Development of a new Hospital system

Name

Institution
 1. Introduction

Like many other health information systems, the hospital facility will need a new

system that will enhance the quality of care in the hospital under this study. The hospital has

an aim to approach it through patient-centered care, and the current systems have not met the

required expectations. The paper, therefore, discusses the various ways in which the hospital

could implement the system from a project management perspective. After extensive research

in the health facility, it was agreed that a mare implementation of an information system

would not lead to the organization's efficiency. Still, there are many other considerations such

as involving the leadership and management, the establishment of compatibility between

hardware and software, integration of workflow while focusing on user involvement. The last

aspects include system acceptability and the need for training.

2. Problem Statement

The facility has maintained Electronic Health System, but most of the systems are

currently outdated and lack imaging functionality. The goal of the current project is to

implement a customized system that would ensure that the charts and many other

functionalities are lacking in the facility. The initiative has been driven by the government

regulations that apply in Denmark, the USA, and the U.K. The new custom development has

been driven by the need to make data available for patients and improve efficiency ad patient

outcomes (Schoen, Osborn, Squires Doty, Rasmussen, Pierson, 2012). The new system will

also improve doctor-patient relationships in an era where patient care is shared by a team of

professionals while dealing with the rapidly changing work environment. At the same time,

they need to access their medical information in real-time. The main objectives of the new

system are increasing patient outcomes and making the hospital facility be focused on a

patient-centered approach. The hospital has a varied workforce that includes medical
professionals who possess good expertise, power, and autonomy. They may need the system

for various work-related duties such as diagnosing a patient while at home; there will be a

need for prompt access to data in such a case.

3. Background

The change in a healthcare facility is moving at a fast rate to comply with the

regulatory policy requirements such as those by ICD 10 (Alain, 2018). The system needs to

meet the emergence of new models of care such as Patient-Centered home care. The new

practices will be adopted when the new system is implemented (Jeffrey & Hoffer, 2014).

During the stressful times, the providers and their staff have adapted to changes, and the

change has become a new way of life. Fortunately, change management is a well-developed

field, having significant evidence that leads to practices on the way forward towards the

navigation of the change management process. Kotter () believes that the change process in a

company has to be both emotional and situational components, and he proposed a multistep

change model to be used in change management.

It is the work of the healthcare manager to manage an extremely challenging position

and maintain a competitive edge in the healthcare market. Therefore, rapid change is

occurring in many healthcare organizations as they strive to adopt new technologies such as

the implementation of a custom-made chart generation system. Automation has developed

and has become an integral part of the current system as it helps in capturing the information

about patients and allows the sharing of that data. The records to be shared are to be released

to the enterprise-wide system in a summary form (Sattarova and Kim 2017). The data that will

be shared include the immunization data, radiology images, and patient demographics. Other

personal information such as age, weight, and lab tests may give vital signs and billing

information added to the charts.

 The medical sector is a critical area and has always been growing as there is a

population increase; this is true especially when people need to have access to medical

services. As a result, there are challenges in handling the patient data and using the data for

the purpose of budgeting; since the facilities do not grow in any area of coverage, the data

grow by volume of the patients. Hence there is a great need for handling the data in a

particular manner (Fraser, Biodich, Moodley, Choi, Mamlin & Szolovits, 2015). There is a

need for growth of consistency of the data used in decision making by the health officers and

the government. For this to be successful, The Health records system needs to be automated

and operate in a single facility, manage data, and provide access to the data whenever

necessary (Centers for Medicare & Medicaid Services, 2008, March 27). The system will

also be necessary for reducing the time taken to retrieve charts and images from the current

information system. Also, the time is taken to compile data for various reports and reduce

patient data loss. Therefore, the system's main aim is to have the patients at its core (Simborg,

Detmer, Berner, 2013). When using the system, patients are able to store their information.

They have clear access to their data shared by the practitioners, and the patient information

technology is also useful in preventing the disease prevalence and each patient (McDonald,

2019).

4. Significance of the Problem

The problem of imaging has been in the hospital for a long time, and it is important

for the facility to increase the efficiency of the hospital. The goal of the health facility is to

improve patient and nurse outcomes. The health facility also needs to adhere to the CDC's

requirements for the digital divide and allow accessibility of patient records (Jeffrey, 2014).

