The decision to implement a new electronic health record or to upgrade a current system is based on several factors, including providing safe and up-to-date patient care, meeting federal mandates, and Meaningful Use requirements, and leveraging advanced levels of clinical decision support.

You will complete both parts to the case study at the end of the chapter. Make sure you read the case study and the case study follow-up. Discussion problems: 1) Based on what you read in this chapter and the case study, compile an initial list of functional requirements (functions needed) for the new EHR; 2) Create a brief evaluation plan by developing five or six criteria for evaluating a vendor's products; 3) Brainstorm two additional factors you would evaluate for this installation. 

Middleville Hospital, located in a small rural town, is a 58-bed acute care facility with both inpatient and outpatient services. The hospital consists of more than 600 employees and more than 300 volunteers. It is a community owned, not-for-profit hospital dedicated to providing compassionate, accessible healthcare close to home. The facility primarily serves one major county and nine surrounding counties.

The hospital has a homegrown electronic health record (EHR) system but it has the functionality to allow the hospital to barely meet Meaningful Use Stage 1. The hospital's primary goal is to implement a certified EHR but the leaders are weighing the benefits of two options: recruiting a skilled professional to rebuild the current system or purchasing a commercial system. There is pressure to make a decision as soon as possible.

What are the musts, constraints, and barriers?

•The new system must be fully implemented and operational no later than June 2014.
•The EHR must be able to meet MU Stages 2 and 3.
•The EHR must be capable of accepting new ICD-10 codes.
•The hospital has a very small IT department and a modest budget.
•Physicians do not enter orders in the current system. Nurses, unit secretaries, and ancillary personnel enter orders in the EHR from written orders on a paper chart.
•The new EHR requires larger servers, new devices, central monitors, printers, and tablets.
•The wireless infrastructure must be upgraded to eliminate known dead spots in areas of the facility.
•The hospital wants to take advantage of select features such as clinical decision support and incorporate best practices or evidence-based medicine.
Discussion problems

1. Based on what you read in this chapter and the case study, compile an initial list of functional requirements (functions needed) for the new EHR.
2. Create a brief evaluation plan by developing five or six criteria for evaluating vendors' products.

Case Study Follow-Up

The hospital made a list of all pros and cons of rebuilding a homegrown system or buying a commercial product. Realizing that regulations governing healthcare and reimbursement will only become more complicated, the hospital decided to go with a vendor-supplied EHR. Ultimately, it decided to purchase a fully integrated electronic health system that shares a common database to eliminate the issues often seen with interfaces.

Fourteen months later the EHR went live housewide for all staff, including housekeeping and pastoral services. The implementation included the functionality to meet MU and the installation of new servers and hardware in addition to an upgrade of the wireless network. All staff can even view a large monitor showing occupied, clean, and dirty beds that is updated by housekeeping.

The new EHR benefits are many. Initially the physicians grumbled about having to do "secretaries' work" in CPOE but they gradually came to realize the benefits for their patients. Pharmacy reports a 55% decrease in nonformulary medications and a 73% reduction in physician callbacks. The time between a "stat" medication order and administration of the medication and the time between a "stat" lab test order and posting of the lab results have also decreased significantly. Due to the introduction of order sets based on best practices and evidence-based medicine, the hospital has seen a dramatic decrease in its 30-day readmission rates for heart attack, heart failure, and pneumonia patients compared to the U.S. national average and has the lowest rate in the county.