Health Information Technology System Planning Discussion Paper

Introduction

This paper examines the four phases of Health Information Technology when planning the acquisition of an Electronic Health Care Records (EHR) system.  Working through a structured systems development lifecycle approach facilitates better organizational planning and reduces the risk of errors and omissions.  (Tan, J.K.H. 2001). The lens is based from the perspective of a group of physicians looking towards the procurement of an Electronic Health Records System.

Four phases of planning

Needs Assessment

The client needs assessment is aits alongside the requirements statement or scoping document for a systems build project.  Health Information Technology System Planning Discussion Paper As such it remains a foundation document for the project and baseline terms of reference for conducting change control requests. In Project Management Terms this is often referred to as the Project Charter.  [ embraces both needs assessment and requirements or scoping document].

The Needs Assessment has the express purpose of providing a definition of user requirements in order to facilitate decision making.  The process identifies and measures areas for improvement and is mostly focused on human processes.  Areas for improvement are evidenced by showing metrics that identify potential areas of weakness and how they may be improved upon.  A simple diagrammatic representation is illustrated in Fig 1.

Pre assessment – This is essentially a data gathering exercise in order to determine current knowledge of the existing system. This forms the process of ‘gap analysis’ an assessment of the current state, the consideration of future state requirements and the resulting gap. It is this gap that provides ‘the needs’ for facilitating change to the desired state.

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Assessment – This is the evaluation of the gathered data and examines the potential constraints, both internal and external, that will need to be considered in the development of the system.  This constructs a preliminary risk assessment and considered order of events.

Action Plan – This provides a summary of the identified needs and constraints. It lists a potential order of sequence and the importance of the needs to the business.  This is often accompanied by Cost / Benefit Analysis statements that provide financial justification for the stated needs. (Hunt, E.C. 2003)

Systems Selection

One the business requirements are identified and after the process of systems analysis and design have been completed, a formal evaluation phase is accomplished in order to procure the desired systems. This is often accomplished by a formal RFP tender process in order to benchmark comparative system functionality, quality and costs.  This is often a matrix evaluation process following a selected shortlist of the best matched systems solutions.  Fig 2 below illustrates the sequential process involved

Implementation

After the system has been selected this will involve a formal implementation of the system, sometimes referred to as systems integration.  This looks at placing the newly acquired system in to the current system.  It may involve a de-selection of components of the old system, removing these and replacing with the new software.  Within the concept of construction, prior to the formal roll out of these systems, they should have been thoroughly tested via unit and integration tests.

Maintenance

This phase effectively looks after any fine tuning or required changes in the system. This is accomplished by going through documented formal change control procedures. (Soriano, F.I. 2012). The importance of maintenance is to deal with any potential upgrades that may be available or required for the operational system.  This may also include any ‘bug fixes’ that transpire based upon the operational running and performance of the existing system. Routine diagnostics are also included that check such things as operational performance,  operating speeds, download times, file transmission times etc.  Maintenance is normally carried out on a duplicated test system before the appropriate changes or enhancements are migrated to the operational or live system.

Steering committee

There are options in selecting the most suitable Steering Committee for the oversight of a development project.  Essentially these Board Members are there to facilitate the decision making process on behalf of the organization.  Equally, they are concerned with ensuring cultural fit,  value for money and technical integrity of the system to meet the defined needs.  Fig 3 illustrates a typical committee structure.

The Chairman represents the Executive of the Company and will be the final decision make of the committee. He ensures appropriate balance in the workings of the Committee but has Executive responsibility on behalf of the Company.  The Project Sponsor may well be a departmental head who established the initial request for the project e.g. Head of Pharmacology. The Stakeholders, may be 1 or 2 assigned people, are those that are assigned to represent others with a vested interest in the outcome of the project.  The IT Director represents technical input appropriate to the new system build and the HR Director will address any human needs or people requirements as a result of the new systems implementation.

Steering Committees are an important function in not only facilitating the decision making process of the systems development but also providing a valuable quality control check over the final integrity of the systems delivery. This means that the system is (i) fit for purpose, in meeting the identified scope and requirements (ii) is delivered within scope, on time and to identified financial constraints (iii) ensures that the system is a holistic fit in terms of people, culture, environment and ease of use. Health Information Technology

Importance of the needs assessment

The needs assessment is important because it is one of the key foundation documents within the Charter that supports acceptance for the need of the system.  In addition it is a document that supports the financial justification of the project via cost/benefit analysis statements that justify the projected spend on the build and delivery of the project.  In addition the document analyses potential constraints and provides a preliminary risk assessment that is an important element into the project planning process. (Watkins, R.  2011)

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Key elements in the needs assessment

Key elements in the needs assessment include the following item:-

• Normative data
• Evaluations
• Objectives
• Opinion
• Timelines
• Barriers
• Resources

An important part of the data collection is the gathering and assimilation of evidence. It is important to have metrics that both define and underpin the reasons for the needs requirement. These need to be presented in an objective manner i.e. they have specific purpose and address an important business need.  This can be accomplished from either (i) a poorly performing or inadequate process (ii) a gap or a process missing (iii) An error in which a process is contributing to inefficiency.  Timelines are important in order to give an indication of the priority and urgency of the stated need.  Barriers identify the potential risks or constraints in terms of making required changes.  These can be both tangible and intangible risks that will need to be addressed within the systems build process.  Resources provide an estimate of the manpower required in terms of effort to fix the problem. At this stage these are only rough estimates.

References

Eleanor Callahan Hunt, S. B. (2003). The Nursing Informatics Implementation Guide. New York: Springer Verlag.

Ryan Watkins, M. W.-M. (2011). A Guide to Assessing Needs: Essential Tools for Collecting Information . Washington DC: International Development Association.

Health Information Technology System Planning Discussion Paper