The Children’s Center Pediatric Clinic (TCCPC) and outpatient therapy program see more than 2,300 patients each year. There are not many facilities like TCCPC and its unique outpatient therapy that specializes in caring for complex medical patients. Many patients will travel long distances in order to make it to their appointments. Patient portals streamline communication and allow easy access to a child’s medical record; the parent is an active participant in their child’s healthcare. Patient portals offer secure access to patients’ health records online. The software encourages patients to access their records, communicate with providers, pay bills, and schedule appointments. The use of patient portals enhances the quality and portability of patient records.
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The patient-facing software is an expensive application. Coplan discusses several crises in healthcare including cost, quality, and accessibility (Coplan, 2011). A major crisis for the hospital is the cost of patient-facing software. Due to the cost of the software, the hospital has not implemented patient-facing software within the clinic setting. To tackle this massive project, Coplan discusses five process groups that must occur; initiating, planning, executing, controlling, and closing (Coplan, 2011). The initiation process is a crucial phase. During this phase the organization will determine the value of patient-facing software, engaging stakeholders and identify meaningful use. Once the project has been approved, the team will create a detailed plan. The plan will include the specific role of each board member, other members involved and their duties, budget, and timeline. The board will review the completed plan and give approval for the project manager to execute. The role of project manager is becoming more critical to assure the survival of the plan and goals (Kerzner, 2017), instilling them as a valuable assets for the successful integration of the plan.
Two crucial information management knowledge areas for the project are user requirement management and conversion management. User requirement management knowledge identifies possible project errors and how the team must create solutions to achieve the goals of the project (Coplan, 2011). Inadequate identification of issues could delay the project. Therefore information technology (IT) strategies must align with the organization’s plan to continue to achieve common goals by implementing ways to evaluate performance (Wu, et al., 2015). Conversion management is an essential piece of the project which ensures adequate interoperability with the current EHR system with the patient portal
Project management and information management overlaps with change management. Change management is a process that is often overlooked when initiating a project. Change management recognizes the need to adopt new health information technology and addresses why it is happening, who it is affecting, and how it will change (Coplan, 2011). Understanding the reasoning behind change will allow users to more readily embrace the change and be less likely to resist. Proper training plays a vital role in educating users to navigate and operate the system successfully. If the system is too complicated for the average user, then the system will ultimately fail. That is why information management is essential after implementation of a patient portal. The information management team will continue to analyze the system in order understand the flow of user actions to better support them.
I used Southwestern Oklahoma State University library EBSCOhost search engine search for the keywords patient portal, patient portal implementation, change management, project management, and information management and came across several articles and books. I limited the searched to articles and books published within the last five years. The Effect of Patient Portals on Quality Outcomes and Its Implications for Meaningful Use: A Systematic Review analyzes meaningful use of patient portals within technology and the ability to achieve specific objectives to improve patient care. Stage two of meaningful use is the phase of incorporating technology to provide patients with their medical records electronically. Users were overall pleased with the implementation of patient portals but several complaints about the use of sophisticated medical terminologies were expressed. Patient portals have allowed patients to become more engaged in their health by encouraging adherence to a medication regimen, raising disease awareness, and making it easy to connect with providers and ask questions.
Project Management: A Systems Approach to Planning, Scheduling, and Controlling by Kerzner. In chapter two, Kerzner explains that successful project management is when projects are completed within a timeline, within budget, at desired performance/technology level, using assigned resources effectively and efficiently, and are accepted by the customers. Project managers have the skills and knowledge to overcome obstacles. They measure, evaluate, and track the progress of the project.
How Information Technology Governance Mechanisms and Strategic Alignment Influence Organizational Performance: Insights from a Matched Survey of Business and IT Managers by Wu, Straub, and Liang discusses essential elements for successful information technology integration. IT governance facilitates effective use of information technology by aligning IT visions with the organization’s vision. IT governance can develop strategies to enhance IT support when they have a better understanding of the software they are acquiring. The management of IT is a never ending task. Even after the completion of the project, the management of IT is ongoing. For the software to thrive IT management will need to continue to evaluate and measure outcomes.
