Analysis
Problem Definition
The first step in the Systems Development Life Cycle is the Problem Definition component of the Analysis phase. One would be hard-pressed to offer a solution to a problem that was not fully defined. The Home Health portion of General Hospital had been reorganized as a separate, subsidiary unit located near the main hospital in its own standalone facility. Furthermore, the software they were using was at least seven years old and could simply not keep up with all the changes in billing practices and Medicare requirements and payments. The current system was not scalable to the growing needs and transformation within the environment. Thus, in addition to specific desirable criteria of the chosen software (described in the following section), our explicit purpose in helping General was twofold: 1) to modernize their operations with current technology; and 2) to provide the best patient care available to their clients in the Home Health arena.
A precursor to the Analysis stage, often mentioned in textbooks (e.g., Valacich, George, and Hoffer, 2009) and of great importance in a practical setting, is the Feasibility Study. This preface to the beginning of the Analysis phase is oftentimes broken down into three areas of feasibility:
Technical (Do we have the necessary resources and infrastructure to support the software if it is acquired?)
Economic (Do we have the financial resources to pay for it, including support and maintenance?)
Operational (Do we have properly trained individuals who can operate and use the software?).
Fortunately, these questions had all been answered in the affirmative before we joined the project. The Director of Information Technology at General Hospital budgeted $250,000 for procurement (thus meeting the criteria for economic feasibility); General’s IT infrastructure was more than adequate and up to date with regard to supporting the new software (technical feasibility); and support staff and potential end users were well trained and enthusiastic about adopting the new technology (operational feasibility). Given that the Feasibility Study portion of the SDLC was complete, we endeavored forthwith into the project details.
Requirements Analysis
In the Requirements Analysis portion of the Analysis stage, great care is taken to ensure that the proposed system meets the objectives put forth by management. To that end, we met with the various stakeholders (i.e., the Director of the Home Care facility and potential end-users) to map out the requirements needed from the new system. Copious notes were taken at these meetings, and a conscientious effort to synthesize our recollections was done. Afterwards, the requirements were collated into a spreadsheet for ease of inspection (Exhibit 1). Several key requirements are described here:
MEDITECH Compatible: This was the first, and one of the most important requirements, at least from a technological viewpoint. MEDITECH (Medical Information Technology, Inc.) has been a leading software vendor in the health care informatics industry for 40 years (“About Meditech”, 2009). It is the flagship product used at General Hospital and is described as the number one health care vendor in the United States with approximately 25% market share (“International News”, 2006). All Meditech platforms are certified EMR/EHR systems (“Meditech News”, 2012). “With an Electronic Health Record, a patient's record follows her electronically. From the physician's office, to the hospital, to her home-based care, and to any other place she receives health services, and she and her doctors can access all of this information and communicate with a smartphone or computer” (“The New Meditech”, 2012). Because of its strategic importance to General, and its overall large footprint in the entire infrastructure and day-to-day operations, it was imperative that the new software would be Meditech-compatible.
Point of Care Documentation: Electronic medical record (EMR) point-of-care (POC) documentation in patients' rooms is a recent shift in technology use in hospitals (Duffy, Kharasch, Morris, and Du, 2010). POC documentation reduces inefficiencies, decreases the probability of errors, promotes information transfer, and encourages the caregiver to be at the bedside or, in the case of home care, on the receiving end of the transmission.
OASIS Analyzer: OASIS is a system developed by the Centers for Medicare & Medicaid Services (CMS), formerly an agency of the U.S. Department of Health and Human Services, as part of the required home care assessment for reimbursing health care providers. OASIS combines 20 data elements to measure case-mix across 3 domains–clinical severity, functional status and utilization factors (“Medical Dictionary”, 2010). This module allows staff to work more intelligently, allowing them to easily analyze outcomes data in an effort to move toward improved clinical and financial results (“Butte Home Health”, 2009). Given its strategic link to Medicare and Medicaid reimbursement, OASIS Analyzer was a “must have” feature of the new software.
