information portal sample comprehenisive assessment.1

7/31/2019 Information Portal Sample Comprehenisive Assessment.1

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The attached document is meant to give you a glimpse into what deliverable #3 will look like.

Remember, this is only meant to serve as a guide. However, I believe it would be prudent to go

through each section and try to get a feel for why certain these were included. I hope you find this

document helpful as you prepare your first deliverable.

Randy

Web-Based Portal Information System for CFSS HealthCare

Complete Comprehensive Assessment
https://moodle.cee.utk.edu/user/index.php?id=77&group=214


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Table of Contents

1. INTRODUCTION AND OVERVIEW ................................................................................... 3

1.1 Purpose of the system ............................................................................................................ 4

1.2 Overall Functionality............................................................................................................. 5

1.3 System Assumptions and Dependencies ............................................................................... 8

1.4 Implementation/Rollout Plan ................................................................................................ 9

2. SWOT ANALYSIS ................................................................................................................. 12

2.1 SWOT Analysis Summary .................................................................................................. 13

3. FEASIBILITY ANALYSIS.................................................................................................... 14

3.1 Technical Feasibility ........................................................................................................... 14

3.2 Operational Feasibility ........................................................................................................ 14

3.3 Economic Feasibility ........................................................................................................... 15

3.4 Organizational Feasibility ................................................................................................... 23

4. ANTICIPATED VALUE TO STAKEHOLDERS............................................................... 25

4.1 Tangible Benefits ................................................................................................................ 25

4.2 Intangible Benefits .............................................................................................................. 26

4.3 Organizational Impacts ....................................................................................................... 28

5. CONCLUSION ....................................................................................................................... 29


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1. INTRODUCTION AND OVERVIEW

CFSS Healthcare is an integrated healthcare network based in Osoyoga, California. It is

comprised of two clinics and a 300-bed hospital. Approximately100 physicians and 20 mid-level

providers staff the clinics and hospital. Currently the clinics and hospital have two separate

electronic medical records (EMRs).

CFSS Healthcares organizational strengths evolve from the recent hiring in 2008 of JJ Segha,

MD as Chief Executive Officer. Dr. Segha has brought tremendous unity to our healthcare

system since he is a firm supporter of provider involvement in all aspects of national

benchmarking and quality reporting. Prior to his arrival, CFSS was struggling with low quality

scores, poor physician morale, low nursing core staff retention rates, and recruitment difficulties.

Dr. Segha has made remarkable strides to make CFSS the premiere healthcare system in

Osoyoga, California. Under his helm, we now have a stable workforce, a waiting list of nurses

wanting to join our organization, and a talented and engaged medical staff. The CEO feels

strongly that a positive work environment improves outcomes and increases patient satisfaction.

CFSS patient satisfaction scores are now in the top 90th percentile and our reputation has grown

locally and nationally. The high level of patient satisfaction, due to improved quality of care and

staff satisfaction, positions CFSS to maintain CMS revenue dependent on HCAHPS and quality

outcomes in 2013.

Our organization would like to develop a web-based portal system called Portal, which would

allow integration of the separate EMR systems. Portal is designed to enable the transfer of

patient data between different users. Portal will also allow patients access to their providers,

their personal health record, and to CFSSs robust education website.


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1.1 Purpose of the system

Healthcare needs and deserves an ideal information technology system. The purpose of Portal is

to facilitate healthcare that is accessible, comprehensive, coordinated, and culturally effective.

Portal will virtually compile and centralize all pertinent medical information for each patient and

will optimize patient care.

Centralized Access and Complete Information

Given that medicine is an information dependent science, a critical purpose of Portal is to

provide centralized access of all patient data. Connecting data from multiple care sites and

caregivers is a top priority. Portal will provide clinicians with one location where thepatients

entire medical record will be available and thereby improve the efficiency of patient care.

Healthcare providers will have all the information about a patient in real-time and at the point of

care. This centralized access for physicians and patients will ultimately improve the quality of

patient care.

Patient Safety/Patient-Focused

Another important purpose of Portal is to improve patient safety. Portal will compare data and

produce reminders when data does not comply with guidelines. This includes identifying or

flagging abnormal labs, abnormal vitals, duplicate therapies, drug-allergy interaction, drug-

drug interactions and reminders of formulary guidelines. Over time, the comprehensive portal

will provide data for quality improvement and research.


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Improved Quality Outcomes

Portal will promote continuous improvement in quality and clinical outcomes. It will provide

healthcare workers with decision support and immediate access to core measures and evidence-

based best practices to enable ongoing improvements in healthcare practice. In addition,

providers will be prompted to provide suggested informational patient handouts. Patients are also

able to obtain health information via Portal to further their education on multiple health related

topics.

