Case Description At the end of Chapter 1, you learned about the Mountain View Community...

Case Description

At the end of Chapter 1, you learned about the Mountain View Community Hospital (MVCH) special study team that is developing a long-term strategic and information systems plan for the next five years. The team, composed of Mr. Heller, Mr. Lopez, Dr. Jefferson, and a consultant, is trying to devise a plan that will meet the hospital’s goals of highquality health care, cost containment, and expansion into new services, such as Dr. Browne’s anticipated Geriatric Medicine department. Mr. Heller, MVCH’s CIO, is a member of the Healthcare Information and Management Systems Society (HIMMS) and regularly reads IT-related magazines to keep up with developments and new technologies (e.g., Computerworld, CIO Magazine, Health Management Technology, Health Data Management, and Healthcare Informatics). He also attends health-care IT conferences that allow him to interact with his peers and find out what’s new.

In response to issues with existing systems and recent trends in health-care IT (e.g., electronic medical records [EMRs], work-flow automation), the study team has been evaluating various options for integrating the hospital’s operational, clinical, and financial information. An EMR system would allow physicians to access all medical information for a patient, even though that information is from different systems and locations, including various physician, hospital, laboratory, and insurance records. As part of a transition from the paper chart to EMRs, and as a way of addressing medical errors, hospitals, including MVCH, are also beginning to take a closer look at computerized physician order entry (CPOE) systems. (You may recall that the enterprise model developed by the study team included an ORDER entity.) Primarily implemented in large metropolitan areas and leading government hospitals at the present time, CPOE allows physicians to electronically enter their orders for labs, medications, radiology, and so on. CPOE not only eliminates problems stemming from illegible handwriting, it also provides decision support capabilities, intercepting medication errors at the time of order, or alerting a physician to potential interactions with other medications a patient may be taking.

EMR and CPOE systems, however, represent a significant change in the way health-care information is collected and used. And change is often difficult. After a conversation with Dr. Z, who worked at a large hospital that used a CPOE system prior to joining MVCH, Mr. Heller realizes that physicians may not readily embrace such a system. For example, a physician who wants to prescribe an antibiotic for 10 days or 2 weeks may find that the default in the computer is 1 week. The physician would then have to manually override the default. Not only would this extra step consume extra time, it would also require greater knowledge of the computerized order system on the part of the physician. A handwritten order would have been more convenient. And, according to Dr. Z, this example is just one of a million little things that would be more difficult. While advocating the technology, Dr. Z believes that CPOE’s steep learning curve and need for relearning can make the practice of medicine more difficult. Dr. Z also remembers a situation in which the pharmacy went into the system and unilaterally changed one of his orders.

In addition to his involvement with the hospital’s special study team, Mr. Heller is facing a number of data management issues as a result of HIPAA’s security rules to protect patient information. Contingency planning is one of them. HIPAA’s contingency plan standard has five components: a data backup plan, a disaster recovery plan, an emergency mode operation plan, testing and revision procedures, and applications and data criticality analysis. The latter involves identifying all potential data security threats and determining their level of risk. HIPAA also has audit trail requirements that were briefly described in the Chapter 7 case segment.

Password management has become a huge issue lately. MVCH upgraded its security policies in response to HIPAA’s information access management requirements. Users must have unique names and passwords for many applications and are required to change their passwords regularly. Physicians in particular are complaining about the many passwords they have to keep track of and the problems they have with logging on to an application when they forget a password. As a result, Mr. Heller’s staff is working on making single sign-on (SSO) a reality at MVCH.

Other data management issues of concern to Mr. Heller include the hospital’s data storage needs and data quality. Storage needs at MVCH continue to grow at an unprecedented rate as data (clinical and nonclinical) and diagnostic images are being created. HIPAA and other new regulations are increasing data volumes even more. HIPAA, for example, requires that some types of medical information be retained for many years—even beyond the lifetime of a patient. The study team’s discussions of data warehousing technologies (see MVCH Chapter 9) have also brought data quality to the forefront. At one of the team’s meetings, Mr. Lopez, the hospital’s CFO, wanted to know just how much poor quality data cost the hospital every year. He had read that poor data quality costs account for approximately 4 percent of a hospital’s expenses.1 Given the need for cost containment, Mr. Heller is beginning to feel the pressure to shift away from the current focus on fixing after the fact and moving toward proactively preventing data quality problems and building quality into the process.

Commercial off-the-shelf (COTS) packages for EMR could replace all of the data systems that would have to be integrated to form an EMR system in-house at MVCH. (You might want to research a few as background to this question.) Develop a list of pros and cons for purchasing a COTS EMR system versus developing a program for data integration to provide EMR capabilities on top of the existing disparate data source systems within MVCH.