Case Description In Chapter 1, you learned about the Mountain View Community Hospital (M...

Case Description

In Chapter 1, you learned about the Mountain View Community Hospital (MVCH) special study team that is developing a longterm strategic plan, including an information systems plan for MVCH. In assessing the future technology needs of the hospital, the planning team of Mr. Heller, Mr. Lopez, Dr. Jefferson, and a consultant has taken a close look at issues with existing systems as well as trends in the health-care IT industry.

You may recall that MVCH has systems for many different areas, including patient accounting, administrative services, and financial management. Most of the computer applications are implemented using relational database and client/server technology. Some systems were developed internally, while others were acquired from outside vendors. Responding to a recent survey of health-care CIOs, Mr. Heller chose the term limited integration to describe the hospital’s current IT infrastructure: best-in-class systems in some areas, stand-alone systems in other areas, and some remaining manual or paper-based processes. Such limited integration is affecting virtually all of the hospital’s stakeholders.

Patients must negotiate a maze of health plans, administrators, physicians, and clinics in their encounters with the hospital. The hospital’s heterogeneous environment of platforms and applications, as well as the paper-based systems, has made exchange of patient data between the clinical systems and administrative/ financial applications a challenge. At the same time, the managed-care environment and the needs to contain costs and simultaneously improve clinical outcomes, patient satisfaction, and efficiency require MVCH to closely track and analyze its clinical and financial data related to patient care services and provide those data to its administrative and clinical decision makers. Oftentimes, accurate data need to be available in real time.

In addition to these concerns, some important developments in the health-care IT industry factor into the study team’s analysis. One is the trend toward using electronic medical record systems that require various clinical information systems to work together to provide a complete patient record. Hospitals concerned about moving patients through the hospital more efficiently and effectively have begun adopting workflow automation (or business process management) technology and Web technologies are making inroads. Web portals, for example, allow both patients and physicians to communicate online. Health-care alliances are extending their member and patient services beyond their organizational boundaries to the workplace, schools, and homes. Health plan members can check their claim status, send messages to service representatives, and review coverage. Patients can even make their own appointments by accessing appointment schedules.

Given these issues and trends, the study team has concluded that better and more centralized access to operational, financial, and clinical information should be a top priority for the hospital. Specifically, the team would like MVCH to implement a system that integrates all of these data—data from health plans, physicians, and hospital systems—so that accurate realtime information is available.

MVCH’s planning committee believes the adoption of Web-based solutions may greatly improve the hospital’s operations, extend customer service and marketing functions, speed up and improve the quality of patient care, and allow physicians to be more responsive to their patients. The committee specifically sees Web services as a way of addressing many of the hospital’s challenges.

For one thing, given the widespread access to the Internet these days, patients are increasingly demanding online capabilities, such as making appointments, booking surgeries, making payments, and so on. In response, hospitals have begun to implement patient portals that can even provide patients with access to their medical records. Another issue at MVCH is the heterogeneous environment of platforms and applications. As stated in previous chapters, MVCH has applications and software from many different vendors. Consequently, the IT department has been struggling to interface the many different systems and exchange patient data between the clinical systems and software that is not health-care specific, such as reporting and billing applications. Mr. Heller, MVCH’s CIO, believes that Web services would provide an efficient means of making the diverse systems work together.

Such a solution would also be beneficial for the medical staff. Currently, physicians have to log on to multiple applications to retrieve diagnostic information such as radiology reports and digital images, access the latest medical literature regarding a patient condition, or read e-mail. Some doctors have also expressed an interest in accessing clinical systems remotely while working outside of the hospital. A physician’s portal accessed from a standard Web browser could provide faster access to information regardless of location, and doctors could open and navigate multiple applications to extract information. Web services could even push relevant new information regarding a patient’s condition. At a recent conference for health-care CIOs, Mr. Heller also learned from presentations and conversations with peers that Web services could potentially be rolled out in a relatively short time frame—three to six months.

In considering where Web services and other Web-based solutions could be developed for MVCH’s health-care systems, several issues have been raised:

• Privacy and security concerns are of primary importance. Patient health information requires high levels of confidentiality because it is sensitive by nature and because of HIPAA’s privacy and security mandates.

• Data entry questions are also significant. Doctors, nurses, and other health-care workers must be able and willing to enter the data into any system that is provided.

• Given that Web services are built on a foundation of HTTP, system availability and reliability would be crucial if a decision were made to implement a Web-enabled system, particularly for key business processes.

• How would a browser-based system integrate with the systems already in existence at MVCH?

• Would MVCH have the funding and staffing resources to go forward with a Web services project? Would it be necessary to hire an external service provider? Could it be done in-house with existing IT staff?

• How would MVCH demonstrate that the proposed system is cost-effective?

• How will MVCH predict and handle changes in work patterns that may occur?

• What organizational policies and procedures will need to be changed or modified as system changes are implemented?

Case Questions

Do you think that MVCH IT staff under Mr. Heller should and could undertake the project of moving MVCH toward an integrated environment? Should MVCH outsource such a project? Why or why not?