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Business Case Study: Purchasing EMR Package for Specialist Rooms

Question

Task: You are a senior manager in a private hospital setting, with specialist rooms attached. Your CEO has asked you to review available software for an Electronic Medical Record (EMR) package- specific to your organization for the specialist rooms. Your hospital is a small regional one, with involvement from local stakeholders including the Visiting Medical Officers (VMOs), some of whom are on your Board. Some of your VMO’s have preferences and may have financial interests in EMR packages.

With costs for both the technology and support for any EMR package and annual licensing costs post that time, cost is an issue, but getting the right version for your facility is also of prime importance. You have been asked to present a business case study reviewing the key factors in acquiring any software to your Board.

Answer

Introduction to Business Case Study
Healthcare Industry is considered as one of the crucial and ever-growing fields for any economy. In the different health environment, it has been seen that managers are facing troubles from the different segments like the demand for up-to-date technology from clinicians, providers’ equipment with different versions and increasing cost complaints from the insurers. However, in the growing era of technology, hospitals with specialist room require the implementation of advanced technologies like Electronic Medical Record (EMR) for providing advanced level medical support towards the patients. It is generally a software-based system, which is responsible for taking records at the clinician's office. It generally collects crucial data regarding the patient's medical history and treatment process regarding a particular patient. It is mainly helpful in tracking the right direction for providing medical support. This study is focused on a small regional private hospital that has a specialist room attached. This study will discuss different software regarding EMR and identify the appropriate one for the particular system. The study will also highlight the different issues that have faced by the managers in implementing and managing the software. The study will also provide recommendations regarding the software choice and change management system.

Case Study
Background

In most of the cases, it has been seen that the private small regional hospitals are funded with the involvement of local stakeholders like Visiting Medical Officers (VMOs) and some members of the hospital management board. As a specialist room is attached to the hospital, the managers have to concentrate on the development of the services. A specialist room of the medical centre delivers advanced diagnostic or treatment amenities for precise illnesses or parts of the body. This type contrasts with general out-patient clinics (Wu et al., 2021). For that reason, it becomes necessary for the management to store the data for benefits in the future treatment process as it helps in reconnect the treatment process with the past one. In the time of advancement, there is various software that can be used as EMR and some of the most prominent and effective ones are Genie Software, Medical Director Software and Clinic to Cloud software. This software is effective for the EMR facility in specialist rooms though it has some drawbacks in cost management. It has been seen that the technology and support in addition to licensing demands high cost whereas the implementation of the right version of EMR is also essential for better service regarding the hospital.

Issues in Digital Health
Digital health is a process where medical facilities use digital platforms like computers, software and sensors for delivering healthcare and related uses. It is highly different from the approaches of traditional methods as the software is collecting data virtually and store it in the digital platforms. Genie software is a kind of practice computer program that is involved in integrating appointments with the doctors and patients, billing after treatment, and management of the clinical facilities(Kunapareddy et al., 2019). In this case, the major issues that have been seen are the upgrading or replacement of the legacy system where investment and training to the old medical staffs come up with a challenge. Moreover, Medical Director is a general practice software for providing improved care to the patients. It helps in patient management by scheduling the appointment, billing and storing the data regarding the practice process. It is solely dependent upon the cloud. In this case, the most common problem that has been witnessed is the lack of strategic direction to the technology environment. In a small healthcare system, the patchy adoption process of staffs regarding advanced technology has created obstacles in accepting EMR. On the other hand, Clinic to Cloud is a secure platform which is contributing to the optimization of the practice operation, financial performance and delivering a better patient experience. In this case, the lack of broader organizational strategies and little amount of support from the sides of information management has created the problem(Jedwab et al., 2021).

Risks and Benefits in Implementation
It has been seen that technology has provided many crucial changes in the healthcare system. The technological improvement regarding electronic medical records delivers better patient care whereas the traditional paper pen process has some drawbacks. However, the Implementation of such digital platforms in keeping data has its own risks and benefits, which are discussed below.

Risks

Benefits

As in the case of Clinic to cloud software, the information of the patient has been uploaded in the cloud medium where the authority has unauthorized access to the patient information.

In a similar section, it provides more security in keeping the data secure. Although the medical staffs have access but the data is only restricted between that patient and providers.

It is mainly worked on the power of the internet and the entire information and treatment process is provided in the software. In case of unavailability and system failure, the EMR software is unable to provide any kinds of information regarding patient and treatment history(Mahal Alrehaili & Zayyan Alsharqi, 2021).

Although, in the case of Genie, it has been seen that the memorizing and processing power has helped the clinicians to recognize the diseases of the patient and deliver proper treatment with the help of the past records.

