Partners Healthcare System

Partners Healthcare System

  • What are the challenges faced by PHS in implementing an enterprise-wide electronic medical records (EMR) system?

Partners Healthcare System (PHS) is a large organization comprised of many locations, providers, and patients (Kesner, 2009). The size of the organization contributes to the challenges related to implementing an electronic medical record (EMR). In addition, the complexity of caring for patients related to the complexity of the United States’ healthcare system affects quality of care and cost of delivery (Martin et al., 2020). With the implementation of the Health Information Technology (HITECH) act, there was more pressure on healthcare systems to have a system-wide EMR (Saba & McCormick, 2015). However, implementing an EMR had obstacles to include: (a) the high cost of information system implementation, (b) physician resistance, and (c) deficient infrastructure (Kesner, 2009).

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  • What are the challenges faced in establishing a decision-support system to assist healthcare providers in treating their patients?

A decision-support system is designed to help with clinical decision making based on data derived from the system (Saba & McCormick, 2015). The complex nature of PHS makes this integration a challenging endeavor (Kesner, 2009). For example, multiple providers either did not have the infrastructure in their physical space to support this technology or they did not have the desire to support the implementation. In addition, the implementation price per provider was estimated to be costly.

  • From a project management perspective, which system deployment success factors are in place, and which factors appear to be absent?

There were multiple factors in place to safeguard success. John Glaser, CEO, had already undertaken a similar implementation elsewhere, so he had knowledge of the process (Kesner, 2009).  The organization’s key leaders had expertise in both healthcare and information technology (IT). In addition, each section had its own IT specialist, and groups were formed based on expertise to manage implementation. This organizational format is consistent with a steering committee, which is comprised of key individuals selected to oversee the successful integration of a project (Saba & McCormick, 2015). One aspect of the implementation process that could have been improved was physician buy-in, as they are key stakeholders in the organization (Kesner, 2009). In fact, having stakeholder support in an important factor to promote a successful change process (Martin et al., 2020).

  • Does the Information Systems (IS) unit’s approach to the architectural design of the solution mitigate project risk and contribute to a successful outcome? If so, how? If not, please identify what is needed to improve the situation.

Architecture, as defined by the case study, pertains to current systems processes that could act as a barrier to implementing new technology (Kesner, 2009).  In this case, I believe that PHS had an adequate architectural design in-place to facilitate a successful integration outcome. In addition, the workflow diagram and organization leadership chart, which are essential to the planning and analysis phases, both acted as a frameworks for promoting a favorable outcome (Saba & McCormick, 2015).

References

Kesner, R. (2009). Partners Healthcare System (PHS): Transforming healthcare services delivery through information management (Northeastern University) [Northeastern University, College of Business Administration, Case Study]. Ivey Management Services.

Martin, B., Jones, J., Miller, M., & Johnson-Koenke, R. (2020). Health care professionals’ perceptions of pay-for-performance in practice: A qualitative metasynthesis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing57, 1–17. https://doi.org/10.1177/0046958020917491

Martin, T. R., Gasoyan, H., & Wierz, D. J. (2020). Error by omission: A lack of integration across implementation and use in structuring health information technology contracts. Health Informatics Journal6(3), 2202–2212. https://doi.org/10.1177/1460458219898095

Saba, V. K., & McCormick, K. A. (2015). Essential of nursing informatics (6th ed.). McGraw-Hill.

 

 

 

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In reply to Kara Kosycarz

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Crystal Caddell – Wednesday, 18 November 2020, 7:39 AM

Kara,

I find it very interesting that you brought up the issue of staff buy-in. There were many of the health professionals within the organization who were hesitant to transition and not seeing the value added to patient care and cost benefits (Kesner, 2009). As you stated, this is a major theme in both case studies we have reviewed. Therefore, I wanted to elaborate more on ways we can help to improve staff buy-in on a project.

Basically, the simplest way to defend against project failure is to gain sufficient buy-in, 360 degrees around the project. By having staff buy-in, failure is avoided or reduced by prevention or early detection and acts of remedy through stakeholder intervention. This corrects issues and prevents the project from going astray. Teams want to be assured that everyone around them is capable and committed to delivering the outcome, including suppliers and contractors (Aziz, 2014). They need to assure themselves that they are in the right hands; they can trust the project manager, steering committee, and executives. Teams want to feel valued and protected. The project manager needs to identify and deploy methods that emphasize, recognize, highlight, and reward their achievements. An additional need for teams to have buy-in is for them to understand the return on investment. What will this project do for the company? How will it impact me? Individuals want the project to put them in a better place socially or economically. Finally, people need to feel appreciated. Involving them in the process of planning and decision making makes them feel like their voice is heard and they matter to the company. Providing a pre-dictated plan just makes a team feel as if they are perceived as not knowing enough, not being good enough, and that they are insignificant (Aziz, 2014).

References

Aziz, E. E. (2014). How to secure 360 stakeholder buy-in and sustain it? Paper presented at PMI® Global Congress 2014—North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.

Kesner, R. (2009). Partners healthcare system (PHS): Transforming health care services delivery through information management. Northeastern University, College of Business Administration.

 

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In reply to Kara Kosycarz

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Sokhira Yang – Saturday, 21 November 2020, 11:35 AM

Kara,
Great informative post! I think PHS did a better job in segwaying their product into the system, there were some hesitancy with providers due to the lack of infrastructure. In the comparison with case study one and case study two, would you have change the process in implementing PHS or did you feel that the planning phase was well thought out?

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In reply to Kara Kosycarz

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Amy Carey – Sunday, 22 November 2020, 8:29 AM

Hi Kara,
Thank you for your discussion post! I wanted to research more about the Health Information Technology Act, as you mentioned there is a lot of pressure on organizations to apply the electronic health record. In an article written last month, October of 2020, it is not yet clear that what the actual effectiveness of EHR promotion is like since the Health Information Technology for Economic and Clinical Health (HITECH) Act ( Yuan, Li & Wu,2020). The levels of progress made at different stages of EHR vary for different providers, The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 is the largest US initiative to date for widespread use of EHRs , and represents the largest US initiative to date for widespread use of EHRs ( Yuan,Li & Wu,2020).The federal government has committed about US$650 million under the HITECH Act to establish up to 70 regional health information technology extension centers. The amount of the incentives to each hospital will be more than US$2 million if they can meet the ‘meaningful use’ criteria (Yuan, Li & Wu,2020).
Meaningful Use is defined as ‘use of digital medical and health records to improve quality, safety and efficiency of patient health information (Joneidy & Burke,2019). The health care industry in the United States has invested heavily in promoting what is referred to as the ‘meaningful use’ of information systems, in hopes that organizations will take advantage of the uptake of EHR systems. The field of research explains ‘using digital medical and health records can improve quality, safety, efficiency, and reduce health disparities, engage patients and family, improve care coordination and population and public heath, and maintain privacy and security of patient health information ( Joneidy & Burke,2019). All this meaningful, rich information can be used to help providers to deliver high quality of care. It is believed that the efficiencies of the US healthcare system cannot be realized without the widespread use of EHRs ( Joneidy & Burke,2019).
It is such an eye opener to me, the changes that have occurred in healthcare over the last ten years. Technology is a great tool which can help us in so many ways , but I am sure there are many who frown upon it, especially our older generation of physicians who have been practicing for so many years, using there own little system, some big changes!
Thank you for your post!

References

Joneidy, S., & Burke, M. (2019). Towards a deeper understanding of meaningful use in electronic health records. Health Information and Libraries Journal, 36(2), 134–152. https://doi.org/10.1111/hir.12233
Yuan, B., Li, J., & Wu, P. (2020). The effectiveness of electronic health record promotion for healthcare providers in the United States since the Health Information Technology for Economic and Clinical Health Act: An empirical investigation. The International Journal of Health Planning and Management. https://doi.org/10.1002/hpm.3085

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In reply to Content Services (LJ)

Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Crystal Caddell – Monday, 16 November 2020, 2:42 PM

Case Study II

Partners Healthcare System (PHS) is a large enterprise consisting of 6,300 physicians, 11 hospitals, specialty clinics, and community health centers (Kesner, 2009). This organization aimed to implement a system-wide electronic medical record (EMR) system to improve the utilization of services for more cost-effective care. The challenges PHS faced included (a) physicians and physician offices were scattered across the greater Boston area, (b) the physician offices typically lacked the technology and communication infrastructures needed to meet the needs of the enterprise collectively, and (c) there was a high demand for technology training and support to ensure the change was successful. Furthermore, there were many of the health professionals within the organization who were hesitant to transition and did not see the value added to patient care and cost benefits. Decision-support systems help practitioners make the best decisions for their patients’ treatment at the lowest possible cost. However, challenges are faced when practitioners do not value this guidance either through being “stuck in their ways” or not trusting the accuracy of digital systems.