1.2 Overall Functionality

As noted, improved communication between providers and reducing the numbers of repeated

tests performed on patients are part of Portals function. Portal communication will demonstrate

a reduction in resource utilization and improve clinical outcomes. Examples of metrics to

monitor Portals effect will include reduction in admissions and readmissions, increased use of

core measure medications, higher rates of preventative screening, and lower mortality.

Portal will also enable automatic downloading of patient data and results to the patients

healthcare providers. Test results will require an acknowledgement process in order to ensure

close follow up. This process will be memorialized in Portals memory. Specific data sets to be

shared and transferred through Portal include: Hospital-Physician data; Physician-Physician data;

Outpatient Services-Physician-Hospital data; Pharmacy-Physician-Hospital data; Patient-

Physician data; and Physician or Patient Education data.


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Hospital-Physician Data Transfer

Hospital data will primarily flow from the hospital to thephysicians EMR. Each hospital

system (e.g. radiology information system (RIS), lab information system (LIS), admitting

information system (AIS)) will connect through Portal, then send and receive information

between the outpatient EMR and hospital systems. Hospital summaries, consultant notes,

laboratory and radiographic results, are the key items that will be downloaded into the outpatient

record. Hospital summaries include emergency department reports, inpatient dictations (history

and physical examinations, consultations, and discharge summaries), operative and procedure

reports, and outpatient reports (e.g. radiation oncology or wound center reports). Outpatient tests

performed by physicians will flow from physician EMRs through Portal to the hospital EMRs

specific systems, such as echocardiograms and PET scans to cardiology and radiology systems.

Additional available information includes insurance status, home address, contact and emergency

phone numbers and the preferred email address. Case Managers, Home Health, and outpatient

physicians can also utilize information for transitional care planning.

Physician-Physician Data Transfer

Most of the inpatient physician information from the hospitals health information system (HIS)

will go through Portal into the outpatient record. Yet, integration of the outpatient with the

inpatient EMR is another vital function of Portal, as it provides the inpatient caregivers with

problem lists, current medications, and outpatient results. In addition to sharingpatients results,

physicians can transfer traditional consults as well as E-Consults through Portal. E-consults are

the modern version of the sidewalk consult, but are now maintained in the medical records as

an intact focused consultation.


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Outpatient Services-Physician-Hospital Data Transfer

Portal will integrate the transfer of results and information between providers. Examples include

results from labs, radiology centers, and cardiology offices, and also include reports from

outpatient surgery centers and home health agencies.

Pharmacy-Physician-Hospital Data Transfer

Besides electronic prescriptions, the transfer of medication information between providers allows

medication lists to be shared and updated in a continuous fashion. An added benefit of Portal will

enable medications to be monitored for dangerous interactions or allergies with notifications to

the prescribing providers.

Patient-Physician Data Transfer

Patient portal access will allow patients to contact their physician offices electronically for

scheduling, authorizations, and medication refills. It will also allow patients to communicate

with physicians for health-related questions, information, receiving test results, and follow-up.

Patient and Physician Education via Portal

CFSS Healthcare will maintain a comprehensive multi-lingual patient and physician education

database. This database will be maintained by CFSSs interdisciplinary education committee.

For patients, this database will contain general educational materials (e.g. Weight Loss

Techniques, Tips on Exercise) and patient specific materials (e.g. Coumadin Instructions,

Post Knee Replacement Home Care). The educational database will be accessible to

physicians, hospitals, CFSS patients, and the general public. Healthcare providers can provide


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patients with tailored educational materials electronically or by printed handouts. Portal will

automatically document such instructions and information into their EMR. Successful education

will enhance patient care by lowering complications, admissions, readmissions, and improve

patient and provider satisfaction.

CFSS patients may access the portal educational site using their specific log-in and password.

Because Portal will have access to patients medical records from the hospital or clinics, the

system can electronically tailor the education material to the patients search. For example, a

diabetic patient requesting information on weight loss will be provided with low carbohydrate

ADA diets.

The general public can also access the portal educational site. However, this group will only

have access to general educational material and will be required to provide demographic

information to access the site. This information can later be used for advertising and marketing

of CFSS Healthcare.

CFSS physicians and staff will also have access to Portals education site. They can access links

to patient education sites and external resources such as Pub Med, Up-To-Date and CFSS Best

Practice guidelines. Additionally, Portal will provide updated links to evidence-based guidelines,

related educational material, and previously recorded grand rounds and lectures.