Change management for Sustainability by Houng Ha explains the impact change management can have on the organization’s performance and sustainability. The process requires planning, coordinating, organizing, and controlling skills. Understanding the need for change and how the change will impact the organization is an essential concept for sustainability. Failure to adopt change can result in threats to the survival of the organization and cause existing problems to becoming more significant issues. One given phenomenon of change is resistance. People will sometimes perceive change as a threat. One of the significant barriers to enacting change is ineffective communication. Change management understands that this negative feeling toward change is expected and finds ways to address them. For instance, thorough training about new policies or practice is an essential component for the acceptance of change.
Feasibility and testing
TCCPC proposes to implement a patient portal with hopes that it will engage the patient and family in healthcare decisions. We are the only non-profit pediatric rehabilitation hospital in Oklahoma that also offers outpatient therapy and sees patients in the pediatric outpatient clinic. The outpatient clinic utilizes eMDS EHR software. The facility is moving toward phase two of meaningful use, adapting technology to make patients records electronically available. A patient portal is a secure website that can interface with an EHR. The portal serves as a twenty-four hours a day, seven days a week, access point for patients. It can provide two-way communications between patients, providers, and other staff members.
The facility will acquire a commercial off the shelf program to implement patient portal. The reason for this is the software company has employed a team of experts to design and develop a functional patient portal that can interface with our current EHR system. The company would be able to offer us support during implementation. Patient portal software cost can vary from one company to another. Some companies can charge monthly fees, annual fees, or fees for a set amount of users. The time to implement should take no more than one month. Other than the purchase of the software and maintenance fee, there will be no additional cost. The clinical informatics team and IT management team will work together to ensure interoperability and network security.
The stakeholders will be happy to offer patients and their family the accessibility to their health records. The project is satisfying to stakeholders because it coincides with the hospital’s mission of maximizing the potential of every child by providing excellent pediatric care. Access to patient portals can allow parents to request medication refills, communicate with staff, schedule appointments, and obtain specific information about the disease process affecting their children. Information about gastrostomy tube care, tracheostomy tube care, therapy splint maintenance, hearing aid care, assistive devices, car seat safety, and basic ventilator functions will be available to our patients’ parents. Patient-facing technologies are playing a critical role in informing and engaging patients in improving personal healthcare involvement (Ahern, et al., 2011).
To assess and address user requirements the team and stakeholders will create a baseline of what they expect the software to do. Coplan (pg. 123) discusses reviewing the current system and focusing on future needs. By understanding what the software is capable of delivering we can better understand how to maximize the product. We also need to understand what the user expects from the product and what they are looking to gain. The product will fail if we implement a system that does not address user needs. Surveys and questionnaires can be given to future users to answer and provide additional comments. Do the users want patient portals to be more than scheduling and bill pay? Do they want to be able to email, online chat, review medications, and look up disease specific issues? Targeting these concerns before implementation will help stakeholders and the team to select the best product. For stakeholder and user satisfaction the team will facilitate continuous quality improvements.
To prepare for infrastructure management Coplan (pg.139) discuss that IT management will need to prepare and address many components including, system capacity, network, support system, new hardware, installs, testing, component constraints, and space. Patient portal is a web based uniform resource locator (URL) application. The most secured form of web based applications are hypertext transfer protocol secure (HTTPS) allowing for secure data exchange. IT management will need to assure there is enough hardware space if the software needs to be installed for EHR interface.
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The organization and vendor will need to address who will troubleshoot issues of logging, escalation and resolution, and system updates (Coplan, 2011). Other support and support training will include online instructions, online videos, and quizzes to assess new user understanding. Informational manuals as well as technical support via phone and email should also be provided. The organization may need to schedule department specific training depending on how big of a shift the new software program is for its employees.
