HIM 500 Module 3 Final Project Milestone One Example

Final Project Milestone One: Lessons, Standards and a Seven-Step Process for Evaluating Health IT at Bramble Bay

[Student Name]

Southern New Hampshire University

HIM 500: Healthcare Informatics

Final Project Milestone One

[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 Milestone One: Lessons, Standards and a Seven-Step Process for Evaluating Health IT at Bramble Bay

Bramble Bay Medical Center receives more technology proposals than it can evaluate. This quarter alone, the record vendor has offered an ambient documentation tool and a larger decision support package, and the regional exchange has invited the hospital to join a national network. Decisions have been made by whichever leader hears the pitch first. This milestone gives the hospital a better basis: lessons from informatics history, the standards any new system must meet and a structured process for evaluating technology against the hospital's needs and legal duties.

Three Lessons From History

The Module Two history offers three lessons for evaluation. First, benefits come from the logic, data and workflow built around a system rather than the software itself; research on order entry showed large safety gains only where decision support and implementation were done well. Second, clinician involvement in design predicts whether a system is used well, as the Veterans Affairs experience suggests. Third, systems configured in a hurry to meet external deadlines often need expensive rework later, as Bramble Bay learned after its 2012 installation. Each lesson becomes a step in the evaluation process below.

Standards a New System Must Meet

Standards make systems able to share and interpret data. Terminology standards give data consistent meaning: SNOMED CT for clinical findings and problems, LOINC for laboratory tests and observations, RxNorm for medications and ICD-10-CM and CPT for diagnoses and procedures in billing. Messaging standards move data between systems; HL7 version 2 messages still carry most laboratory results and admissions inside hospitals, while C-CDA documents carry care summaries between organizations. Interface standards let applications connect: HL7 FHIR defines resources such as Patient and Observation that can be retrieved through modern web interfaces. Mandel et al. (2016) described SMART on FHIR, which adds standard authorization and app launch so that one application can work across record systems, the basis of today's patient and provider access interfaces.

Certification completes the picture. The federal Health IT Certification Program sets criteria that record products must meet, including standardized interfaces, and federal payment programs require hospitals to use certified technology. A new tool that stores or exchanges patient data should therefore be checked against these standards and, where applicable, certification.

The Seven-Step Evaluation Process

The process has seven steps, each producing a written result. Step one defines the need in measurable terms, such as documentation time per visit or the share of transfers arriving without outside records, so that success can be judged later. Step two converts the need into requirements that any product must meet. Step three checks standards and certification: which terminologies, interfaces and certification criteria the product supports. Step four reviews legal duties, including a security risk analysis, a business associate agreement, information blocking obligations and any specially protected data. Step five weighs the evidence that the technology achieves the need in settings like Bramble Bay's. Step six tests usability with the clinicians and staff who would use it. Step seven estimates five-year cost and compares options.

Several steps rest on research. Kawamoto et al. (2005) found that decision support systems succeeded most often when they delivered recommendations automatically within clinical workflow, at the time and place decisions were made, which gives the evidence step specific features to look for. Ratwani et al. (2015) found wide variation in how record vendors practiced user-centered design, so step six relies on testing with Bramble Bay's own staff rather than vendor claims. Sittig and Singh (2010) showed that technology, people, workflow, organization and external rules interact, so the process examines each rather than the software alone.

Weighted Criteria

To compare options consistently, the steering committee will score each against weighted criteria agreed before any vendor demonstration. Table 1 shows the proposed criteria and weights.

Table 1. Proposed Evaluation Criteria and Weights

Note. Criteria and weights proposed by the author for the steering committee.

Governance of the Process

Ownership of the process sits with an informatics steering committee led by the chief medical information officer, whose members include health information management, nursing, pharmacy, information security, compliance and finance, will own the process. Proposals will enter through a single intake form that states the need. Cresswell et al. (2013) emphasized that large health IT projects succeed when leadership, user involvement and attention to organizational change accompany the technology, which argues for giving the committee authority to decline proposals that skip steps, even when a vendor offers a discount.

A Worked Example of Steps Three and Four

To test the process, the manager ran the ambient documentation proposal through steps three and four in advance. The tool records the visit conversation, sends audio to the vendor's cloud service and returns a draft note into the record through a FHIR interface. The standards check found that the draft notes arrive as unstructured text, so problems and medications mentioned in the conversation are not coded unless the clinician adds them, which matters for the problem list work the hospital has underway. The legal review raised three questions: whether recordings are retained and for how long, whether patients must be told the visit is being recorded under Georgia law and hospital policy, and whether the vendor may use recordings to train its models. None of these answers appeared in the sales materials, which is exactly why the steps exist.

Applying the Process

The three current proposals will be the first to go through the process. For ambient documentation, the need will be defined as documentation time outside scheduled hours; for decision support, as the medication alert override rate; and for national exchange, as the share of transfer patients arriving without outside records. Milestone Two will review the legal and regulatory ramifications of these technologies, and Milestone Three will apply the full process to produce recommendations.

Conclusion

Bramble Bay's technology decisions have been driven by timing and vendor offers. Lessons from history, attention to standards and certification and a seven-step process with weighted criteria give the hospital a way to decide on evidence and need instead. The rest of the project will put that process to work.

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

Kawamoto, K., Houlihan, C. A., Balas, E. A., & Lobach, D. F. (2005). Improving clinical practice using clinical decision support systems: A systematic review of trials to identify features critical to success. BMJ, 330(7494), Article 765. https://doi.org/10.1136/bmj.38398.500764.8F

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

Ratwani, R. M., Fairbanks, R. J., Hettinger, A. Z., & Benda, N. C. (2015). Electronic health record usability: Analysis of the user-centered design processes of eleven electronic health record vendors. Journal of the American Medical Informatics Association, 22(6), 1179-1182. https://doi.org/10.1093/jamia/ocv050

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