1.3 System Assumptions and Dependencies

The web-based portal will be fully funded by CFSS Healthcare and will not involve

pharmaceutical companies. The current website,www.cfsshealth.org, provides basic information

about the CFSS Healthcare organization and provides educational material for patients. This
http://www.cfsshealth.org/http://www.cfsshealth.org/http://www.cfsshealth.org/


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website will become the entry point for patients and will be integrated into our two EMRs.

Through Portal, both EMRs can exchange electronic health information with each other as well

as scheduling, billing, radiology, laboratory, and pharmacy services.

Portal will be able to extract information from the different sections of the EMR for patients and

physicians. To protect patient privacy, encryption and password protection will be built into the

system. All users will have to follow specific rules and guidelines to maintain this level of

privacy.

1.4 Implementation/Rollout Plan

The implementation phase of the portal project will require the assistance of many key

stakeholders. The Implementation Clinical Advisory Committee ( ICAC) will be comprised of

the following representatives: Physician leadership from the hospital based specialties and

satellite clinic Divisions, Chief Information Officer and IT Team leaders, nursing leadership,

Chief Medical Officer, Director of Laboratory Services, Director of Radiology, Director of

Pharmacy, Case Management representative, financial department, and central scheduling. The

Chief Medical Officer, Chief Nursing Officer, Chief Operating Officer, Chief Information

Officer and the Chief Financial Officer will serve as the Portal Oversight Committee. Both

Committees will remain active post-implementation in order to ensure that full portal integration

is attained and maintained. The ICAC will meet bi-weekly and the CIO and CMO will brief the

Portal Oversight Committee on a monthly basis.

The planning for this comprehensive proposal has already taken 17 months (Figure 1). Once the

final decisions have been made regarding Portal design and functionality, the IT team will be

responsible for installation. The implementation will be in a staggered approach with the clinics


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going live first and will be followed by hospital implementation. This will allow for testing in a

smaller setting prior to going live in the larger hospital setting. The entire process of installation

and implementation will take approximately one year (Figure 2).

Figure 1: Planning Timeline

1/5/2010 5/31/2011

4/1/2010 7/1/2010 10/1/2010 1/1/2011 4/1/2011

Dr. Segha

announcesIT project

to integrate

outpatient

and

hospital

EMRs

Project defined,

request for RFPs

Proposals

received

Vet proposals

Narrow to 2

proposalsChoose

Portal

Site Visits Define exact system,

negotiate contractPrepare

assessment

Contract

and system

defined

Comprehensive Assessment

submitted to Board byDr. Segha

8/29/20105/17/2010 3/17/20112/19/2010 11/25/2010

Figure 2: Implementation Timeline

9/1/2011 9/1/2012

10/1/2011 1/1/2012 4/1/2012 7/1/2012

Initiate

intallation

3/2/2012

Complete

installationand testing

5/2/2012

CompleteClinic Roll Out

6/5/2012

HospitalGo-live

Continuous Staff Education

Installation, customization, and

testing

Go-live in clinicsCheck and confirm

system functioning

Each site will identify and train superusers who will be responsible for training members of

their own departments and will also serve as important resources during the Go-live phase.

Superusers will be given protected time for these activities. The training phase for each division

is anticipated to be completed within one month and will include all team members including the


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nursing staff, physician team, respiratory therapists and mid-level providers. The laboratory,

pharmacy, radiology and financial departments will also undergo extensive training. Two months

after the clinics have implemented Portal, the hospital will go live.

After the installation and training phases have been completed, patient enrollment in the portal

system will commence. Each new patient will be offered complimentary enrollment in the

program on the day of service. A questionnaire and consent form will be completed by the

patient during the visit. In addition to general demographic information, the patient will be asked

to list their preferred email address. The registration personnel will provide the patient with the

CFSS website to access the portal using their assigned username and password.

Marketing for the portal project will consist of home mailings to current patients, office

brochures, and displays in the clinics and hospital. In addition, television and newspaper

advertisements for CFSS Healthcare will serve as an important marketing strategy and will

highlight the new portal option as a patient-focused hospital initiative.