Physician Portal: The chosen software package must have an entryway for the attending, resident, or primary caregiver physician to interact with the system in a seamless fashion. Such a gateway will facilitate efficient patient care by enabling the physician to have immediate access to critical patient data and history.
Other “Must Haves” of the New Software: Special billing and accounts receivable modules tailored to Home Health; real-time reports and built-in digital dashboards to provide business intelligence (e.g., OASIS Analyzer); schedule optimization; and last, but certainly not least, the system must be user friendly.
Desirable, But Not Absolutely Necessary Features: Security (advanced, beyond the normal user identification and password type); trial period available (i.e., could General try it out for a limited time before fully committing to the contract?).
Other Items of interest During the Analysis Phase: Several other issues were important in this phase:
Is the proposed solution a Home Health-only product, or is it part of a larger, perhaps enterprise-wide system?
Are there other modules available (e.g., financial, clinical, hospice; applications to synchronize the system with a PDA (Personal Digital Assistant) or smart phone)?
Is there a web demo available to view online; or, even better, is there an opportunity to participate in a live, hands-on demonstration of the software under real or simulated conditions?
We also made note of other observations that might be helpful in selecting final candidates to be considered for site visits. To gain insight into the experience, dependability, and professionalism of the vendors, we also kept track of information such as: experience (i.e., number of years in business); number of clients or customers; revenues; and helpfulness (return e-mails and/or phone calls within a timely manner or at all).
Finally, some anecdotal evidence was gathered to help us evaluate each vendor as a potential finalist. For instance, Vendor A had an Implementation/Installation Team to assist with that stage of the software deployment; they also maintained a Knowledge Base (database) of Use Cases/List Cases describing the most frequently occurring problems or pitfalls. Vendor C sponsored an annual User Conference where users could share experiences with using the product, as well as provide feedback to be incorporated into future releases. To that end, Vendor C also had a user representative on their Product Advisory Board. Vendor E offered a “cloud computing” choice, in that the product was hosted in their data center. (A potential buyer did not have to choose the web-enabled solution.) Vendor E’s offering was part of an enterprise solution, and could be synchronized with a PDA or smart phone.
Analysis
Problem Definition
The first step in the Systems Development Life Cycle is the Problem Definition component of the Analysis phase. One would be hard-pressed to offer a solution to a problem that was not fully defined. The Home Health portion of General Hospital had been reorganized as a separate, subsidiary unit located near the main hospital in its own standalone facility. Furthermore, the software they were using was at least seven years old and could simply not keep up with all the changes in billing practices and Medicare requirements and payments. The current system was not scalable to the growing needs and transformation within the environment. Thus, in addition to specific desirable criteria of the chosen software (described in the following section), our explicit purpose in helping General was twofold: 1) to modernize their operations with current technology; and 2) to provide the best patient care available to their clients in the Home Health arena.
A precursor to the Analysis stage, often mentioned in textbooks (e.g., Valacich, George, and Hoffer, 2009) and of great importance in a practical setting, is the Feasibility Study. This preface to the beginning of the Analysis phase is oftentimes broken down into three areas of feasibility:
Technical (Do we have the necessary resources and infrastructure to support the software if it is acquired?)
Economic (Do we have the financial resources to pay for it, including support and maintenance?)
Operational (Do we have properly trained individuals who can operate and use the software?).
Fortunately, these questions had all been answered in the affirmative before we joined the project. The Director of Information Technology at General Hospital budgeted $250,000 for procurement (thus meeting the criteria for economic feasibility); General’s IT infrastructure was more than adequate and up to date with regard to supporting the new software (technical feasibility); and support staff and potential end users were well trained and enthusiastic about adopting the new technology (operational feasibility). Given that the Feasibility Study portion of the SDLC was complete, we endeavored forthwith into the project details.
