206 ◾ Mary Ellen Skeens
Call Placed to
Schedule Cath
Procedure
Cath
Procedure
Scheduled
Inpatient or
Outpatient?
Pre Cath
Review of
Tests
(Labs/EKG)
Order
Placed
Patient
Picked up
in Lobby
Outpatient
Arrives to
Admitting
Inpatient on
Floor
Selection of
Patient
Heart diagram
created
Report findings
entered into
physician report
Image import of
heart diagram
into report
Cath Report
Completed
Patient Moved
Cath Procedure
Room
Pt Selected
from Worklist
on Modality
Admission of
Patient via
Worklist
Assessment
Completed
Close pt
case
Cath
Performed
Reselect Pt
Procedures
& Inventory
documented
Q&A of
case
Post
procedure
data
documented
Pt Case
opened in
holding area
Patient
Transferred
to Holding
Area
Patient
Discharged
from Unit
End case
Database analysis
reports run
Close pt case
In cath lab
Report Finalized
(Triggers PDF HL7
Result)
Print to Cath Dept
and Fax to MD
Office
Patient
Transported
to Cath Lab
Admission/
Preps/
Consent
Completed
Future Cath Lab Workflow Diagram
Physician
Office
RNMD Patient
Data Analys
t
Figure 23.2 Sample workow diagram.
Information and Technology Systems Analysis, Evaluation, and Selection ◾ 207
System Selection Techniques
Ranking of the systems should be based on a combination of the analysis of the RFP responses,
product demo feedback from the project stakeholders, industry rankings of vendor solutions, feed-
back from references and site visits, as well as the cost–benet and risk analysis of the solution
alternatives. Some methodologies and tools that may aid in the systems selection process include
the nominal group technique, prioritization matrices, Pareto charts, and histograms.
Performing a cost–benet analysis of solution alternatives provides quantication of the sys-
tem benets and determination of the estimated return on investment of each solution. Financial
measures such as the internal rate of return and the payback period should be calculated and
included in the analysis. Quantifying soft benets such as physician and patient satisfaction can
be challenging, but these should also be considered for inclusion in the cost–benet analysis. In
calculating the overall solution cost, it is important to consider not only the third-party vendor
quotation for the selected system, but the work eort that will be required by internal resources
PDF
Result
PDF
DICOM Modality Worklist
Final and Corrected Results
ORM
HL7 Pointer to
PDF Result
Result
Results
ADT
Results
ORM
Cardiovascular
Clinical
Application
Clinical Data
Repository
Report
Share
Hospital A
HIS
Hospital B
HIS
Hospital C
HIS
ADT
ResultsORM
Results
ORM ORU
ORM
Interface
Engine
Application
Interface
Images
Echo
Results
ADT
Cardiology PACS
SAN
DICOM Modalities
Archive
Application
Interface
Figure 23.3 Sample dataow diagram.
208 ◾ Mary Ellen Skeens
as well as any infrastructure, hardware, or software project components that are to be provided by
the healthcare organization. Service maintenance agreements for the vendor system should also
be included in this calculation. Based on the period of time dened in the cost–benet analysis,
consideration of a hardware refresh or storage expansion may be required.
Project risk should be a factor in the identication of a selected solution. Important consid-
erations include the probability and impact of each identied risk. Risks may be people, process,
or technology related. Preliminary risk mitigation plans should be developed to address any risks
uncovered during this stage.
Contracting Process
e healthcare information system contract represents the project deliverables and negotiated
terms and conditions of sale with a vendor. Inputs to the contracting process include the project
charter statement, functional requirements document, and risk assessment. Outputs of this pro-
cess include the solution contract inclusive of a sales quotation, statement of work, and terms and
conditions specifying agreed to payment terms and dened system acceptance criteria. e formal
project initiation should not begin prior to the conrmation of order acceptance from the vendor.
To prevent delays to the project initiation, it is helpful to understand the contracting require-
ments of the vendor including any signed documentation and down payments required for order
acceptance as well as the lead time for having a project team assigned by the vendor.
References
1. US Department of Health and Human Services Health Resources and Services Administration,
HRSA Health IT Adoption Toolkit, http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/
(accessed September 28, 2012).
2. Deming, W. Edwards (2000). e New Economics for Industry, Government, Education (Second Edition).
MIT Press.
3. Healthcare Information and Management Systems Society, http://www.himss.org/content/les/
ChangeManagementTFFramework.pdf?src=winews20110309. (accessed October 7, 2012).
4. KLAS, About KLAS, http://www.klasresearch.com/about/company.aspx (accessed October 2, 2012).
5. MD Buyline, About MD Buyline, http://www.mdbuyline.com/about/about-us#sthash.WCdlK0mv.
dpbs (accessed October 4, 2012).
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