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2. SWOT ANALYSIS

Helpful to achieving the objective Harmful to achieving the objective

InternalOrigin

(CFSSHealthcare)

Strengths Strong physician executive leadership Active Physician involvement Exceptional access to clinical data and

research

Strong internal IT department Telemedicine has already been

initiated

Proven organizational commitment toelectronic communication

EMRs already functional Strong current financial position Solid RN/MD relationships Voted Best Hospital in Osoyoga, 2010 Organizational commitment to quality

and patient satisfaction

Weaknesses Lack of bilingual medical librarian Lack of integrated EMR system, each

hospital has a different vendor

Lack of full internal IT team that cansupport Portal implementation and rollout

Requires computer access and literacy ofthe users

Minimal reimbursement for electroniccommunication

Some staff have expressed concerns aboutPortal implementation

No new facilities have been added to CFSSHealthcare

Maintenance constraints with Portal toensure accuracy of information

ExternalOrigin

(Environment)

Opportunities

Expand Telemedicine capabilities andmarketing

Ability to decrease staff time byscheduling appointments on-line

New technologies: iPhone apps, UltraSound probe in iPhone that connects toEMR

Opportunity to send results via internet Marketing to non-CFSS patients Resource utilization optimization Incorporate patient data from additional

sources (non-CFSS clinics, out of areasites)

Increased private donations and investorfunding

Single location to provide information forpatients

Decrease billing costs

Decrease phone calls from patients Physician to physician discussions

electronically

Enhance CFSS identity and reputation

Threats

Competitors already have EPIC and will beimplementing My Chart shortly

Competitors are expanding to the CFSScatchment area

More advanced technology may beavailable after our implementation

Difficulty hiring a bilingual librarian Lack of patient Internet access Inability to hire skilled portal IT staff Decreased medical reimbursement may

inhibit funding for the portal project

If system works poorly or slowly, this canlead to loss of physicians, employees, andpatients

System malfunctions can interrupt the newworkflow process

HIPPA constraints Unlawful access to personal health care

data


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2.1 SWOT Analysis Summary

In light of CFSSs strengths, which include a focus on electronic communication; a strong IT

department; and functioning EMRs, there are many potential opportunities. These include

expanding the use of Portal to assist with telemedicine consulting; decreased costs; improved

patient satisfaction; and increasing marketing to potential customers highlighting our

commitment to patient centered care. Additional telemarketing efforts would have minimal cost,

but could be potentially lucrative. Portal implementation will help to improve patient

satisfaction as results will be rapidly available and patients can schedule their own appointments

online. This in turn, will increase the efficiency and effectiveness of patient care as it will allow

for better employee and physician resource and time management. Portal will also help to reduce

duplicate testing and associated potential complications from additional testing. Physicians can

electronically communicate important information to their patients and other physicians.

Furthermore, because Portal will be user-friendly and provide a much needed patient service, it

will be an excellent marketing tool to engage new patients who are currently outside the CFSS

system. Due to the strong physician leadership model and our reputation as being one of the top

hospitals in Osoyoga, there is also an opportunity to recruit additional nationally recognized

physicians.

In light of CFSSs weaknesses, threats include other organizations that are on the verge of

implementing a Portal system such as My Chart. Competition in regards to patient volume is

also a significant threat as competitors are slowly encroaching on our catchment areas and we

have not added any additional sites to our healthcare system. HIPAA, medicolegal constraints,

and threats from unlawful access of the patients personal healthcare record constraints may also

present serious barriers to Portal implementation and maintenance. While the goal is rapid


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medical care, some patients may not have Internet access or check their email frequently and

therefore electronic communication may not occur in a timely manner. The current economic

crisis can limit the extent of Portal development, as there is not only an implementation cost but

also an ongoing maintenance cost. Hiring of skilled IT personnel and a bilingual librarian may

also pose a challenge for Portal implementation.

3. FEASIBILITY ANALYSIS

3.1 Technical Feasibility

CFSS is a leader in establishing a multi-discipline computerized medical record system.

Therefore, the current infrastructure provides the technical feasibility to implement Portal. The

current EMRs have the capacity to support physician order entry, provide clinical decision

support, and capture information relevant to health care quality. Portal will easily integrate with

the EMRs and exchange electronic health information.

Portal implementation will advance CFSSs information technology capabilities and allow

immediate access to key information, such aspatients diagnoses, results, medications, and

consults through its robust servers with rapid access time. Therefore, all providers in multiple

settings will have immediate access to the patients entire medical record.

The ability to enter and store prescriptions, tests and services requires a strong data processor.

Using reminders, alerts and computerized decision-support requires technology that is capable of

integrating data from various sources and automatically flagging or sending appropriate alerts to

the appropriate providers. These functions, in addition to decreased access time, increased data

processing, and multi-user integration are available with the current CFSS hardware. However, the


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integration of Portal with the current systems will require two additional servers and one

additional IT staff.

Portal includes state of the art encryption software and security. In order to access Portal, CFSS

internal users, external users (e.g. physician access from their homes), and patient users will

require access to computer systems with the following specifications: Operating systems such as

Windows XP, Vista, Windows 7, or Mac OS X; Web browsers such as Internet Explorer, Safari,

or Google Chrome; Adobe Flash Player, and Adobe reader. Any processor greater than 1.2 GHz,

display resolution of 960x600 or higher, and Internet access are also required. All computers in

use at CFSS meet these minimum requirements.

