This paper will be the goal statement which includes an overview of the current state of Shoreline Health System (SHS) in regard to current legal and financial risks, accreditation concerns, ethical issues, and technology needs. You will consider the current goals and the need for the transition to the ambulatory EHR to share with stakeholders. Provide a 2-3 slide presentation of the current state of the organization. Consider the current goals and the need for the transition. Think about the information that key stakeholders would need. In part two of this assignment, create a department budget for the implementation of the ambulatory EMR. Analyze the budget, consider the financial impact, and detail the potential risks. A cop of the assignment specifics has been attached, along with a copy of the SHS case study.
HIM 480 Milestone One Guidelines and Rubric
Overview: As a professional in the HIM field, you will be tasked in the final project with handling the multiple complexities of implementing an EMR at Shoreline
Health System (SHS), mimicking all the considerations and issues of a real-life implementation. Such an undertaking requires research, understanding of the
current environment at SHS, financial evaluation, and engaging invested stakeholders. Beyond justifying your choice of EMR vendor, you will also assess how
such implementation will meet the complex needs of SHS by meeting required standards. Knowing that your educated opinion will be essential to how the
system is implemented, you will be required to present your proposal as a PowerPoint presentation, as if you were presenting to the Board of Directors of SHS.
You will need to review this case study for detailed information about SHS.
Prompt: In this milestone, you will submit the goal statement and budget components of the final project. You will submit an overview of the current state of
the organization in regard to current legal and financial risks, accreditation concerns, ethical issues, and technology needs. In addition, you will create a
department budget for the implementation of the ambulatory EMR.
Specifically, the following critical elements must be addressed:
I.
Goal Statement: Provide a 2- to 3-slide overview of the current state of the organization in regard to current legal and financial risks, accreditation
concerns, ethical issues, and technology needs. You will consider the current goals of the organization and the need for the transition to the ambulatory
EMR. Think about the information that key stakeholders would need.
II. Financial Considerations: Create a department budget for the implementation of the ambulatory EMR.
a. Analyze the budget to inform strategic decision making.
b. Consider the financial impact by discussing the operational metrics to be considered.
c. Detail the potential risks for the investment.
Rubric
Guidelines for Submission: The goal statement should be submitted as a 2- to 3-slide PowerPoint file. The budget portion can be submitted using this template,
or you may create one of your own. Sources should be cited according to APA style. Please note that although you are submitting the budget separately, you will
need to incorporate elements from section II Financial Considerations above into your Final Project PowerPoint Presentation, which is due in Module Seven.
Note that the “Possible Indicators of Success” are examples for you and the instructor of the types of concepts to look for to demonstrate proficiency. They are
neither exhaustive nor prescriptive; they should be used only as guides for illustrating how your work embodies the outcome. Course outcomes represented in
the milestone components may not contain all of the Possible Indicators of Success but rather may focus on one or two of those elements. Additional
elements will be found in other milestones. This allows you to practice meeting the course outcomes with different Possible Indicators of Success in milestone
assignments.
For this milestone, the rubric below will be used to assess your progress toward meeting the course outcomes. If you are making progress toward meeting the
course outcome, you will receive “In Progress.” If your submission does not show progress toward the course outcome, you will receive “Not Proficient.” In your
final submission, incorporate feedback from your instructor to help better meet each course outcome.
The final capstone submission will assess your proficiency in the course outcomes. The milestone submissions demonstrate whether you are
making progress toward meeting the outcomes.
HIM-480-02: Analyze the uses, risks, and management of health
In Progress
Not Proficient
statistics and biomedical research data and their support to
100%
0%
performance-improvement programs
Possible Indicators of Success that may be evident in the final submission:
Does the milestone demonstrate the ability to illustrate the important data points required to come up with relevant health data to guide
program development?
Does the milestone demonstrate the ability to interpret the meaning of health statistics or data outcomes?