The new system will help resolve these problems and help the facility navigate the

interdependency, and improve patient care. The hospital also needs to access complete
clinical information that is usually unavailable at the point of care. Currently, no system

addresses the above needs. There is also a lack of innovations currently in the hospital to

improve the system, thus making a new system more urgent (Fraser, Biodich, Moodley, Choi,

Mamlin & Szolovits, 2015).

5. Consequences of the Problem

The facility will need to use the system in accessing up-to-date information from the

database, the new user interface to facilitate the use of graphics. At the same time, the

continued use of the current technology by the nurses and doctors may lead to a negative

attitude towards the use of the new system, hence slow down the hospital operations

(Sattarova and Kim,2017). Since the hospital staff will have access to multiple data, their

enhanced access may lead to patient data disclosure, which is a risk that must be mitigated or

controlled. This is because the nurses may disclose patient-specific data to unauthorized

users. This may negatively affect work-flows and patient-provider interactions, and

information overload from the computer-generated data (Simborg, Detmer, Berner 2013).

The other consequence of the system slow adoption of future technologies by the hospital.

6. Practice Knowledge Gap

Health Information system has improved the coordination of care delivered to the

high-need patients, and productive the health system, the HIT tools available have hindered

the development of new systems, the research team interviewed experts and many hospital

organizations to define the obstacles and determine the path towards improving the healthcare

delivery. The research gap found that there are four barriers to the creation of the complex

coordination of healthcare. Number one, most healthcare information system designers are

handicapped when trying to come up with ways to address the complexity of the healthcare
system. Secondly, experts also remain divided on the activities and the providers that should

be factored into the coordination and other initiative activities. The third fact is that there is a

need for diversified practice patterns, job definitions, and workflows; this shows an enormous

variation from one practice to the next while defining the roles and responsibilities among the

various experts.

7. Literature review

The expenditure by the hospital in software has risen, with the spending reaching

more than 67% of I.T. budget allocation on I.T. operations in 2018 alone, and the numbers

are expected to rise. The rise in costs includes procurement, development of new software,

and investment in the modifications and upgrades. Implementation of software change is not

an easy task, as it involves investment and unique staffing needs, which is why it is critical to

get it right the first time. Well-implemented change management is a key component of every

software change. The process will give the decision-makers a complete and accurate

understanding of the impact of the software changes and identify the potential disruptions to

functions, operations, and departments affected by the change. There are many ways to

approach change management, and the best approach is to ensure a glitch-free approach to

the change rollout.

One of the disadvantages of the modern workplace is the emergence of data

warehouses. The warehouses can hamper efficiency and growth and cause other problems

that include redundancy in effort and decreased collaboration. There is a need for efficient

application, discovery, and dependency mapping to break these problems as a crucial step in

the management of the change project. According to the findings of the Forester Survey, 56%

of the I.T. managers have no complete view of their dependences, especially between the

application and the infrastructure. Another survey revealed that 30% of the Information
Technology managers think of having all the inventory for hardware and software in-house is

critical for I.T. efficiency. Despite this, 42% still do not collect their data, while another 39%

maintain their inventory manually.

One major disadvantage of inefficient dependency mapping includes low

productivity, increased overheads, and poor team. The critical step in solving the issues is

ensuring that the right technology for dependency mapping is used. It can support a solid

foundation for a software change for any information technology project. When a reliable and

agile software solution is adopted, it means that it will provide micro and macro views of the

changes to be made on the software; additionally, the I.T. decision-makers can have a

consolidated view of their application stack across the multiple message queues, databases,

and unifying languages and codes.

The process of change management has traditionally been related to software

maintenance; the process of controlling changes has been defined as part of configuration

management. The literature review considers two common viewpoints of software change

management. The first viewpoint is examining the process for managing changes in the

existing software configurations and items in any software development life cycle phase.

There has discussion on the relationship between software configuration management and

change management. The software configuration management examines software from

version control, release-oriented, and change-oriented SCM.