CFSS currently has IT resources and expertise that will be used in the implementation and

maintenance of Portal. This includes the Chief Information Officer and CFSS IT Team leaders.

Thus, in regards to technical feasibility, it will be both beneficial and practical to initiate Portal at

CFSS.

3.2 Operational Feasibility

Operational feasibility is presented as an analysis of the components affected by Portal

implementation, use, and maintenance. As the outpatient clinics and the hospitals already have

EMRs, there are no barriers to access Portal by clinic or hospital staff. Furthermore, since all

physicians and staff already have basic computer skills to use the EMRs, they should not have

any difficulty using Portal. Nonetheless, these groups will need time set aside for education on

using Portal. Additional costs have been budgeted for staff training purposes. Group and

individual education will need to be available frequently during the roll out period to ensure all

users are rapidly trained on use of Portal and its applications.


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The entire installation, implementation, education, and go live phase will be completed within

one year, and is defined in section 1.4:Implementation/Rollout Plan. This timeframe enables

CFSS computer systems to rapidly integrate CFSS EMRs, and provides CFSS with state of the

art patient and physician electronic communication.

CFSSs primary goals for Portal are integration of the EMRs and to provide CFSS with

encrypted access for physicians, outside providers (labs, radiology, pharmacies), and patients. At

this point, we must assume Portal will be effective in reaching these goals as demonstrated by

our due diligence with the vendor and the two separate site visits to St. Judes Health and

Doctors Medical Center. Additional programming to personalize Portal functions for CFSS will

allow us to reach one of our primary goals of automatically populating both EMRs with clinical

results and reports, including notifications (flagging) to healthcare providers.

The physicianto-physician and patient-to-physician communication is a basic email system

using EMR templates, and automatically downloads to the patient EMR. This system will allow

our providers electronic communication with each other and their patients.

Ongoing support and maintenance of portal is feasible with CFSS IT staff and vendor technical

support. Portal staff will be on-site for the implementation and roll out. The Portal contract has

provisions for continued technical support for five years, which ensures Portal will continue to

function properly, to receive routine updates and maintenance, and meet CFSS needs.

In addition to this prolonged support from the vendor, the Portal ICAC will need to redefine

itself after the roll out period is completed. It will become the Portal Advisory Committee

(PAC). The new committee will be responsible for reassessment of Portals functions. This will


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include identifying weaknesses and identifying new modules or applications for our health

system. This committee will use dashboards to monitor Portals effectiveness.

Patients will access Portal through CFSSs existing website. Portal will not work for patients

who lack computer access or for those who are unable to use computers. However, because of

the user friendly website with easy to find help, even novice computer users will be able to

access their medical record and contact their physician. Our existing call center will be able to

answer patients web navigation questions. Our IT department will hire two additional FTEs in

order to meet the ongoing technical support needs of Portal users.

3.3 Economic Feasibility

The economic feasibility will depend on comparing the cost of Portal and the potential revenue

and/or savings of using Portal. The cost includes implementation and ongoing maintenance of

Portal. The implementation costs consist of license fees, hardware, manpower required for

implementation, and the initial training. Additionally, there are maintenance costs, which

includes software and website maintenance, ongoing staff training, and customer support.

Implementation Costs

CFSS considered the monthly license fees of $60 per hour per provider versus purchasing the

license for a one-time fee of $2,000 per provider. With 100 physicians and 20 mid-level

providers, the decision was made to use the purchase price of $240,000 in the analysis. The

license will allow Portal to integrate with the current practice management program and provide

immediate access to on-line scheduling and billing. There is a vast infrastructure already in

place, but two new servers will be added and dedicated to Portal. The servers will provide rapid


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flow of information through the interfaces and modules, which can be added to Portal. Each

interface will currently cost $100,000 and CFSS has chosen four interfaces at this time. This will

allow the hospitals EMR, clinics EMR, CFSS website, and educational database to connect to

Portal and access labs, x-ray, pharmacy which are already integrated into each EMR. This

provides the opportunity for data to flow in any direction through Portal.

Furthermore, CFSS has selected three modules, at a cost of $50,000 each. These include E-

consult, marketing, and data reporting modules. The modules, along with the Portals integration

with billing and scheduling, will provide financial and quality benefits for CFSS.

The actual implementation is estimated to require 500 vendor hours at a cost of $300 per hour.

Training costs include formal training and a loss of productivity from staff while learning to use

Portal. This is estimated for 400 hours at a cost of $125 per hour and includes superuser training.

All of these costs are summarized in Table 1.


