Scenario: Midwest Regional Health is one of Wisconsin's largest and most sophisticated hospitals, is Implementing a new EHR system that will better their services to their internal and external customers. They are asking ITMC (I-Tech Medical Consortium) to help them navigate through this long term project, thereby improving their commitment to their surrounding community.

1. MIDWEST REGIONAL HEALTH EHR
I-Tech Medical Consortium
Overview of the Electronic
Patient Record System

2. Midwest Regional Health Background
Midwest Regional Health is one of Wisconsin's largest
and most sophisticated hospitals. Located in Pewaukee, this
hospital opened in 1953 and has been an integral part of the
community ever since.
They offer an extensive scope of services complemented
by a highly qualified medical staff representing a wide
variety of medical and surgical specialties. Where they are
proud to provide high-quality health care services to
Wisconsin.
Midwest Regional Health is frequently recognized by the
national associations and local publications for its
unsurpassed commitment to providing high-quality
healthcare to the Wisconsin community and beyond.

3. Product Objectives
The goals of the product are as follows:
 Computerized physician order entry to allow health care personnel
to process orders for medication or other medical services directly
from the computer.
 Provide patients with an electronic copy of their health information
upon request.
 Capability to exchange clinical information with other providers of
care
 Full EMR that will include lab orders, results, billing, and full
medical history.
 Privacy and security of data — access control by patient and
providers
 Greater patient access to medical history data
 Increased quality of care
 Improved efficiency and time management of medical staff

4. Product Requirements
 The system and all hardware utilizing the system must be
encrypted for security reasons
 The system and the data storage facilities must be HIPPA
compliant
 Application must follow the HITSP and IHE
 The EHR system must be accessible 24/7 to all health care
personnel
 User(s) must be able to access records remotely
 The EHR system must accessible by any approved health care
personnel in any location within the organization’s various
locations
 ePrescribe
 E-sign – Electronic signature for physician / nurse
 All patient record information must be backed-up onto data
storage tapes every day for emergency backup support, and
then be stored at a secure off-site location

5. Patient Log-in page

6. Patient Medical History Page

7. I-Tech Medical Consortium
I-Tech Medical Consortium is a nonprofit organization
consisting of a wide variety of experienced partners,
including research, academic, public, and private
healthcare organizations professionals, dedicated to
championing the development of a universal patient
record system.
Its mission is to improve patient care and provide real-
time access to complete and accurate patient history
through the development of this innovative system.

8. Project Team members
 Myra Sanchez – Project Manager
 Brett Fry - Technical Lead
 Willie Greer - Quality Assurance Analyst
 James Tillman – Risk Management Analyst II
 Charles Winters – Talent Development Research
Analyst

9. Project Objectives
Electronic data has the vast potential to improve the quality of
healthcare audit and research. However, increasing access to data
through an EHR system also brings new risks to the privacy and
security of health records.
Among the proposed projects objectives are:
 The creation, expansion and linkage of electronic healthcare
record (EHR) - successfully implement and deploy a fully
functioning EHR system.
 Training – successfully train all necessary personal on the EHR
system.
 Security – successfully secure the data both on-site and off-site
and ensure all personnel have the appropriate security access to
EHR system and/or data.
 HIPPA compliancy – successfully ensure that the EHR system is
HIPPA compliant.

10. Project scheduled milestones
June 5th, 2012 – Project team kick-off meeting
June 7th, 2012 – Meeting with client
November 26th, 2012 – Vendor selection process
January 30th, 2013 – Live and fully functioning at
all clinics
July 20th, 2013 – Live and fully functioning at
hospital
December 6th, 2013 – Project sign-off meeting
with client
December 16th, 2013 – Team project closure
meeting

11. Project Boundaries
 Obtain list of product and/or service
requirements from the client
 Obtain a subject expert matter
 Research and selection of vendors
 Train all affected personnel
 Implementation of the EHR system throughout
business center location, main hospital location
and 3 separate clinic locations
 18 months schedule
 $16 - $20 million budget