The approach gives a 12-level improvement framework for the configuration and

change management where the first level of the configuration includes version control

activities. At this level, change management is limited to the storage and creation of the

change documents. The other levels include the change-oriented level, which supports

software evolution and maintenance; the last six levels also include product management and
efficiency highlight use of the reusable components of the advanced assembly systems

(Tomasi, Facchini & Maia, 2014). The difference between system evolution and software

maintenance is that software maintenance deals with fine-grained changes while system

evolution deals with structural changes. The system evolution changes the system's structure;

it is not a short-term activity and has produced few economic benefits. It, on the other hand,

system evolution increases the economic and strategic values of the software.

8. Project Overview

a) Scope of Project

The project includes the preparation of software that implements imaging in a health

facility. The system is to be developed to ensure the various security measures that do not

violate HIPAA requirements. The software will be developed using an agile development

environment that also demands the presence of agile teams.

b) Deliverables

Goals and Objectives

The goal of the system is to improve patient care and nursing outcomes. The project's

main feature will include adding a charting functionality to the system; apart from this, there

are other structural information such as increasing coordination between departments, cash

points and laboratory, and other clinical departments. The medical service billing and

laboratory test functionalities are also included in the project. The system will also add

patient profiles such as medication history and generating reports.

 In Scope of the project

 Software development

 Transfer of data, change management, and also workflow creation

 Training of the users on the new system

Out of Scope

 System maintenance and update monitoring are out of the scope of the current

system.

c) Goals of the system

Specific:

 The new technology will ensure an easier store of electronic data, and the clinicians

will also have access to the providers and other integrated needs.

 It will also allow easy communications around the facility and

Measurable

 The accuracy of data access will increase by 30%.

 The efficiency of communication will increase by 30%

 The clinical outcome and customer satisfaction will increase by 20%.

Attainable

 There is goodwill from the board on the new system; therefore, the senior board is not

an obstacle to developing the new system.

  Nurses and doctor preparedness have been going on for some time, and they are

anticipating the new system.

 Doctors also have a strong belief that the new technology will improve their

outcomes.

Related to the Goal

The main goal of the hospital is to improve efficiency and patient outcome. The

information system being developed will assist towards this by:

 Improving communication among the clinicians, nurses, and doctors

 Increase the response time to patient queries in time by doctors.

 Improve the time it takes to assess medical conditions through improved imaging and

charts.

 Collaborate with insurance brokers in sharing patient data to facilitate treatment

settlements.

Timely

 The implementation of the information system will be done in less than one year.

d) Project Players

The key stakeholders for the project include the project manager, team members, and

also resource managers. The team will do the project's actual implementation, while the

health facility owners will be interested in how effective and the project's outcome. The

project manager will ensure that the team delivers what they need, and the resource manager

will contact the suppliers and ensure that the project has enough teams to work on the project.
 Key Change Agent

Project Manager

Key Stakeholders

Role or Name Department

Facility Board of governors I.T.
Information Technology Team I.T.

Project Sponsor

Community Partner

Project Team

Role or Name Department Est. Hours Rate Total

Vendor selection team member I.T. 40 220 $8,800
Testing team I.T. 20 35 $7,000
Implementation team I.T. 30 25 $7,500
Training team I.T. 23 20 $8,000
Client Tracking system I.T. 12 201 $2,400
Completion and launching team I.T. and health 3 1201 $3,600
Total $37,300
 Institutional Leadership

The leadership of the project has been linked to several functions, and it is a

requirement of the hospital care; these include system performance and achievement of

healthcare reforms, the requirement of timely system delivery, and ensuring that the system

developed helps in ensuring the integrity of the system and efficiency during the development

process. Since the facility, like the other hospitals, is diverse in services being offered,

institutional leadership has to ensure that the system developed adheres to a number of

mechanisms, including the government policy and balancing the power of service providers.

Therefore, the leadership ensures that there is high-quality healthcare that is both safe

and consistent with the hospital goals. Clinical leadership engagement is, therefore, an

important element in the success of the system. Leadership is crucial in the administration

and management of tasks, and it has also been identified to be crucial in improving an

organization's efficiency and performance.

e) Level of Communication

All forms of communication are through the project managers, and there will be many

types of communication, such as through team applications. A communication plan is

important for the hospital to ensure a smooth transfer of data. The most common

communication levels include emotional, auditory, physical, and verbal communications.

When used in combination with such techniques as matching and mirroring individual

posture and gesture, the receptivity of the message will increase. To have effective

communication at the physical level, there is a need to connect with them in form and

movement and hand and gestures.