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Table 1: Initial Cost of Implementing Portal

CATEGORGY ITEM COST PER UNIT TOTAL COST

LICENSES Portal License $2,000 /provider $240,000

HARDWARE 2 Servers $20,000 $40,000

INTERFACESPortal to Hospitals EMR

Interface (for physicians)$100,000 $100,000

Portal to Clinics EMR

Interface (for physicians)$100,000 $100,000

Portal to website interface(for patients)

$100,000 $100,000

Portal to Education Databaseinterface

$100,000 $100,000

MODULES E-Consult module $50,000 $50,000

Marketing Module $50,000 $50,000

Data Reporting Module $50,000 $50,000

IMPLEMENTATION 500 hours $300/hr $150,000

TRAINING 400 hours $125/hr $50,000

TOTAL $1,030,000

Maintenance Costs

Maintenance costs include yearly cost charged by the vendor, the need for increased internal IT

personnel, and the addition of a clinical nurse with Health Information Technology (HIT)

training. The vendor will charge 20% of the initial license fee as the yearly maintenance cost to

provide updates and external support to keep Portal functional. In addition, CFSS will increase

the internal IT department by adding another IT specialist dedicated for on-site Portal issues at a

cost of $80,000 per year. The HIT clinical nurse will oversee the education database and will

cost $100,000 per year. These costs are summarized in Table 2.


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Table 2: Maintenance Costs

ITEM SPECIFICS COST (per year)

Vendor Charges (for

Maintenance) 20% of initial license fees $48,000

IT PersonnelOne additional IT specialistwill be added to current ITdepartment

$80,000

Clinical Nurse(HIT Trained)

Will develop and maintaineducational database

$100,000

TOTAL $228,000

Potential Revenue and Savings

As discussed previously, there are multiple benefits of implementing Portal. We have discussed

the potential for increased quality of care through rapid access of medical records and the

opportunity to engage patients in education of their illnesses. There is also potential for

increasing revenue and decreasing operating costs. CFSS had annual revenue of $750,000,000

for the past year.

Portal is projected to slowly increase CFSSs market share, and starting in the second year, this

will increase revenue by 0.1% per year. The online bill-paying capabilities will avoid lost bills,

missed payments, and help to collect on bad debt, which will further increase revenue. However,

the contribution margin for CFSS is 20%, thus not all of the increased revenue will be available

as cash flow. The calculations are shown in the attached Excel spreadsheet (Appendix A) and

summarized in Table 3. CFSS is a non-profit organization; therefore, taxes are not included in

the analysis.


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E-consults will provide intangible benefits but no definitive financial benefits at this time.

Patients ability to request on-line refills and access parts of their medical record will decrease

phone calls to providers by 20%. The online scheduling capabilities will decrease calls to

schedulers by 30%. Additionally, as providers begin to send results electronically, postal costs

will decrease by 20%. These savings will begin in the first year and will eventually plateau.

Based on the above projections, initial implementation costs and ongoing maintenance costs, the

net cash flow and cumulative cash flow can be calculated. Although the net cash flow is

estimated to be positive after the second year, the cumulative cash flow will show gains in the

fourth year. These calculations are performed on the attached Excel spreadsheet (Appendix A)

and are summarized in Table 3.


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Table 3: Calculating Cash Flows

IMPACT OF PORTAL Year 1 Year 2 Year 3 Year 4 Year 5

Revenue from increasedmarket share

$0 $750,000 $1,502,900 $2,261,259 $3,027,657

Revenue from collecting onbad debt

$0 $700,000 $800,000 $900,000 $1,000,000

Total increase in Revenue dueto Portal

$0 $1,450,000 $2,302,900 $3,161,259 $4,027,657

Contribution Margin -20%(Cash Flow from Increased

Revenue)$0 $290,000 $460,580 $632,252 $805,531

Savings from decreasedpatient phone calls to provider

$30,000 $80,000 $100,000 $100,000 $100,000

Savings from decreasedpatient calls to scheduler

$45,000 $90,000 $120,000 $120,000 $120,000

Savings from decreased postalcosts

$50,000 $50,000 $50,000 $50,000 $50,000

Implementation Costs $1,030,000 $0 $0 $0 $0

Maintenance Costs $228,000 $228,000 $228,000 $228,000 $228,000

Net Cash Flow ($103,000) $282,000 $502,580 $674,252 $847,531Cumulative Cash Flow ($1,133,000) ($851,000) ($348,420) $325,832 $1,173,363


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Cost-Benefit Analysis

Utilizing the above tables, a Cost-Benefit Analysis can be performed. Payback Period is

calculated using the following formula.