12. Project Assumptions
 Application vendor of choice will be responsible for patient
data records while in full compliance of the HIPPA regulations.
 Application vendor will create and monitor data backup and
have an offsite data storage location
 Current workstations meet system requirements to run the
EHR application
 All Workstations will have system encryption software.
 Internet service provider can support the network bandwidth
needs
 Full guarantee from data facility including: useable data, secure
off-site location and access to backup information within a
maximum of 3 hours from the time of the backup information
request
 All staff will be trained in time to utilize the system

13. Project Constraints
 Timeline constraint
 Lack of technical resources
 Data transfer failure
 Overlooked features missing from application
 Limited access to subject matter expert
 Employee resistance to new system
 This type of system has never been implemented
so nothing to reference

14. Communication Matrix

15. Work breakdown structure

16. Cerner EHR Selected Vendor
By choosing Cerner for this application, they
support the application 100%, while
providing a secure data infrastructure system
which includes a guaranteed network
systems that stores all patient data, data
backups, and multiple data servers which
will minimize any chances of accessing any
private patient data.

17. Cerner – EHR Infrastructure Diagram

18. Vendor Supported EHR Benefits
The key benefits of this system are:
 Increased communications throughout the health care system
and their providers.
 Meeting HIPPA requirements by enabling the exchange of
discrete clinical information.
 Meets HITSP and IHE compliance guidelines
 It’s availability 24/7/365 except for maintenance windows
 It’s accessibility from a tablet, laptop and stand-along computer
without loss of functionality
 Reduces costs and increases efficiency by automating patient
services
 will provide a Disaster Recovery Plan along with maximum
outage timeline before they start subtracting money from the
signed contract terms.

19. Cerner EHR Cost of Operation
 370 devices that will receive the Cerner EHR application.
 Cerner Application and support - Based on the current
count of 370 beds to support the cost per bed equals
$17,200.
 The expected cost is $6,364,000; this covers the cost of
the bed and the annual operating costs.
 As more clinics are brought online, at this time the
estimated cost is $14,500 with an additional annual
operating of $2700 per bed.

20. RACI Chart

21. Network Structure
 Midwest Regional Health will provide an internet link between
the Office Center, hospital, and clinics will be redundant links
that are supported both by AT&T and TW Telecom.
 Both the Main Hospital and the Office Center will have a
connection to all clinics which also provides a complete
redundant link protecting from any major downtime due to an
ISP issue.
 The primary links between the Main Hospital and the Office
Center will be a 10Gig connection from both ISP’s and T1
connections to all clinics producing a “Mesh Network”
 To have internet provided in this manner a total cost for a 5
year support plan will cost $198,000 or 45,000 per year.

22. ISP Network Structure

23. Workstations and Mobile Carts
 Midwest Regional will provide all workstations and mobile
EHR carts fully encrypted with all staff security credentials
installed for all locations.
 There will be (15) workstations and (10) mobile EHR carts
located at all nurses’ stations supporting each department of
the 3 floors for ICU, CICU, 1 Burn department, 1 ER
department, and 1 Day Surgery department for the Hospital. At
each clinic there will be (3) workstations and (3) mobile EHR.
 The workstations that will be provided will consist of a Dell 790
or equivalent at a cost of $900 per station and monitor. Each
mobile cart will consist of a mobile cart that has a built in
security laptop lock and a Dell Latitude laptop at a cost of $1800
per cart.
 Not including the temporary command center workstations, a
total cost of $291,600 will be required to supply the appropriate
number of workstations and mobile carts.

24. EHR Mobile Cart
 Mobile EHR Cart and laptop information
 Enovate Lite Medical Cart: Lvl1 (Trade Compliant)
 Mfg. Part: L-S10-01-0 | CDW Part: 1921360

25. Quality Management in Healthcare
Any evaluation of services provided and the
results achieved as compared with accepted
standards. In one form of quality assurance,
various attributes of health care, such as cost,
place, accessibility, treatment, and benefits, are
scored in a two-part process.
First, the actual results are compared with
standard results; then, any deficiencies noted or
identified serve to prompt recommendations for
improvement.

26. What is Quality management?
Quality management is the act of overseeing all
activities and tasks needed to maintain a desired
level of excellence. This includes creating and
implementing quality planning and assurance, as
well as quality control to your products or services to
achieve a more consistent quality level.

