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The Case for Electronic Medical Records Systems

Below is a small assignment that I complete for a Systems Analysis and Design class as part of my MBA program. Below is the charge for the assignment, followed by my response.

The concept for an information systems project can spring from almost anywhere in an organization: from any functional area, from any level of employee. Sometimes it is an opportunity seen by someone within the organization (not necessarily in IT), sometimes it can be reaction to a requirement imposed from outside (such as with government regulation). No matter the origin, it will need to be developed and assessed for its strategic or operational value, and then weighed against other potential uses for the same development resources. The more persuasive the initial presentation of the business case, the more likely it is that the project will advance further.

The system initiation phase is the first formal phase of a systems development project, and involves collaboration with system owners and other stakeholders to produce the plan for the project. This will result in the initial business scope definition, goals, schedule, and budget. Before this can occur however, an initial proposal or idea is needed.

Your task in this assignment is to present such a preliminary initial rationale, for investigating the implementation of an electronic medical record system. Imagine you are the new office manager at a radiography and medical imaging clinic, which does not have fully electronic records. You are aware from a previous job of the benefits of such systems, and have been at the clinic long enough to have identified the problems the clinic has with their business processes, that such a system could address. You have decided to write a report to describe the benefits of such a system, in the hopes of convincing the organization to investigate further.

Drawing on the PIECES framework in the text, explain the ways in which an electronic medical record system could benefit the clinic. You may focus on some or many of the factors contained in the framework. To do this you will need to research such systems.

You should create a report approximately three pages long, which describes:

1. The purpose of an electronic medical record system (or automated patient record system) and how it functions.
2. What data would be held in the system.
3. What benefits this would bring to the clinic.

Structure the report in the form of a memo to upper management. As such, grammar, spelling, and structure will matter.

Include any references you use in making your case as a separate section following the memo (with citations within the memo as appropriate).

 

My response is seen below:

 

TO:                Senior Leadership/Executive Committee

 

FROM:          Eric Miley

 

DATE:            February 12, 2011

 

SUBJECT:      Proposal to Adopt a New Electronic Medical Records System

 

An industry left behind:

I would like to take this opportunity to voice my support of a new and improved way of doing our work. As we move towards a system of universal health care in the United States and begin to understand the demands and challenges that the medical industry must take on, it’s important for practitioner to be open to trying new strategies and approaches. As many of you are aware, there has been an explosion in the power and influence of many tools for information and communications technology. Many industries from defense to manufacturing to energy production have begun harnessing these tools in order to make their work more effective and more efficient.

 

The airline industry has totally shifted the way in which they create ticket reservations and the speed and accuracy in which they are able to unload passengers, deliver their particular pieces of luggage, and shuttle them to their vehicle for departure. Management is able to understand a comprehensive collection of data on the aircrafts being flown and the metrics that speak to their return on investment and overall performance for the airline. The point being, that there has been noticeable progress in leveraging technology to improve performance.

 

This progress is also seen in the retail industries of consumer goods. Wal-Mart is an obvious case that we are all familiar with. There are also some sectors and businesses that are more relevant to our work, such as the medical supply industries. Although not yet perfected, the supply chains and distribution networks that we rely on so heavily have gone a long way in leveraging the data and information systems that have been built to provide our firm with highly-reliable service. In a matter of seconds I am able to tell you the current location of the diagnostic equipment that we ordered earlier in the week as well as the benefit(s) that it will provide and all of the various specifications that it includes. I am also able to tell you the history of a particular tool in terms of the maintenance records and/or issues that it has had in the past. We can do this quite easily through the use of innovative technology solution and we are doing this because it is important to our business. The question that now arises and a question that I am putting forth to the Senior Leadership Team; is why we haven’t started down this path towards electronic medical records as a way to benefit our patients and our overall level of service delivery?

 

The Business Case for Electronic Medical Records:

Aside from the EMR incentives in the American Recovery and Reinvestment Act, there are a whole host of arguments in favor of adopting such a system. Below is a sample of a few of the most persuasive and appropriate for our firm. We should keep in mind that these benefits are assuming that we undergoing a thorough system analysis and design process and that our board is prepared to release the necessary support and resources to implement this in the right way.  

 

Process Efficiency:

The healthcare industry as we know it is comprised as a set of inter-related and many times highly-complex business processes. It is well-known that one of the ongoing challenges of our industry is the inefficiencies that are engrained into these processes. Many times, the bottlenecks are a direct result of poor information, late information, or flat out wrong information. The aggressive adoption of a comprehensive EMR system will be the first step for us to be able to identify, map, model, and improve our set of processes. At the heart of any good information system is an element of agility and a clear and logical tie to the underlying business processes. If we would like to see our firm providing a greater level of services to our patients and to have more control over our operational processes, we should strongly commit to making this investment. 

