HIM 560 Module 5 Final Project Milestone Two Example

Final Project Milestone Two: What the New Systems Must Do. Requirements for Pelican Shoals Health

[Student Name]

Southern New Hampshire University

HIM 560: HIM Informatics and Technology Infrastructure

Final Project Milestone 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.

Final Project Milestone Two: What the New Systems Must Do. Requirements for Pelican Shoals Health

The current-state assessment ranked five gaps at Pelican Shoals Health: servers and backups exposed to flooding with no recovery targets, an unsupported interface engine, document imaging nearing end of support, clinics unable to exchange data electronically and single network circuits to each clinic. This milestone translates those gaps into requirements. It explains how requirements were gathered, presents the most important ones by category, shows how each traces to a gap and ranks them so that the vendor evaluation in the next milestone has clear criteria.

How Requirements Were Gathered

Kaplan and Harris-Salamone (2009) reviewed why health IT projects succeed or fail and stressed early, continuing involvement of the people who will use a system and close attention to their work. Requirements were therefore built from four workshops, each with a different group: health information staff, nurses and physicians, clinic managers and front-desk staff and the IT team. Each workshop walked through real tasks, such as releasing a record for a subpoena, finding a clinic note for an admitted patient or restoring the record after an outage, and described what should happen in the new environment. These walk-throughs became twelve use cases, from which the requirements were drawn.

Requirements are written as needs rather than features. For example, the requirement states that a release-of-information specialist must be able to send a complete, redacted record to the outsourced portal without printing, rather than naming a product feature. This keeps the evaluation open to different technical solutions.

Functional Requirements

For document management, the replacement must let staff scan and index documents at the point of care, retrieve any chart in under three seconds, apply retention rules and legal holds, redact for release and send records to the release-of-information portal electronically. For the clinics, clinicians at the hospital must see clinic visit notes, medication lists and results for shared patients within one minute of their being signed, and clinic staff must see hospital discharge summaries within one hour of signature. Either a shared record or reliable interfaces could meet these needs, and the requirements do not presume which. Release of information adds its own needs: every disclosure must be logged with the requester, purpose and pages sent, accounting reports must be producible on request and records under legal hold must be protected from routine purging. Health information staff also asked that indexing errors be correctable in one step, with the correction recorded, since misfiled documents are among the department's most time-consuming problems today.

Technical and Security Requirements

Every system must be hosted in facilities outside the flood zone with a second recovery site, and must return to service within four hours while losing at most a quarter hour of recent entries, the targets set during the hosting discussion. Interfaces must support HL7 version 2 for results and admissions and FHIR application programming interfaces for on-demand queries, and the interface engine must be vendor-supported with a named backup analyst. Systems must support single sign-on, role-based access, complete audit logs and encryption in storage and in transit. Backups must be kept offline or immutable so that ransomware cannot alter them.

Usability Requirements

Usability is often treated as a matter of taste, but it affects safety and efficiency. Ratwani et al. (2015) examined the user-centered design processes of eleven record vendors and found wide variation, with several not following recommended testing practices. The requirements therefore ask each vendor to document its user-centered design process and to let Pelican Shoals staff complete scripted tasks, such as indexing a scanned consent or finding a clinic medication list, during evaluation. Coders must be able to view the full chart and encoder side by side without switching applications, a need raised in every health information workshop.

Requirements Traced to Gaps

Table 1 shows selected requirements, the gap each addresses, the group that raised it and its priority. Must requirements are conditions any solution has to meet; should requirements carry significant weight; could requirements are desirable if affordable.

Table 1. Selected Requirements with Traceability and Priority

Note. Prepared by the author from four requirements workshops.

Organizational Requirements

Cresswell and Sheikh (2013) found that organizational factors, such as leadership, resources, training and the fit between technology and existing work, shape whether health IT is adopted. The requirements therefore include commitments from Pelican Shoals as well as from vendors: an executive sponsor, backfill for staff during training, a named system owner for each application and a governance process for changes. A vendor cannot meet these, but the project cannot succeed without them.

Next Steps

The must requirements will serve as pass or fail screens for vendors. Should and could requirements will become weighted scoring criteria, with weights agreed by the steering group before any proposal is opened, so that no one adjusts the scoring to favor a product they already like. The next milestone will apply these criteria to three vendor proposals, and each vendor will receive the same use cases and scripted tasks so that demonstrations can be compared fairly rather than shaped by each company's sales script.

Conclusion

The requirements describe what Pelican Shoals needs in terms its staff recognize: records that arrive without faxes, charts that open quickly, systems that recover within hours and backups no storm or attacker can reach. Each requirement traces to a gap found in the assessment and to a group that raised it, which gives the vendor evaluation a fair and defensible basis.

References

Cresswell, K., & Sheikh, A. (2013). Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review. International Journal of Medical Informatics, 82(5), e73-e86. https://doi.org/10.1016/j.ijmedinf.2012.10.007

Kaplan, B., & Harris-Salamone, K. D. (2009). Health IT success and failure: Recommendations from literature and an AMIA workshop. Journal of the American Medical Informatics Association, 16(3), 291-299. https://doi.org/10.1197/jamia.M2997

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