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The attached document is meant to give you a glimpse into what deliverable #3 will look like. Remember, this is only meant to serve as a guide. However, I believe it would be prudent to go through each section and try to get a feel for why certain these were included. I hope you find this document helpful as you prepare your first deliverable. Randy

Web-Based Portal Information System for CFSS HealthCare

Complete Comprehensive Assessment

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Table of Contents
1. INTRODUCTION AND OVERVIEW ................................................................................... 3 1.1 Purpose of the system............................................................................................................ 4 1.2 Overall Functionality............................................................................................................. 5 1.3 System Assumptions and Dependencies ............................................................................... 8 1.4 Implementation/Rollout Plan ................................................................................................ 9 2. SWOT ANALYSIS ................................................................................................................. 12 2.1 SWOT Analysis Summary .................................................................................................. 13 3. FEASIBILITY ANALYSIS.................................................................................................... 14 3.1 Technical Feasibility ........................................................................................................... 14 3.2 Operational Feasibility ........................................................................................................ 14 3.3 Economic Feasibility ........................................................................................................... 15 3.4 Organizational Feasibility ................................................................................................... 23 4. ANTICIPATED VALUE TO STAKEHOLDERS ............................................................... 25 4.1 Tangible Benefits ................................................................................................................ 25 4.2 Intangible Benefits .............................................................................................................. 26 4.3 Organizational Impacts ....................................................................................................... 28 5. CONCLUSION ....................................................................................................................... 29

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1. INTRODUCTION AND OVERVIEW

CFSS Healthcare is an integrated healthcare network based in Osoyoga, California. It is comprised of two clinics and a 300-bed hospital. Approximately100 physicians and 20 mid-level providers staff the clinics and hospital. Currently the clinics and hospital have two separate electronic medical records (EMRs). CFSS Healthcares organizational strengths evolve from the recent hiring in 2008 of JJ Segha, MD as Chief Executive Officer. Dr. Segha has brought tremendous unity to our healthcare system since he is a firm supporter of provider involvement in all aspects of national benchmarking and quality reporting. Prior to his arrival, CFSS was struggling with low quality scores, poor physician morale, low nursing core staff retention rates, and recruitment difficulties. Dr. Segha has made remarkable strides to make CFSS the premiere healthcare system in Osoyoga, California. Under his helm, we now have a stable workforce, a waiting list of nurses wanting to join our organization, and a talented and engaged medical staff. The CEO feels strongly that a positive work environment improves outcomes and increases patient satisfaction. CFSS patient satisfaction scores are now in the top 90th percentile and our reputation has grown locally and nationally. The high level of patient satisfaction, due to improved quality of care and staff satisfaction, positions CFSS to maintain CMS revenue dependent on HCAHPS and quality outcomes in 2013. Our organization would like to develop a web-based portal system called Portal, which would allow integration of the separate EMR systems. Portal is designed to enable the transfer of patient data between different users. Portal will also allow patients access to their providers, their personal health record, and to CFSSs robust education website.

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1.1 Purpose of the system

Healthcare needs and deserves an ideal information technology system. The purpose of Portal is to facilitate healthcare that is accessible, comprehensive, coordinated, and culturally effective. Portal will virtually compile and centralize all pertinent medical information for each patient and will optimize patient care.

Centralized Access and Complete Information

Given that medicine is an information dependent science, a critical purpose of Portal is to provide centralized access of all patient data. Connecting data from multiple care sites and caregivers is a top priority. Portal will provide clinicians with one location where the patients entire medical record will be available and thereby improve the efficiency of patient care. Healthcare providers will have all the information about a patient in real-time and at the point of care. This centralized access for physicians and patients will ultimately improve the quality of patient care.

Patient Safety/Patient-Focused

Another important purpose of Portal is to improve patient safety. Portal will compare data and produce reminders when data does not comply with guidelines. This includes identifying or flagging abnormal labs, abnormal vitals, duplicate therapies, drug-allergy interaction, drugdrug interactions and reminders of formulary guidelines. Over time, the comprehensive portal will provide data for quality improvement and research.