Does the milestone demonstrate the ability to evaluate resources needed to effectively implement the research projects and performanceimprovement programs?
HIM-480-03: Interpret and apply current laws, regulations, policies, and
In Progress
Not Proficient
healthcare ethics as they relate to decision making in healthcare delivery
100%
0%
and systems
Possible Indicators of Success that may be evident in the final submission:
Does the milestone demonstrate the ability to assess federal and state regulations relevant to the project and their potential impacts?
Does the milestone demonstrate the ability to use evidence-based ethical decision making and critical thinking to support outcomes and goals?
Does the milestone demonstrate the ability to address potential ethical challenges?
Does the milestone demonstrate the ability to employ communications skills that consider and are sensitive to stakeholders and those
impacted by the initiative?
HIM-480-06: Using current management principles and recognizing
In Progress
Not Proficient
100%
0%
limits on human and financial resources, propose solutions and develop
project management plans to solve organizational challenges
Possible Indicators of Success that may be evident in the final submission:
Does the milestone demonstrate the ability to integrate the organization’s mission, vision, and values into the project goals?
Does the milestone demonstrate the ability to identify limits in resources when implementing project goals?
Does the milestone demonstrate the ability to evaluate needs and formulate project management plans within the changing world of
healthcare?
Does the milestone demonstrate the ability to list considerations for future iterations or needs of the implementation?
Does the milestone demonstrate the ability to collaborate with others working toward a common healthcare goal?
Value
30
30
30
Articulation of Response
I
In Progress
100%
Is the milestone free of major errors related to citations, grammar, spelling, syntax, and organization?
I
Not Proficient
0%
10
HIM 480 Shoreline Health System Case Study
Profile of Shoreline Health System
Shoreline Health System (SHS) is located in coastal South Carolina in the United States. It is a teaching
and research affiliate of the University of Southern Carolina in Columbia, South Carolina, and serves the
broad coastal region as well as referrals from surrounding states in specialty care areas. It employs
approximately 10,000 people and consists of five hospitals, including three general hospitals, a pediatric
facility, and a women’s care institution. Likewise, SHS is an integrated delivery network with a wholly
owned health plan (SHS Health) that covers approximately 400,000 members regionally.
SHS also owns long-term care facilities and a mail-order pharmacy. There are 250 employed physician
practices, half of which are specialists and half of which are primary care practices. Likewise, there are
another 100 regional practices that are not owned by SHS, but refer over 70% of their cases to SHS
hospitals and clinics. Specialists focus on both clinical care and research with nationally renowned
programs in endocrinology, heart disease, and gynecology-oncology.
Section 1: EMR Implementation and Current State of SHS
SHS would like to convert all their facilities to the same electronic medical record (EMR) system in order
to better coordinate care and communicate throughout the health system. It is particularly important to
SHS to implement a total inpatient and ambulatory electronic record for documentation, ordering,
results review, admissions, and discharge. They want to get all of the current members of their practice
into the system. They would also like to have a patient portal so that patients can access their
information.
SHS has received two proposals from EMR companies to implement such a system.
The hospital’s current admissions and discharge, billing, and registration system is a decades-old
upgraded mainframe product called Medipac, which has trouble interfacing with most newer EMRs. The
hospital also has electronic pharmacy, laboratory, and radiology systems, but each is a standalone
system.
There are other information systems at SHS. A best-of-breed master person index (MPI) product called
Initiate is in place to handle both patient/person and physician master file management and
identification. The commercial product called Cloverleaf runs as an HL7-based integration engine
running billing, registration, results, and MPI interfaces between the different information systems.
The chief executive officer (CEO) at SHS, Jim Bradley, is very concerned about the competitive threats in
the region and their potential impact on ambulatory and specialty patient volumes at SHS. He would like
to see SHS positioned to use its IT environment strategically to offer innovative solutions to the
community in order to maintain and possibly grow new market share.
