Healthcare Informatics

Introduction:
Today’s healthcare environment is comprised of teams of professionals working toward
common goals. When the organization sets a goal, there is generally a project to launch and
support the goal to its completion. Health informatics professionals are participants and
leaders in projects involving the implementation of new technologies or in the training and
maintenance that will take place after the technologies are in place. A project such as the
adoption of an electronic health record (EHR) across a healthcare system takes significant
planning, strong leadership, and the ability to manage change in the environment.
Informatics professionals need to be skilled in all of the aspects of project management,
including its evaluation and ongoing revisions, as the organization grows into everyday
usage of the new technologies.
For this task, you will read the attached -EHR Project Management Team.
Note: Responses to the tasks listed should be completed in an OUTLINE format (suggested
length of 6-8 pages), with descriptions given to clarify conceptual understanding.
TASK INSTRUCTIONS:

A. Examine elements of the vendor selection process by doing the following:

  1. Justify how a cost-benefit analysis will help to focus the vendor selection process.
  2. Discuss the difference between a request for information and request for proposal.
    a. Explain why one might be preferred.
    b. Explain why both may be used.
  3. Identify the elements included in writing a request for proposal.
    a. Determine who would be the contact person for gathering information on each element.
  4. Discuss how you would establish a good working relationship with vendors and company
    representatives involved in the selection process for new technology.
    B. List four functional electronic health record (EHR) applications needed by clinical end-
    users in the acute care setting.
  5. Describe how each application may be used.
  6. Identify specific human resources needed in the acute care setting to facilitate
    implementation of new technology, including training needs.
  7. Discuss one strategy that might be used when introducing new technology to enable it to
    interoperate with old technology in the acute care setting.
    C. List three functional applications needed by clinical end-users in the outpatient setting.
  8. Explain how each application may be used.
  9. Identify specific human resources needed in an outpatient setting to facilitate
    implementation of new technology.
    D. Compare two models being used today in health information exchanges.
  10. Describe benefits to developing health information exchanges.
  11. Describe current challenges impacting more widespread implementation of health
    information exchanges.
    E. Explain three factors to be considered by an organization in providing a personal health
    record to patients.
  12. Identify two businesses or organizations outside of the scenario offering a personal
    health record service.
  13. Identify three qualities of a personal health record which should be determined before its
    adoption.

    STOP TASK HERE

HEALTHCARE INFORMATICS 2
F. If you use sources, include all in-text citations and references in APA format.
Note: When using sources to support ideas and elements in a paper or project, the
submission MUST include APA formatted in-text citations with a corresponding reference
list for any direct quotes or paraphrasing. It is not necessary to list sources that were
consulted if they have not been quoted or paraphrased in the text of the paper or project.

Healthcare Informatics

A. Elements of Vendor Selection Process

  1. Importance of Cost Benefit Analysis
    Cost-benefit analysis is an important facet of a vendor selection process, and it refers to
    the systematic process of comparing and calculating costs and benefits of a given project,
    government policy, and decision. There are two main purposes that this comprehensive process
    entails: it determines if the project to be undertaken is sound, justifiable and feasible; and it
    provides a basis for comparing projects, where the total cost expected is calculated and compared
    for each option against the total benefits expected from them, so that the disparity between costs
    and benefits can be evaluated (Parthiban, Zubar & Katakar, 2013). In the process of selecting a
    vendor for an electronic health record system, doing a cost-benefit analysis comes in very handy.
    Since there are many options available out in the market, which have varied areas of
    applications, it is sound for the organization to conduct this analysis, in order to determine which
    option is best suited for its situation, and that which would have the lowest costs, as compared to
    benefits. Thus, cost-benefit analysis will be important in drawing close attention to the vending
    process and evaluating various vendors available in the market, including determining the total
    cost of ownership (TCO) and return on investment (ROI) (Parthiban, Zubar & Katakar, 2013).
  2. Difference between request for information and request for proposal

HEALTHCARE INFORMATICS 3
Understanding the difference between request for information (RFI) and request for
proposal (RFP) is important in making an advised and informed choice, especially where
outsourcing is necessary. More importantly, in the process of choosing the right vendors, getting
acquainted with this difference would provide a distinctive method going about the vending
process. Request for proposals are usually submitted as distinctive requirements for projects
portions as specified in the request. More often than not, these requests are in made in relation to
the procurement of products and/or services required in the implementation of the project, such
as electronic health records. On the other hand, request for information is submitted every time,
continuously to gain sufficient information regarding specific sorts of products and services for
which a request for proposal may be ultimately provided. RFI serves the purpose of vendor
identification, which can fulfill certain specified requirements for formal delivery of products
and services (Parthiban, Zubar & Katakar, 2013).