Even with the challenges faced, PHS had many deployment success factors in place. The organization hired an experienced project manager and created stakeholder governance committees. These end-user teams work to ensure the steering committee thoroughly understands practitioner/patient requirements and a system’s feature needs (Saba & McCormick, 2015). It is obvious that they did an excellent job with their SWOT analysis and determined their strengths, weaknesses, opportunities, and threats thoroughly to take proactive action for addressing these concerns. They integrated strong tech support for the staff initially and ongoingly and provided financial incentives to add economic value to increase the staff’s desire to change. Desire can be broken down into three dimensions: (a) agency, (b) competence, and (c) effort (Cohen et al., 2017). Cohen et al. (2017) studied 267 adults using a questionnaire to learn how these dimensions correlated and to determine which dimension was a more vital driving force of desire. The researchers identified that mastery was socially desirable, but something’s economic value was more impactful overall.

Additionally, the architecture of the system design utilized workflows to create improved decision making and better consistencies of care. Saba and McCormick (2015) stated it is inevitable that organizations with complex processes will have system breakdowns. Workflow diagrams help to alleviate these efficiency issues (Faulkner, 2018). Therefore, these workflow diagrams and decision trees integrated into the technology helps to mitigate risk and contribute to successful outcomes.

 

References

Cohen, J., Darnon, C., & Mollaret, P. (2017). Distinguishing the desire to learn from the desire to perform: The social value of achievement of goals. The Journal of Social Psychology, 157(1). 30-46. http://dx.doi.org/10.1080/00224545.2016.1152216

Faulkner, A. (2018). Lucidchart for easy workflow mapping. Serials Review44(2), 157–162. https://doi.org/10.1080/00987913.2018.1472468

Kesner, R. (2009). Partners healthcare system (PHS): Transforming health care services delivery through information management. Northeastern University, College of Business Administration. https://hbsp.harvard.edu/download?url=%2Fcourses%2F761900%2Fitems%2F909E23-PDF-ENG%2Fcontent&metadata=e30%3D

Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics. McGraw-Hill Education.

 

 

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In reply to Crystal Caddell

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Kara Kosycarz – Tuesday, 17 November 2020, 4:51 PM

Kosycarz: Week 5 Reply 1

Crystal, thank you for your post. You mention that physician-related challenges existed during the implementation of Partners Healthcare System’s (PHS) electronic medical record (EMR) integration. In fact, stakeholder buy-in can positively impact implementation outcomes (Ersek et al., 2018). For example, one study found that resistance among providers acted as a barrier to implementation; whereas, clarity in communication facilitated implementation. This is an important concept to understand, and it can be applied back to the PHS case scenario. Kesner (2009) discussed how providers were resistant to EMR implementation. With the cost of implementation being an expensive endeavor, clearly defining advantages of the implementation could have helped providers to understand its importance. I do think that the use of the workflow diagram, which can conceptually display processes, was helpful in this implementation plan (Saba & McCormick, 2015; Kesner, 2009).

  References

Ersek, M., Hickman, S. E., Thomas, A. C., Bernard, B., & Unroe, K. T. (2018). Stakeholder perspectives on the optimizing patient transfers, impacting medical quality, and improving symptoms: Transforming institutional care (OPTIMISTIC) project. The Gerontologist58(6), 1177–1187. https://doi.org/10.1093/geront/gnx155

Kesner, R. (2009). Partners Healthcare System (PHS): Transforming healthcare services delivery through information management (Northeastern University) [Northeaster University, College of Business Administration, Case Study]. Ivey Management Services.

Saba, V. K., & McCormick, K. A. (2015). Essential of nursing informatics (6th ed.). McGraw-Hill.

 

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In reply to Crystal Caddell

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Sokhira Yang – Thursday, 19 November 2020, 2:34 PM

Crystal,

I agree, PHS complex process did help mitigate risk and contribute to the successful outcome. PHS had a plan in action, with barriers that were in place, they had solutions as well. I do believe that they should have catered more to healthcare providers as they were the essential users. Possibly painting more of positive outlook utilizing technology with providers, some felt that it would change their way in practice. Maybe discuss healthcare provider polls on effectiveness of the system. Researchers have shown that providers that are more engaged in care are likely to have “better outcomes and reduced health care costs” (Gee et al, 2016).

Gee, P., Patmon, F., Readdy, N., & Rylee, T. (2016). “Using Interactive Patient Engagement Technology in Clinical Practice: A Qualitative Assessment of Nurses’ Perceptions”. Journal of Medical Internet Research. 18 (11), 298.

 

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In reply to Crystal Caddell

Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Sharon Higgins – Thursday, 19 November 2020, 6:49 PM

Hi Crystal,

Thank you for your post. I looked at two different articles looking at physician hesitation in transition to an EMR. One article touched upon the education physicians get with regards to the technical aspect of the EMR but they don’t address the changes that occur with patient-doctor communication that happens when a physician changes over to an EMR. One facility integrated best practices for patient-centered EMR use into the required EMR training for all incoming residents and fellows. They felt this would improve the quality of the patient-doctor relationship (Lee et al., 2016).

The other article looked at the physicians who desired to move forward with an EMR. It was found these physicians trained during medical school in facilities that had robust IT applications and they were able to see the benefits of using the system. More recently trained physicians have become more reliant on the clinical IT systems for their standard patient care processes (Menachemi et al., 2009). I think about my nursing career and the changes I have seen with adoption of the EMR. I have done documentation on paper and now everything is done electronically. It is amazing how you come to rely on the technically. We use a dragon technology as a voice driven dictation and now I hate when it isn’t working and have to rely on my typing skills. It is also a challenge when a system goes down and you now have to revert to a paper system. Half the staff doesn’t even know where to begin.

References

Lee, W.W., Alhureishi, M., Ukabiola, O., Venable, L., Ngool, S., Staisiunas, D.,

Wroblewski, K. & Arora, V., Patient perceptions of electronic medical record

use by faculty and resident physicians: A mixed methods study. Journal of 

          General Internal Medicine, 31 (11), 315-322.

 

Menachemi, N., Matthews, M., Ford, E.W., Hikmet, N., & Brooks, R.G., (2009). The

relationship between local hospital IT capabilities and physician EMR

adoption. Journal of Medical Systems, 33(5), 329-335.

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In reply to Content Services (LJ)

Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Allison Racine – Monday, 16 November 2020, 4:30 PM

  1. What are the challenges faced by PHS in implementing an enterprise-wide electronic medical records (EMR) system?

Partners has faced great challenges when implementing an enterprise-wide EMR system. Many of the challenges faced were in relation to the process changes that were required to make patient information available to all PHS services networks (Kesner, 2009). The greatest challenge was bringing together the different medical professionals under the same PHS and computerized patient order entry (CPOE), as 2/3 of the medical professionals were affiliated with a Partners hospital, though the rest had affiliations with other practices and hospitals (Kesner, 2009). Also, it was difficult to incorporate systems training into certain offices that lacked the appropriate infrastructures to support the EMR platform, Longitudinal Medical Record (LMR) (Kesner, 2009). It is widely known that EMR implementation has great advantages, such as decreasing health care cost, aiding with data collection, reducing medical errors, and increasing the availability of patient records between patients and providers (Haider et al., 2017). There are also many studies that demonstrate how implementation of EMR can slightly decrease the productivity of physicians early-on, due to the changes in workflow and adjusting to the system (Haider et al., 2017). When implementing the EMR, Partners experienced this and had to adjust accordingly. Many of the medical professionals were concerned with the ability to see patients and utilize a computer system at the same time; the utilization of an EMR appeared stressful and less efficient (Kesner, 2009). The cost was also relatively high ($40,000 per physician) (Kesner, 2009). Along with the implementation cost, training and preparing physicians were also costly and required reimbursement between the network physicians and insurance companies (Kesner, 2009).

  1. What are the challenges faced in establishing a decision-support system to assist healthcare providers in treating their patients?

Establishing a decision-support system to assist healthcare providers in treating their patients also presents with various challenges, as indicated by Partners’ experience. In order to be successful, Partners required the development of decision-support processes to support the medical providers in providing safe and effective care to the patients (Kesner, 2009). A variety of organizational units were required to ensure successful business processes, such as the Center for Information Technology Leadership at Partners, the Center for Clinical and Quality Analysis, and the Center for Connected Health (Kesner, 2009). It was rather difficult to bring all the medical providers under “one roof” and establish what information is valued by physicians (Kesner, 2009). For example, what would help the physician better diagnosis a patient in a more cost-effective way, or how could therapies, allergies, or other data be more readily available (Kesner, 2009)? The process for doing so required multiple increments and the establishment of committees and working groups, such as the Physicians Executive Council, the Architectural Council, and the Council of Chief Medical Officers and Chief Nursing Officers (Kesner, 2009). Along with the barrier of multiple councils and processes to ensure medical professionals guide the way EMRs work, there was also a great financial burden due to the necessary requirement of financial incentives (Kesner, 2009).

Ensuring practitioners aid in the development of EMRs is important for success and utilization, as their decisions and ability to provide care for the patients must be safe and made easier due to the implementation of the EMR. For example, a study was completed on decision-support guidance for physicians identifying and treating tobacco use (Bernstein et al., 2017). The physicians aided in implementing the EMR to discuss requirements such as creating an alert if the patient is a smoker (Bernstein et al. 2017). This alert allowed more physicians to be aware of patients who smoke, prescribe tobacco treatment medications, and add tobacco use disorder to the patients’ problem list (Bernstein et al., 2017). Decision-support systems are very beneficial, though it is timely and the intervals to do so take great thought, require many processes, and can be costly (Kesner, 2009).

