HIM 425 Module 7 Final Project Example

Final Project: A Record That Stays Up and Stays Whole, Case Analysis and Technology Solution Brief for Cedar Fork Community Health

[Student Name]

Southern New Hampshire University

HIM 425: Healthcare IT Infrastructure and Network Management

Final Project

[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.

Final Project: A Record That Stays Up and Stays Whole, Case Analysis and Technology Solution Brief for Cedar Fork Community Health

Executive Summary

Cedar Fork Community Health's clinical record depends on a seven-year-old server in a clinic closet and, for two mountain clinics, a single wireless link that failed 14 times last year. About one in five clinically relevant patient phone messages never reaches the chart. This brief recommends moving the record to the vendor's hosted service, giving every clinic two independent network connections, replacing the separate messaging tool with telephone encounters in the record routed first to nurse pools and adopting a tested recovery plan. First-year capital cost is about $85,000, within the approved budget, and implementation takes seven months. The request to leadership is approval of this plan together with the vendor contract terms set out below.

The Case in Brief

Cedar Fork is a federally qualified health center with five clinics and about 41,000 visits a year. In the past twelve months its record server went down three times for a total of 9.5 hours, its shared wireless link to two clinics failed repeatedly and nearly a third of video visits at those clinics failed or became phone calls. An audit of 200 phone messages found that 18% of those with clinical content left no trace in the chart. The analysis in earlier milestones traced these symptoms to three root causes: a design with single points of failure, limited rural broadband and a messaging workflow built around a tool outside the record.

Why It Matters

Record availability is a patient safety issue. Sittig and Singh (2012) place a working, available system at the foundation of safe electronic record use, ahead of how the system is used. Connectivity is an access issue: Wilcock et al. (2019) linked lower broadband availability with less telemedicine use, a pattern Cedar Fork's own video failures mirror. And an incomplete record undermines continuity: a medication change discussed by phone and never charted is invisible to the next clinician. Every part of the problem reaches patients.

The Recommended Solution

The solution has four components that work together, summarized in Table 1. Hosting removes the server as a single point of failure, but it makes the network more important, so the network component is not optional. The messaging change brings phone conversations into the chart, and the recovery plan covers the times when any component fails.

Table 1. Solution Components

Note. Components developed across the project milestones.

Evidence Behind the Choices

Each component rests on evidence as well as case data. Griebel et al. (2015) found that hosted and cloud services in health care can reduce local maintenance and scale more easily, while raising security, legal and connectivity concerns that contracts and network design must address. Routing phone encounters to nurse pools responds to Murphy et al. (2016), whose count of daily electronic notifications reaching primary care physicians showed how little inbox capacity clinicians have left. The recovery plan takes seriously the finding by Dameff et al. (2023) that a ransomware attack on one health system spilled over into longer waits and crowding at neighboring emergency departments; a small health center's failure would push its patients onto the region's hospitals.

Implementation Schedule

Implementation proceeds in five phases over seven months, shown in Table 2. Network work comes first because the hosted record cannot go live until every clinic has two working paths. The messaging change follows the record migration so that staff learn one new workflow at a time.

Table 2. Implementation Schedule

Note. Schedule prepared by the author with the IT support provider.

People and Change

Technology changes of this size succeed or fail with the people who use them. Cresswell et al. (2013) highlight the need for strong leadership, user involvement in design, attention to workflow and continued support after launch in large health IT implementations. The project will be sponsored by the medical director, with a nurse lead from each clinic on the design team for the telephone encounter workflow and super-users trained in each building. Staff will be told early what will change and why, and the health information team will run short weekly check-ins during the first two months after each go-live.

Costs and Funding

First-year capital costs are about $85,000: $38,000 for hosting setup and data migration, $41,000 for network equipment and installation and $6,000 for downtime viewer workstations. Recurring charges come to roughly $99,600 a year, combining the hosting subscription and the new connections, partly offset by ending server maintenance contracts and the current wireless circuit. The capital cost fits within the $120,000 approved for this year, and a pending federal infrastructure grant request would cover part of the network cost.

Risks and Mitigation

Four risks require attention. Vendor dependence will be managed through contract terms on uptime, recovery, the return of all data if the contract ends and prompt notice of any breach. Migration disruption will be limited by a weekend cutover with a tested rollback plan. Satellite service can be affected by obstructions and weather, which the second path and failover address. And staff resistance to retiring the messaging tool will be reduced by involving nurses in the design and measuring whether the new workflow saves them time.

Measuring Success

At twelve months, the project will be judged against the problems it set out to solve: unplanned record downtime under two hours for the year, zero clinic-wide outages caused by a single link, video visit failure below 5% at every clinic, at least 98% of sampled clinical phone encounters documented in the chart, downtime documentation reconciled within 48 hours and two completed drills. Results will be reported to the board's quality committee.

Conclusion

Cedar Fork's record has been only as reliable as its weakest server and its most fragile link, and incomplete wherever conversations happened by phone. The four-part solution addresses availability and completeness together, at a cost within budget, with a schedule, a change plan, managed risks and clear measures. Approving it would give Cedar Fork's clinicians and patients a record that stays up and stays whole.

References

Cresswell, K. M., Bates, D. W., & Sheikh, A. (2013). Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association, 20(e1), e9-e13. https://doi.org/10.1136/amiajnl-2013-001684

Dameff, C., Tully, J., Chan, T. C., Castillo, E. M., Savage, S., Maysent, P., Hemmen, T. M., Clay, B. J., & Longhurst, C. A. (2023). Ransomware attack associated with disruptions at adjacent emergency departments in the US. JAMA Network Open, 6(5), Article e2312270. https://doi.org/10.1001/jamanetworkopen.2023.12270

Griebel, L., Prokosch, H.-U., Köpcke, F., Toddenroth, D., Christoph, J., Leb, I., Engel, I., & Sedlmayr, M. (2015). A scoping review of cloud computing in healthcare. BMC Medical Informatics and Decision Making, 15, Article 17. https://doi.org/10.1186/s12911-015-0145-7

Murphy, D. R., Meyer, A. N. D., Russo, E., Sittig, D. F., Wei, L., & Singh, H. (2016). The burden of inbox notifications in commercial electronic health records. JAMA Internal Medicine, 176(4), 559-560. https://doi.org/10.1001/jamainternmed.2016.0209

Sittig, D. F., & Singh, H. (2012). Electronic health records and national patient-safety goals. New England Journal of Medicine, 367(19), 1854-1860. https://doi.org/10.1056/NEJMsb1205420

Wilcock, A. D., Rose, S., Busch, A. B., Huskamp, H. A., Uscher-Pines, L., Landon, B., & Mehrotra, A. (2019). Association between broadband internet availability and telemedicine use. JAMA Internal Medicine, 179(11), 1580-1582. https://doi.org/10.1001/jamainternmed.2019.2234