 At the emotional level, few people appreciate how emotions play down and are

integrated by the recipients. In rhetoric, Aristotle’s pathos refers to appealing to different

human emotions. This form of communication is important to an individual receptive to

another who has a negative life approach or a critical individual (Goedert, 2014). Therefore,

for an individual to communicate effectively at this state, there is a need to be aware of their

mental state and release negative emotions to connect with others. There are other levels,

such as the energetic level, where individuals communicate effectively when they hold their

highest intention for other people's wellbeing. All levels are interdependent and affect each

other. From the communication matrix, the levels are as shown in Table 6.

The following table shows various levels of communication

Topic Audience Frequency/Date Owner

Kick-off meeting Project team, Daily ICT manager
health team
Project Team meetings Weekly ICT manager
Meeting with the vendors. All HIS vendors Monthly ICT manager

Meeting with the health experts. Health department Weekly ICT manager

Training wellness clients Wellness clients Daily Project manager

Milestone review All stakeholders Weekly Project Team

Status reports I.T. Department Monthly ICT manager
Lessons learned Team leader Weekly ICT manager
Hardware Resources and Cost

NO ITEM DETAILS QNT UNIT COST SHOP

    Desktops      
    3.0 GHZ Speed 13      
1 Computers 4.0 GB DDR 2 40,000.00 80,000.0
    500 GB HDD       0
    Server 1 50,000.00 50,000.0
2 LTS PowerBack 4 4,500.00 18,000.00
    D-Link Router 1 15,000.00 15,000.00

The Computing Solutions Ltd.

3 LAN CAT 6 Cables 50 m 80 4,000.000
  Infrastructure
  Conduits, Clips 20 100 2,000.00
4 Operating Windows 10 Pro 1 27,000.00 27,000.0
5 SystemsOffice Microsoft Office 2016 1 19,305.00 19,305.00
  Application
4GL Object Enterprise
JavaEdition
SE 8.0 1 FREE FREE0
Oriented        
6 Development
       
    Java F.X. Scene Builder 1 9,000.00 9,000.00
  Software        
7 Local MySQL 1 32,000.00 32,000.0
8 Database
Antivirus McAfee Antivirus 2016 4 2,800.00 11,200.00
Standards and Guidelines 0
         
for Electronic Medical Record
9 Relevant   1 1,500.00 1,500.00
  Publication
  Systems in Kenya — MOH      
 In addition to the hardware and software costs, there will be costs associated with development teams. The above costs show how the

costs will be distributed in the system.

Outcome Objectives

Data governance: The result of data governance is to avail the integrity, usability, and integrity of data across the enterprise systems

(France, 2011). Effective data governance means that data is consistent and trustworthy and does not get misused as well. As the organization

will continue facing the new data privacy regulations, they would rely on data analytics to optimize the data operations.

Data standardization: When the company uses the latest technology, it will allow data conversion to the standard formats to process and

analyze the data. The new technology will use cloud storage, databases, and various data sources to not make it problematic for various uses to

access.

Risk management
 Most software projects are risky and face many problems that might arise during the development cycle. The experience from the

previous projects means that the new project team must learn from these mistakes and continually develop software. The following list of

software risks is eminent in software (Protti, 2010).

New and Unproven software: The majority of the software projects use new technologies, tools and techniques, and other development

standards. Any of the risks can arise, and even improper use of the new technologies often leads to project failure.

User and Functional Requirements: Fictional requirements continually evolve with respect to the failures and functions related to the

quality of service. The process requirements are sometimes lengthy and tedious, and complex, which means that software engineers need to look

at the discovery and the integration activities., there are also modifications to the user requirements that may not translate to the functional

requirements (Sheikh et al., 2011). The disruptions may lead to the critical failure of the system.

Performance: The various considerations must be given to the risk management officer; performance must be tested throughout the

project and to ensure that the products are moving in the right course.

Risk management Plan

 The risk management plan includes two options for risk management; risk monitoring ad mitigation. Risk monitoring includes

publishing the project status regularly, reporting the risk issues, regularly revising the risk plan for any change made to the software, reviewing,

and finally reprioritizing and eliminating the lowest priority risks.