Intended audience and plan of action
The implementation of a patient facing software is a massive project. It will affect both patients and employees who are involved in or receiving care. The most critical aspect is educating patient users on how to navigate through the patient portal and explaining the different types of functionalities. Training videos will be produced demonstrating how to create a login, sign in, and navigate through the portal. These videos will be playing on the clinic’s television in the waiting room. The videos hyperlink will also be emailed out to patients. Brochures will be mailed out to patients to inform them of new portal service and training opportunities. Emails and brochures will be sent out within one week of go live. The clinic will be able to determine if the training videos were helpful by counting the number of people who have signed up for a patient portal account.
Another recommendation for practice change will be the request of medical records. While patients can still request their medical files, the staff can inform the patient that their data is readily available on their patient portal at no extra cost. Patient users will have no wait to access and print their medical records within the portal because of how it rapidly retrieves data. Also, integrated within the patient portal is the option to share files with authorized personnel. A study examined the Department of Veteran Affairs (VA) patient’s engagement and satisfaction with a patient portal. Over 70% of users surveyed were satisfied stating that the portal helped them to understand their health history better and the option to share health information with non-VA providers made health communication easier (Turvey, 2014). Patients can share their file with other providers and family members electronically limiting errors that can occur with scanning and faxing. Informing patients that their medical record is available through the patient portal to view and print will be completed within one month of implementation. Clinical staff will contact patients via phone, email, handing out pamphlets, or verbally telling them when they come to the office. The goal will be achieved when the clinic notices a 50% reduction rate in paper chart requests, and more than 75% of patient portal users are using the share medical record functionality within the patient facing software.
Furthermore, with the implementation of patient-facing software it will require clinical staff to additional responsibility of responding to patient portal emails. The response time a clinician or clinical staff takes to respond to an email is crucial to patient satisfaction and continuity of care. During a systematic review, the number one reported positive attribute to patient portals from both patient and clinical staff is the capability for patient-provider communication (Kruse, et al., 2015). Policies will be in place stating how soon a provider or clinical staff needs to respond to the patient’s email. Training medical staff about the new policy will minimize resistance to change. There will also be a policy addressing how soon a medical summary needs to be completed so providers will complete their notes promptly. Informing patients that portal messaging is not for emergencies but instead for same day concerns will reduce confusion. The policies will be implemented one week before project completion. Employee user response time to email messaging will be evaluated monthly for the first year and quarterly thereafter. The team will analyze the data gathered from the patient facing software to determine the average response time of emails. The clinic strives to respond to emails within one to two hours during business hours Monday through Friday. Any emails sent after hours during weekdays can expect a response within four hours from when the next business day starts. Any emails sent over the weekend can expect a response within four hours from when business day starts. Patients will be reminded that secured portal messaging is not for emergent use.
Reimbursement for the service of answering patient portal messages was identified as a gap in literature. As more facilities adopt patient portals for the functionality of secure messaging, compensation for this service will need to be addressed. There was little literature present about the use of patient portals among the pediatric population. The majority of the research discussed adult patient usage of patient portals but did not address the pediatric population with a complex medical diagnosis. Additional research will be needed to understand the care delivered through secure messaging in this particular population.
To ensure the success of any project, stakeholders need to be engaged and informed of the project’s process. Coplan (p.218) explains performing an analysis survey to increase stakeholders’ awareness of plan and identify their motives. The Stakeholder analysis survey uses a five-point scale with 1-being strongly agree, 2- agree, 3- neutral, 4-disagree, and 5- strongly disagree. The questions on the survey refer to the project based on importance, influence, engagement, and commitment to better understand stakeholders’ behaviors and attitude towards the project. Eskerod and Jepsen (2013) state that it is important to intertwine stakeholders analysis into project’s activities because not only are they essential for the initial phase but for informing and incorporating potential changes. Power sharing and effective communication influences how stakeholders engage with the project.