27. 6 key dimensions of health care quality
 Health care should be Safe – unintended patient
injuries should be avoided.
 Health care should be Effective – based on scientific
knowledge, service should be provided to all who
could benefit. Services should not be provided to
people who are not likely to benefit.
 Health care should be Patient-centered – this means
providing care that is respectful of and responsive to
individual patient preferences, needs, and values and
ensuring that patient values guide all clinical
decisions.

28. 6 key dimensions of health care quality…
 Health care should be Timely – we should reduce
waits and sometimes harmful delays for those who
receive care.
 Health care should be Efficient – we should avoid
waste, including waste of equipment, supplies, ideas,
and energy.
 And lastly, health care should be Equitable – this
means that health care should not vary in quality
because of a patient’s personal characteristics such
as gender, ethnicity, geographic location, and
socioeconomic status.

29. I-Tech Medical Consortium Quality Policy
I-Tech Medical Consortium quality policy is based on the
fundamental concept that the control of quality is a team
obligation that recognizes that quality is built into every
aspect of the project.
Our team will provide quality products and services that
meet or exceed Midwest Regional Health’s (MRH’s)
requirements, delivered safely, on time, and within
budget.

30. Quality Management Importance
Quality Management is essential to ensure
that the project deliverables, whether they are
tangible or intangible, are on par with
expectations. Maintaining quality is
accomplished by reviewing outputs and
establishing systems for quality assurance. These
deliverables includes:
Quality planning,
assurance and control,
Issue identification, tracking, resolution.

31. Quality Management Standards
 ISO 9001:2008 is the standard that provides a set of
standardized requirements for a quality management
system, regardless of what the user organization does, its
size, or whether it is in the private, or public sector.
 ISO 9004:2009 is the standard which provides a
measurement framework for improved quality
management, similar to and based upon the measurement
framework for process assessment.
 Six Sigma combines established methods such as
statistical process control, design of experiments and
failure mode and effects analysis in an overall
framework.

32. Quality Improvement & Risk Management Functions
Risk Management
Risk Identification
Risk Control
Claims Management
Patient Relations &
Disclosure
Safety
Compliance
Mandatory Event
Reporting
Worker’s Compensation
Quality Improvement
Quality Measures
Benchmarking
Best Practice/ Clinical
Guidelines
Provider Performance &
Competency
Accreditation
Coordination
Patient Satisfaction
Improvement Projects

33. RISK MANAGEMENT…

34. Security Risk Analysis
A security risk assessment is required under the HIPAA
Security Rule.

35. What is Risk Management?
Risk management is the identification,
assessment, and prioritization of risks
(defined in ISO 31000 as the effect of
uncertainty on objectives, whether positive or
negative) followed by coordinated and
economical application of resources to
minimize, monitor, and control the
probability and/or impact of unfortunate
events or to maximize the realization of
opportunities.

36. Risk Management Methodology
For the most part, these methods consist of the
following elements, performed, more or less, in the
following order.
 identify, characterize, and assess threats
 assess the vulnerability of critical assets to specific
threats
 determine the risk (i.e. the expected likelihood
and consequences of specific types of attacks on
specific assets)
 identify ways to reduce those risks
 prioritize risk reduction measures based on a
strategy

37. Risk Management Process
According to the standard ISO 31000"Risk management
– Principles and guidelines on implementation,” is that
the process of risk management consists of several
steps which involves:
 Identification of risk in a selected domain of
interest
 Planning the remainder of the process.
 Mapping out the following:
– the social scope of risk management
– the identity and objectives of stakeholders
– the basis upon which risks will be evaluated,
constraints.

38. Risk Management Process…cont
 Defining a framework for the activity and an
agenda for identification.
 Developing an analysis of risks involved in
the process.
 Mitigation or Solution of risks using
available technological, human and
organizational resources.

39. RISKs
 Unauthorized access to patient information
 Internet Service Provider
 Network connectivity
 Data storage
 Data backup
 Secure patient data
 IT infrastructure (servers, network, etc…)
 Secure data center entry
 Budget
 Quality standards not met
 Inadequate skills / training

40. Risk Register Matrix

41. The End…and Thank You