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Improved Quality Outcomes

Portal will promote continuous improvement in quality and clinical outcomes. It will provide healthcare workers with decision support and immediate access to core measures and evidencebased best practices to enable ongoing improvements in healthcare practice. In addition, providers will be prompted to provide suggested informational patient handouts. Patients are also able to obtain health information via Portal to further their education on multiple health related topics.

1.2 Overall Functionality

As noted, improved communication between providers and reducing the numbers of repeated tests performed on patients are part of Portals function. Portal communication will demonstrate a reduction in resource utilization and improve clinical outcomes. Examples of metrics to monitor Portals effect will include reduction in admissions and readmissions, increased use of core measure medications, higher rates of preventative screening, and lower mortality.

Portal will also enable automatic downloading of patient data and results to the patients healthcare providers. Test results will require an acknowledgement process in order to ensure close follow up. This process will be memorialized in Portals memory. Specific data sets to be shared and transferred through Portal include: Hospital-Physician data; Physician-Physician data; Outpatient Services-Physician-Hospital data; Pharmacy-Physician-Hospital data; PatientPhysician data; and Physician or Patient Education data.

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Hospital-Physician Data Transfer Hospital data will primarily flow from the hospital to the physicians EMR. Each hospital system (e.g. radiology information system (RIS), lab information system (LIS), admitting information system (AIS)) will connect through Portal, then send and receive information between the outpatient EMR and hospital systems. Hospital summaries, consultant notes, laboratory and radiographic results, are the key items that will be downloaded into the outpatient record. Hospital summaries include emergency department reports, inpatient dictations (history and physical examinations, consultations, and discharge summaries), operative and procedure reports, and outpatient reports (e.g. radiation oncology or wound center reports). Outpatient tests performed by physicians will flow from physician EMRs through Portal to the hospital EMRs specific systems, such as echocardiograms and PET scans to cardiology and radiology systems. Additional available information includes insurance status, home address, contact and emergency phone numbers and the preferred email address. Case Managers, Home Health, and outpatient physicians can also utilize information for transitional care planning.

Physician-Physician Data Transfer Most of the inpatient physician information from the hospitals health information system (HIS) will go through Portal into the outpatient record. Yet, integration of the outpatient with the inpatient EMR is another vital function of Portal, as it provides the inpatient caregivers with problem lists, current medications, and outpatient results. In addition to sharing patients results, physicians can transfer traditional consults as well as E-Consults through Portal. E-consults are the modern version of the sidewalk consult, but are now maintained in the medical records as an intact focused consultation.

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Outpatient Services-Physician-Hospital Data Transfer

Portal will integrate the transfer of results and information between providers. Examples include results from labs, radiology centers, and cardiology offices, and also include reports from outpatient surgery centers and home health agencies.

Pharmacy-Physician-Hospital Data Transfer

Besides electronic prescriptions, the transfer of medication information between providers allows medication lists to be shared and updated in a continuous fashion. An added benefit of Portal will enable medications to be monitored for dangerous interactions or allergies with notifications to the prescribing providers.

Patient-Physician Data Transfer

Patient portal access will allow patients to contact their physician offices electronically for scheduling, authorizations, and medication refills. It will also allow patients to communicate with physicians for health-related questions, information, receiving test results, and follow-up.

Patient and Physician Education via Portal

CFSS Healthcare will maintain a comprehensive multi-lingual patient and physician education database. This database will be maintained by CFSSs interdisciplinary education committee. For patients, this database will contain general educational materials (e.g. Weight Loss Techniques, Tips on Exercise) and patient specific materials (e.g. Coumadin Instructions, Post Knee Replacement Home Care). The educational database will be accessible to physicians, hospitals, CFSS patients, and the general public. Healthcare providers can provide

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patients with tailored educational materials electronically or by printed handouts. Portal will automatically document such instructions and information into their EMR. Successful education will enhance patient care by lowering complications, admissions, readmissions, and improve patient and provider satisfaction.