 

Cost effectiveness:

There is no doubt that this is a strategic capital investment. We should not pretend that this will be a cheap undertaking, nor should we expect that we can cut corners and save money in places where a strong and sizable investment is needed. We are investing in our firm in the same way that a new state of the art building would allow for enhanced service delivery. An electronic medical records system would catapult this firm into a regional powerhouse and provide us with the necessary infrastructure to pursue other more traditional growth strategies.  The creation of new electronic archiving and real-time record keeping, coupled with the incremental conversion of outdated paper-based records, we will see a decrease in needed storage space; a decrease is related storage costs, and an increase in the amount of total useable space for services delivery or eventual divesture. 

 

Better data and better decisions:

This importance of better data and better access to accurate and reliable data cannot be understated! We work in a fluid field and in a work environment that shifts in a short period time. We are generally forced to make decisions with very limited information and data. We cannot completely control this reality, but we can help ensure the data we collect is accessible and user friendly in a way that doesn’t add undue pressures onto these decision. Having a robust electronic medical records system will address this problem on the front end with data entry as well as on the back end with efficient retrieval and analysis.

 

The Technological Opportunity for Electronic Medical Records:

Interoperability and Integration:

I have already mentioned a few of the stakeholders that are involved in the service deliver process. The suppliers of medical equipment are just the tip of this iceberg. There are medical regulators, boards of directors, public interest groups, patient advocates, charitable organizations, and many other stakeholders that could benefit from this type of innovation. Some in direct ways and others in more indirect manners such and being consumers of aggregated data and research-based publications. Ultimately though, the beneficiaries of this investment will be the patients themselves.

 

The patients will now have the ability to access and understand their medical records while giving them must needed control of the information that pertains to their health and well-being. This may prove to be the biggest return that we can provide to them. Enabling the patient to be an empowered member of the team and engaging them like never before, will prove to be an important outcome of this great shift. These are the types of big picture goals and aspirations that we should be keeping in mind with this suggested investment. We are changing the way that medical data and information is collected and stored with the eventual goal of significantly improving the performance of the health care industry and the health of our population as a whole.

 

Mobility and ubiquity:          

An exciting front in this technological revolution is the popularity and utility of mobile devices and the ‘anywhere on’ reality.  No longer is it commonplace to have a geographical gap between the provider and the patient become a major obstacle. The increased reliance on telemedicine and the need to draw on diverse, geographically dispersed expert resources is driving this need to upgrade data and information systems. If we can provide our medical personnel with the important data and information they needed to make critical decisions and deliver this in a flexible, mobile format; we will be moving our practice    

 

Concluding Remarks:

It’s important for the senior leadership to understand the magnitude of this opportunity and embrace this transformation in a way that will make it a deep rooted success. This type of undertaking must be fully supported by senior leaders so that your input and interests will be reflected in the development process and in the final product. Inevitably there will be risks and challenges associated with this project. Identifying, analyzing, understanding, and properly prioritizing them will be a critical component of success.

 

Many of these risks and challenges will be properly unearthed through the application of a structured system analysis process. It’s important to understand that we will work to develop this new system with an incremental, highly-controlled analysis. Following best practices, we will plan several distinct phases with clear and mutually agreed upon milestones. This will allow the senior leaders to stay very engaged in the process and it will ensure that the system we create reflects our firm’s requirements and needs.

 

Please take this time to consider moving forward with this proposal and allow us to begin doing some initial fact finding and requirements gathering. The successful design and development of a brand new electronic medical records system will be an accomplishment that we can all celebrate and enjoy. Most importantly however, we will be able to better serve our valued patients and move much closer toward successfully fulfilling our mission as an organization.

 

Sincerely,

Eric L. Miley

 

 

 

 

Sustainability Problems and Potential Solutions in Information and Communication Technology

The following is an excerpt from a paper that I recently wrote for a sustainability management course. This project took on an interesting path as I started to research and review the most relevant thinking in this area. Many students and professional might choose to focus on alternative energy innovations and the efforts to change an organizations processes an practices around material consumptions. These are very important and very relevant, but I thought that one of the most interesting areas to explore was around high-tech, information and communication efforts. I plan to cover some of these topics in the next few weeks by including pieces of my past research and simultaneouslybuilding on these concepts to incorporate the continuously evolving "best-thinking" by industry experts and top researchers. Especially important to this conversation is the understanding and recognition of cloud computing as the next frontier to maximizing business performance, while fullfilling press need to build and develop more sustainable enterprises .

12/2010 Paper - Excerpt from: "Sustainability Problems and Potential Solutions in Information and Communication Technology".

As I have been progressing through this great course in sustainability management, it is clear that there are many outstanding issues and problems that are yet to be fully understood and/or solved. Central to many efforts around sustainability are measures taken to change the effect that a given process or system has on the environment. Much of the current research and literature focuses on the growing problems that exist in terms of energy use and the consumption of scarce natural resources. This is the central problem that we face in the efforts to achieve true sustainability. The consequences of inaction are well documented and better understood than most closely related topics. However, smart energy technologies can sometimes overshadow some of the more granular topics that occupy an important space in the sustainability domain.

Some of the efforts being made to address areas of un-sustainability ironically prove to be unintended contributors to the problems that they set out to solve. In this paper, I plan to delve into some of those areas and talk not only about the problems that exist, but also really try to focus on the solutions being developed and utilized. Specifically, I want to concentration on the sustainability efforts being made in the information and communication technology arena. This is a fairly broad area to consider, so I will be focusing the majority of this paper on one main hardware issue/problem and one main software solution.