  1. A. Why either RFI or RFP may be preferred
    Request for information might in many instances be preferred to request for proposal,
    since the latter requires much more efforts to deliver than the former. For financial arrangement
    considerations, it might be logical to submit a request for proposal, since is more detailed, and
    provides a clear understanding to the vendor that a client is looking for a negotiation with
    someone based on quality of delivery and price. However, the RFI gives the client a chance to
    constantly fish out information and gather recon without necessarily giving out the details of the
    project to a third party (Parthiban, Zubar & Katakar, 2013). This helps to safeguard the privacy
    of patent information, and at the same time helping the client to achieve his goals of vendor
    selection.
  2. B. Why both may be used

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In cases where the client requires complete information about the vendor including
quality of delivery, price and ability to meet set requirements, a more holistic approach might
have to be adopted, and both tools may be used. The RFI will provide all information that
includes rates, vendor experience, and plausible reasons for applications for tender allocation.
Additionally, the RFP would be significant in providing detailed financial information for a
vendor’s option, since most vendors do not consider a request for information to contain
financial bartering. The use of RFI alone, therefore, may not provide the client with all the
information regarding quality of delivery and price, which are all important in conducting cost-
benefit analysis.

  1. Elements of a request for proposal
    There are several elements of a request for proposal, though some differ according to the
    project being implemented. However, there are some key elements which are common across all
    fields, including an overview of the business issue, which in this case is installation and
    implementation of an electronic health record system. This is usually presented in a lucid and
    succinct manner that describes the problem driving the need for such a project. Secondly, a
    description of products or services is presented in a cogent but brief manner, to outline all
    products and services needed by the organization. Another component is a detailed business
    requirement, which augment the description of products or services. It would include such
    elements as delivery guidelines, support requirements, quality metrics, and design specifications
    among others. The RFP would also include an element of approach suggestions, in which the
    purchasing personnel is knowledgeable of what is required for the project, and gives suggestions
    to suppliers of what the organization might require. Performance metrics which would be used to
    evaluate the performance of a supplier are also included, as well as the specification for a

HEALTHCARE INFORMATICS 5
proposal format as will be expected from the supplier by the client. A due date is also included,
not to mention the selection criteria for applicants, which is an important segment of the RFP
(Parthiban, Zubar & Katakar, 2013). An RFP should also specify the criteria of asking questions
by suppliers; display a timeline that details creation date, sending date, question period, selection
periods, due date of proposals, and project award date; specify the point of contact for both the
supplier and the purchaser; cost breakdowns for the purchaser; and a detailed criteria of sending
responses.

  1. A. Contact persons
    In provision of a general overview of the business issue, a lead manager would be most
    suited, while an IT expert would be crucial as a contact person for description of products and
    services, approach suggestions as well as providing detailed business requirements. The
    personnel manager would specify the performance metrics, the selection date and criteria. The
    project coordinator would take care of the supplier questions, due date, and project timelines.
    The chairman of the tender committee would act as a point of contact, providing criteria on how
    to deliver responses. The finance officer would provide a cost breakdown for the entire project.
  2. Establishing a good working relationship
    A company is not an isolated entity from its suppliers, thus, a good relationship must be
    maintained between them to ensure a cohesive and mutual business. One aspect of maintaining
    good relationship is to view suppliers as partners, rather than commodity providers. This way,
    they get to have knowledge of the project, and commit themselves to providing the best products
    and services that would see it to completion. Vendors and company representatives need to
    negotiate contracts from the onset of a project, to initiate some forward planning. This would be

HEALTHCARE INFORMATICS 6
crucial in establishing the stability of the relationship, as well as setting a platform for both
parties to work synergistically.
B. Functional EHR applications needed in acute care setting

In an acute care system, several functionalities of EHR are required in order to optimize
operations within such setting. The most important functionality in acute care setting is the
emergency or theater management application, which may come as a module embedded within
PAS, or interfaced to a PAS via HL7. This optimizes operations in an acute care setting.
Similarly, resident/client medical history is an important functionality that would be required to
assess the illness and medication history of a patient so to apply a relevant and holistic approach
to treatment. A list of problems, medications, and allergies of the client is another key
functionality which must be provided by an EHR in acute care setting, to help avoid medication
errors. Lastly, an EHR should be able to provide workflow management or next-step reminders
and prompts, to help health care providers in carrying out a complicated treatment process, such
as surgical operation (Simon, et al. 2008).

  1. Use of applications
    The theater management functionality is a very important application of every EHR
    system, and is used to assist health care providers in the event of carrying out a delicate
    procedure like surgery. The client medical history provides patient-specific information that is
    crucial in making decisions regarding medications, prescriptions and any other treatment
    procedure. A list of patient’s safety risks such as allergies is used by care providers to avoid
    committing medication errors like overdosing, administering of wrong doses, and another other
    mistake that could jeopardize the life of a patient. The workflow and next step reminders can be

HEALTHCARE INFORMATICS 7
used to guide care providers along sophisticated processes like surgery, to avoid errors of
omission and commission (Coffield, DeLoss & Mooty, 2008).