Medical Director software, especially Helix has now fully integrated with telehealth, where the entire data is controlled by the software. In case of any technical glitch or system failure, there is a high risk of losing data permanently.

On the other hand, as the software is efficient enough in delivering the services to the patient in a quick and smart manner, it can be said that it is helpful in time management for the medical staffs(Enaizan et al., 2018).

 

Table 1: Risks and Benefits of EMR Implementation
(Source: As created by author)

Review of the Software
Safety

With the technological advancement, it has been seen that the medical sectors are replacing paper pen methods with the EMR. As the system is working on the online platform, there are some safety measures that have been taken for that sake. It has been seen that despite the cybercrime, the entire record-keeping process through genie, helix by medical director and clinic to cloud can be secure if the proper precautions have been taken. Saving the entire system from hacking is one of the top priority in this field as it can be easily stolen in the cyber section. On the other hand, the human factor is also crucial as most of the medical staffs related to the old staff management has faced challenges in adjusting the process. It is also important to develop a properly trained workforce(Mammen et al., 2019).

Efficiency
The EMR is highly effective in assisting the primary care providers as the EMR is capable of providing charts of weight, cholesterol level and blood pressure which is not possible in the paper pen method. The electronic system is also self-alarming as it is capable of proving alerts for the treatment goals. It is not only restricted to the care providers, but it also provides assistance to the patients. In the case of Genie, the software help in connecting the patients with the physician, where the development of relationships happened. In such a process the treatment process went smoother. Moreover, it is also beneficial for the physicians and other medical staffs as it is highly time-saving than that of the traditional process as the velocity of computing helps in comparing the treatment-related data at one time.

Suitability
In the case of a small private hospital with a specialist room, the patients expect that the organization can provide excellent care for them. In order to make the patients comfortable with the treatment process, it is necessary for the physician to be aware of the patient information and treatment history at the same time. Implementation of EMR software helps in taking the information from the patient and keeping the past treatment process simultaneously. For that reason, the physician can access the information, disease report and past treatment and medication history at the same time. It will not only help in tracking the correct treatment process also helps 6the doctor to stay on the right path avoiding different drawbacks. Apart from that, the cloud memory of the software keeps the data secure and private for each patient (Msiska, Kumitawa& Kumwenda, 2017).

Financial Impact
Cost

The cost of the EMR software is one of the major challenges for the hospital as the technological advancement required many kinds of activity. Apart from the software cost, there are many other areas that must be invested in order to perform it in the right manner. There is a high cost that is required in the training process so that the software can be expertly handled by the staffs. It has been seen that top-performing practices spend almost 30,000 dollars per doctor for their EMR system while the other practices require 20,000 dollars. Apart from that, it has been seen that licensing for the MER software is also taking a lot of money. In the case of Genie, a monthly subscription cost around 200 dollars perusers. Moreover, it has been expected that the licensing fees are around 1500 to 5000 dollars depending upon the organizational size(Al-hihi et al., 2017).

Value for Money
Electronic medical record systems have the prospective to deliver considerable welfares to doctors, clinic rehearses, as well as healthcare organizations. These systems can expedite workflow plus increase the excellence of patient upkeep in addition to patient security, although their financial effects have not been as well documented. Although, implementation of the EMR software is costly in nature but overall, it has been seen that the use of those software increases the financial benefits for the organization. It has been seen that before patients have to wait for months for an appointment whereas the implication of helix facilitate the entire process and as a result, the organization can provide more facilities in a small amount of time.

Funding
In the case of small private medical sectors, the funding for running the organization is coming from the VMOs. It has been seen that most of the cases support for the new technology is sparse in nature and most of the funding come from those who are vested interests. The lack of cost-effectiveness analysis sometimes creates a major problem in the implication of the EMR software. As the organization is a regional one, it is expected that funding is also limited and the managers have to analyze well in different kinds of software so that the right software can be chosen within the fund limit. Apart from that as the entire EMR software comes under business practice, it has been seen that some of the VMOs have preferences regarding some kinds of specific EMR software as it provides financial interest to that VMO. For that respect sometimes it has been seen that some of the software is high cost regarding the fund and sometimes it has been seen that the software is not appropriate for the system functions (Pandya et al., 2019).

Governance Mechanism
In order to perform well with the new technology, it is important for the organization to plan and implement proper change management so that strategies can channelize the roles of staffs, physician, and IT teams. In this case, the hospital has included staffs, physicians and volunteers to support the EMR change management process. The main role for the change management is gone to the subject matter expert who is nurses, physicians and healthcare officers who must support the entire process. This encompassed decision-making to aid develop the build and undertaking system testing to ensure it fulfilled the rigour of day-to-day operations. Additionally, the staffs and physicians have to train on a regular basis so that it can be habituated with their daily works and in case of technological improvement they can handle the situation. With an emphasis on longsuffering requirements present and in future, as well as the distribution of high-quality plus harmless patient care, this machinery employment, containing empowered barcode scanning, microelectronic command entry, barcode sample trailing as well as medication management, reinforced amended patient care and safety experience(Canaway et al., 2019).