3. From a project management perspective, which system deployment success factors are in place, and which factors appear to be absent?

From a project management perspective, it is important to understand knowledge management to promote a successful EMR implementation (Gharamah et al., 2019). Certain categories that are important include culture, organizational, IT, measurement, and leadership (Gharamah et al., 2019). During the implementation process at Partners, certain factors that were in place included the availability of support services (Kesner, 2009). The purpose of these support services were to help ease the transition for the physicians in order to see more effective and beneficial outcomes (Kesner, 2009). There was available early, intensive training, and the rollout was completed in phases that allowed for better understanding of improvements required and what went well (Kesner, 2009). The deployment was organized and enough support was provided, such as the creation of workshops and creation of a solid platform to process information and integrate data (Kesner, 2009). Factors that appeared to be absent included more feedback from other healthcare workers, included administration and nursing. It appeared there were different portals; however, not much was discussed on gaining feedback from other areas of healthcare.

4. Does the Information Systems (IS) unit’s approach to the architectural design of the solution mitigate project risk and contribute to a successful outcome? If so, how? If not, please identify what is needed to improve the situation.

The Information Systems (IS) unit’s approach to the architectural design of the solution lessens the overall project risk and contributes to an overall successful outcome. The service-oriented architecture provides an organized approach to accessing care. For example, the web-based portals provide a customized access to patient information depending upon the role and needs of the provider (Kesner, 2009). Also, it includes logic and tools for accessing information, as well as technical support (Kesner, 2009). The organization of portal, application, services, and data layers create an organized framework for the needs of every healthcare worker. For example, physician and nurses can mor readily manage important events, such as process, fulfill, deliver and document orders (Kesner, 2009).

References

Bernstein, S., Rosner, J., DeWitt, M., Tetrault, J., Hsiao, A., Dziura, J., Sussman, S., O’Connor, P., & Toll, B. (2017). Design and implementation of decision support for tobacco dependence treatment in an inpatient electronic medical record: a randomized trial. Translation Behavioral Medicine, 7(2), 185-195. https://doi.org/10.1007/s13142-017-0470-8

Gharamah, A., Noordin, M., Ali, N., & Brohi, I. (2019). Approach for successful knowledge management system deployment for organizations. International Journal of Engineering & Technology, 7(2), 74-78.

Haider, Y., Moshtaghi, O., Mahboubi, H., Ziai, K., Hojjat, H., Armstrong, W., & Djalilian, H. (2017). Association between electronic medical record implementation and otolaryngologist productivity in the ambulatory setting. JAMA Otolaryngology Head & Neck Surgery, 143(1), 20-24. https://doi.org/10.1001/jamaoto.2016.2528

Kesner, R. (2009). Partners Healthcare System (PHS): Transforming health care services delivery through information management. Northeastern University, College of Business Administration. https://hbsp.harvard.edu/download?url=%2Fcourses%2F761900%2Fitems%2F909E23-PDF-ENG%2Fcontent&metadata=e30%3D

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In reply to Allison Racine

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Kara Kosycarz – Wednesday, 18 November 2020, 9:45 AM

Kosycarz: Week 4 Reply 2

Allison, thank you for your interesting discussion pertaining to Partners Healthcare System (PHS). You discuss the advantages for establishing a decision-support system (DSS), and I would like to expand on those benefits. A DSS is similar to a clinical-decision support system (CDSS), as both utilize data to support best-decisions in a given scenario (Saba & McCormick, 2015). In one clinical study, providers were given a case study regarding urinary tract infections (UTI) and asked to prescribe the drug of choice for the given diagnosis (Neugebauer et al., 2020). Providers were allowed only one tool, with the control group having to make a clinical decision without the aid of information support. Interestingly, less than 30% of providers prescribed the preferred treatment. Having a CDSS built-in as an automated system is convenient, and this study shows the benefits for provider-support when making important clinical decisions (Saba & McCormick, 2015; Neugebauer et al., 2020).

  References

Neugebauer, M., Ebert, M., & Vogelmann, R. (2020). A clinical decision support system improves antibiotic therapy for upper urinary tract infection in a randomized single-blinded study. BMC Health Services Research20(1). https://doi.org/10.1186/s12913-020-5045-6

Saba, V. K., & McCormick, K. A. (2015). Essential of nursing informatics (6th ed.). McGraw-Hill.

 

 

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In reply to Allison Racine

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Amy Carey – Sunday, 22 November 2020, 2:29 PM

HI Allison,
You did a great job with your discussion post regarding decision support making and its challenges. Decision support system is a tool that supports the decision-making activities and outcomes (Saba & McCormick,2016). The system is designed with many rules and can access many databases for more information. Standardized clinical terminology is needed for evidence using plans of care, order sets, alerts, and rules. Colera (2003). defines clinical decision support as a system that augments human performance and provides help to providers subject to human error (Saba & McCormick,2016). One great benefit of clinical decision-making is that it sets off reminders, indicating that reminders improved performance by 76% of received studies (Saba & McCormick,2016).
Decision support systems means helping decision-makers and increasing their ability, not replacing their judgments (Mahmoodi et al.,2020). Some applications of the medical decision support system help the providers with : Preventive care services, like screenings for blood pressure and cancer , Patient symptom checker , Care plan, and a guide to reducing long hospital stays ( Mahmoodi et al.,2020). The patient can benefit from decision making tools because the symptom checker can provide a risk assessment tool which is simple to use in the clinical environment, preventing the patient from undergoing invasive testing , it can be effective to estimate the population at risk of cancer ( Mahmoodi,2020).
References

Mahmoodi, S. A., Mirzaie, K., Mahmoodi, M. S., & Mahmoudi, S. M. (2020). A Medical Decision Support System to Assess Risk Factors for Gastric Cancer Based on Fuzzy Cognitive Map. Computational & Mathematical Methods in Medicine, 1–13. https://doi.org/10.1155/2020/1016284

Saba, V. K., & McCormick, K. A. (2015). Essential of nursing informatics (6th ed.). McGraw-Hill.

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In reply to Content Services (LJ)

Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Ruben Jimenez – Monday, 16 November 2020, 4:54 PM

Partners Healthcare System

Case Study #2 

 


     Partners Healthcare System maintains a centralized electronic records collection on approximately 4.6 million patients (Keener 2010). This data includes medical artifacts such as X-rays, prescriptions, and therapies in real-time as patients visit practitioners. These functionalities were promoted by using enterprise-wide electronic medical records systems, which may pose some challenges during implementation. For instance, PHS has multiple records that may increase daily, and therefore the challenge of scalability. The system may be overwhelmed by excess information, causing it to fail or become slower. Other challenges include practitioners working in non-hospital environments, which may pose a challenge to used equipment such as telecommunications infrastructures. Practitioners were also not all willing to use computers for notetaking while examining a patient (Evans, Lloyd & Pierce, 2012).

When it comes to establishing the decision-support system used to assist practitioners in treating patients, few challenges were presented. First, just as in electronic medical records, not all practitioners were open to using a computer while seeing a patient (Beeler, Bates & Hug, 2014). Some did not like the implication of computers in the office for decision-making since it may have implied practitioners could not do so on their own (Beeler, Bates & Hug, 2014). Decision-support systems are also reliant on computers and other technologies, and therefore, where they are not available, decision-support techniques cannot be applied.

From a project manager’s perspective, system development success factors in place for this project included appropriate research management from executive managers; use of highly skilled employees in significant positions in the company; and the use of an enterprise-level architectural approach to the development, adaptation, and maintenance of the system (Kesner, 2010). Support from executive management assisted with the care of the objectives, with clarity while ensuring highly skilled people took up key positions, provided a high standard throughout development (Lewis et al., 2012). The executive management sanctioned research based on various aspects of the development, which ensured that the solution was equal to the problem at hand.

The information system’s design approach mitigated project risk while also contributing to the success of the project through strategies like the use of highly skilled professionals in critical areas and executive sanctioned research. The use of highly skilled professionals in key positions ensures the highest level of professionalism and execution during the project period and eliminates the risk of shoddy work done because leaders have no idea about the project’s technical part (Lewis et al., 2012). Project research also contributed to the mitigation of project risk because it promoted prior knowledge of the problem before designing a solution. Research also reduced the risk of developing a non-feasible product, which may lead to financial loss. However, there was no assessment tool to examine the progress of the project and its adherence to the specified objectives. This, however, did not interfere with the success of the project and its implementation.

References

 

Beeler, P. E., Bates, D. W., & Hug, B. L. (2014). Clinical decision support systems. Swiss medical weekly, 144, w14073.

Evans, R. S., Lloyd, J. F., & Pierce, L. A. (2012). Clinical use of an enterprise data warehouse. In AMIA Annual Symposium Proceedings (Vol. 2012, p. 189). American Medical Informatics Association.

Kesner, R. (2010). Partners Healthcare System: Transforming Health Care Services Delivery through Information Management. Ontario, Canada: Ivey Publishing.

Lewis, D., Hodge, N., Gamage, D., & Whittaker, M. (2012). Understanding the role of technology in health information systems. Pacific health dialog, 18(1), 144-54.