Payback Period = number of years prior to full recovery + (unrecovered cost at start of

year / cash flow during full recovery year)

Payback Period = 3+ (348,420 / 674,252) = 3.52 years = 42 months

Thus, it will take CFSS 42 months to recover the cost of implementing Portal. Payback period

analysis does not take into account cash flows beyond the payback period and ignores the time

value of money. Given these limitations, further analysis was performed using the attached Excel

spreadsheet (Appendix A).

Net Present Value (NPV) for five years was calculated to be $587,774; Internal rate of return

(IRR) was 21%, Modified Internal Rate of Return (MIRR) was 17%, and the Profitability Index

(PI) was calculated to be 1.6. These calculations, along with the estimated payback period of 42

months, confirm that implementing Portal is economically feasible and financially advantageous

over a five-year period.

3.4 Organizational Feasibility

Now that the immediate pressing issues of stability and improved workplace morale have been

addressed, Dr. Segha and the executive leadership team would like to concentrate our

organizations attention on being the first healthcare system in our area that has a fully integrated

Portal system. The strategic importance of this endeavor cannot be overemphasized as successful

implementation will not only allow us to serve our patients more effectively, but also increase


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our current market share by focusing marketing efforts on easy access to care and emphasize

our state of the art care and resources.

As a result of his proven track record, Dr. Segha has the full support of the Board of Trustees and

the Board of Directors who share his vision of leading our system to the forefront of quality care.

The Information Technology era is rapidly changing the face of healthcare. A strong

organization must be prepared and willing to be on the cutting edge of health information

technology. Due to our strong physician leadership at all governance levels, the implementation

of Portal has full backing from the entire organization.

Commitment to Portal is evidenced by formation of the ICAC and the Portal Oversight

Committee. Dr. Segha and our Chief Medical Officer, Dr. Ben Nevolent, have already met with

the entire staff. The Chief Nursing Officer has met with her nursing leadership team, who in turn

has met with their nursing staff. Likewise, leaders such as the Director of Respiratory Services,

the Director of Pharmacy, the Director of Finances and the Director of Scheduling have met with

their respective teams. A total of 40 employees and 10 physicians have shown concern about

their ability to use Portal efficiently. However, none of these healthcare providers have

expressed resistance to change. Additional coaching sessions have been planned to assist these

providers in Portal use. The IT staff will be increased to provide support during implementation,

rollout, and maintenance of Portal. By being proactive and encouraging open discussion, our

organization is truly prepared for Portal implementation.


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4. ANTICIPATED VALUE TO STAKEHOLDERS

4.1 Tangible Benefits

There are multiple tangible benefits gained from Portal. Portal has the potential to improve

quality, increase patient safety, reduce length of stay, increase efficiency, and improve financial

returns. The traditional view of return on investment compares the financial impact of operating

costs to the revenues and savings gained from any given service. As shown above, Portal will

increase revenue and savings, thus giving the project a significant return on investment.

Tangible benefits of reducing costs can be obtained through reduced length of stay, reduced

transcription cost, decreased paper-chart related costs, and improved staff efficiency. Patient self-

scheduling and decreased number of phone calls to providers can decrease salary expenses over

time. In addition, a substantial decrease in paper and postal supplies is anticipated due to fewer

preprinted educational materials, the electronic use of appointment reminder notifications and

decreased reliance on the US Postal Service. Tangible benefits that are revenue enhancing

include increased income through improved coding, improved charge-entry accuracy and

improved provider productivity. In addition, effective and targeted marketing will help to

increase our market share, which will translate into increased revenue.

Reduction in hospital length of stay results from timeliness and completeness of clinical data that

produces quicker diagnosis and treatment. There are also improved organizational efficiencies

through the prevention of duplicate testing and cost reduction from decreased administrative,

clinical staffing and resource requirements. Portal will enhance revenue by improving billing and

charge capture as well as improving on productivity gains through decreased medication

distribution and reduced radiology turnaround times.


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The clinical dimension of return on investment is attained through better adherence to clinical

protocols and clinical decision-making. Increasing outpatient preventive quality measures

reduces morbidity and mortality in patients, and thus reduces the costs to treat these conditions.

Enhanced standardization of inpatient care also increases numerous core and quality measures,

and reduces length of stay, readmissions and complications. An additional benefit of

standardizing care is a reduction in the number of malpractice claims. Furthermore, by

decreasing the number of claims, it may be possible to renegotiate CFSS Healthcares

malpractice insurance premium rates.

Improved adherence to medication recommendations, simplified physician referrals, and

increased capture of billable expenses are other tangible benefits. In addition, improved quality

of patient outcomes, through flagging alerts as well as clinical decision guidelines, reduce

medical errors, morbidity, and mortality. The resulting savings can also be found in a reduction

in medication errors, adverse drug reactions, and an increase in cost-efficient drug selections.

