HCS 487 Week 2 Selecting a Health Information System Example

Three Vendors, Forty-One Requirements and One Afternoon of Clinicians Clicking: How a Health Center Network Selected Its Electronic Consultation Platform

[Student Name]

University of Phoenix

HCS/487: Technology and Systems Approach for Health Care Managers

Week 2 Assignment

[Instructor Name]

[Date]

The health center network, the vendors and the scores are composites written for a model paper; frameworks and research come from the sources listed.

Last week, the network of a dozen community health centers introduced in the evaluation chart compared four technologies for shortening waits for specialist advice and recommended an electronic consultation platform with referral tracking. The chief operating officer approved moving to selection with a budget ceiling of $180,000 for the first year. This paper describes how the network chose a specific platform, from forming the team to signing the contract.

The Selection Team

The team included two primary care physicians and a nurse practitioner, a referral coordinator, a cardiologist and a dermatologist from partner specialty groups, the network's clinical informatics manager, an information security analyst, a finance analyst and the project manager. Clinicians made up almost half the team, reflecting the lesson from last week's survey that usefulness and ease of use would decide whether anyone used the platform. Davis (1989) found that both perceived usefulness and perceived ease of use predicted people's intention to use a technology, with usefulness the stronger influence.

Needs Assessment

The team reviewed a sample of 200 recent referrals and interviewed clinicians and coordinators. The review echoed published experience with e-consult systems, where many referrals turn out to need advice rather than a visit (Liddy et al., 2016). They found that about 40% of cardiology and dermatology referrals asked questions a specialist could likely answer from records and images, that referral letters often lacked key test results and that coordinators spent hours each week calling specialty offices for status updates.

Requirements

The team wrote 41 requirements. Must-haves included sending and receiving consults within the network's electronic health record without separate logins, specialty-specific question templates prompting for required results, image attachment for dermatology, specialist response tracking with alerts after three business days, conversion of an e-consult into a scheduled referral with one click, Spanish-language patient letters, compliance with privacy and security rules and reports on volume, response times and outcomes. Desirable features included mobile access for specialists, patient-facing status messages and analytics dashboards.

Request for Proposals

A request for proposals went to three vendors with the requirements, the network's technical environment, expected volume of 4,000 e-consults a year and questions about implementation, training, support, pricing and references. All three responded within four weeks. One failed two must-haves: its product ran outside the health record and lacked image attachment.

Scripted Demonstrations

The two remaining vendors each led a half-day session using the same scripts. A primary care physician sent a cardiology e-consult for a patient with an abnormal electrocardiogram, a nurse practitioner sent a dermatology e-consult with photographs and a specialist answered each. Team members timed tasks and rated ease of use. Vendor A's consult took an average of four minutes to send; Vendor B's took nine, because clinicians had to re-enter information already in the record.

Reference Calls

The team called two community health centers using each product, chosen by the team from a list rather than only the vendor's suggestions. Vendor A's references praised the integration but reported slow support tickets in the first year. Vendor B's references reported clinicians abandoning the tool after six months because of duplicate data entry.

Thinking About Abandonment

Greenhalgh et al. (2017) developed a framework explaining why health technologies are not adopted or are abandoned, showing that the more complicated the illness, the product, the business case, the people expected to use it, the organization and the surrounding policy environment are, the more likely a technology is to stall or be dropped. The team used the framework's questions: Who pays specialists for e-consults? How much work does the tool add for each group? Would the network's other priorities crowd it out? A platform can pass every demonstration and still be abandoned if nobody's job gets easier.

Weighted Scoring

The team weighted criteria before scoring: usability 25%, integration 20%, specialist workflow 15%, reporting 10%, vendor support and stability 15% and five-year cost 15%. Vendor A scored 84 of 100 and Vendor B 67. Vendor A's five-year cost was $41,000 higher, but its usability and integration scores outweighed the difference.

Implementation Readiness

Selection also looked ahead to implementation. Each vendor was asked to describe its typical timeline, the staff time it would need from the network and how it trains clinicians. Vendor A proposed a 16-week implementation with two on-site trainers during the first week of go-live and weekly calls for three months. It also required the network to assign an internal project manager and a clinical champion at each site. The team judged these requirements reasonable and began identifying champions before the contract was signed, so implementation could start without delay.

Payment for Specialists

The framework's question about who pays specialists proved decisive. Neither partner group would answer e-consults without payment, and the network's Medicaid plans did not yet pay for them. The network agreed to pay specialists $30 per answered consult from its own budget for two years while negotiating with the plans, a cost built into the total below.

Total Cost of Ownership

Over five years, Vendor A's total cost, including licensing, interface fees, training, internal staff time and specialist payments of $30 per answered e-consult, was estimated at $760,000, or about $38 per e-consult at expected volume.

Contract Protections

The contract negotiated with Vendor A includes 99.5% uptime with credits for failures, four-hour response to urgent support tickets, a named support contact for the first year, the network's ownership of all data with export in a standard format, a cap on annual price increases of 3%, a business associate agreement for privacy and security and the right to end the contract after two years with 90 days' notice.

The Decision

The selection team recommended Vendor A, and the network's executive committee approved the contract. The first-year cost, $168,000, fell under the budget ceiling.

Conclusion

The network selected its e-consult platform through a process that started with needs and requirements, put clinicians at the center of testing and checked vendor claims with independent references. A framework on technology abandonment added questions that demonstrations alone would not answer, and weighted scoring made the decision transparent. Contract terms protect the network after go-live, when next week's implementation begins.

References

Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319-340. https://doi.org/10.2307/249008

Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19(11), Article e367. https://doi.org/10.2196/jmir.8775

Liddy, C., Drosinis, P., & Keely, E. (2016). Electronic consultation systems: Worldwide prevalence and their impact on patient care: A systematic review. Family Practice, 33(3), 274-285. https://doi.org/10.1093/fampra/cmw024