HIM 480 Module 6 Capstone Milestone Three Example

Capstone Milestone Three: Pilot, Measure, Spread, an Implementation and Evaluation Plan for Problem List Accuracy

[Student Name]

Southern New Hampshire University

HIM 480: Health Information Management Capstone

Capstone Milestone Three

[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.

Capstone Milestone Three: Pilot, Measure, Spread, an Implementation and Evaluation Plan for Problem List Accuracy

Module Five designed a six-part program to make Hollis Ridge Health's problem lists more complete and current. A design is only a hypothesis until it is tried. This milestone plans how the program will be introduced, first in a pilot and then across all 12 primary care clinics, and how its effects will be measured so that leaders can decide whether to keep, change or stop each component.

Pilot First, Then Spread

The program will begin in three clinics for 12 weeks. The clinics were chosen deliberately: the clinic with the lowest baseline completeness, 61%, a mid-range clinic and the clinic with the most part-time clinicians, so the pilot tests the program where it is hardest. The remaining nine clinics will continue current practice during the pilot and then adopt the program in three waves of three clinics, one wave each month. This staged approach lets the waiting clinics serve as a comparison during the pilot and gives the team time to fix problems before each wave.

Within the pilot, components will be introduced in a set order and tested in small cycles before the full pilot begins. According to Taylor et al. (2014), plenty of hospital teams have claimed to use plan-do-study-act while really running one large change without small tests or documented learning. To avoid that, the reconciliation step will first be tried by one nurse and one physician for a week, and the suggestion rules will be run silently for two weeks, recording what they would have suggested, before any clinician sees them.

Roles and Training

The chief medical information officer sponsors the program and resolves conflicts over priorities. The capstone author, as data integrity specialist, coordinates the project, produces the monthly reports and leads the health information cleanup. An informatics analyst builds the problem pane and suggestion rules. At each pilot clinic, a physician champion and a nurse lead model the reconciliation routine and gather feedback. Training takes 30 minutes per clinic at a staff meeting, scheduled during the week before each clinic starts, covering why the list matters, the new policy, the reconciliation routine and how to handle suggestions, followed by two weeks of at-the-elbow support from the nurse lead.

Communication

Clinicians need to hear why before how. The sponsor will introduce the program at the primary care leadership meeting using the heart failure near miss and the baseline data. Each pilot clinic gets a single printed sheet explaining the program plus a brief weekly note read aloud at its morning huddle, and all clinicians will see the monthly clinic reports once the spread begins. Cresswell et al. (2013) emphasize that large health IT changes succeed when leaders communicate the purpose, involve users in design and keep supporting them after launch, which this plan builds in through champions, huddles and reports.

Measures, Baselines and Targets

Table 1 lists the measures. Outcome measures show whether the lists improve, process measures show whether the program is being used and balancing measures watch for harm, such as longer visits or alert fatigue.

Table 1. Evaluation Measures

Note. Measures and targets proposed by the author and reviewed with the sponsor.

How Results Will Be Analyzed

During the pilot, each month's process results go onto simple time-ordered charts, which become control charts once about a year of points has built up. Benneyan et al. (2003) describe statistical process control as a way to tell whether a shift in the numbers reflects a real change in how work is done or just the usual ups and downs, a question that matters when a program arrives in stages and several things change at once. Quarterly audits will compare pilot clinics with waiting clinics during the pilot, and each wave with its own baseline afterward. Because clinics adopt the program at different times, an improvement that appears in each clinic soon after it adopts the program, and not before, would be stronger evidence of effect than a single before-and-after comparison.

Costs

The program's costs are mainly staff time. The informatics analyst estimates 60 hours to build and test the problem pane and suggestion rules and four hours a month for maintenance. Training takes about 30 minutes per clinic, and champions will spend about two hours a month on the program during the pilot. The data integrity specialist's audits and reports take about 16 hours a month. No new software is required, since the record system already supports the pane, rules and portal flag.

Sustaining the Gains

If the program works, three steps will keep it working. The ownership policy will become part of the medical staff rules. The reconciliation step will be written into the rooming workflow and nurse orientation. And the quarterly audit and monthly clinic reports will continue as a standing responsibility of the health information data integrity team, reported to the primary care quality committee.

Risks

Two risks could undermine the evaluation. If clinicians find the suggestions inaccurate, they may ignore them, so the silent test period and the dismissal review are designed to catch weak rules early. If audits change method over time, results will not be comparable, so the same reference standards and reviewers will be used throughout, with an agreement check each quarter.

Conclusion

This plan introduces the problem list program where it is hardest, tests each part in small cycles, spreads it in waves that allow comparison and judges it against clear baselines, targets and balancing measures. The final capstone report will bring the proposal, analysis, design and this plan together for the sponsor.

References

Benneyan, J. C., Lloyd, R. C., & Plsek, P. E. (2003). Statistical process control as a tool for research and healthcare improvement. Quality and Safety in Health Care, 12(6), 458-464. https://doi.org/10.1136/qhc.12.6.458

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

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862