CFSS patients may access the portal educational site using their specific log-in and password. Because Portal will have access to patients medical records from the hospital or clinics, the system can electronically tailor the education material to the patients search. For example, a diabetic patient requesting information on weight loss will be provided with low carbohydrate ADA diets.

The general public can also access the portal educational site. However, this group will only have access to general educational material and will be required to provide demographic information to access the site. This information can later be used for advertising and marketing of CFSS Healthcare. CFSS physicians and staff will also have access to Portals education site. They can access links to patient education sites and external resources such as Pub Med, Up-To-Date and CFSS Best Practice guidelines. Additionally, Portal will provide updated links to evidence-based guidelines, related educational material, and previously recorded grand rounds and lectures.

1.3 System Assumptions and Dependencies

The web-based portal will be fully funded by CFSS Healthcare and will not involve pharmaceutical companies. The current website, www.cfsshealth.org, provides basic information about the CFSS Healthcare organization and provides educational material for patients. This

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website will become the entry point for patients and will be integrated into our two EMRs. Through Portal, both EMRs can exchange electronic health information with each other as well as scheduling, billing, radiology, laboratory, and pharmacy services.

Portal will be able to extract information from the different sections of the EMR for patients and physicians. To protect patient privacy, encryption and password protection will be built into the system. All users will have to follow specific rules and guidelines to maintain this level of privacy.

1.4 Implementation/Rollout Plan

The implementation phase of the portal project will require the assistance of many key stakeholders. The Implementation Clinical Advisory Committee ( ICAC) will be comprised of the following representatives: Physician leadership from the hospital based specialties and satellite clinic Divisions, Chief Information Officer and IT Team leaders, nursing leadership, Chief Medical Officer, Director of Laboratory Services, Director of Radiology, Director of Pharmacy, Case Management representative, financial department, and central scheduling. The Chief Medical Officer, Chief Nursing Officer, Chief Operating Officer, Chief Information Officer and the Chief Financial Officer will serve as the Portal Oversight Committee. Both Committees will remain active post-implementation in order to ensure that full portal integration is attained and maintained. The ICAC will meet bi-weekly and the CIO and CMO will brief the Portal Oversight Committee on a monthly basis.

The planning for this comprehensive proposal has already taken 17 months (Figure 1). Once the final decisions have been made regarding Portal design and functionality, the IT team will be responsible for installation. The implementation will be in a staggered approach with the clinics

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going live first and will be followed by hospital implementation. This will allow for testing in a smaller setting prior to going live in the larger hospital setting. The entire process of installation and implementation will take approximately one year (Figure 2).

Figure 1: Planning Timeline

Project defined, request for RFPs

Proposals received Vet proposals

Narrow to 2 proposals Site Visits

8/29/2010 10/1/2010

Contract Choose and system Portal Define exact system, defined Prepare negotiate contract assessment
11/25/2010 1/1/2011 3/17/2011 4/1/2011 5/31/2011

2/19/2010 4/1/2010 1/5/2010

5/17/2010 7/1/2010

Dr. Segha announces IT project to integrate outpatient and hospital EMRs

Comprehensive Assessment submitted to Board by Dr. Segha

Figure 2: Implementation Timeline

Installation, customization, and testing

Complete installation and testing

Complete Hospital Clinic Roll Out Go-live Check and confirm system functioning
6/5/2012 7/1/2012 9/1/2012

Go-live in clinics
3/2/2012 10/1/2011 9/1/2011 1/1/2012 4/1/2012 5/2/2012

Initiate intallation

Continuous Staff Education

Each site will identify and train superusers who will be responsible for training members of their own departments and will also serve as important resources during the Go-live phase. Superusers will be given protected time for these activities. The training phase for each division is anticipated to be completed within one month and will include all team members including the

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nursing staff, physician team, respiratory therapists and mid-level providers. The laboratory, pharmacy, radiology and financial departments will also undergo extensive training. Two months after the clinics have implemented Portal, the hospital will go live.