Recommendations
The implementation of the EMR software is essential for the organization in order to provide more accurate and effective services. In order to implement the software, it has been seen that there are some obstacles that can create problems. Here are some recommendations that can help the organization to coup up with the situation.

Identification of the right software should be the main criteria for the organization. As the hospital is a small and regional one and also have a specialist room, it is essential for the organization to implement the right kind of EMR software which can connect the system with patients. Genie is multifunctional software which is capable of storing data of the patients along with the creation of bills and appointment. It can be used by the patients by downloading the application on their phone. On the other hand, Helix by Medical Director helps in practising management with the clinical workflow in a modern interface. It is helpful in managing all kinds of patient interaction in a secure format. Moreover, Clinic to Cloud is also an effective software that is capable of storing all kinds of history of the patients related to the treatment process. Here, the physician can access all the information regarding the patient in one interface resulting in speeding up the process.

The cost is one of the major factors in the implementation of the EMR software. In most cases, it has been seen that the funding has arisen from those who are not capable of cost analysis. The organization have to develop a proper finance team who can take part in a meeting with the financial heads of the organization those are the VMOs and Executives. In some cases, the VMOs are attracted to the false EMR software due to some financial interest. However, the organization have to take proper decision in implementing the right kind of software according to the way of work as the funding is limited in this case.

Moreover, the organization have to focus on the technological advancement of the organization as after implication all the data can be accessed through the software and any kinds of difficulties can lead to the stuck or failure of the treatment process.

The staffs and medical experts who will be in charge of the specialist room must be trained well so that they can access eh software and manage the situation when some of the technical glitches will arise.

It is also important to be aware of cybercrime as the entire system is working on the internet platform. It has been seen that there is a high possibility of a loss of information due to hacking possibilities. The organization have to secure the server and only then they can use it properly.

Change Management Process
In order to make the software implementation in a small medical sector replacing the traditional technique, there is a high need for change management in the process. In order to do so, the application of Kotter's 8 step model of change can play a major role in the entire process.

Step 1: Creating Urgency
Identification of the threat and repercussion is the most important part of creating a change. Examination of the opportunity can be followed so that the change can be effective in the process. In this case identification of the cyber threats and understanding of the positive outcome can help in implementing the software (Pawar& Charak, 2017).

Step 2: Creation of Guiding Team
In order to create an advancement in the technological section, it is important to create a team of experts in the starting phase as they will access the new technology along with the training process of the old staffs of the medical sector.

Step 3: Vision and Strategy
The creation of a proper vision is the core process of making a change in a workplace. The implication of the EMR software will provide better facilities to the patients and helps the organization to manage the details of the treatment process (Buzan& Whitehead, 2021).

Step 4: Communicating with the Vision
Creating a communicating workplace is important as with the change of the vision, it is also important to make a link among the new and old medical staffs so that they can produce a coalition effort towards the successful use of the software (Bhatt, 2017).

Step 5: Removing Obstacles
By understanding the working process of the software, it is crucial to overcome the challenges in the early phase. Continuous checking of the working process of the software and developing the loopholes can create a stable organizational change.

Step 6: Creating Short-Term Goals
Creating short time goals can be effective in changing environment. Training of the physicians is important rather than the associates as the physicians have to interact with the software more. The small steps of training can help the organization to achieve the goals easily(Kang et al., 2020).

Step 7: Consolidating Gains
Improvement of the staffs can be a self-motivating factor and it can be enhanced by providing individual recognition. Improvement of the personal experience can help the medical staffs to acquire the software in a more effective manner.

Step 8: Change in Corporate Culture
In order to make proper changes in the workplace, it is important to change the working culture. It has been seen that retention of the traditional culture can restrict the change process as the staffs want to remain in their comfort zone. With the change of the culture, the staffs can easily accommodate with the change without any kinds of difficulties(Brock et al., 2019).

Kotter 8 step model in business case study

Figure 1: Kotter's 8 step model
(Source: ERRIDA, LOTFI& SEMMA, 2018)

Conclusion
From the entire study, it can be concluded that with the advancement of technology the medical sectors must adopt different technologies in their workplace. In the case of a small regional medical centre where the specialist room is attached, it is important to implement EMR in the working process in order to better patient care. In this process, the organization has faced different challenges regarding cost management and security issues. With the help of expertise in employment, training, financial analysis and cybersecurity management, the software can be easily installed. With the help of Kotter's 8 Step change management, the organization can introduce the software by managing the stakeholders.

