HIM 685 Module 5 Final Project Milestone One Example

Final Project Milestone One: Why We Are Joining and What It Will Take. A Strategic Analysis of Exchange Integration at Longleaf Regional Medical Center

[Student Name]

Southern New Hampshire University

HIM 685: Advanced Topics in HIM II

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: Why We Are Joining and What It Will Take. A Strategic Analysis of Exchange Integration at Longleaf Regional Medical Center

Longleaf Regional Medical Center's board decided in a single meeting to join the statewide health information exchange. Decisions made quickly are not necessarily made well, and the health information department, which will carry much of the work, needs a clear account of why the hospital is joining, what success looks like and what stands in the way. This milestone provides that analysis for the composite Mississippi hospital. It examines the strategic rationale, the external environment, the department's internal position, the stakeholders involved and the goals, success factors and risks that will shape the integration and change plan.

Strategic Rationale

The hospital's strategic plan has three priorities: keeping care local, improving transitions after discharge and holding down avoidable costs. The exchange supports all three. Patients from surrounding rural counties often move between Longleaf, larger hospitals in Jackson and their own clinics, and their records rarely move with them. Menachemi et al. (2018) found that studies with designs suited to causal inference consistently reported benefits from exchange, including fewer duplicated procedures, less imaging and lower costs, with community exchanges more likely to show benefit than enterprise or vendor networks. The statewide exchange is a community exchange, which makes it a good fit for the hospital's strategy. Texas hospitals whose boards took part in planning and whose chief executives owned the plan tended to report healthier finances (Kaissi & Begun, 2008), and the board's involvement here is a strength the department should use.

External Environment

Three external conditions matter. Federal interoperability policy increasingly expects hospitals to send admission, discharge and transfer notices and to make records available electronically, so not joining carries regulatory and reputational risk. The exchange's own finances are a concern: Because exchange organizations have often lacked a lasting source of revenue (Adler-Milstein et al., 2013), the hospital should not assume the exchange will provide extensive support or last forever without members' commitment. Finally, competing hospitals in the region have already joined, which means clinicians there will soon expect Longleaf's data to be available too.

Internal Position

The case analysis in Module One found strengths in an experienced coding team, accurate data and committed leaders, and weaknesses in a mail and fax release process, two clinic systems with different patient identifiers and no staff experience managing interfaces. The exchange model analysis added a fourth weakness: the hospital's document server was not built for round-the-clock queries. Vest and Gamm (2010) found the hardest exchange problems to be organizational ones, and Longleaf's own are inside the hospital rather than at the exchange.

Stakeholders

Table 1 maps the main stakeholders by their interest in the integration and their influence over it. The map helps decide where to spend leadership time.

Table 1. Stakeholder Interests and Influence

Note. Influence reflects ability to speed or stall the integration, not formal authority alone.

Integration Goals

Four goals will guide the plan. First, link the two clinic identifiers and reduce Longleaf's duplicate record rate from 4.1% to under 1% before the first feed goes live in month four. Second, send admission, discharge and transfer notices for all inpatients within fifteen minutes of each event by month five. Third, make signed discharge summaries available for query within 48 hours of discharge for 95% of stays by month eight. Fourth, answer at least 40% of incoming record requests from other providers through the exchange rather than by mail or fax by month twelve, with no reduction in release-of-information staff positions.

Alignment With Other Initiatives

The integration does not happen in isolation. The hospital is also upgrading its record system's patient portal this year and renegotiating its laboratory interface, and both projects compete for the same two IT analysts. The HIM department's goals have been sequenced so that identity cleanup, which needs mostly HIM and registration staff, comes first while IT finishes the portal, and the notice and document feeds follow once analysts are free. The portal project also creates an opportunity: patients who request their own records can be steered toward the portal, which will lower the release-of-information team's patient request volume at the same time as provider requests begin moving to the exchange. Coordinating the two lets the team see its work changing in a planned way rather than through a series of surprises. A shared calendar of go-live dates across the three projects will be reviewed at each monthly steering meeting so that no two cutovers fall in the same week.

Critical Success Factors and Risks

Four factors will decide success: clean patient identity before go-live, a reliable document server, physicians' willingness to sign summaries promptly and a release-of-information team that sees the change as an opportunity rather than a threat. The main risks mirror them. If identity work runs late, the first feed will spread duplicates across the state. If the server is not upgraded, queries will fail at night. If physicians delay signatures, retrieved summaries will be incomplete. And if the release team resists, the old mail and fax process will continue alongside the new one, doubling the work. The last risk is the least technical and the most likely, which is why the next milestone centers on change management.

Conclusion

Joining the exchange fits Longleaf's strategy and its environment. The obstacles are mostly internal, and several fall to health information management. The four goals give the department clear targets, and the stakeholder map shows where leadership effort is needed most, especially with the release-of-information team. Milestone Two will build the change management and implementation plan around them.

References

Adler-Milstein, J., Bates, D. W., & Jha, A. K. (2013). Operational health information exchanges show substantial growth, but long-term funding remains a concern. Health Affairs, 32(8), 1486-1492. https://doi.org/10.1377/hlthaff.2013.0124

Kaissi, A. A., & Begun, J. W. (2008). Strategic planning processes and hospital financial performance. Journal of Healthcare Management, 53(3), 197-208. https://doi.org/10.1097/00115514-200805000-00011

Menachemi, N., Rahurkar, S., Harle, C. A., & Vest, J. R. (2018). The benefits of health information exchange: An updated systematic review. Journal of the American Medical Informatics Association, 25(9), 1259-1265. https://doi.org/10.1093/jamia/ocy035

Vest, J. R., & Gamm, L. D. (2010). Health information exchange: Persistent challenges and new strategies. Journal of the American Medical Informatics Association, 17(3), 288-294. https://doi.org/10.1136/jamia.2010.003673