After the installation and training phases have been completed, patient enrollment in the portal system will commence. Each new patient will be offered complimentary enrollment in the program on the day of service. A questionnaire and consent form will be completed by the patient during the visit. In addition to general demographic information, the patient will be asked to list their preferred email address. The registration personnel will provide the patient with the CFSS website to access the portal using their assigned username and password.

Marketing for the portal project will consist of home mailings to current patients, office brochures, and displays in the clinics and hospital. In addition, television and newspaper advertisements for CFSS Healthcare will serve as an important marketing strategy and will highlight the new portal option as a patient-focused hospital initiative.

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2. SWOT ANALYSIS
Helpful to achieving the objective Harmful to achieving the objective

Strengths Strong physician executive leadership Active Physician involvement Exceptional access to clinical data and research Strong internal IT department Telemedicine has already been initiated Proven organizational commitment to electronic communication EMRs already functional Strong current financial position Solid RN/MD relationships Voted Best Hospital in Osoyoga, 2010 Organizational commitment to quality and patient satisfaction

Weaknesses Lack of bilingual medical librarian Lack of integrated EMR system, each hospital has a different vendor Lack of full internal IT team that can support Portal implementation and rollout Requires computer access and literacy of the users Minimal reimbursement for electronic communication Some staff have expressed concerns about Portal implementation No new facilities have been added to CFSS Healthcare Maintenance constraints with Portal to ensure accuracy of information

(CFSS Healthcare )

Internal Origin

Opportunities Expand Telemedicine capabilities and marketing Ability to decrease staff time by scheduling appointments on-line New technologies: iPhone apps, Ultra Sound probe in iPhone that connects to EMR Opportunity to send results via internet Marketing to non-CFSS patients Resource utilization optimization Incorporate patient data from additional sources (non-CFSS clinics, out of area sites) Increased private donations and investor funding Single location to provide information for patients Decrease billing costs Decrease phone calls from patients Physician to physician discussions electronically Enhance CFSS identity and reputation

Threats Competitors already have EPIC and will be implementing My Chart shortly Competitors are expanding to the CFSS catchment area More advanced technology may be available after our implementation Difficulty hiring a bilingual librarian Lack of patient Internet access Inability to hire skilled portal IT staff Decreased medical reimbursement may inhibit funding for the portal project If system works poorly or slowly, this can lead to loss of physicians, employees, and patients System malfunctions can interrupt the new workflow process HIPPA constraints Unlawful access to personal health care data

External Origin (Environment)

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2.1 SWOT Analysis Summary

In light of CFSSs strengths, which include a focus on electronic communication; a strong IT department; and functioning EMRs, there are many potential opportunities. These include expanding the use of Portal to assist with telemedicine consulting; decreased costs; improved patient satisfaction; and increasing marketing to potential customers highlighting our commitment to patient centered care. Additional telemarketing efforts would have minimal cost, but could be potentially lucrative. Portal implementation will help to improve patient satisfaction as results will be rapidly available and patients can schedule their own appointments online. This in turn, will increase the efficiency and effectiveness of patient care as it will allow for better employee and physician resource and time management. Portal will also help to reduce duplicate testing and associated potential complications from additional testing. Physicians can electronically communicate important information to their patients and other physicians. Furthermore, because Portal will be user-friendly and provide a much needed patient service, it will be an excellent marketing tool to engage new patients who are currently outside the CFSS system. Due to the strong physician leadership model and our reputation as being one of the top hospitals in Osoyoga, there is also an opportunity to recruit additional nationally recognized physicians. In light of CFSSs weaknesses, threats include other organizations that are on the verge of implementing a Portal system such as My Chart. Competition in regards to patient volume is also a significant threat as competitors are slowly encroaching on our catchment areas and we have not added any additional sites to our healthcare system. HIPAA, medicolegal constraints, and threats from unlawful access of the patients personal healthcare record constraints may also present serious barriers to Portal implementation and maintenance. While the goal is rapid

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medical care, some patients may not have Internet access or check their email frequently and therefore electronic communication may not occur in a timely manner. The current economic crisis can limit the extent of Portal development, as there is not only an implementation cost but also an ongoing maintenance cost. Hiring of skilled IT personnel and a bilingual librarian may also pose a challenge for Portal implementation.