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In reply to Ruben Jimenez

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Crystal Caddell – Thursday, 19 November 2020, 9:20 AM

Ruben,

You made an excellent observation regarding the lack of an assessment tool to measure the project outcomes. As we have been learning, use cases provide a list of goals and establish measurable outcomes (Usability.gov, 2020). Additionally, use cases focus projects on those who stand to benefit, and help to guard against insufficient planning (Ford, 2019). A recommendation for how this project could have been handled better is utilizing a use case. However, even with the challenges faced, PHS had many success factors in place. The organization hired an experienced project manager and created stakeholder governance committees. These end-user teams work to ensure the steering committee thoroughly understands practitioner/patient requirements and a system’s feature needs (Saba & McCormick, 2015). It is obvious that they did an excellent job with their SWOT analysis and determined their strengths, weaknesses, opportunities, and threats thoroughly to take proactive action for addressing these concerns. Overall, I would consider it a successful project, but without the evaluation you suggested, an outcome cannot be determined.

References

Ford, K. M. (2019). Who will use this and why? User stories and use cases. Information Technology and Libraries38(1), 5-7. https://doi.org/10.6017/ital.v38i1.10979

 

Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics. McGraw-Hill Education.

 

Usability.gov. (2020). Use cases. U.S. General Services Administration, Technology Transformation Services. https://www.usability.gov/how-to-and-tools/methods/use-cases.html

 

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Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Sharon Higgins – Tuesday, 17 November 2020, 12:15 PM

Hi Everyone,
Attached you will find my response. Thanks, Sharon

 Case Study 2 PHS.docx

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Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Cassandra Plamondon – Friday, 20 November 2020, 1:50 PM

Cassandra Plamondon
Week 4 Case Study Response 1
November 20, 2020

Hi Sharon, thank you for your informative post! You make some excellent points regarding the challenges faced in establishing decision support systems. I also touched upon several of the same factors as it pertains to the data set and the need for standardization and maintenance. To add to this, it can be difficult to establish a decision support system when health care professionals are resistant to change or find the change stressful (Leviss, 2013). A critical analysis done by Khairat et al. (2018) found that users who were more accepting of clinical guidelines, reminders, alerts, and diagnostic suggestions had more favorability towards a clinical decision support system (CDSS). The CDSS is built as an input-process-output system. Patient information (input) is entered into the system, the CDSS processes this information and then, depending on the type of CDSS (knowledge based or non-knowledge based), provides a clinical suggestion or algorithm (output) (Kharait et al., 2018). Healthcare professionals are often not aware of how the CDSS process works or how the clinical suggestions are determined resulting in resistance, hesitation, and lack of acceptance (Kharait et al., 2018). To add to this, I found a systematic review that discusses several barriers and facilitators to the adoption of CDSS in clinical practice. The top barriers discussed included lack of time, economic constraints, lack of knowledge of the system and its content, reluctance to use the system in front of patients, physician/user attitude towards the system, workflow issues, reliability of information, lack of agreements with the system, too many unwanted alerts, complexity, less user friendly, and prior bad experience (Devaraj et al., 2014). Top facilitators included providing or collecting information relevant for patient, the potential to improve quality of care, improve productivity, proper documentation of procedures, fast information exchange, flexibility of the system, positive user attitude, integration of CDSS into workflow, good information presentation, user friendly, ease of finding information, usability testing, and economic incentives (Devaraj et al , 2014).

Lastly, I found some information on clinical decision support interventions (CDSI) and wanted to share. CDSIs such as alerts, or reminders can help improve clinical compliance with practice guidelines and patient outcomes (Cieslowski et al., 2020). When developing a CDSI, it is important for organizations to consider the five “rights”: 1) the right information, 2) the right person, 3) right intervention format, 4) the right channel, and 5) the right time in workflow (Campbell, 2013). The information needs to be evidence-based and then targeted to the right clinician (physician, nurse, dietician, etc) (Campbell, 2013). The type of intervention then needs to be determined. The intervention can be in the form of an alert, text message, an order set, a protocol, or a patient monitoring system (Campbell, 2013). Once the intervention is decided on, the right channel is then chosen, and this could be done through an electronic health record, computerized physician order entry, or Smartphone app (Campbell, 2013). Choosing the time in which the intervention occurs during clinical workflow is critical. If the wrong time is chosen, it could result in poor or adverse outcomes. Campbell (2013) provides an example of wrong timing when a physician sends a prescription for Coumadin to a pharmacy. After the prescription is sent, an alert occurs reminding the physician that the patient is already on aspirin. Campbell (2013) states that better timing would have been an alert occurring at a point in the ordering process before the prescription was sent through rather than after.

 

References

Campbell, R. (2013). The five rights of clinical decision support: CDS tools helpful for meeting meaningful use. Journal of AHIMA 84(10), 42-47.

Cieslowski, B., Brock, L., Richesson, R. L., Silva, S., & Kim, H. (2020). Optimization of nursing-specific flu alerts. CIN: Computers, Informatics, Nursing, 38(9), 433–440. https://doi.org/10.1097/CIN.0000000000000616

Devaraj, S., Sharma, S.K., Fausto, D. J., Viernes, S., & Kharrazi, H. (2014). Barriers and facilitators to clinical decision support systems adoption: A systematic review. Journal of Business Administration Research. 3(2), 36-53.

 

Khairat, S., Marc, D., Crosby, W., & Al Sanousi, A. (2018). Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis. JMIR medical informatics6(2), e24. https://doi.org/10.2196/medinform.8912

Leviss, J. (2013). HIT or MISS: Lessons Learned from Health Information Technology Implementations. AHIMA

 

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Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Amy Carey – Tuesday, 17 November 2020, 6:03 PM

Amy Carey
Nursing Informatics
Discussion 1 PHS
Week 4

1. What are the challenges faced by PHS in implementing an enterprise-wide electronic medical records (EMR) system?

In 1989, an Electronic Health record was established. In 1994, Brigham and Womans, MGH, and Partners Healthcare became an enterprise, and together, adopted the Electronic Health Record to work under the same electronic umbrella. There were some challenges during the implementation of the EMR. It was a lot of work and time consuming to convert paper to shareable digital format. Partners Healthcare system was in the process of many changes to adopt platforms from various information systems. There were 6,000 practitioners under the same umbrella, 2/3 of practitioners worked in the hospitals and 1/3 of the practitioners worked in local offices in the community. The Primary Care offices lacked information and lacked technology to support the system. It was difficult to train staff to learn the EMR as they had no time because it took away from the patients. They lacked computer access and did not have interest in using a computer. Practitioners in the office felt it was more efficient to hand write prescriptions, as it did not create stress. It was expensive to implement the system. It cost each doctor $40,000, legislation did not support these finances. In 2002-2003, All providers from Partners healthcare were under the same medical management umbrella. This was a big challenge to change the providers focus on technology, as it will add value to the patient/provider experience. The implementation of the EMR would help assist the doctors to diagnose, treat, and cut costs while caring for the patient. It would provide easy access to help identify recommended therapies, capture patient data quickly. Doctors had trouble accepting the technology use as it took away from their personal relationships with their patients, even at a cost. There was a need for change regarding the physicians focus to accept the technology, with the goal to improve quality care, patient safety, and cost.

2. What are the challenges faced in establishing a decision-support system to assist healthcare providers in treating their patients?

It is difficult to change from functioning independently, to having to learn and getting the encouragement to appreciate decision making in healthcare. To put the trust in the hands of the authorities who have control of the electronic system is challenging to go from one extreme to the other. The personal touch is lost between the physician and the patient. New rules had to be followed, new protocols were in place to abide by these protocols to prove the work is done, it is documented, so that the best quality , cost effective approach was provided to the patient. By abiding to these rules, the physician can be reimbursed by the insurance companies.

3. From a project management perspective, which system deployment success factors are in place, and which factors appear to be absent?

Success factors regarding the system deployment included a well thought and researched plan. Money was invested over the years and it was affordable implement the electronic record. A budget was well thought out. Knowledgeable staff was hired to support IT issues, many computers were purchased, which seemed like enough. The team consisted of thousands of employees involving community engagement and using medical practitioners as stakeholders for the project. Support was provided for staff and a well-developed plan was in place. There was training that went well, the chief of medicine and nursing provided guidance, came up with clinical plans and approved clinical strategies. Regular meetings were held to discuss goals. The physician’s executive council provided support. It was recognized early that there was a need to consolidate data and the digital record, decision support process was needed help guide doctors to recommend best therapy for a good outcome with decreased cost. The need for knowledgeable management who will teach lessons and support ongoing delivery was noticed. It was also in the budget to hire end users to support the ongoing system.
Factors which could have improved include the the paper charts flow into digital record to make shareable was a lot of work, as every physician needed to be included in the network and made available. Thirty-three % of providers were out of network in the office setting. The office settings lacked supplies, computers and were more familiar with the paper. Providers felt more comfortable writing prescriptions, and felt it was not a personal experience with the patient to use the computer. It was expensive for outpatient doctors to buy and there was no support from legislation. An important feature in the adoption of this system is the decision-making tool. It is not really mentioned how they prepared doctors or educated them on the decision-making tool. I think this is a huge undertaking for doctors, especially doctors that have been in practice for many many years. They earned autonomy, independence and developed their own patient practice. It must be difficult to process the transition from paper to computers in a short time frame. It mentions training was extensive but does not provide a time frame of how long the training was. The support was present for physicians after the electronic record started, there was lack of education and support prior to implementation of decision-making system. The case study did not discuss policies and procedures and on-going education for staff. Policies and procedures were not specified in the system and there was not a test or go-live date mentioned. The goal was to have evaluations on the value of quality care, but the value and importance was not educated or discussed in detail