References
Al-hihi, E., Shankweiler, C., Stricklen, D., Gibson, C., & Dunn, W. (2017). Electronic medical record alert improves HCV testing for baby boomers in primary care setting: adults born during 1945–1965. BMJ Open Quality, 6(2), e000084. https://doi.org/10.1136/bmjoq-2017-000084

Bhatt, R. (2017). Theoretical perspective of change management. CLEAR International Journal of Research in Commerce & Management, 8(2).

Brock, J., Peak, K., & Bunch, P. (2019). Intuitively Leading Change: Completing a Kinesiology Department-to-School Transformation using Kotter’s 8-Stage Change Model. JOURNAL OF PHYSICAL EDUCATION AND SPORTS MANAGEMENT, 6(2). https://doi.org/10.15640/jpesm.v6n2a2

Buzan, S., & Whitehead, M. T. (2021). Moving communication and collaboration online: making changes for home-based learning with Kotter’s 8-Step Process.

Canaway, R., Boyle, D., Manski?Nankervis, J., Bell, J., Hocking, J., & Clarke, K. et al. (2019). Gathering data for decisions: best practice use of primary care electronic records for research. Medical Journal Of Australia, 210(S6). https://doi.org/10.5694/mja2.50026

Enaizan, O., Zaidan, A., Alwi, N., Zaidan, B., Alsalem, M., Albahri, O., & Albahri, A. (2018). Electronic medical record systems: decision support examination framework for individual, security and privacy concerns using multi-perspective analysis. Health And Technology, 10(3), 795-822. https://doi.org/10.1007/s12553-018-0278-7

ERRIDA, A., LOTFI, B., & SEMMA, E. (2018, November). Measuring change management performance: a case study of a Moroccan construction company. In 2018 IEEE International Conference on Technology Management, Operations and Decisions (ICTMOD) (pp. 206-213). IEEE.

Jedwab, R., Hutchinson, A., Manias, E., Calvo, R., Dobroff, N., Glozier, N., & Redley, B. (2021). Nurse Motivation, Engagement and Well-Being before an Electronic Medical Record System Implementation: A Mixed Methods Study. International Journal Of Environmental Research And Public Health, 18(5), 2726. https://doi.org/10.3390/ijerph18052726

Kang, S., Chen, Y., Svihla, V., Gallup, A., Ferris, K., & Datye, A. (2020). Guiding change in higher education: an emergent, iterative application of Kotter’s change model. Studies In Higher Education, 1-20. https://doi.org/10.1080/03075079.2020.1741540

Kunapareddy, G., Switzer, B., Jain, P., Conces, M., Chen, Y., & Patel, B. et al. (2019). Implementation of an electronic medical record tool for early detection of deep vein thrombosis in the ambulatory oncology setting. Research And Practice In Thrombosis And Haemostasis, 3(2), 226-233. https://doi.org/10.1002/rth2.12176

Mahal Alrehaili, M., & Zayyan Alsharqi, O. (2021). The Impact of Upgrade towards Comprehensive Electronic Medical Record System on Hospital Performance: A Single Tertiary Care Center Experience in Saudi Arabia. Journal Of Business And Management Sciences, 9(1), 17-30. https://doi.org/10.12691/jbms-9-1-3

Mammen, J., Java, J., Halterman, J., Berliant, M., Crowley, A., & Frey, S. et al. (2019). Development and preliminary results of an Electronic Medical Record (EMR)-integrated smartphone telemedicine program to deliver asthma care remotely. Journal Of Telemedicine And Telecare, 1357633X1987002. https://doi.org/10.1177/1357633x19870025 Msiska, K. E. M., Kumitawa, A., & Kumwenda, B. (2017). Factors affecting the utilisation of electronic medical records system in Malawian central hospitals. Malawi medical journal, 29(3), 247-253.

Pandya, C., Clarke, T., Scarsella, E., Alongi, A., Amport, S. B., Hamel, L., & Dougherty, D. (2019). Ensuring effective care transition communication: implementation of an electronic medical record–based tool for improved Cancer treatment handoffs between clinic and infusion nurses. Journal of oncology practice, 15(5), e480-e489.

Pawar, A., & Charak, K. (2017). Study on Adaptability of Change Management: Review of Kurt Lewins and Kotter Model of Change. Research Revolution International Journal of Social Science and Management, 5(4), 79-83.

Wu, C., Chiu, R., Yeh, H., & Wang, D. (2021). Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise’s cross-enterprise document sharing integration profile. Retrieved 2 April 2021, from.

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