3. FEASIBILITY ANALYSIS
3.1 Technical Feasibility
CFSS is a leader in establishing a multi-discipline computerized medical record system. Therefore, the current infrastructure provides the technical feasibility to implement Portal. The current EMRs have the capacity to support physician order entry, provide clinical decision support, and capture information relevant to health care quality. Portal will easily integrate with the EMRs and exchange electronic health information. Portal implementation will advance CFSSs information technology capabilities and allow immediate access to key information, such as patients diagnoses, results, medications, and consults through its robust servers with rapid access time. Therefore, all providers in multiple settings will have immediate access to the patients entire medical record.

The ability to enter and store prescriptions, tests and services requires a strong data processor. Using reminders, alerts and computerized decision-support requires technology that is capable of integrating data from various sources and automatically flagging or sending appropriate alerts to the appropriate providers. These functions, in addition to decreased access time, increased data processing, and multi-user integration are available with the current CFSS hardware. However, the

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integration of Portal with the current systems will require two additional servers and one additional IT staff.

Portal includes state of the art encryption software and security. In order to access Portal, CFSS internal users, external users (e.g. physician access from their homes), and patient users will require access to computer systems with the following specifications: Operating systems such as Windows XP, Vista, Windows 7, or Mac OS X; Web browsers such as Internet Explorer, Safari, or Google Chrome; Adobe Flash Player, and Adobe reader. Any processor greater than 1.2 GHz, display resolution of 960x600 or higher, and Internet access are also required. All computers in use at CFSS meet these minimum requirements.

CFSS currently has IT resources and expertise that will be used in the implementation and maintenance of Portal. This includes the Chief Information Officer and CFSS IT Team leaders. Thus, in regards to technical feasibility, it will be both beneficial and practical to initiate Portal at CFSS.

3.2 Operational Feasibility

Operational feasibility is presented as an analysis of the components affected by Portal implementation, use, and maintenance. As the outpatient clinics and the hospitals already have EMRs, there are no barriers to access Portal by clinic or hospital staff. Furthermore, since all physicians and staff already have basic computer skills to use the EMRs, they should not have any difficulty using Portal. Nonetheless, these groups will need time set aside for education on using Portal. Additional costs have been budgeted for staff training purposes. Group and individual education will need to be available frequently during the roll out period to ensure all users are rapidly trained on use of Portal and its applications.

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The entire installation, implementation, education, and go live phase will be completed within one year, and is defined in section 1.4: Implementation/Rollout Plan. This timeframe enables CFSS computer systems to rapidly integrate CFSS EMRs, and provides CFSS with state of the art patient and physician electronic communication. CFSSs primary goals for Portal are integration of the EMRs and to provide CFSS with encrypted access for physicians, outside providers (labs, radiology, pharmacies), and patients. At this point, we must assume Portal will be effective in reaching these goals as demonstrated by our due diligence with the vendor and the two separate site visits to St. Judes Health and Doctors Medical Center. Additional programming to personalize Portal functions for CFSS will allow us to reach one of our primary goals of automatically populating both EMRs with clinical results and reports, including notifications (flagging) to healthcare providers. The physicianto-physician and patient-to-physician communication is a basic email system using EMR templates, and automatically downloads to the patient EMR. This system will allow our providers electronic communication with each other and their patients. Ongoing support and maintenance of portal is feasible with CFSS IT staff and vendor technical support. Portal staff will be on-site for the implementation and roll out. The Portal contract has provisions for continued technical support for five years, which ensures Portal will continue to function properly, to receive routine updates and maintenance, and meet CFSS needs. In addition to this prolonged support from the vendor, the Portal ICAC will need to redefine itself after the roll out period is completed. It will become the Portal Advisory Committee (PAC). The new committee will be responsible for reassessment of Portals functions. This will

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include identifying weaknesses and identifying new modules or applications for our health system. This committee will use dashboards to monitor Portals effectiveness. Patients will access Portal through CFSSs existing website. Portal will not work for patients who lack computer access or for those who are unable to use computers. However, because of the user friendly website with easy to find help, even novice computer users will be able to access their medical record and contact their physician. Our existing call center will be able to answer patients web navigation questions. Our IT department will hire two additional FTEs in order to meet the ongoing technical support needs of Portal users.