On the hardware side, I think that it would be unfortunate if I don’t cover some of the current issues that are emerging around electronic waste. This is a topic that is producing many short-term problems and consequences as well as prompting some well-deserved concern about the long-term consequences of not dealing with this issue. What are the main arguments that exist here? I will also mention a potential solution to most of these problems and highlight a retailer that is working to deliver smarter ways to recycle and reuse discarded electronic components.

On the solution and software side of things, I want to spend some time learning about virtualization, cloud computing, and other innovations that are being developed to improve overall business efficiencies around data and information. Beyond that, many of the changes and transformations are occurring due to the strong mandate that businesses have to cut their total energy consumption and slash their overall carbon footprints. That is the large question that we will begin to wrestle with; can the move to new, more flexible data storage and services provision strategies help lessen the net carbon footprint of businesses in the information age? This is a somewhat complex question, but there have been some interesting studies completed that set out to frame the question properly, understand the scope of the solutions, and measure actual and projected results. Rather than diving too deeply into the merits of the studies or the methodologies upon which the data was collected and/or analyzed, we will look to focus on synthesizing and extracting the most important knowledge and theories being developed.

We know that technology represents an important tool in the battle to transform our business world into a truly sustainable space. However, the terms and ideas associated with technological sustainability are sometimes more loosely used than one would prefer, and therefore it is important to be clear about what technology you are referencing and understand both the intended meaning and the generally accepted interpretation or association that the technology has. Balancing the desire to innovate in the name of solving tough sustainability problems, with the need to do it in a responsible way is where the real art is. Yes, providing employees with laptops or PCs to make them more mobile and more efficient is important, but what about the physical components of the products that are considered to be unusable or simply out of mode? What are the true effects of an across the board hardware refresh that moves everyone in the organization to a new high definition monitor with the newest state-of-the-art sound system? Where does the old hardware and material end up, and why should we care about these types of questions?

Electronic Waste

Electronic waste has been defined in several different ways, depending on who is framing the problem and what aspects of the issue they are trying to highlight. Some definitions focus on all electronic surpluses (not being used), some focus on the amount of discarded materials and products that are environmentally harmful, while still, others use a combination of these parameters and integrate a component of the producer’s responsibility and accountability. The point is that electronic waste comes in many different forms and fashions and in reality; this is an evolving concept due to its relationship with technological innovation on the production end.  In other words, as technological advancements continue to proliferate, there are inevitable byproducts that must be properly handle and disposed of.  When there is new hardware involved with the innovation, there will always be the eventual decision and work that arises around what to do when the product becomes obsolete or it is ‘necessary’ for the product to be upgraded or refreshed.

Challenging Warrren Buffett...Ridiculous Hot Air or the End of an Era?

What do you think of the blog entry in the link below? I am a huge fan and follower of Warren Buffett so I find this both troubling and sort of interesting. I also see that the author attended the University of Maryland and is now an MBA candidate at the Johnson School of Business at Cornell. Very interesting mix in my opinion. Below you can see a slide from the presentation that can be found here. This slide is particularly important because it captures the major area that Raj attempts to highlight.

Should you be investing in Buffett and his companies when it's safe to say that he is at the tail end of his career? Are investors basically betting their money on hope and past performance? Has Buffett really violated some of his very own rules recently? If so, is this a signal that things are falling apart or is it an indication for just how bad things are and how bad we can expect things to get in the near future? Is anyone else will to step up and add their support to Rajagopa? Is this just some kids trying to get his name out there by doing the unthinkable (challenging the greatest investor of our time? Or should more of us begin taking a critical look at the state of the economy and reassessing the holdings and positioning of our portfolios?

I myself purchased BRK.B a few months ago, but eventually decided that I didn't want to be on board with this company that is so exposed to the US economy, so I abruptly sold it before its inclusion in the S&P 500. Clearly, a violation of Benjamin Grahams teachings in The Intelligent Investor.

Anyway, it is typical Buffetology to talk about his willingness to bet on the US economy in the long run, but does our long run suddenly look different than it did a year ago or should we stay the course and stomach the short-term volatility and ride this out in the spirit of the long-term value investing philosophy that "intelligent investors" are instructed to follow?

I don't really know the answer to all of these questions, but I will plan to provide a follow-up to this piece when I get more clarity on the direction of Berkshire (BRK.B) specifically, and the other issues that are set to come out of Washington in the very near future. Personally, I'm more comfortable owning companies like Google and Apple at this point but other the enormous growth potential and their ability to truly excite the market, but perhaps Mr. Buffet will prove some of us wrong once again with is counter cyclical/counter intuitive thinking and actions.

What is really behind the purchase of Burlington Northern? Was Buffet simply being defensive and protecting the value of this mound of cash by throwing it in a hard asset or is he 5 steps ahead of the game and in perfect position to capitalize on a federally backed, national rail system that will redefine how we transport goods or even how we travel?

Below is one of the concluding slides from Raj Rajagopa's presentation:  

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