4.2 Intangible Benefits

Portal will provide immense intangible value to the physicians and staff by uniting all branches

of CFSS Healthcare and giving CFSS a new cohesive identity. In general, large health systems

live and work in silos. This is best exemplified by the current manner in which outpatient

primary care physicians (PCPs) obtain inpatient data. Historically, they rarely communicate with

the inpatient care team beyond faxed results and dictated summaries. Portals seamless

connection of the outpatient and inpatient EMR, along with all the other interconnections of the

patients clinical records, becomes the virtual heart of CFSS. This will redefine CFSS as a

united organization providing continuous comprehensive personal care to each and every patient,


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whether the patient is a five year old getting their school physical or an octogenarian being

discharge to assisted living.

Portals connections will allow higher quality and more personal and timely care, thus patients

and CFSS care team will also experience more value and satisfaction. CFSS will no longer be a

group of silos, but will be one entity living its vision to provide high quality comprehensive care.

This united communication provides additional intangible value to all providers, mostly because

of improved efficiency and time saved for staff and physicians. There will be immense time

saved for physicians communicating via E-consults, reducing repeat phone calls and difficulties

deciphering each others handwriting. Reducing duplication of labs and tests also saves time for

the patient and the providers and reduces adverse outcomes that result from false positive tests.

Electronic prescriptions are another time saver for patients and physicians. Direct integration

with CFSSs educational site not only saves time for providers via decision support and

immediate online access to clinical resources such as Up to Date.com, it also enables physicians

to provide higher value care (higher quality in less time).

Patients will experience improved value and time saved by using electronic scheduling and

emails with their physicians. These time savings will also be experienced by all the staff who

handle scheduling and phone calls.

The result of all these intangible efficiencies and time saved will increase staff and patient

satisfaction. But more importantly, Portal enables all providers to bring one of CFSSs ultimate

values to the patient- an opportunity to increase direct, face-to-face patient care.


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4.3 Organizational Impacts

CFSS Healthcares key stakeholders include patients, staff, physicians, Board members,

investors and CFSS organizational executives. There are many important reasons that Portal

should be implemented and these include the items discussed under the Tangible and Intangible

Benefits sections. Our SWOT analysis revealed that while CFSS has many strengths and

opportunities in the era of healthcare reform, we are also faced with significant external threats

that can further compound our weaknesses. However, due to our strong model of physician

involvement and the proven accomplishments of our physician-led executive team, we are

perfectly positioned to successfully implement Portal. Specific organizational impacts before and

after implementation are discussed below.

Impact of Development and Implementation Phase

Rapid and detailed communication to all team members will be imperative throughout the

various phases of Portal implementation. Therefore, an effective plan for timely communication

is a mandatory prerequisite. A clear timeline, an explanation of the training process, and an

honest evaluation of the workload changes should also be openly disseminated in order to

alleviate any preconceived barriers to successful implementation. Town hall meetings will

provide a medium for staff communication and education. Additional resources have already

been allocated for the necessary IT personnel to assist Portal CFSS users and patient access. The

bilingual librarian will further enable patient access to Portal.


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Impact of Post-Implementation Phase

The role of marketing cannot be underemphasized, as patient utilization of Portal is the key to

increasing market share. Ongoing funding for Portal marketing should be an integral part of

CFSSs budget. The best method of ensuring patient use is by completely engaging the staff. If

the staff is convinced that Portal will be beneficial to the patient, their enthusiasm will be

sincerely conveyed to the patient.

Post implementation work flows should also be evaluated as there is learning curve to any new

system and physicians and providers will become discouraged if they are delayed in providing

patient care and face the risk of decreased revenue. Ultimately, provider efficiency will increase

due to the decreased number of patient and other provider phone calls per day and improve

availability of results. Furthermore, Portal will increase the ease of communication with patients

about their diagnostic results. Each provider will need to evaluate which results can be

transmitted electronically and which results require in-person reporting.

5. CONCLUSION

CFSS would like to be at the forefront of health information technology through the Portal

initiative. Portal will transform CFSS into a united cohesive organization and will provide

patients access to their providers, their personal health record, and to CFSSs robust education

website. The SWOT and feasibility analyses suggest that CFSS should move forward with Portal

implementation. Portal will allow us to better serve the needs of our patients and will ultimately

improve outcomes by rapid and streamlined patient-focused quality care. CFSS remains

committed to our primary mission of providing exceptional care, one patient at a time.

information portal sample comprehenisive assessment.1

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