3.3 Economic Feasibility

The economic feasibility will depend on comparing the cost of Portal and the potential revenue and/or savings of using Portal. The cost includes implementation and ongoing maintenance of Portal. The implementation costs consist of license fees, hardware, manpower required for implementation, and the initial training. Additionally, there are maintenance costs, which includes software and website maintenance, ongoing staff training, and customer support.

Implementation Costs

CFSS considered the monthly license fees of $60 per hour per provider versus purchasing the license for a one-time fee of $2,000 per provider. With 100 physicians and 20 mid-level providers, the decision was made to use the purchase price of $240,000 in the analysis. The license will allow Portal to integrate with the current practice management program and provide immediate access to on-line scheduling and billing. There is a vast infrastructure already in place, but two new servers will be added and dedicated to Portal. The servers will provide rapid

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flow of information through the interfaces and modules, which can be added to Portal. Each interface will currently cost $100,000 and CFSS has chosen four interfaces at this time. This will allow the hospitals EMR, clinics EMR, CFSS website, and educational database to connect to Portal and access labs, x-ray, pharmacy which are already integrated into each EMR. This provides the opportunity for data to flow in any direction through Portal.

Furthermore, CFSS has selected three modules, at a cost of $50,000 each. These include Econsult, marketing, and data reporting modules. The modules, along with the Portals integration with billing and scheduling, will provide financial and quality benefits for CFSS.

The actual implementation is estimated to require 500 vendor hours at a cost of $300 per hour. Training costs include formal training and a loss of productivity from staff while learning to use Portal. This is estimated for 400 hours at a cost of $125 per hour and includes superuser training. All of these costs are summarized in Table 1.

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Table 1: Initial Cost of Implementing Portal

CATEGORGY LICENSES HARDWARE INTERFACES ITEM Portal License 2 Servers Portal to Hospitals EMR Interface (for physicians) Portal to Clinics EMR Interface (for physicians) Portal to website interface (for patients) Portal to Education Database interface MODULES E-Consult module Marketing Module Data Reporting Module IMPLEMENTATION TRAINING TOTAL 500 hours 400 hours COST PER UNIT $2,000 /provider $20,000 $100,000 $100,000 $100,000 $100,000 $50,000 $50,000 $50,000 $300/hr $125/hr TOTAL COST $240,000 $40,000 $100,000 $100,000 $100,000 $100,000 $50,000 $50,000 $50,000 $150,000 $50,000 $1,030,000

Maintenance Costs

Maintenance costs include yearly cost charged by the vendor, the need for increased internal IT personnel, and the addition of a clinical nurse with Health Information Technology (HIT) training. The vendor will charge 20% of the initial license fee as the yearly maintenance cost to provide updates and external support to keep Portal functional. In addition, CFSS will increase the internal IT department by adding another IT specialist dedicated for on-site Portal issues at a cost of $80,000 per year. The HIT clinical nurse will oversee the education database and will cost $100,000 per year. These costs are summarized in Table 2.