4. Does the Information Systems (IS) unit’s approach to the architectural design of the solution mitigate project risk and contribute to a successful outcome? If so, how? If not, please identify what is needed to improve the situation.
The purpose of implementing the electronic record is to provide safe care, improve quality care and decrease cost. My implementing such a system, patient information is easy to access, and is shared through different appointments and providers. There is access to the complete record including medical history, allergies, current medications, and lab results, x-rays etc. By investing in this it is expected that delays in care can be reduced, and medical errors can be prevented, The Computer Drug Order Entry System is designed to help target therapies , and help choose a medication therapy at a reduced cost. The architectural council supports this system and reviews documentation for compliance. Overall, the United States healthcare delivery system is complex. It can be associated with risks to the patient as low-cost treatment therapies are chosen, providers are provided with high performance initiatives to improve the delivery of health. Health prevention is included in the medical therapy plan ,it is tracked that providers educate or assist with prevention steps, have follow up visits with the patients, monitor vital signs, and have ongoing treatment, and set up screening tests. With the steps provided, and assist with medical decision making, and proof of documentation there is lower risk for poor outcome. Diseases can be better managed due to a system that is organized and can implement reimbursement reform

References

Kesner, R. (2009). Partners Healthcare System (PHS): Transforming health care services delivery through information management, (p. 15).

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Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Sharon Higgins – Wednesday, 18 November 2020, 12:11 PM

Hi Amy,
Thank you for your post. I pulled up an article that looked at a patient’s perception of an EMR. We have read about a physician’s perspective but thought it would be interesting to see it from a patient’s perspective. This article stated that 85% of the total codes that were collected from the patients reflected positive perceptions of the EMR. Patient expressed liking the doctor’s clinical efficiency which allowed the doctors to review other physician’s notes and promoted teamwork and communication among providers. They also liked that doctors used the EMR to promote patient engagement and discussion and were able to use visuals such as pictures and graphs to explain their care. Additionally, they felt the doctors were more transparent in their use of the EMR by explaining what they were doing on the computer which to the patient reflected increased quality of care (Lee, et a., 2016).
There were some negative experiences from the patients related to the EMR. Based on this research it was 15% of total patient perception. The common one was related to physical focus. They felt that the physicians were more focused on the computer than the patient. Some of the comments included poor eye contact and poor screen positioning. They also noted as a negative experience patient engagement. Some patients didn’t like it when physicians did not use the computer to facilitate discussion and failed to explain what there were doing on the computer. Overall, most patients liked when their physicians used the computer during their visit and nearly one-third of patients were ambivalent and had variable experiences (Lee, et al., 2016).
The other article I looked at reviewed the barriers of cost for some of the smaller medical groups in being able to implement an EMR. This article suggested that smaller medical groups link to a larger health system so that they can use their EMR. Initially, federal laws and regulations prohibited this type of sharing. However the U.S. Department of Health & Human Services had to modify their existing policies and rules to permit hospitals and certain other organizations to donate their EMR technology and supporting services to physicians without violating those previous policies. However, some physician groups perceived this arrangement as ceding a significant amount of professional autonomy to other organization Menachemi, et al., 2009). It seems we saw this in the Harvard Case Review with the 10% of physician offices not moving towards the PHS. Thanks, Sharon

 

References

 

Lee, W.W., Alhureishi, M., Ukabiola, O., Venable, L., Ngool, S., Staisiunas, D.,

Wroblewski, K. & Arora, V., Patient perceptions of electronic medical record

use by faculty and resident physicians: A mixed methods study. Journal of 

          General Internal Medicine, 31 (11), 315-322.

 

Menachemi, N., Matthews, M., Ford, E.W., Hikmet, N., & Brooks, R.G., (2009). The

relationship between local hospital IT capabilities and physician EMR

adoption. Journal of Medical Systems, 33(5), 329-335.

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Re: Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Amy Carey – Sunday, 22 November 2020, 4:08 PM

Sharon,
Thank you for sharing, what a great idea to look at the patient’s perspective! It makes me feel better that such many patients looked at it in a positive way. You gave me the idea to look into how physicians feel about the electronic record! The number of doctors using EHRs has increased from 17% in 2009 to 50% through the first half of 2013, according to the U.S. Department of Health and Human Services ( Bendix,2014) When clinical data is on paper, you don’t have a prayer of using it for quality measurement in any efficient fashion, if it’s in electronic form, you can start to make those measures better, and start to create standards for them ( Bendix,2014), It is almost certain that the EHR should become more user-friendly as vendors incorporate feedback from customers into newer versions ( Bendix,2014). Those were some physicians point of views of technology.
I researched more recent opinions in the year of 2020. I found a study interviewing 9 physicians over the phone for 30 minutes who worked in a medical center. , physicians felt a positive mindset toward change when they were provided an upgrade of training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation ( Sieck et al.,2020).

References

Bendix, J. (2014). Assessing the payoff from meaningful use of EHRs: more physicians are using electronic health records, but opinions are mixed over the value of digitization. Medical Economics, 2, 72.

Sieck, C. J., Pearl, N., Bright, T. J., & Yen, P.-Y. (2020). A qualitative study of physician perspectives on adaptation to electronic health records. BMC Medical Informatics and Decision Making, 1. https://doi.org/10.1186/s12911-020-1030-6

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Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Allison Racine – Wednesday, 18 November 2020, 6:07 PM

Hi Amy,

Thank you for your informative post! I agree that many approaches were successful throughout the process. Major successes, as you mentioned, included the well-researched plan. Clinical decision support systems (CDSS) were put into place that examined both inpatient and outpatient systems (Varghese et al., 2016). They also looked into laboratory, medication, and radiology decision support, and clinical and documentation related CDSS as well (Varghese et al., 2016). The training, meetings, and thousands of specialized, trained individuals who partook in this plan of process implementation communicated well with one another and in turn, saw successful outcomes.

I also agree with your ideas on what should be improved upon, such as ensuring certain practices switch from paper to digital so all practices can be “on-board” with the implementation. It is important to be well-prepared with the tools necessary in order to see success. Again, this also pertains to the adequate supplies, such as computers and additional office setting supplies, as you mentioned. The physicians who had difficulty accepting or transitioning away from paper charts would benefit from increased and lengthier training. When I was working at Boston Children’s, I remember one of the physicians who worked there refused to chart on PowerChart. He used his old typewriter and had them scanned into the chart. As you mentioned, it must have been difficult for many physicians, as they developed autonomy and spent most of their careers writing on paper for their patients. Research has also found that many physicians are experiencing increased burnout due to the transition away from paper charting, as some workflow processes in EMRs are poorly designed and create additional work or steps for the physicians (Prather, 2019).

References

Prather, D. (2019). The electronic health record: a driver of physician burnout in the United States. [Thesis, California State University]. ScholarWorks.

Varghese P., Wright A., Andersen J.M., Yoshida E.I., Bates D.W. (2016) Clinical decision support: the experience at Brigham and Women’s Hospital/Partners HealthCare. Berner E. (eds) Clinical Decision Support Systems. Health Informatics. Springer, Cham. https://doi.org/10.1007/978-3-319-31913-1_13

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Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Ruben Jimenez – Friday, 20 November 2020, 8:06 PM

Amy

I agree with your observation regarding the challenges of implementing an EMR system. As in any system, EMR developers must understand how to integrate information to ensure that the system can function properly (Beeler et al.,2014). Even with the challenges, PHS had many key factors in place. PHS had an experienced project manager and created stakeholder governance committees. These teams worked to ensure the steering committee thoroughly understood practitioner/patient requirements, and a system’s feature needs (Saba & McCormick, 2015).

Business Intelligence (BI) enables developers to state what is needed throughout the organization and simplifies the implementation process during implementation deployment and administration. Implementing and integrating EMR systems is costly, but healthcare providers must adopt systems like this to ensure accuracy, errorless information.

As technology rapidly emerges, healthcare organizations will be required to adopt new practices to maintain and streamline processes (Lewis et al., 2012). Electronic medical records systems have surfaced to eliminate inefficiency, errors, and cut enormous spending. Organizations must strategically implement and interact with agencies outside of their walls to integrate EMR systems into their infrastructure (Beeler et al.,2014).

 

References

Beeler, P. E., Bates, D. W., & Hug, B. L. (2014). Clinical decision support systems. Swiss medical weekly, 144, w14073.

Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics. McGraw-Hill Education.

Lewis, D., Hodge, N., Gamage, D., & Whittaker, M. (2012). Understanding the role of technology in health information systems. Pacific health dialog, 18(1), 144-54.