Mitigation activities include

Acceptance: This acknowledges that the risk impacts the project, and there is a need to accept the risk.

Avoid: This is the scope adjustment to avoid the software risk.

Control risk: this involves taking actions to minimize the impacts of the risk.

Transfer: This is the implementation of the organizational risks to give the risk to another company.

Continued monitoring of risks: for low impact risks, it is important to continue monitoring of risks.

 Implementation methods

 The method for implementing the software will be agile methodology. The requirements will have iterated over and again till the

required requirements are met.

 9. Evaluation Plan

The work of the evaluation plan is to set the proposed details about the evaluation and to set out what will be evaluated during the

process (Safi, Thiessen & Schmailzl, 2018). The major components of the evaluation plan are setting out what is to be evaluated and how the

evaluation is to be carried out. The evaluation plan for the change will have the following elements;

f) Measures

Since the methodology uses agile development methods, the evaluation metrics will include the lead time, cycle time, and team velocity

(Chen, Li, Liang & Tsai, 2018). Other metrics include production that measures the attempts to find out how much work is done and also

determines the efficiency of the development teams.

g) Data sources

Surveys and Questionnaire: the survey's open-ended information and close-ended information from patients, clients, and other

providers.

Focus groups and interviews: The focus groups use interviews for specific themes; the focus group for the evaluation will come

from patients and doctors.

Evaluation data sources

Statistical models such as T-tests will be applied in the evaluation of data sources.

h) Methods of data collection

The data collection will be done through interviews and questionnaires on the physicians.
 1. References

Alain, G. (2018). Can Governance and Regulatory Control ensure private higher education as business or public goods in Bangladesh? Afr. J.
But Manage, 3(12): 890-906.

Rao, V. (2018). Recent development in life sciences research: Role of bioinformatics. Afr. J. Biotech. 7(5); 495-503.

Sattarova, Y and Kim T. (2017) 1T Security Review: Privacy, Protection, Access Control, Assurance, and System Security.
Fraser, F., Biodich, P., Moodley, D., Choi, S., Mamlin, B., & Szolovits. (2015). Implementing electronic medical record systems in developing
countries. Informatics in Primary Care, 14(1), 83-95.

Tomasi, E., Facchini, L A., & Maia, M.,(2014). Health information technology in primary health care in developing countries: A literature
review Bulletin of the World Health Organization,820 0,867-874.

McDonald, C., (2019). The Barriers to electronic medical record systems and how to overcome them. Journal of the American Medical
Informatics Association, 4(3), 213-221.

Goedert, J. (2014). Finding the right HIPPA mix. Health Data Management, 12(13), 48. Ministry of Medical Services 2009.2014 Strategic Plan.

Centers for Medicare & Medicaid Services. (2008, March 27). Choosing An Appropriate System Development Methodology. Retrieved June 30,
2016, from Centers for Medicare & Medicaid

Jeffrey A. Hoffer, J. F. (2014). Modern Systems Analysis and Design (7th ed.). (S. Wall, Ed.) Edinburgh Gate: Pearson Education Limited.
Retrieved July I, 2016

France FR. (2011). eHealth in Belgium, a new “secure” federal network: role of patients, health professions and social security services. Int J
Med Inform;80:e12–6

Protti D, Johansen I. (2010). Widespread adoption of information technology in primary care physician offices in Denmark: a case study. Issue
Brief (Commonw Fund)80:1–14.
Price M, Singer A, Kim J.(2013). Adopting electronic medical records: are they just electronic paper records? Can Fam Physician.
July;59(7):e322-9.

Schoen C, Osborn R, Squires D, Doty M, Rasmussen P, Pierson R, et al.(2012). A survey of primary care doctors in ten countries shows
progress in use of health information technology, less in other areas. Health Aff (Millwood). December;31(12):2805-16.

House of Commons. Committee of Public Accounts. Department of Health (2006). The National Programme for I.T. in the NHS. Twentieth
report of session 2006-7.

Sheikh A, Cornford T, Barber N, Avery A, Takian A, Lichtner V, et al (2011). Implementation and adoption of nationwide electronic health
records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals. BMJ.
October 17;343:d6054.

Simborg DW, Detmer DE, Berner ES (2013). The wave has finally broken: now what? J Am Med Inform Assoc. June;20(e1):e21-5