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Table 2: Maintenance Costs

ITEM Vendor Charges (for Maintenance) IT Personnel Clinical Nurse (HIT Trained) TOTAL SPECIFICS COST (per year)

20% of initial license fees One additional IT specialist will be added to current IT department Will develop and maintain educational database

$48,000

$80,000

$100,000 $228,000

Potential Revenue and Savings

As discussed previously, there are multiple benefits of implementing Portal. We have discussed the potential for increased quality of care through rapid access of medical records and the opportunity to engage patients in education of their illnesses. There is also potential for increasing revenue and decreasing operating costs. CFSS had annual revenue of $750,000,000 for the past year. Portal is projected to slowly increase CFSSs market share, and starting in the second year, this will increase revenue by 0.1% per year. The online bill-paying capabilities will avoid lost bills, missed payments, and help to collect on bad debt, which will further increase revenue. However, the contribution margin for CFSS is 20%, thus not all of the increased revenue will be available as cash flow. The calculations are shown in the attached Excel spreadsheet (Appendix A) and summarized in Table 3. CFSS is a non-profit organization; therefore, taxes are not included in the analysis.

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E-consults will provide intangible benefits but no definitive financial benefits at this time. Patients ability to request on-line refills and access parts of their medical record will decrease phone calls to providers by 20%. The online scheduling capabilities will decrease calls to schedulers by 30%. Additionally, as providers begin to send results electronically, postal costs will decrease by 20%. These savings will begin in the first year and will eventually plateau.

Based on the above projections, initial implementation costs and ongoing maintenance costs, the net cash flow and cumulative cash flow can be calculated. Although the net cash flow is estimated to be positive after the second year, the cumulative cash flow will show gains in the fourth year. These calculations are performed on the attached Excel spreadsheet (Appendix A) and are summarized in Table 3.

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Table 3: Calculating Cash Flows

IMPACT OF PORTAL Revenue from increased market share Revenue from collecting on bad debt Total increase in Revenue due to Portal Contribution Margin -20% (Cash Flow from Increased Revenue) Savings from decreased patient phone calls to provider Savings from decreased patient calls to scheduler Savings from decreased postal costs Implementation Costs Year 1 $0 $0 $0 Year 2 $750,000 $700,000 $1,450,000 Year 3 $1,502,900 $800,000 $2,302,900 Year 4 $2,261,259 $900,000 $3,161,259 Year 5 $3,027,657 $1,000,000 $4,027,657

$0

$290,000

$460,580

$632,252

$805,531

$30,000

$80,000

$100,000

$100,000

$100,000

$45,000 $50,000

$90,000 $50,000

$120,000 $50,000

$120,000 $50,000

$120,000 $50,000

$1,030,000

$0

$0

$0

$0

Maintenance Costs

$228,000

$228,000

$228,000

$228,000

$228,000

Net Cash Flow

($103,000)

$282,000

$502,580

$674,252

$847,531

Cumulative Cash Flow

($1,133,000)

($851,000)

($348,420)

$325,832

$1,173,363

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Cost-Benefit Analysis

Utilizing the above tables, a Cost-Benefit Analysis can be performed. Payback Period is calculated using the following formula.

Payback Period = number of years prior to full recovery + (unrecovered cost at start of year / cash flow during full recovery year) Payback Period = 3+ (348,420 / 674,252) = 3.52 years = 42 months Thus, it will take CFSS 42 months to recover the cost of implementing Portal. Payback period analysis does not take into account cash flows beyond the payback period and ignores the time value of money. Given these limitations, further analysis was performed using the attached Excel spreadsheet (Appendix A).

Net Present Value (NPV) for five years was calculated to be $587,774; Internal rate of return (IRR) was 21%, Modified Internal Rate of Return (MIRR) was 17%, and the Profitability Index (PI) was calculated to be 1.6. These calculations, along with the estimated payback period of 42 months, confirm that implementing Portal is economically feasible and financially advantageous over a five-year period.

3.4 Organizational Feasibility

Now that the immediate pressing issues of stability and improved workplace morale have been addressed, Dr. Segha and the executive leadership team would like to concentrate our organizations attention on being the first healthcare system in our area that has a fully integrated Portal system. The strategic importance of this endeavor cannot be overemphasized as successful implementation will not only allow us to serve our patients more effectively, but also increase

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our current market share by focusing marketing efforts on easy access to care and emphasize our state of the art care and resources.

