HIM 560 Module 9 Final Project Example

Final Project: Out of the Basement and Onto One Record. A Technology Infrastructure Plan for Pelican Shoals Health

[Student Name]

Southern New Hampshire University

HIM 560: HIM Informatics and Technology Infrastructure

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: Out of the Basement and Onto One Record. A Technology Infrastructure Plan for Pelican Shoals Health

Executive Summary

Pelican Shoals Health runs its inpatient record in a flood-exposed basement, keeps its backups beside its servers, depends on an unsupported interface engine understood by one analyst, faces the end of support for its imaging system in eighteen months and receives its own clinics' records by fax. After assessing these gaps, defining requirements with staff and evaluating three proposals, leaders chose to join a regional health system's shared record. This plan sets out how to get there in sixteen months, what to protect in the meantime, what it will cost, which risks to manage and how success will be measured. The five-year cost is estimated at $7.4 million, offset in part by retiring on-site servers, the interface engine and the imaging system.

Target Architecture

Table 1 compares the current and future state of each major component.

Table 1. Current and Future Architecture

Note. Prepared by the author from the assessment and the selected proposal.

Protections That Cannot Wait

Go-live is sixteen months away, and a hurricane season falls in between. Three measures will therefore begin in the first month. Nightly backups will be copied to immutable storage at an inland provider, closing the gap in which a flood or ransomware could destroy both systems and backups. A second analyst will be trained on the interface engine, and its configuration will be documented. Downtime workstations and the storm plan from the downtime paper will be put in place before June. The NIST contingency planning guide emphasizes protecting backups from the threats facing primary systems (Swanson et al., 2010), and these steps do so at modest cost while the larger change proceeds.

Implementation Phases

The work proceeds in four phases. In months one to three, the shared-instance agreement is signed, governance seats and change-request terms are confirmed and the local project team is formed. In months four to ten, the regional system and local teams build Pelican Shoals' departments, order sets, document types and interfaces, with health information staff defining document indexing, release-of-information workflows and legal record rules. Months eleven to fourteen are for testing, including integrated tests of admission-to-billing workflows, two full downtime drills and training. Hospital and clinics go live together in month sixteen, two months before imaging support ends, followed by ninety days of stabilization.

Kaplan and Harris-Salamone (2009) identified user involvement, attention to workflow and realistic timelines as recurring features of successful projects, and each phase includes frontline staff in design and testing rather than consulting them only at the end.

Legacy Data and the Archive

Not all history should move. Two years of discrete data, including problem lists, allergies, medications, immunizations and recent results, will be converted into the shared record so clinicians see what they need. Older records and all scanned images will move to a read-only archive that meets the hospital's retention obligations under state and federal rules and can produce a complete legal record on request. Health information staff will validate conversion with a sample of 200 patients, checking that allergies and medications match the source. The archive will be linked from the shared record so users can open older documents without a separate login, a lesson from the unused clinic viewer.

Security, Privacy and Agreements

The shared-instance agreement will set out each party's HIPAA responsibilities, including business associate terms, breach notification duties, audit access and a clear exit clause under which Pelican Shoals receives complete, readable copies of its records should the partnership end. Role-based access will limit regional system staff to Pelican Shoals patients only where care or operations require it, and the privacy officer will review access reports monthly for the first year. Future third-party applications will connect through FHIR interfaces with standard authorization, the approach Mandel et al. (2016) described, rather than custom connections.

Training and Support

Holden and Karsh (2010) found that perceived usefulness and ease of use shape whether clinicians accept a system, so training will focus on the tasks each role performs most, not on menus. Each unit and clinic will have a physician or nurse champion trained a month early. For two weeks after go-live, trained helpers will be on every unit and in every clinic around the clock, with a command center for issues. Health information staff will receive extra training in document indexing, release and record correction, since they will be the first to see errors.

Budget

The five-year estimate of $7.4 million includes the hospital's share of licensing, hosting and support, implementation services, training backfill, the archive and internal staff. Retiring the on-site servers, interface engine and imaging system avoids about $1.9 million in replacement and support costs over the same period, and eliminating faxing and scanning frees about two full-time positions for match review and record quality work.

Risk Register

The main risks are a storm or outage before go-live, addressed by the interim protections; loss of local influence in a larger system, addressed by the governance seat and change-request terms; conversion errors, addressed by sample validation; clinician resistance, addressed by champions and on-floor support; and safety events during cutover. Larsen et al. (2018) showed how downtime disrupts care, so cutover will occur on a low-census weekend with paper procedures ready and pharmacy verification of every active order.

Measures of Success

At six and twelve months after go-live, success will be judged on recovery drills meeting the four-hour target, faxed pages from the clinics falling from about 120 a day to fewer than ten, chart retrieval under three seconds, clinician use of outside records measured through access logs, release-of-information turnaround and staff satisfaction. Results will go to the governance committee and the board.

Conclusion

The plan moves Pelican Shoals Health's records out of a flooded basement and onto one record shared with its clinics and regional partner, while protecting the hospital during the sixteen months it takes to get there.

References

Holden, R. J., & Karsh, B.-T. (2010). The technology acceptance model: Its past and its future in health care. Journal of Biomedical Informatics, 43(1), 159-172. https://doi.org/10.1016/j.jbi.2009.07.002

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

Larsen, E., Fong, A., Wernz, C., & Ratwani, R. M. (2018). Implications of electronic health record downtime: An analysis of patient safety event reports. Journal of the American Medical Informatics Association, 25(2), 187-191. https://doi.org/10.1093/jamia/ocx057

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

Swanson, M., Bowen, P., Phillips, A. W., Gallup, D., & Lynes, D. (2010). Contingency planning guide for federal information systems (NIST Special Publication 800-34, Rev. 1). National Institute of Standards and Technology. https://doi.org/10.6028/NIST.SP.800-34r1