HCS 487 Week 3 Implementing a Health Information System Example

Sixteen Weeks, Twelve Sites and a Champion in Each: The Implementation Plan for an Electronic Consultation Platform Across a Community Health Center Network

[Student Name]

University of Phoenix

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

Week 3 Assignment

[Instructor Name]

[Date]

The health center network, its sites and its timeline are composites written for a model paper; frameworks and research findings come from the sources listed.

A composite network of community health centers signed a contract for an electronic consultation platform after a selection process led by its clinicians. The platform will let primary care clinicians at 12 sites send clinical questions to cardiology, dermatology and endocrinology specialists, receive advice within days and convert consults into appointments when needed. This paper sets out the plan to implement it in sixteen weeks and to support it through the first ninety days of use.

Governance and Roles

The chief medical officer is the executive sponsor, responsible for removing obstacles and making decisions the project cannot. A project manager runs the timeline, budget and risk log. A clinical informatics lead configures templates and reports. Each site has a clinical champion, usually a respected physician or nurse practitioner, and a lead referral coordinator. The vendor provides an implementation consultant and trainers. A steering group of the sponsor, project manager, informatics lead, two champions and a partner specialist meets weekly and records decisions.

Timeline

Weeks 1 to 3: workflow mapping and redesign. Weeks 4 to 7: configuration, templates and interface build. Weeks 8 to 9: testing. Weeks 10 to 13: pilot at two sites. Weeks 14 to 16: training and phased go-live at the remaining ten sites in three waves. Days 1 to 90 after the final wave: stabilization and measurement.

Workflow Redesign

The team mapped the current referral process at three sites and found that clinicians spent time writing referral letters, coordinators faxed them and no one tracked whether specialists responded. In the new workflow, the clinician selects an e-consult order, completes a short specialty template that pulls results automatically from the record and signs. The coordinator reviews the request for completeness and routes it. The specialist answers in the platform. The answer returns to the clinician's inbox, and if a visit is recommended, the coordinator schedules it. Coordinators, not clinicians, own follow-up on late responses.

Configuration and Interfaces

The informatics lead built specialty templates with the partner specialists: cardiology asks for the reason, electrocardiogram and recent echocardiogram; dermatology requires at least two photographs; endocrinology asks for recent laboratory values and medication history. The vendor built interfaces for orders, results and documentation with the health record.

Testing

Testing covered each consult type from order to answer, including failures: a consult sent without required fields, a specialist response after the three-day limit and a network outage. The team ran 60 test scenarios and fixed 14 defects before the pilot.

The Pilot

Two sites, one large and one small, used the platform for four weeks. The pilot found that dermatology photographs taken with older clinic tablets were too blurry, so the network bought four new cameras. It also found that clinicians did not see specialist answers promptly because they arrived in a crowded inbox, so answers were flagged with a distinct color. The pilot cost four weeks and saved the network from rolling out two problems to ten more sites.

Training

Training was role-based. Clinicians received a 45-minute hands-on session and a one-page guide. Coordinators received four hours covering routing, tracking and scheduling. Specialists received a short remote session on answering consults. Champions received extra training so they could support colleagues.

Communication and Resistance

Kotter (1995) argued that change efforts fail when leaders do not communicate the vision enough or neglect short-term wins. The sponsor explained the purpose at every site's staff meeting: patients waiting months for answers they could have in days. Pilot results were shared as early wins, including a patient whose rash was diagnosed by photograph within two days.

Managing Risk

Greenhalgh et al. (2017) showed that health technologies are often abandoned when their value is unclear to users or the work they add falls on the wrong people. The risk log tracked those risks, including specialist response times slipping as volume grew, clinicians returning to paper referrals and the unresolved question of plan payment for e-consults.

Specialist Engagement

Specialists are outside the network's control, so the plan treated them as partners rather than users. Each specialty group named a lead physician who joined template design, reviewed the first 20 consults for completeness and met monthly with the network's chief medical officer. The groups received a monthly report showing their response times and the number of consults resolved without a visit, which let them see the value of their work. When one dermatologist's responses slowed during a vacation, the group arranged coverage without being asked, a sign that the partnership was working.

Phased Go-Live

The remaining ten sites went live in three waves a week apart. Each site had a vendor trainer and its champion at the elbow for the first two days, and the project team held a 15-minute huddle each morning to review problems.

Productivity Dip

The plan expected clinicians to be slower in the first two weeks and reduced each clinician's schedule by one patient per session during that time, paid for from the project budget.

Measures and Targets

Targets were drawn from published results. Olayiwola et al. (2016) found that 69% of cardiology e-consults in a similar network were resolved without a specialist visit and that the median time to specialist review fell to 5 days. The network set targets of median specialist response within 3 business days, at least 50% of e-consults resolved without a visit in the first six months and at least 80% of eligible referrals sent as e-consults by month three.

The First Ninety Days

Weekly reports track volume, response times, resolution without a visit and consults returned incomplete. Champions meet every two weeks to share problems. At day 90, the steering group will decide whether to add specialties.

Conclusion

The implementation plan turns a signed contract into daily use through clear governance, workflow redesign before configuration, thorough testing, a pilot that caught real problems, role-based training and a phased go-live with support. Risks drawn from research on technology abandonment and targets drawn from a trial in a similar network give the project a way to judge success.

References

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

Kotter, J. P. (1995). Leading change: Why transformation efforts fail. Harvard Business Review, 73(2), 59-67.

Olayiwola, J. N., Anderson, D., Jepeal, N., Aseltine, R., Pickett, C., Yan, J., & Zlateva, I. (2016). Electronic consultations to improve the primary care-specialty care interface for cardiology in the medically underserved: A cluster-randomized controlled trial. Annals of Family Medicine, 14(2), 133-140. https://doi.org/10.1370/afm.1869