Case Studyacquiring An Ehr Systemvalley Practice Provides Patient Care ✓ Solved

CASE STUDY Acquiring an EHR System Valley Practice provides patient care services at three locations, all within a fifteen-mile radius, and serves nearly 100,000 patients. Valley Practice is owned and operated by seven physicians; each physician has an equal partnership. In addition to the physicians, the practice employs nine nurses, fifteen support staff, a business officer manager, an accountant, and a chief executive officer (CEO). During a two-day strategic planning session, the physicians and management team created a mission, vision, and set of strategic goals for Valley Practice. The mission of the facility is to serve as the primary care “medical home†of individuals within the community, regardless of the patients' ability to pay.

Valley Practice wishes to be recognized as a “high-tech, high-touch†practice that provides high-quality, cost-effective patient care using evidence-based standards of care. Consistent with its mission, one of the practice's strategic goals is to replace its current paper-based medical record with an EHR system. Such a system should enable providers to care for patients using up-to-date, complete, accurate information, anywhere, anytime. Dr. John Marcus, the lead physician at Valley Practice, asked Dr.

Julie Brown, the newest partner in the group, to lead the EHR project initiative. Dr. Brown joined the practice two years ago after completing an internal medicine residency at an academic medical center that had a fully integrated EHR system available in both the hospital and its ambulatory care clinics. Of all the physicians at Valley Practice, Dr. Brown has had the most experience using an EHR.

She has been a vocal advocate for implementing an EHR and believes it is essential to enabling the facility to achieve its strategic goals. Dr. Brown contacted the Regional Extension Center (REC) in the community for assistance with the initiative. Dr. Brown agreed to chair the project steering committee.

She invited other key individuals to serve on the committee, including Dr. Renee Ward, a senior physician in the practice; Mr. James Rowls, the CEO; Ms. Mary Matthews, RN, a nurse; and Ms. Sandy Raymond, the business officer manager.

Dr. Brown suggested that the committee work with the REC to guide committee members through the system acquisition process. The physician partners approved this request, and the committee made arrangements for a representative from the REC to work with them on the selection process. After the project steering committee was formed, Dr. Marcus met with the committee to outline its charge and deliverables.

Dr. Marcus expressed his appreciation to Dr. Brown and all of the members of the committee for their willingness to participate in this important initiative. He assured them that they had his full support and the support of the entire physician team. Dr.

Marcus reviewed with the committee the mission, vision, and strategic goals of the practice as well as the committee's charge. The committee was asked to fully investigate and recommend the top three EHR products available in the vendor community. He stressed his desire that the committee members would focus on EHR vendors that have experience and a solid track record in implementing systems in physician practices similar to theirs and that have Office of the National Coordinator for Health Information Technology (ONC)-certified EHR products. He expressed concern that there is a flurry of vendors offering EHR-type products without a solid track record. Dr.

Marcus felt strongly that the EHR system needed to enable providers to access patient information from any of Valley Practice's three sites and from their homes. He also spoke of the need for the system to provide health maintenance reminders, drug interactions, and access to clinical practice guidelines or standards of care. The practice also intends to take advantage of the CMS EHR Incentive Program and achieve meaningful use. Dr. Marcus is interested in exploring what opportunities are available for health information exchange within the region.

He envisions that the practice may eventually partner with specialists, hospitals, and other key stakeholders in the community to provide coordinated care across the continuum. Under the leadership of Dr. Brown, the members of the project steering committee established five project goals and the methods they would use to guide their activities. Ms. Moore, the consultant, assisted them in clearly defining these goals and discussing the various options for moving forward.

They agreed to consider EHR products from only those vendors that had five or more years of experience in the industry and had a solid track record of implementations (which they defined as having done twenty-five or more). Dr. Ward, Mr. Rowls, and Ms. Matthews assumed leadership roles in verifying and prioritizing the requirements expressed by the various user groups.

The five project goals were based on Valley Practice's strategic goals. These project goals were circulated for discussion and approved by the CEO and the physician partners. Once the goals were agreed upon, the project steering committee appointed a small task group of committee members to carry out the process of defining system functionality and requirements. Because staff time was limited, the task group conducted three separate focus groups during the lunch period—one with the nurses, one with the support staff, and a third with the physicians. Ms.

Moore, the consultant, conducted the focus groups, using a semistructured nominal group technique. Concurrently with the requirements definition phase of the project, Mr. Rowls and Dr. Brown, with assistance from Ms. Moore, screened the EHR vendor marketplace.

They reviewed the literature, consulted with colleagues in the state medical association, and surveyed practices in the state that they knew used an EHR system. Mr. Rowls made a few phone calls to chief information officers (CIOs) in surrounding hospitals who had experience with ambulatory care EHR to get their advice. This initial screening resulted in the identification of eight EHR vendors whose products and services seemed to meet Valley Practice's needs. Given the fairly manageable number of vendors, Ms.

Moore suggested that the project steering committee use a short-form request for proposal (RFP). This form had been developed by her consulting firm and had been used successfully by other physician practices to identify top contenders. The short-form RFPs were sent to the eight vendors; six responded. Each of these six presented an initial demonstration of its EHR system on site. Following the demonstrations, the practice staff members completed evaluation forms and ranked the various vendors.