Evaluation plan and achievements of SLOs
My anticipated problems with the implementation are resistance from both employee users and patient users. Users will vary in levels of health literacy. If the patient facing software is too complex with sophisticated medical jargon it will discourage the patient from accessing and using the patient portal. The system needs to be easy to navigate and present materials at a reading level everyone can understand. According to research 52.5% of older generations are less likely to sign up and access their patient portal because they are slower to adapt to technology (Smith, et al., 2015). The main care giver for our patient population are the grandparents. Providing training videos and information about immediate access to patient records will allow care giver to be involved in medical decision making. A staff member will be available to provide training and answer user questions. Intervention strategy is important to monitor and reduce disparities in users.
Employee user will feel that the patient portal adds extra responsibilities such as answering and responding to emails. To address this issue, policies will be created to dictate how often and how soon to respond. Training will be provided for all clinic employees. Establishing expectations and regarding policy compliance will reduce resistance and keep staff on the same page. Policy will also contain consequences and an action plan for employees who do not fulfill the new expectations associated with the patient portal.
The project’s success will be re-evaluated quarterly for the first year and then annually. It will be evaluated by sending out electronic surveys to employee users. Electronic questionnaires will also be sent out to the patient users. One neat function of the patient facing software is being able to add questionnaires to the portals. Patients will be asked if they are willing to answer a questionnaire to improve user experience. All the answers will be reviewed by our Informatics committee and an enhancement request will be sent to the software company.
My student learning outcomes were achieved in this paper by analyzing and applying multidisciplinary research and evidence to an increasingly important healthcare issue. The healthcare issue addressed was implementing a patient portal within the pediatric clinic setting. The health information system continues to advance and expand to improve the quality of the overall healthcare experience. Meaningful use of health information technology includes improving patient safety, prevent medical errors, reducing health disparities, and ensuring adequate patient health information privacy and security. The hospital is shifting towards meaningful use stage two with the implementation of a patient portal within the pediatric clinic. The hospital prides itself on exceptional care and this is certainly another step in that direction. To accomplish the project, objective multidisciplinary teams were created. Project management, IT management, and change management are all essential components to manage the success and survival of the project.
- Ahern, K., Woods, S., Lightowler, C., Finley, W., & Houston, K. (2011). Promise of and Potential for Patient-Facing Technologies to Enable Meaningful Use. American Journal of Preventive Medicine, 40(5). doi:10.1016/j.amepre.2011.01.005
- Coplan, S., & Masuda, D. (2011). Project management for healthcare information technology. New York, NY: McGraw Hill.
Eskerod, P., & Jepsen, A. (2013). Project Stakeholder Management (1st ed.). Ashgate
Publishing, United Kingdom.
- Ha, H. (2014). Change management for sustainability. New York, NY: Business Expert Press.
Kerzner, H. (2017). Project management: A systems approach to planning, scheduling, and
controlling. Hoboken, NJ: Wiley.
- Kruse, C., Argueta, D., Lopez, L., & Nair, A. (2015). Patient and Provider Attitudes Toward the Use of Patient Portals for the Management of Chronic Disease: A Systematic Review. Journal of Medical Internet Research, 17(2). doi:10.2196/jmir.3703
Kruse, S., Bolton, K., & Freriks, G. (2015). The Effect of Patient Portals on Quality Outcomes and Its Implications to Meaningful Use: A Systematic Review. Journal of Medical
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Smith, G., O’Conor, R., Aitken, W., Curtis, M., Wolf, S., & Goel, S. (2015). Disparities in
registration and use of an online patient portal among older adults: Findings from the
LitCog cohort. Journal of the American Medical Informatics Association, 22(4), 888-895. doi:10.1093/jamia/ocv025
- Turvey, C., Klein, D., Fix, G., Hogan, T., Woods, S., Simon, S., & Nazi, K. (2014). Blue Button use by patients to access and share health record information using the Department of Veterans Affairs online patient portal. Journal of the American Medical Informatics Association, 21(4), 657-663. doi:10.1136/amiajnl-2014-002723
Wu, P., Straub, W., & Liang, T. (2015). How Information Technology Governance Mechanisms and Strategic Alignment Influence Organizational Performance: Insights from a Matched Survey of Business and IT Managers. MIS Quarterly, 39(2), 497-518.
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