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Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Alyssa Azevedo – Saturday, 21 November 2020, 12:22 PM

Hi Amy, you are correct that Partners Healthcare had to collaborate with BWH and MGH to help develop a system that would allow for ample information to be provided so these healthcare practitioners would be able to provide quality care. Research has shown that many healthcare leaders recommend the use of health information technology (HIT) for patient care to deliver high quality patient care (Marshall & Lam, 2020). Now with any new development and system implementation there is always reluctance to change and decision support and engagement are required to help with the transition. A research article by Charnock (2019) highlighted how involving the users in the design phase of the software as well as providing education and training on the new system helped decrease inaccuracies. Through information management and implementation of a widespread electronic medical records (EMR) system it allows for shareable healthcare information that provides safer care for all patients.

References

Charnock, V. (2019). Electronic healthcare records and data quality. Health Information & Libraries Journal, 1, 91. https://doi.org/10.1111/hir.12249

Kesner, R. (2009). Partners Healthcare System (PHS): Transforming health care services delivery through information management, (p. 15).

Marshall, A. N., & Lam, K. C. (2020). Research at the Point of Care: Using Electronic Medical Record Systems to Generate Clinically Meaningful Evidence. Journal of Athletic Training (Allen Press), 55(2), 205–212.

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Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Sokhira Yang – Wednesday, 18 November 2020, 3:36 PM

Sokhira Yang

Discussion Post 1: Case Study

NU-710-01-20PBFA Informatics in Health Care

Due Date: 11/17/2020

Case Study 2

  1. What are the challenges faced by PHS in implementing an enterprise-wide electronic medical records (EMR) system?

Implementing an enterprise wide EMAR faces many challenges but there were one challenge in particular that PHS experienced with providers. PHS was very well versed and many found it as an efficient service. Partners were highly regarded and focused on the complex quality of care. The case study stated that “partners focused both on keeping the costs of its service under control and continuously improving the quality of service delivery” (Kesner, 2009), this was a problem in the healthcare delivery prior to PHS as there was a discussion that healthcare expenditures have risen over budget.  As PHS was implementing the EMAR process and integrating providers under one umbrella, some providers were not receptive to interacting on a computer system as “taking notes and issuing prescriptions when they have perceived hand written were more efficient” (Kesner, 2009). Another barrier reported that the health care delivery would change the approach of the provider, “these systems came at the cost of changing the doctor’s personal approach to interaction with the patient and at a steep initial investment” (Kesner, 2009).

 

  1. What are the challenges faced in establishing a decision-support system to assist healthcare providers in treating their patients?

PHS felt the development of a system based EMR could help providers develop a consistency and some continuity in their care with their patients. Although the idea was originated to decrease the cost of healthcare delivery with the most cost effective treatment, it was also to consolidate care in an integrated digital record (Kesner, 2009). Some providers reported changing the system of their care can become stressful and change their way of practice. Some doctor’s office weren’t familiar with information technology and telecommunication infrastructure.

  1. From a project management perspective, which system deployment success factors are in place, and which factors appear to be absent?

PHS had an idea to implement a technology based EMR, their idea was for better of the healthcare delivery and quality of care that can be implemented towards patient. Their resources were present and had an appealing management team. They had a well thorough and thought out plan of action but unfortunately they did not take careful consider the healthcare providers reluctance to adhere to the computerized method. Essentially, healthcare providers would be the prime users of the source. It was a sufficient program as any healthcare provider can access records digitally, some felt that it may change their way of their practice and their relationships with their patient.

  1. Does the Information Systems (IS) unit’s approach to the architectural design of the solution mitigate project risk and contribute to a successful outcome? If so, how? If not, please identify what is needed to improve the situation.

The information System units approach did mitigate certain risk and contributed to successful outcome because there was a concrete plan of action. PHS identified project objectives and invested primarily on the informational technology that is utilized. PHS “hired some of the best information management professionals in the industry”, by hiring a knowledge based team, there were resources and capability of troubleshooting problematic situations.

Reference:

Kesner, R. (2009). Partners Healthcare System (PHS): Transforming health care services delivery through

Information management, (p. 15).

 

 Casestudy2.docx

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Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Ruben Jimenez – Saturday, 21 November 2020, 9:58 PM

Hello Sokhira:

EMR is said to benefit the healthcare system by improving quality, safety, and efficiency of care (Haskew, 2015). Healthcare providers are no longer using paper records but have instead opted to utilize an electronic medical record (EMR). While not all offices and hospitals have switched to an EMR, it is becoming more standard to be routine healthcare (Haskew, 2015). Now patients can even view their health care records on the cell phones. Providers can access a patient’s health records at home and no longer be stuck in the office.  Although EMR has many benefits, it also provides drawbacks. One of the main disadvantages of EMR is the potential for privacy threats. EMR is easily accessible and sometimes may be accessed accidentally or by individuals who intentionally breach confidentiality.

Any introduction of new technology increases the potential for errors, sometimes inevitable (Balestra, 2017). Errors like computer crashes, data capture anomalies, programming errors, missing information entered due to bad handwriting, and worst missing information (Balestra, 2017). This is all to be expected, which why so many are reluctant to this evolution at first. Like all other computers, technology time is needed to allow users to become comfortable using them and work out the problems that often accompany new technology (Balestra, 2017).

There are several actions an entity can take to make sure that their EHR systems and IT assets are secure. Such measures leverage an integrated use of data loss prevention tools, intrusion prevention, anti-malware, file integrity monitoring, robust identity management and authentication programs, role-based access, and data security solutions (Balestra, 2017). Laws will also have to continue to develop and change to accommodate the ever-changing technology.

References

Balestra, L. (2017)  Electronic Health Records: Patient Care and Ethical and Legal Implications for Nurse Practitioners Journal for Nurse Practitioners, 13 (2), pp. 105-111.

Haskew, G., Turner, K., Sirengo, M., & Sharif, S. (2015). Implementation of a Cloud-Based Electronic Medical Record to Reduce Gaps in the HIV Treatment Continuum in Rural Kenya. PLoS ONE 10(8): e0135361. https://doi.org/10.1371/journal.pone.0135361

 

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Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Kimberly Anderson – Wednesday, 18 November 2020, 8:02 PM

  1. What are the challenges faced by PHS in implementing an enterprise-wide electronic medical records (EMR) system?
    Most of the providers worked in the hospitals under the umbrella of partners. However, there was providers that work independently in their own office in and around the Boston area. The doctors that were affiliated hospital mostly saw their patients in offices of the hospital premises. With the office not being in the hospital there were issues with technological status, and having the immediate support to work thru concerns or issues. Time was taken away from patient care to work to complete solving technological issues. Many of the providers were not buying into the use of technology for prescriptions, notes, etc. The cost of 40,000.00 per doctor was also a concern. There is not available support for implementation and the cost came from revenue developed.

    2. What are the challenges faced in establishing a decision-support system to assist healthcare providers in treating their patients?
    Health care continues to grow and new treatment, therapies, and other specialties develop that can assist the patients. However without the communication and the ability to share the information appropriately and quickly the window of opportunity can be lost. Various health settings and systems use varied means of technology which may not communicate or be as beneficial as the next system. The system could be hindering and not promoting quality care but holding the providers back.
    When President Barak Obama was in office in 2009 he signed the American Recovery and Reinvestment Act which was a package set to work toward improving health care by having all patients record go digital. The specific section of the bill was the Health Information Technology for Economic and Clinical Health Act (HITECH). This bill provided over thirty five billion in promotions and incentives for providers, hospitals, and professionals to adopted and use electronic health care records ( Reisman,2017).

    3. From a project management perspective, which system deployment success factors are in place, and which factors appear to be absent?
    The teams were provided a great deal of support from the IS departments who were setting up the programs. The means used to collect, organize, process and share information that was set up in the platform from the IS department met and exceeded expectations. The quality and accuracy of the data was pleasing. A hindrance that was negative in the project was the cost of the set up as well as the need of the appropriate, requested, and required doctors would have to provide to obtain some back of the lost cost. Not all doctors felt this would be beneficial and left the health system, retired, or closed practice.
    Many things go into making an implementation of an electronic medical record successful. A study that was completed provided results that human factors and project management was major factors on the outcome. The projects that have a roadmap that started with the team establishment, leadership, implements ion, training systems, and continued support had the most positive outcomes. Project managers should be aware of the skills and knowledge that are required to start, and maintain the system and utilize appropriate personal to complete the task. Other items that need to be present to have a successful implementation is the confidentiality of the information and observation of data security. Without this visual completion by human observation, the system could appear perfect but allowing for security breaches which would be a major issue and downfall for all parties (Safdari et al., 2015)

    4. Does the Information Systems (IS) unit’s approach to the architectural design of the solution mitigate project risk and contribute to a successful outcome? If so, how? If not, please identify what is needed to improve the situation.
    The IS system that was put in place assisted with the outcome in a positive light in regards to the project mitigation. “The Service orientated architect” allowed for the information to flow in and be organized and categorized the type of data that came in and provided lists. Software systems were able to use these lists as needed to obtain appropriate information. There was standardization of data dialogue that aloud for improved reporting, and support around clinical decision making. Information was readily available to be shared throughout the health network system. The workflows used in the systems led to an effective means of time management, and appropriate care management.