  1. Human resources in acute care settings
    Some of the specific human resources needed in acute care settings to facilitate
    implementation of new technology include ability multi-talented information technology expert,
    a clinician who is conversant with the various modes of operations within the setting, and who
    possesses human resource management skills. The training needs include rallying of staff
    schedules with training programs, willingness to participate in trainings, trainings on the
    importance of adopting a new technology, and offering comparative data on the disparity
    between the old and new systems.
  2. Strategy to enhance interoperability
    In order to enhance interoperability between the old and technology, sufficient approach
    needs to be adopted. The old system of operations in most hospitals involves the use of paper-
    based entry, and manual communications using telephone extensions. In order to ensure that this
    system communicates with the new technology, a version of the EHR software that mimics
    paper-based entry needs to be created (Simon, et al. 2008). The Direct Project, which involves
    creation of a low-cost, pragmatic mechanism for exchanging information of health care over the
    internet, is such a program that allows smooth transition and interoperability, since it is simple,
    scalable, secure and standards-based (Coffield, DeLoss & Mooty, 2008).
    C. Functional applications needed in outpatient setting
    In an outpatient setting, the coding and billing functionality is an essential part of the EHR
    system. Additionally, ordering capability is needed to enter prescriptions for patients. Lastly,
    documenting feature would be applicable in entering patient data into the system.

HEALTHCARE INFORMATICS 8

  1. Use of each application
    The coding and billing functionality is useful in providing unique codes to patients, as
    well as filling of payment receipts. It allows follow-up of all finances generated in the outpatient
    section, thus easing the audit process. The ordering capability allows care providers to enter
    prescriptions for patients electronically, thus making it easy to carry out medication refills, call-
    backs and finding alternatives for medication. The documentation functionality is used by care
    providers to enter patient-specific information that will be later used as prior medication history.
    Data entering can either be in structured or unstructured form.
  2. Human resources needed in outpatient setting
    In the outpatient care setting, the specific human resources required to facilitate the
    implementation of EHR include IT experts, data entry experts, staff with background in medical
    records, and finance officers to take care of billing systems. Knowledge on data entries and
    comparative analysis in excel and SPSS formats, is required. In addition, health care providers
    need to have financial handling skills, such as basic knowledge in accounting and financial
    reporting, which would go a long way in enhancing handling of all hospital finances, and
    providing lucid information on receipt, usage and dispatch of all money received. As a matter of
    fact, the personnel in outpatient settings also need to have basic skills, or should be able to be
    trained on information technology, which would be helpful in facilitating the adoption and
    implementation of the new technology.
    D. Comparison of models used in information exchange

Health information exchanges (HIE) is the process of health information sharing in a
reliable and interoperable electronic manner that safeguards the privacy, confidentiality, and
security of information. There are basically three types of HIE models currently in use: the

HEALTHCARE INFORMATICS 9
centralized, hybrid, and federated models. In the centralized model, data is accumulated and
managed in a singled and centralized repository, while in the hybrid system, centralization or
distribution of data is reliant on specific project requirements (Simon, et al. 2008). In the former,
the state health information organization (HIO) has full autonomy and control over the ability to
authenticate and data stored within the system, and the HIO is responsible for the management of
data storage, patient ID, and privacy; while the hybrid system has an MPI that is used to link
patient records across all databases, and a user interphase that brings patient information together
from various source, and can be manipulated from a local point (Walker, et al. 2005).

  1. Benefits of HIE
    Health information exchange enables caregivers to be thoroughly engaged, as it facilitates
    patient-centric care, and improves coordination among them. In addition, it reduces health costs
    by eliminating duplicate costs, rework and procedures. It also improves outcomes as provider
    collaboration is enhanced. HIE also helps organizations achieve meaningful use.
  2. Challenges facing HIE implementation
    Numerous challenges have continued to falter the implementation of HIE systems,
    including budgetary concerns, which involves operation costs, initial costs, and costs incurred
    during implementation. Unwillingness of existing stakeholders, especially healthcare providers
    to change from their current are of familiarity to a new system is a continuing concern. Lastly,
    the issue of privacy, confidentiality, and security of information shared across the network has
    been a constant obstacle to a widespread adoption of HIE.
    E. Personal health records

Key considerations that have to be made by an organization when availing PHRs to
patients are security of data, the accuracy of clinical information stored in those PHRs, and the

HEALTHCARE INFORMATICS 10
challenges of keeping information offered in the PHRs updated (Coffield, DeLoss & Mooty,
2008).

  1. Organizations that are offering public health records service are Lawrence Hospital
    Center located in Bronxville, New York; Google, which offers an online PHR service;
    and Medem Inc., an association owned by medical associations in the U.S.
  2. A good PHR should have the ability to safeguard information privacy; provide a link
    between a patient and medical librarians; and should be mobile-device enabled, so as to
    facilitate access by a great deal of patients.

References

Coffield R.L, DeLoss G.E. & Mooty G.P. (2008).The rise of the personal health record: panacea
or pitfall for health information. Health Lawyers News, 12(10):8–13.
Parthiban, P. P., Zubar, H., & Katakar, P. (2013). Vendor selection problem: a multi-criteria
approach based on strategic decisions. International Journal Of Production
Research, 51(5), 1535-1548. 
Simon S.R., et al. (2008). Electronic health records: which practices have them, and how are
clinicians using them? J Eval Clin Pract.  14(1):43–47. 
Walker J, Pan E, Johnston D, Adler-Milstein J, Bates D.W. & Middleton B. (2005). The value of
health care information exchange and interoperability Health Aff (Millwood) Web
Exclusives:W5-10-W15-18.

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