HIM 200 Module 7 Project Two Example

Project Two: Opening the Portal and Closing the Fax Tray at Brennan County Medical Center

[Student Name]

Southern New Hampshire University

HIM 200: Introduction to Health Information Technology

Project Two

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Project Two: Opening the Portal and Closing the Fax Tray at Brennan County Medical Center

Summary

Brennan County Medical Center's patient portal reaches only 31% of patients, and its reach thins further among seniors, Medicaid and uninsured patients and those who prefer Spanish. Meanwhile, 40% of outside records still arrive by fax, occupying 1.5 HIM staff to scan and index. This plan proposes changes that would raise portal activation to 45% within a year while narrowing gaps between groups, and cut the fax share to 25%. It costs about $69,000 in its first year, partly offset by reduced scanning work, and relies mainly on changes to workflow and policy rather than new systems.

Goals and Objectives

Within twelve months, the plan aims to raise overall portal activation from 31% to 45%, activation among patients 65 and older from 19% to 30% and among Spanish-preferring patients from 9% to 25%; raise the share of registrations at which the portal is offered from 46% to 90%; shrink faxed intake from 40% of outside documents to 25%; and reduce documents requiring manual patient matching by 30%.

Portal Change 1: Activation Without Waiting in Line

The Project One audit showed staff skip activation when lines grow. Instead of relying on registrars, the hospital will send every patient a text message with an activation link after check-in, and tablets in waiting areas will allow patients to activate while they wait. Registrars will still offer help, but activation will no longer depend on a quiet desk.

Portal Change 2: People to Help

Two part-time portal helpers, totaling one full-time position and including one bilingual staff member, will work in the main waiting area and outpatient clinics during peak hours. They will help patients activate accounts, set up password recovery and learn to view results and send messages. Irizarry et al. (2015) found that usability and support shape whether patients adopt portals, and hands-on help addresses both.

Portal Change 3: Language and Access

The hospital will license its vendor's full Spanish interface, so every screen and notification is available in Spanish. Password reset will move to a text-message code, since 17% of surveyed non-users had given up on login problems and 22% lacked email. Patients who prefer the phone will keep phone access to results and scheduling; the plan expands choice rather than forcing digital use.

Portal Change 4: Caregivers and Clinicians

Many older patients rely on family members. The plan introduces a simple, documented proxy access process, reviewed by HIM, so an authorized caregiver can use a separate login instead of sharing the patient's password. Clinicians will be asked to mention the portal during visits, for example by telling patients their results will appear there, since encouragement from clinicians appears repeatedly in the research as a driver of use.

Exchange Step 1: The Ten Busiest Faxers

Ten clinics account for about 60% of faxed documents. HIM and information technology staff will visit each to set up secure direct messaging, which most certified record systems already support but many small practices have never configured. Menachemi et al. (2018) found that rigorous studies of exchange consistently reported benefits, such as fewer duplicated tests, which gives clinics a reason to participate beyond helping the hospital.

Exchange Step 2: Emergency Department Query Access

Emergency department clinicians will receive single sign-on access to query the state exchange for outside records from within the hospital's record. Everson and Adler-Milstein (2016) found exchange concentrated among hospitals sharing a dominant vendor, so a vendor-neutral community exchange is the most practical way to reach Brennan County's many different-vendor partners.

Exchange Step 3: Better Patient Matching

Registration will adopt standard formats for names, addresses and phone numbers, and HIM will review duplicate record reports weekly. Cleaner demographics improve automatic matching of incoming documents from both faxes and electronic sources. Patients will also be encouraged to use FHIR-based apps, which Mandel et al. (2016) showed can run across different record systems, to carry their own records to outside specialists.

Equity Safeguards

Ancker et al. (2011) and Goel et al. (2011) both found racial, ethnic and insurance gaps in who signs up and logs in, so the plan builds in safeguards. Activation will be reported monthly by age, insurance, language and race and ethnicity. Portal helpers will prioritize clinics serving the most Medicaid and uninsured patients. The hospital will partner with the county library and senior center to offer monthly help sessions for patients without home internet.

A Sociotechnical Check

Sittig and Singh (2010) remind planners that technology, people, workflow, policy and measurement interact. The plan touches each: the Spanish interface and text reset address the interface; helpers and clinician scripts address people; post-check-in texts address workflow; proxy and activation policies address organizational rules; and monthly reporting addresses measurement. No single change carries the plan alone.

Timeline and Roles

The HIM director will lead the plan, with the patient access manager, the information technology applications lead and the ED nurse manager responsible for their areas. Table 1 shows the schedule.

Table 1. Implementation Timeline

Note. Schedule approved by the HIM director and patient access manager.

Budget

First-year costs total about $69,000: $42,000 for portal helpers, $18,000 for the Spanish interface license, $6,000 for waiting-area tablets and $3,000 for community outreach. Information technology staff time is absorbed in existing work. If the fax share falls to 25%, scanning and indexing work could drop by about one-third of a full-time position, saving roughly $22,000 a year, and fewer phone calls for results would free clinic staff time.

Measuring Success

HIM will report monthly on activation overall and by group, the portal offer rate, active use in the past 90 days, message response time, the fax share of outside documents and the number of documents needing manual matching. A quarterly summary will go to the hospital's quality committee, and the hospital's family advisors will see the group-level results twice a year.

Risks

Three risks need attention. Proxy access must respect patient privacy, especially for adolescents and patients who do not want family to see certain information, so HIM will define limits and exceptions in the policy. Some clinics may decline direct messaging; for them, HIM will offer a secure upload portal as an alternative to fax. And helpers may be pulled into registration duties, so their role will be protected in writing.

Conclusion

The plan tackles the portal and the fax tray together because both are about making patient information reach the people who need it. By removing workflow barriers, adding human help, closing language and access gaps and working directly with the clinics that fax most, Brennan County can widen portal use fairly and shrink the paper that still flows through its HIM department.

References

Ancker, J. S., Barrón, Y., Rockoff, M. L., Hauser, D., Pichardo, M., Szerencsy, A., & Calman, N. (2011). Use of an electronic patient portal among disadvantaged populations. Journal of General Internal Medicine, 26(10), 1117-1123. https://doi.org/10.1007/s11606-011-1749-y

Everson, J., & Adler-Milstein, J. (2016). Engagement in hospital health information exchange is associated with vendor marketplace dominance. Health Affairs, 35(7), 1286-1293. https://doi.org/10.1377/hlthaff.2015.1215

Goel, M. S., Brown, T. L., Williams, A., Hasnain-Wynia, R., Thompson, J. A., & Baker, D. W. (2011). Disparities in enrollment and use of an electronic patient portal. Journal of General Internal Medicine, 26(10), 1112-1116. https://doi.org/10.1007/s11606-011-1728-3

Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient portals and patient engagement: A state of the science review. Journal of Medical Internet Research, 17(6), Article e148. https://doi.org/10.2196/jmir.4255

Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: A standards-based, interoperable apps platform for electronic health records. Journal of the American Medical Informatics Association, 23(5), 899-908. https://doi.org/10.1093/jamia/ocv189

Menachemi, N., Rahurkar, S., Harle, C. A., & Vest, J. R. (2018). The benefits of health information exchange: An updated systematic review. Journal of the American Medical Informatics Association, 25(9), 1259-1265. https://doi.org/10.1093/jamia/ocy035

Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl. 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085