Requirements Analysis
In the Requirements Analysis portion of the Analysis stage, great care is taken to ensure that the proposed system meets the objectives put forth by management. To that end, we met with the various stakeholders (i.e., the Director of the Home Care facility and potential end-users) to map out the requirements needed from the new system. Copious notes were taken at these meetings, and a conscientious effort to synthesize our recollections was done. Afterwards, the requirements were collated into a spreadsheet for ease of inspection (Exhibit 1). Several key requirements are described here:
MEDITECH Compatible: This was the first, and one of the most important requirements, at least from a technological viewpoint. MEDITECH (Medical Information Technology, Inc.) has been a leading software vendor in the health care informatics industry for 40 years (“About Meditech”, 2009). It is the flagship product used at General Hospital and is described as the number one health care vendor in the United States with approximately 25% market share (“International News”, 2006). All Meditech platforms are certified EMR/EHR systems (“Meditech News”, 2012). “With an Electronic Health Record, a patient's record follows her electronically. From the physician's office, to the hospital, to her home-based care, and to any other place she receives health services, and she and her doctors can access all of this information and communicate with a smartphone or computer” (“The New Meditech”, 2012). Because of its strategic importance to General, and its overall large footprint in the entire infrastructure and day-to-day operations, it was imperative that the new software would be Meditech-compatible.
Point of Care Documentation: Electronic medical record (EMR) point-of-care (POC) documentation in patients' rooms is a recent shift in technology use in hospitals (Duffy, Kharasch, Morris, and Du, 2010). POC documentation reduces inefficiencies, decreases the probability of errors, promotes information transfer, and encourages the caregiver to be at the bedside or, in the case of home care, on the receiving end of the transmission.
OASIS Analyzer: OASIS is a system developed by the Centers for Medicare & Medicaid Services (CMS), formerly an agency of the U.S. Department of Health and Human Services, as part of the required home care assessment for reimbursing health care providers. OASIS combines 20 data elements to measure case-mix across 3 domains–clinical severity, functional status and utilization factors (“Medical Dictionary”, 2010). This module allows staff to work more intelligently, allowing them to easily analyze outcomes data in an effort to move toward improved clinical and financial results (“Butte Home Health”, 2009). Given its strategic link to Medicare and Medicaid reimbursement, OASIS Analyzer was a “must have” feature of the new software.
Physician Portal: The chosen software package must have an entryway for the attending, resident, or primary caregiver physician to interact with the system in a seamless fashion. Such a gateway will facilitate efficient patient care by enabling the physician to have immediate access to critical patient data and history.
Other “Must Haves” of the New Software: Special billing and accounts receivable modules tailored to Home Health; real-time reports and built-in digital dashboards to provide business intelligence (e.g., OASIS Analyzer); schedule optimization; and last, but certainly not least, the system must be user friendly.
Desirable, But Not Absolutely Necessary Features: Security (advanced, beyond the normal user identification and password type); trial period available (i.e., could General try it out for a limited time before fully committing to the contract?).
Other Items of interest During the Analysis Phase: Several other issues were important in this phase:
Is the proposed solution a Home Health-only product, or is it part of a larger, perhaps enterprise-wide system?
Are there other modules available (e.g., financial, clinical, hospice; applications to synchronize the system with a PDA (Personal Digital Assistant) or smart phone)?
Is there a web demo available to view online; or, even better, is there an opportunity to participate in a live, hands-on demonstration of the software under real or simulated conditions?
We also made note of other observations that might be helpful in selecting final candidates to be considered for site visits. To gain insight into the experience, dependability, and professionalism of the vendors, we also kept track of information such as: experience (i.e., number of years in business); number of clients or customers; revenues; and helpfulness (return e-mails and/or phone calls within a timely manner or at all).
Finally, some anecdotal evidence was gathered to help us evaluate each vendor as a potential finalist. For instance, Vendor A had an Implementation/Installation Team to assist with that stage of the software deployment; they also maintained a Knowledge Base (database) of Use Cases/List Cases describing the most frequently occurring problems or pitfalls. Vendor C sponsored an annual User Conference where users could share experiences with using the product, as well as provide feedback to be incorporated into future releases. To that end, Vendor C also had a user representative on their Product Advisory Board. Vendor E offered a “cloud computing” choice, in that the product was hosted in their data center. (A potential buyer did not have to choose the web-enabled solution.) Vendor E’s offering was part of an enterprise solution, and could be synchronized with a PDA or smart phone.
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