Functional Specifications

This is a paper I wrote for one of my classes during my Master’s certificate course:

 Functional Specifications

            Introducing new technology is a way of life for the health care industry in the 21^st century as federal mandates and consumer demand drive health informatics to the forefront of health providers’ agendas.  Merely automating existing processes and systems, however, is not the best use of new technology in a field that demands efficiency, accuracy, and safety (Spector, 2010).  A successful deployment of new technology involves identifying organizational requirements as defined by end-users that support organizational strategic goals and mission statements.  In addition, an assessment of the current system in terms of weaknesses, strengths and its ability to meet regulatory requirements are two of many possible prerequisites for determining functional specifications for a new or improved informatics system (Bazile, 2010).  In this paper, I will examine a 300-bed hospital’s emergency department’s urgent need for a CPOE system, describing end-user requirements and the steering committee’s process to arrive at an effective IT solution. 

The Problem

            Madison Hospital (not a real name) recently acquired a sophisticated IT infrastructure consisting of multiple LANs and WANs, HL7 interfaces, operating on a client/server system with single sign-on and relational databases with open database connectivity (ODBC) (Wager, Lee, Glaser, & Burns, 2009).  Interoperability among disparate systems in radiology, pharmacy and lab departments allowed departments to exchange data in real-time.  Madison Hospital, in collaboration with physicians with practice privileges and an appreciation of the merits of IT, enabled integration with local practices, which resulted in a significant decrease in redundant paperwork, patient reporting errors, inaccurate medical history, and incorrect allergy information.  Patient throughput increased by 25%.  Despite these substantial improvements, the emergency department experienced three separate adverse drug events.  One scenario involved a 10-year-old boy who suffered a severe allergic reaction to peanut butter and received a near-fatal adult dose of a drug.  The nurse had misread the doctor’s handwriting.  The media publicized this event, which sent patients 15 miles down the road to a competitor. 

Wants and Needs

ED physicians and nurses urged the CMO (Chief Medical Officer) and CNO (Chief Nursing Officer) to provide a solution that would prevent a medication dispensing error of this magnitude again.  The nurses wanted a system that would eliminate the need for interpreting illegible physician handwriting and the opportunity for miscommunication via verbal orders.  Nurses also wanted to close the gap between the patient complaint and when the patient received medication, especially when a patient was in pain and the nurse was just waiting on the doctor to write the order.  ED physicians wanted the ability to access and input information at the patient bedside.  Between seeing patients, writing orders, tracking down results and decision-making with very little patient history, physicians wanted their workflow streamlined. 

Steering Committee

            The CMO and CNO took these requests to the CIO (Chief Information Officer).  The CIO, realizing the urgency and importance of this new system, communicated with the CEO (Chief Executive Officer), who decided a steering committee was in order.  The steering committee consisted of the CEO, CMO, COO (Chief Operating Officer), CIO, CNO, VP of Legal Services and Corporate Compliance, VP of Communications and Marketing, VP of HR, two ED Physicians and the Chair of the Institutional Review Committee.  The CIO was asked to chair the committee and tasked with leading a smaller group consisting of fewer committee members and more IT staff whose purpose was to determine requirements and functionality of the CPOE.  The CIO delegated project management to, Tim, an IT manager who was detailed, organized, and a natural leader.  Most important, ED physicians and nurses respected Tim and considered him the preferred go-to person for IT problems (Wager, Lee, Glaser, & Burns, 2009). 

Mission and Goal

            The CEO reminded the committee of Madison Hospital’s mission statement:  To provide quality care while improving the health of patients. The strategic goal was to become a premier health organization in the United States and always strive to provide clinical and service excellence.  Underlying the purpose of the meeting were two important organizational values:  accountability and safety.  The hospital vowed to be accountable for their actions and outcomes and to eliminate or minimize potential harm to patients (Huntsville Hospital, 2009).  The CEO stated Madison Hospital’s values and mission statement must drive the IT solution toward achievement of their strategic goal. 

