HIM 685 Module 9 Final Project Example

Final Project: Connected and Ready. An Exchange Integration and Change Management Plan for Longleaf Regional Medical Center

[Student Name]

Southern New Hampshire University

HIM 685: Advanced Topics in HIM II

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: Connected and Ready. An Exchange Integration and Change Management Plan for Longleaf Regional Medical Center

Summary

Longleaf Regional Medical Center will join the statewide health information exchange within twelve months. The technology is the smaller part of the work. The larger part falls to health information management: making sure each patient appears once, that documents are complete when strangers retrieve them and that a release-of-information team built around mail and fax becomes the team that runs the hospital's exchange presence. This plan asks leaders to approve five workstreams, a twelve-month roadmap, a change approach that moves only as fast as the people affected are ready and a first-year budget of about $142,000, and to endorse a commitment that no release-of-information positions will be cut.

Why Join

The exchange serves all three priorities in the hospital's strategic plan: keeping care local, improving transitions and avoiding unnecessary cost. Patients from the surrounding counties move between Longleaf, larger hospitals and their own clinics, and their records seldom follow. A systematic review found that studies designed to support causal claims consistently reported benefits from exchange, such as fewer repeated procedures and lower costs, and that community exchanges like the statewide one were the most likely to show them (Menachemi et al., 2018). Competing hospitals have already joined, and clinicians will soon expect Longleaf's data to be there too.

What the Hybrid Model Asks of HIM

The exchange holds a master patient index, a record locator and a store of lab results and admission notices centrally, while full documents remain on Longleaf's server and are pulled on request. That design makes four duties fall to HIM: owning patient identity, since the index matches people across members; owning document quality, since summaries are read by clinicians who cannot ask follow-up questions; deciding with the privacy officer what is shared and honoring patients who opt out; and watching the feeds daily. Benson and Grieve (2021) stress that interoperability requires agreement on both message structure and terminology, and the department's data dictionary defines twelve elements against HL7, LOINC, SNOMED CT, RxNorm and C-CDA standards with testable quality rules.

Goals

Four goals anchor the plan. Before the first feed in month four, the duplicate record rate falls from 4.1% to under 1%. By month five, admission, discharge and transfer notices reach the exchange within fifteen minutes. By month eight, 95% of discharge summaries are signed and available within 48 hours. By month twelve, at least 40% of incoming provider requests are answered through the exchange, with no reduction in release-of-information positions.

Workstreams and Roadmap

Five workstreams carry the work, each with one owner: patient identity, interfaces and infrastructure, documents, the release-of-information transition and patient notice and choice. Identity leads the sequence, since no feed can be trusted until patients are matched. The notice feed follows in month four, labs in month five and document queries in month seven. The release team's transition runs the full year instead of waiting for the end, and paper and fax handling continues until the exchange has met its target three months in a row.

Leading the Change

Exchange efforts have more often stalled on organizational barriers than on technology (Vest & Gamm, 2010), so the change approach receives as much attention as the interfaces. The plan follows the sequence set out by Kotter (1995), from building a case for change and a guiding group through short-term wins to anchoring new practices, but the case for change is framed around patients rather than around threats to jobs. Before each phase, the steering group checks readiness with two questions drawn from Weiner (2009): do the people affected think the change worthwhile, and do they feel able to do it, and pauses when the answers are not yet positive. When a veteran specialist described the exchange as a slow way of firing her, the plan treated that as information, as Ford et al. (2008) recommend, and added shadowing visits so the team could see the new work done before training began.

A Promise to the Release Team

The plan commits in writing that no release-of-information positions will be cut because of the exchange. The team's work will change from copying and mailing toward reviewing unmatched patients, handling restricted and unusual requests, auditing disclosures and monitoring feeds. Job descriptions will be rewritten around the new duties, with pay grades reviewed where responsibilities grow, and team members will help design what the new day looks like. The promise matters because the team's practical influence over the change is high, and because the hospital's earlier handling of coding staff has left a memory that words alone will not overcome.

Measures and Budget

The steering group tracks the four goals monthly along with two measures of how people are coping: release team readiness scores and turnover. Table 1 shows the first-year budget.

Table 1. First-Year Budget

Note. Excludes existing staff salaries; the release team's positions are retained.

Risks

The main risks are identity cleanup running late, the document server failing overnight queries, physicians delaying signatures and the release team losing confidence. Each has a response: identity work starts first with temporary help, the server is upgraded before document queries go live, physician champions and reminders target signatures and readiness gates pause the plan when the team needs more time.

The steering group will review the risk list at every meeting and add new risks as they appear, such as a change in the exchange's fees or a long outage at a partner hospital, so the list keeps changing as the project does.

Request

The plan asks the chief executive to approve the five workstreams and their owners, the roadmap and the first-year budget of about $142,000, and to state publicly the commitment to the release-of-information team. With that support, a year from now Longleaf's patients will be visible to clinicians across the state, and the team that once mailed their records will be the team that keeps them accurate and available.

References

Benson, T., & Grieve, G. (2021). Principles of health interoperability: FHIR, HL7 and SNOMED CT (4th ed.). Springer.

Ford, J. D., Ford, L. W., & D'Amelio, A. (2008). Resistance to change: The rest of the story. Academy of Management Review, 33(2), 362-377. https://doi.org/10.5465/amr.2008.31193235

Kotter, J. P. (1995). Leading change: Why transformation efforts fail. Harvard Business Review, 73(2), 59-67.

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

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67