    Harvard Business Publishing Education. (n.d.). Hbsp.Harvard.Edu. Retrieved November 19,
    2020, from
    https://hbsp.harvard.edu/download?url=%2Fcourses%2F761900%2Fitems%2F909E23-
    PDF-ENG%2Fcontent&metadata=e30%3D
    Reisman, M. (2017). EHRs: The Challenge of Making Electronic Data Usable and
    Interoperable. P & T : A Peer-Reviewed Journal for Formulary Management, 42(9), 572–
    575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565131/
    Safdari, R., Ghazisaeidi, M., & Jebraeily, M. (2015). Electronic Health Records:
    Critical Success Factors in Implementation. Acta Informatica Medica, 23(2),
    102. https://doi.org/10.5455/aim.2015.23.102-104

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In reply to Kimberly Anderson

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Alyssa Azevedo – Sunday, 22 November 2020, 12:48 PM

Hi Kimberly, thank you for your post and pointing out how healthcare continually growing can mean that communication is lost, and care and technology can be costly. Research has pointed out that health information technology (HIT) and access to electronic records are crucial for interactive patient-clinician care (Marshall & Lam, 2020). Cost can be a huge hindrance for both patients and providers because not investing and having an electronic medical record (EMR) system available means that current up to date data is not available and can cause inaccuracies and potential safety concerns when treating clients. Data has shown that implementation of the EMR has been shown to promote the triple aim of “Better health, better healthcare, and lower cost” (Wyatt, Lampon, and McKevitt, 2020). Overall, the software system implementation between partners healthcare, BWH, and MGH allowed for better communication that did not hinder or hold providers back from providing quality safe care.

References

Kesner, R. (2009). Partners Healthcare System (PHS): Transforming health care services delivery through information management, (p. 15).

Marshall, A. N., & Lam, K. C. (2020). Research at the Point of Care: Using Electronic Medical Record Systems to Generate Clinically Meaningful Evidence. Journal of Athletic Training (Allen Press), 55(2), 205–212.

Wyatt, D., Lampon, S., & McKevitt, C. (2020). Delivering healthcare’s “triple aim”: electronic health records and the health research participant in the UK National Health Service. Sociology of Health & Illness, 42(6), 1312–1327. https://doi.org/10.1111/1467-9566.13101

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In reply to Alyssa Azevedo

Re: Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Kimberly Anderson – Sunday, 22 November 2020, 6:34 PM

Alyssa,
Thank you for your response. I believe that electronic medical records can be beneficial for both the provider and the patients. However, there is concern surrounding the ability of the patient to be able to access, review, contribute or correct the information. A study that was completed in New York in 2014 showed that patients and providers using electronic medical records increased. Communication increased between patient and physicians around medications, allergies, immunizations, and surgeries. Health outcomes did not appear to show any increased positivity from this study. A concern that came from studies showed that having health literacy, as well as lower socioeconomic status could cause more stress surrounding the use of a electronic medical record on the side of patient. Physicians were also concerned with the increased risk of liability due to patient having immediate access to the information (Lester et al., 2016).

Lester, M., Boateng, S., Studeny, J., & Coustasse, A. (2016). Personal Health Records:
Beneficial or Burdensome for Patients and Healthcare Providers? Perspectives in Health
Information Management, 13(Spring), 1h.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832132/

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In reply to Content Services (LJ)

Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Cassandra Plamondon – Wednesday, 18 November 2020, 10:49 PM

Cassandra Plamondon
Week 4 Case Study 2
November 18, 2020

Initial Post

  1. What are the challenges faced by PHS in implementing an enterprise-wide electronic medical records (EMR) system?
    Partners Healthcare System faced numerous challenges which included a third of the physicians office’s being spread out throughout the city, several of the offices were out of hospital with many of these offices lacking the technology required to support implementation of EMR, training was a concern as it pulled healthcare providers focus from patient care, many office physicians were not onboard with utilizing an EMR system since they felt it was easier for them to keep a paper system, and the cost of implementation to these offices were substantial (Kesner, 2009)

    2. What are the challenges faced in establishing a decision-support system to assist healthcare providers in treating their patients?
    Decision-support systems (DSS) need centralization of data to support data from multiple institutions. A lack of centralization creates the risk for the DSS to be inaccurate (Wilcox et al., 2006). Another challenge is the various clinical terms and languages. Data needs to be standardized to ease the exchange of information (Wasleywicz & Scheepers, 2018). Challenges also exist for a project team to find the correct balance of the number of and types of alerts within a DSS so as to prevent clinical alert fatigue ( Douglas & Celli, 2015). Data systems or rule engines need to be updated and maintained, especially when implementing an EMR across a multitude of organizations, so that it may represent best practices (Kesner, 2009). Maintaining rule engines can be time-consuming and costly (Waslewicz & Scheepers, 2018). Healthcare providers who are resistance to change, a lack of organizational awareness of stress levels of staff during implementation, and a lack of stakeholder engagement during the development phase are other challenges that exist when attempting to establish a decision support system (Leviss, 2013).

  2. From a project management perspective, which system deployment success factors are in place, and which factors appear to be absent?
    Planning was thought-out and extensive, they identified the scope and their goals, and involved organizational leadership and other key stakeholders in project governance. Their three-prong strategy was physician, patient, and usability focused. They addressed financial concerns and made negotiations to reduce financial burden to those joining the system. They allowed an opportunity for physicians to choose their platform that would align best with their needs. Orientation training, workshops, and ongoing technical support was provided. They phased the roll out rather than going live all at once in all offices. Data was collected, reviewed, and validated (Kesner, 2009).

    Some areas not mentioned was a timeline, no mention of how they tracked or logged issues to resolve, and no mention of a feasibility study which is important to assess whether a system can be built or compatible with existing technology (Douglas & Celli, 2015).

    4. Does the Information Systems (IS) unit’s approach to the architectural design of the solution mitigate project risk and contribute to a successful outcome? If so, how? If not, please identify what is needed to improve the situation.
    The information Systems (IS) unit’s approach to the architectural design certainly mitigated project risk and contributed to a successful outcome. They already had a strong electronic health record system with technology standards and architecture to build off of that was flexible to communicate with a variety of IT platforms (Kesner, 2009). Appendix A- Glossary of the case study it is stated that architected solutions “take full advantage of the technologies, operational processes and technical expertise already in place across the agency, facilitating IT systems integration, maintenance, and support” (Kesner, 2009, p.15). The question to ask is, why fix something that isn’t broken (Leviss, 2013)?

References

Douglas, M. & Celli, M.(2015). System life cycle: A framework. In V. K. Saba & K. A. McCormick (Eds.), Essentials of Nursing Informatics (pp. 525-536). McGraw-Hill Education.

Kesner, R. (2009). Partners Healthcare System (PHS): Transforming health care services delivery through information management.

Leviss, J. (2013). HIT or MISS: Lessons Learned from Health Information Technology Implementations. AHIMA

Wasylewicz, A.T. M. & Scheepers-Hoeks, A. M. J. W. (2018). Clinical Decision Support Systems. In P. Kubben, M. Dumontier, A. Dekker (Eds). Fundamentals of Clinical Data Science [Internet]. Cham (CH): Springer; 2019. Retrieved November 17, 2020 from https://www.ncbi.nlm.nih.gov/books/NBK543516/ doi: 10.1007/978-3-319-99713-1_11

Wilcox, A., Kuperman, G., Dorr, D. A., Hripcsak, G., Narus, S. P., Thornton, S. N., & Evans, R. S. (2006). Architectural strategies and issues with health information exchange. AMIA … Annual Symposium proceedings. AMIA Symposium, 2006, 814–818.

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In reply to Cassandra Plamondon

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Kimberly Anderson – Sunday, 22 November 2020, 6:51 PM

Cassandra.
Thank you for your post. I agree with everything stated especially the cost of the implementation of the electronic medical record system being extremely expensive. The cost up front can cause a practice to have severe stress, and a loss of revenue for a period of time. However, studies indicate that after a time of usage the net benefit will be recouped. Quality care of the patient can also be recognized as priceless. A study conducted for five years for multiple providers showed that in the end there was approximately net gain of close to 86,500 per provider in five years. These savings were found due to improvement of tests in radiology, charges capturing, drug costs, and billing error decreases. The cost for the first year related to implementation would be estimated 11,200 in the first year, and five year total of close to 47,000. With the outcome being more positive for patients and providers the implementation of the electronic systems in the provider office would be beneficial in the long run for all parties (Wang et al., 2003).
Wang, S. J., Middleton, B., Prosser, L. A., Bardon, C. G., Spurr, C. D., Carchidi, P. J., Kittler, A.
F., Goldszer, R. C., Fairchild, D. G., Sussman, A. J., Kuperman, G. J., & Bates, D. W.
(2003). A cost-benefit analysis of electronic medical records in primary care. The
American Journal of Medicine, 114(5), 397–403. https://doi.org/10.1016/s0002-
9343(03)00057-3

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In reply to Content Services (LJ)

Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Alyssa Azevedo – Wednesday, 18 November 2020, 11:40 PM

  1. What are the challenges faced by PHS in implementing an enterprise-wide electronic medical records (EMR) system?

    The challenges that PHS faces in implementing an enterprise-wide electronic medical record (EMR) system included providers operating out of local offices, not having the training, the cost factor, and incorporation of technology keeping them away from their clients (Kesner,2020). In local offices, the technological advancements were lacking and in order to implement the LMR/ CPOE it would cost around $40,000 per doctor (Kesner, 2020). Now with anything, cost is a major factor that plays a role in influencing one’s decisions. Yet, research has shown the incorporating an EMR, may cost expensive but it allows for central repository for all clients (Daly, 2020). One last factor that multiple providers complained about was the time that was being taken away from provider-patient treatment (Kesner, 2020).

