal of Medical Informatics, 81(3), 204-217.
Sockolow, P. S., Rogers, M., Bowles, K. H., Hand, K. E., & George, J. (2014). Challenges and facilitators to nurse use of a guideline-based nursing information system: Recommendations for nurse executives. Applied Nursing Research, 27(1), 25-32.