After reviewing the completed RFPs and getting feedback on the vendor presentations, the committee determined that three vendors had risen to the top of the list. Dr. Brown and Dr. Ward visited four physician practices that used EHR systems from these three finalists. Mr.

Rowls checked references and prepared the final vendor analysis. A detailed cost-benefit analysis was conducted, and the three vendors were ranked. All three vendors, in rank order, were presented in the final report given to Dr. Marcus and the other physician partners. Dr.

Marcus, Dr. Brown, and Mr. Rowls spent four weeks negotiating a contract with the top contender. It was finalized and approved after legal review and after all the partners agreed to it.

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Acquiring an Electronic Health Record (EHR) System at Valley Practice: A Case Study Analysis
Introduction
Electronic Health Record (EHR) systems have revolutionized the healthcare landscape, providing enhancements in patient care, data management, and operational efficiency. Valley Practice, a multi-physician primary care practice, recognizes the critical need to transition from a paper-based medical record to an EHR system as part of its strategic goals. This case study outlines the key process steps involved in acquiring an EHR system at Valley Practice, with an emphasis on the roles of the project steering committee, user requirement gathering, vendor selection processes, and implementing change management strategies.
Strategic Goals and EHR Implementation
Valley Practice's mission to serve as a "medical home" for individuals aligns with the anticipated transition to an EHR system. The practice aims to deliver high-quality, cost-effective patient care that adheres to evidence-based protocols (Jha et al., 2010). Dr. John Marcus, the lead physician, emphasized the need for an accessible and integrated EHR system capable of providing up-to-date information, clinical decision support, and health maintenance reminders. These features are critical for achieving meaningful use under the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program (DesRoches et al., 2013).
To achieve its strategic EHR goals, the project steering committee, led by Dr. Julie Brown, was formed to oversee the initiative’s implementation. This committee was essential for ensuring stakeholder engagement, addressing clinician concerns, and establishing a collaborative environment conducive to successful system integration (Boonstra & Broekhuis, 2010).
Project Goals and User Requirements
The project steering committee established five primary project goals aligned with the strategic objectives of Valley Practice: improving patient care quality, enhancing operational efficiency, empowering staff through user-friendly technology, enabling data-driven decision-making, and achieving compliance with regulatory requirements (Boonstra & Broekhuis, 2010). These goals provided a clear framework for vendor selection and system functionality.
To accurately identify user requirements, the committee organized focus groups comprising nurses, support staff, and physicians. Utilizing a semistructured nominal group technique enabled participants to express their needs and concerns (Murphy et al., 2015). Engaging users early in the EHR selection process is vital for creating a system that meets clinical demands and is well-received by staff (Gagnon et al., 2014).
Vendor Selection Process
The selection process for an EHR vendor started with a screening of the marketplace to identify products that aligned with Valley Practice's needs. Eight potential vendors were identified based on existing partnerships, regional recommendations, and historical performance (Gagnon et al., 2014). A short-form Request for Proposal (RFP) was issued, which effectively narrowed the field to six responsive vendors.
Each vendor was invited to provide an on-site demonstration of their EHR capability after which practice staff members evaluated vendors using standardized scoring forms (Häyrinen et al., 2008). Evaluation considered essential factors such as functionality, user interface, cost, and ongoing support services. Ultimately, three vendors met the selection criteria established by the committee. This meticulous vetting process ensured that the chosen EHR would adequately serve Valley Practice's diverse functional requirements (Sittig & Singh, 2010).
Site Visits and Final Vendor Analysis
Recognizing the importance of real-world feedback, Dr. Brown and Dr. Ward conducted site visits to practices using systems from the top three vendors. Insights gained from these visits were instrumental in understanding how the systems functioned in practice and the experiences of users in various clinical environments. Building on these analyses, Mr. Rowls conducted reference checks and prepared a comprehensive vendor analysis, ultimately leading to a detailed cost-benefit analysis (Häyrinen et al., 2008).
Final Negotiation and Contract Approval
Following extensive evaluations, Dr. Marcus, Dr. Brown, and Mr. Rowls engaged in four weeks of contract negotiations with the top vendor contender. This phase required careful consideration to ensure that terms were favorable and adequately met the needs of Valley Practice. The flexibility to negotiate allowed the committee to address specific concerns regarding implementation timelines, system training, and post-implementation support (Kellerman & Kopeny, 2015).
Legal review and consensus among all physician partners were paramount before finalizing the agreement. This strategy fostered transparency and trust, ensuring every partner was on board and thus increasing the likelihood of successful EHR implementation (Häyrinen et al., 2008).
Conclusion
Transiting to an EHR system requires comprehensive planning, stakeholder engagement, and responsive vendor selection processes. Valley Practice's strategic decision to implement an EHR aligns with its mission to provide accessible, quality care while embracing technological advancements. By following a methodical approach to defining user requirements, conducting vendor evaluations, and assembling a dedicated project steering committee, Valley Practice can mitigate potential challenges and fulfill its strategic goals for enhanced patient care.
References
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