    2. What are the challenges faced in establishing a decision-support system to assist healthcare providers in treating their patients?

    The challenges that are being faced in establishing a decision-support system or an IT enabled integrated software to assist patients with healthcare included providers being unable to correct their mistakes, alter the course of treatment, cost, and proper training (Kesner, 2020). For many providers in their smaller offices they were lacking the information technology necessary to run the IT-enabled system (DSS).

    3. From a project management perspective, which system deployment success factors are in place, and which factors appear to be absent?

    From a project management standpoint, incorporating a business sponsor in every IT project is beneficial to allow for positive business requirements, responsibilities, budgets, and timeliness to be managed by an expert (Kesner, 2020). These projects were being evaluated by many stakeholders so having an individual who was well versed in the business aspects was important to help communicate and keep the program running. A barrier that was present was financial incentives related to the providers personal patient interaction (Kesner, 2020).

    4. Does the information systems (IS) unit’s approach to the architectural design of the solution mitigate project risk and contribute to a successful outcome? If so, how? If not, please identify what is needed to improve the situation.

    Information systems (IS) unit’s architectural design approach does help keep the focus on essential components to bring about success, yet risks are still present and will always be there. The IS unit is very organized and able to provide best practice by having consistency, stability, and top talent including individuals that also have a business degree (Kesner, 2020). In this model IT had its very own customer facing CIO who would be the staffs advocate focusing on the needs of nurse practitioners as well as systems information (Kesner, 2020). This focus allows for needs of healthcare providers and the system to both take a priority to help decrease risks present.

    References

    Daly, J. (2020). The expanding role of point-of-care testing in patient care. MLO: Medical Laboratory Observer, 52(2), 22–24.

    Kesner, R. (2009). Partners Healthcare System (PHS): Transforming health care services delivery through information management, (p. 15).

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In reply to Alyssa Azevedo

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Sokhira Yang – Saturday, 21 November 2020, 11:43 AM

Alyssa,
You make a great point by stating that incorporating a business sponsor in every IT project is beneficial, I believe incorportating business sponsor as they have the knowledge that healthcare professionals don’t. We as healthcare professionals are savvy in the clinical department, wether it comes down to patient care and the clinical effects on the patient. Knowledge from a business sponsor can introduce us to technology that has been effective in the past. It is evident that healtcare has transitioned into the informatics world nicely, the purpose of doing so is to implement patient safety. Health information technology has impacted us all as it improves patient’s safety by reducing medication errors, reducing adverse drug reactions, and improving compliance to practice guidelines (Frederico, 2017).

Frederico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal. 38(12),1173–1180.

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In reply to Alyssa Azevedo

Re: Re: Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS)

by Allison Racine – Saturday, 21 November 2020, 12:41 PM

Hi Alyssa,

Thank you for your post. EMRs are incredibly important and introduce a variety of benefits. Regarding hospital information systems and information sharing, researchers found that clinical practice can be improved through the reduction of staff errors, ability to improve upon automated harm detection, enhance the continuity of care with handoffs between physicians, and also monitor infections in a more effective way (Reis et al., 2017). Developing a safe and effective plan for implementation of the process, such as what was seen through Partners, is crucial for expansion and quality improvement.

I agree with your statement that the architectural approach mitigates project risks and contributes to a successful outcome due to the organization and stability present in the design. Frameworks should be adjusted for certain complex, construction projects that can make practical yet comprehensive decisions (Firmenich, 2017). Factors are not typically perfectly informed and rational, and therefore, the design should be able to adapt over time and demonstrate a dynamic, yet organized framework (Firmenich, 2017). The approach seen with Partners included individuals with great experience and also from business standpoints, with individuals present for the practitioners to discuss their needs and advocate for them.

 

References

Firmenich, J. (2017). Customizable framework for project risk management. Construction Innovation, 17(1), 68-69. https://doi.org/10.1108/CI-04-2015-0022

Reis, Z., Maia, T., Macrolino, M., Becerro-Posado, F., Novillo-Ortiz, D., & Ribeiro, A. (2017). Is there evidence of cost benefits of electronic medical records, standards, or interoperability in hospital information systems? Overview of systematic reviews. JMIR Medical Informatics, 5(3). https://doi.org/10.2196/medinform.7400

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◄ Week 4 Quiz: Concepts 4-6

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2: Complex Systems; and 3: Data Standardization Week 1 Discussion 2: Concepts 1: Systems Thinking; 2: Complex Systems; and 3: Data Standardization (For Grading Purposes Only) Week 1 Discussion 3: Review of LiveText Submission to Date Week 1 Discussion 3: Review of LiveText Submission to Date (For Grading Purposes Only) Week 1: Optional Reflection/Discussion Week 1: Optional Reflection/Discussion (For Grading Purposes Only) Week 1 Checkpoint: Review of e-Log Hours to Date Information Literacy Assessment Questionnaire Week 2: Introduction and Objectives Week 2: What’s Due When Week 2: Learning Materials Week 2 Quiz: Concepts 1-3 Week 2 Discussion 1: Case Study 1: Health Information Technology Week 2 Discussion 1: Case Study 1: Health Information Technology (For Grading Purposes Only) Week 2 Discussion 2: ASSESS/Identify a Practice Issue/Problem Week 2 Discussion 2: ASSESS/Identify a Practice Issue/Problem (For Grading Purposes Only) Week 2 Discussion 3: The Checklist Manifesto Week 2 Discussion 3: The Checklist Manifesto (For Grading Purposes Only) Week 2: Optional Reflection/Discussion Week 2: Optional Reflection/Discussion (For Grading Purposes Only) Preview: Week 3 Assignment 1: Synthesis Paper 1 Week 3: Introduction and Objectives Week 3: What’s Due When Week 3: Learning Materials Week 3 Discussion 1: Concepts 4: Systems Life Cycles, 5: Evidence-based Practice, and 6: Root Cause Analysis Week 3 Discussion 1: Concepts 4: Systems Life Cycles, 5: Evidence-based Practice, and 6: Root Cause Analysis (For Grading Purposes Only) Week 3 Discussion 2: Use Case Week 3 Discussion 2: Use Case (For Grading Purposes Only) Week 3 Discussion 3: Workflow Diagram Week 3 Discussion 3: Workflow Diagram (For Grading Purposes Only) Week 3: Optional Reflection/Discussion Week 3: Optional Reflection/Discussion (For Grading Purposes Only) Week 3 Assignment 1: Synthesis Paper 1 Week 4: Introduction and Objectives Week 4: What’s Due When Week 4: Learning Materials Week 4 Quiz: Concepts 4-6 Week 4 Discussion 1: Case Study 2: Partners Healthcare System (PHS) (For Grading Purposes Only) Week 4 Discussion 2: Use Case Description Week 4 Discussion 2: Use Case Description (For Grading Purposes Only) Week 4 Discussion 3: Use Case Components Week 4 Discussion 3: Use Case Components (For Grading Purposes Only) Week 4: Optional Reflection/Discussion Week 4: Optional Reflection/Discussion (For Grading Purposes Only) Preview: Week 5 Assignment 1: Synthesis Paper 2 Mid Course Evaluation Week 5: Introduction and Objectives Week 5: What’s Due When Week 5: Learning Materials Week 5 Quiz: Concepts 7 and 8 Week 5 Discussion 1: Use Case Development Week 5 Discussion 1: Use Case Development (For Grading Purposes Only) Week 5: Optional Reflection/Discussion Week 5: Optional Reflection/Discussion (For Grading Purposes Only) Week 5 Assignment 1: Synthesis Paper 2 Week 6: Introduction and Objectives Week 6: What’s Due When Week 6: Learning Materials Week 6 Discussion 1: Background and Identified Issue Week 6 Discussion 1: Background and Identified Issue (For Grading Purposes Only) Week 6: Discussion 2: Design Section Week 6: Discussion 2: Design Section (For Grading Purposes Only) Week 6 Discussion 3: Development Section Week 6 Discussion 3: Development Section (For Grading Purposes Only) Week 6: Optional Reflection/Discussion Week 6: Optional Reflection/Discussion (For Grading Purposes Only) Week 7: Introduction and Objectives Week 7: What’s Due When Week 7: Learning Materials Week 7 Discussion 1: Implementation Section Week 7 Discussion 1: Implementation Section (For Grading Purposes Only) Week 7 Discussion 2: Evaluation Section Week 7 Discussion 2: Evaluation Section (For Grading Purposes Only) Week 7 Optional Reflection/Discussion Week 7 Optional Reflection/Discussion (For Grading Purposes Only) Week 7 Assignment 1: ADDIE Paper Week 8: Introduction and Objectives Week 8: What’s Due When Week 8: Learning Materials Week 8 Assignment 1: ADDIE Video Presentation and PowerPoint Week 8 Discussion 1: ADDIE Paper Video: Peer Review Week 8 Optional Reflection/Discussion Week 8 Optional Reflection/Discussion (For Grading Purposes Only) End of Course Evaluation

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