The chief information officer (CIO) is Margaret Fry. There are physicians who volunteer their time to
work on IT projects, but there is no formal physician IT structure. There is a physician representative of
the medical executive committee, Dr. Joe Brown, who has organized the group of physicians to pilot
new EHR systems. Other physicians on the committee feel that it would make more sense for SHS
physicians to keep their current physician office systems.
Section 2: Interoperability Standards
The employed SHS physician practices have many different physician office systems that mostly do
registration, scheduling, and billing with clinical practice run on paper charts. A few have implemented
their respective vendors’ EMR systems for orders and electronic prescribing but are not able to currently
meet the clinical requirements for interoperability standards in the outpatient setting. Many of these
physicians prefer to stay on their current platforms but recognize that they cannot meet interoperability
standards without implementing these vendors’ electronic health records, which would include
expensive interfaces to SHS systems.
While the investment would be sizable, these physicians feel as though there is a justification to
implementing one ambulatory electronic health record along with the inpatient record. They see
colleague physician practices in other states that have optimized billing receivables even more by
installing Epic’s clinical modules. They are also worried that they currently do not have secure HIT
mechanisms for patient outreach to meet interoperability standards given the current systems in the
SHS physician offices.
Section 3: Current Health Information Management (HIM) Environment
Currently, the inpatient HIM department at SHS works well in tandem with the information services
team and the physician staff in general. The inpatient HIM leadership has also established a matrix
reporting relationship with HIM and office management staffs in the SHS physician offices that manage
medical records.
Generally speaking, most HIM quality metrics that can be measured for the inpatient SHS environment
are within quality goals for this year; chart completion percentages are in line with HIM quality goals,
with 80% of charts being complete within 20 days post discharge. Record releases are within projects of
8,000 records per month inpatient and 15,000 records per month across the outpatient practices.
Recent audits examining quality metrics, such as presence of H&Ps on operative charts and presence of
all externally scanned documents in the Epic inpatient record, showed between 98.5% and 99.1%
compliance.
Coding and Documentation Issues, Surgery: One recent area of concern that is taking up a lot of time on
the part of the HIM coding supervisor is the number of physician inquires that coding staff members
must do with regard to physician documentation in the Epic record that does not match coding. These
cases are coming back as errors in the 3M-quality management claims scrubber system and holding up
claims. There is a suspicion on the part of the HIM department that physicians are using the cutandpaste function in Epic excessively and forgetting to update documentation appropriately. The
general same-day surgery areas have the highest volume of issues in this area. The HIM leadership and
finance teams have done root cause analyses and determined that this issue is affecting inpatient days
in accounts receivable, increasing days from the goal of 42 days to 43.5 days as of the last six months.
Section 4: Financial Environment
Current State Financial Information: Currently, the physicians’ offices as a whole at SHS make
approximately a 5.5% profit margin net billing per year, which is reinvested into physician incentives and
necessary capital upgrades—equipment, facilities, and information systems. Historically, this 4 capital
margin has been approximately $5,000,000 per year. However, given concerns over losing ambulatory
volumes to competitors this year, the CFO is projecting this capital margin to be $4,500,000. Of this
margin, $500,000 is allocated toward facilities and equipment upgrades for the physician practices.
Recognizing the competitive concerns and need to meet CMS MU and billing regulations through a
comprehensive health information management strategy, the SHS board of directors has allocated a
one-time $4,000,000 capital expenditure for the ambulatory electronic medical record investment for
this fiscal year. It is projected that this capital expenditure will be spent over a one- to three-year period.
Currently, the total annual operating budget to run the disparate ambulatory information system
platforms in the SHS physician offices is $700,000, including the detailed breakdown of costs below.
There is currently no capital technology expenditure for SHS physician practices.
Software maintenance/support: $300,000
Support/post-production salaries: $150,000
Hardware maintenance/support: $200,000
Other (miscellaneous training and so on): $50,000
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