CPOE:  The Proposed Solution

In speaking with the CMO and CNO, the CIO recommended a CPOE system to the steering committee.  The CPOE (Computerized Physician Order Entry) is an informatics system whereby an authorized user enters orders directly into the device, eliminating handwritten and verbal orders.  CPOE’s advantage is transmission of real-time orders to satellite pharmacies, improving standardization of care and provides a comprehensive medication order with fewer medication errors.  Users order patient medications, tests, referrals, and treatments while maintaining accuracy (Hebda & Czar, 2009).  The committee brainstormed a short questionnaire for ED physicians and charge nurses to elicit information regarding incorporating knowledge data, mandatory and desired system functions, and acceptability of the CPOE.  The committee agreed the emergency department would serve as a pilot for the CPOE system and its success would result in CPOE implementation to the entire hospital. 

Request for Proposal

Tim’s subcommittee reviewed relevant available literature on CPOE systems, read case studies, and researched Klas and Gartner reports.  Based on this investigation, three vendors were selected.  Tim created an RFP (request for proposal) by incorporating results from the questionnaire and sending it to the vendors.  The RFP included (Wager et al. 2009, pp. 154-155):

• Contact information and the proposal deadline
• A statement of objective indicating the need for a CPOE system in the emergency department to eliminate adverse drug events 
• Background information about Madison Hospital ED
  • Organizational strategic goals and mission statement
  • Size, patient volume, staff composition
  • A detailed explanation of existing systems infrastructure
  • A prioritized list of mandatory and desirable functional requirements
  • Vendor qualifications to include background, number of installations and clients, standard contract, and implementation plan
  • Vendor’s proposed solution in context of Madison Hospital’s goals and needs
  • How Madison Hospital will make its decision
  • Contractual requirements
  • Vendor’s price and plan for support per Madison Hospital’s standardized terms

Once Tim received and reviewed the answered RFPs, he scheduled vendor demonstrations around physician and nurse availability.

Vendor Analysis

Tim conducted a vendor analysis based on the vendor’s ability to satisfy functional requirements, support during and after implementation, and a cost/benefit analysis. 

Functional requirements of CPOE (Hagland, 2010, p. 74):

• Drug-allergy contraindications
• Inappropriate single dose
• Therapeutic duplication
• Drug-drug interaction
• Inappropriate route
• Inappropriate dosing based on patient weight
• Drug-diagnosis contraindication
• Age contraindication
• Inappropriate daily dose

Vendor Support:  Vendors 2 and 3 indicated they provide support through implementation, but charge additional fees for post-implementation support.  Vendor 1 contended it supports the product for two years post-implementation with no additional fees. 

Cost/Benefit Analysis:  Based on information gained from the RFPs, research findings, and vendor demonstrations, Tim created a spreadsheet comparing vendors by developing criteria as a way to rank and score each vendor.  These factors included cost of CPOE, broken down into cost per physician, ease of use, interoperability, how well the proposed system met the ED’s requirements, and decision support. 

Summary Report and Contract Negotiations

            Tim met with the steering committee and presented system criteria and goals, results of vendor presentations, cost/benefit analysis, and his final recommendation of vendor 1.  The steering committee reached a consensus to task the CIO with contract negotiations with vendor 1.  After several weeks, the contract was finalized and approved by the legal department.

Conclusion

            Spector (2010) states, “One of the most fundamental choices managers face when introducing new technology is whether to apply that technology in a way that merely automates existing processes or in a manner that transforms those processes (p. 158).”  Madison Hospital urgently needed technology to decrease adverse drug events, while streamlining the emergency department workflow. Although a CPOE system was an obvious solution, its acquisition and plan for implementation involved an exhaustive process to ensure the CPOE met user-defined functional requirements, was able to integrate with existing systems infrastructure, and supported the hospital’s mission statement and strategic goals. 

References

Bazile, E. (2010, July 7). Week four discussion question 1 [Msg. 2]. Message posted to http://University of Phoenix class forum HCI/510—Systems Life Cycle course website.

Hagland, M. (2010, June). CPOE revelations. Healthcare Informatics, 27(6), 74-76.

Hebda, T., & Czar, P. (2009). Handbook of informatics for nurses and healthcare professionals (4th ed.). Upper Saddle River, NJ: Prentice Hall.

Huntsville Hospital. (2009). Huntsville hospital. Retrieved from http://www.huntsvillehospital.org/about/mission/

Spector, B. (2010). Implementing organizational change. Theory into practice. Retrieved from University of Phoenix e-Book Collection.

Wager, K. A., Lee, F. W., & Glaser, J. P. (2009). Health care information systems: A practical approach for health care management (2nd ed.). San Francisco, CA. John Wiley & Sons, Inc.