As a result of his proven track record, Dr. Segha has the full support of the Board of Trustees and the Board of Directors who share his vision of leading our system to the forefront of quality care. The Information Technology era is rapidly changing the face of healthcare. A strong organization must be prepared and willing to be on the cutting edge of health information technology. Due to our strong physician leadership at all governance levels, the implementation of Portal has full backing from the entire organization.

Commitment to Portal is evidenced by formation of the ICAC and the Portal Oversight Committee. Dr. Segha and our Chief Medical Officer, Dr. Ben Nevolent, have already met with the entire staff. The Chief Nursing Officer has met with her nursing leadership team, who in turn has met with their nursing staff. Likewise, leaders such as the Director of Respiratory Services, the Director of Pharmacy, the Director of Finances and the Director of Scheduling have met with their respective teams. A total of 40 employees and 10 physicians have shown concern about their ability to use Portal efficiently. However, none of these healthcare providers have expressed resistance to change. Additional coaching sessions have been planned to assist these providers in Portal use. The IT staff will be increased to provide support during implementation, rollout, and maintenance of Portal. By being proactive and encouraging open discussion, our organization is truly prepared for Portal implementation.

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4. ANTICIPATED VALUE TO STAKEHOLDERS

4.1 Tangible Benefits
There are multiple tangible benefits gained from Portal. Portal has the potential to improve quality, increase patient safety, reduce length of stay, increase efficiency, and improve financial returns. The traditional view of return on investment compares the financial impact of operating costs to the revenues and savings gained from any given service. As shown above, Portal will increase revenue and savings, thus giving the project a significant return on investment.

Tangible benefits of reducing costs can be obtained through reduced length of stay, reduced transcription cost, decreased paper-chart related costs, and improved staff efficiency. Patient selfscheduling and decreased number of phone calls to providers can decrease salary expenses over time. In addition, a substantial decrease in paper and postal supplies is anticipated due to fewer preprinted educational materials, the electronic use of appointment reminder notifications and decreased reliance on the US Postal Service. Tangible benefits that are revenue enhancing include increased income through improved coding, improved charge-entry accuracy and improved provider productivity. In addition, effective and targeted marketing will help to increase our market share, which will translate into increased revenue.

Reduction in hospital length of stay results from timeliness and completeness of clinical data that produces quicker diagnosis and treatment. There are also improved organizational efficiencies through the prevention of duplicate testing and cost reduction from decreased administrative, clinical staffing and resource requirements. Portal will enhance revenue by improving billing and charge capture as well as improving on productivity gains through decreased medication distribution and reduced radiology turnaround times.

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The clinical dimension of return on investment is attained through better adherence to clinical protocols and clinical decision-making. Increasing outpatient preventive quality measures reduces morbidity and mortality in patients, and thus reduces the costs to treat these conditions. Enhanced standardization of inpatient care also increases numerous core and quality measures, and reduces length of stay, readmissions and complications. An additional benefit of standardizing care is a reduction in the number of malpractice claims. Furthermore, by decreasing the number of claims, it may be possible to renegotiate CFSS Healthcares malpractice insurance premium rates.

Improved adherence to medication recommendations, simplified physician referrals, and increased capture of billable expenses are other tangible benefits. In addition, improved quality of patient outcomes, through flagging alerts as well as clinical decision guidelines, reduce medical errors, morbidity, and mortality. The resulting savings can also be found in a reduction in medication errors, adverse drug reactions, and an increase in cost-efficient drug selections.

4.2 Intangible Benefits

Portal will provide immense intangible value to the physicians and staff by uniting all branches of CFSS Healthcare and giving CFSS a new cohesive identity. In general, large health systems live and work in silos. This is best exemplified by the current manner in which outpatient primary care physicians (PCPs) obtain inpatient data. Historically, they rarely communicate with the inpatient care team beyond faxed results and dictated summaries. Portals seamless connection of the outpatient and inpatient EMR, along with all the other interconnections of the patients clinical records, becomes the virtual heart of CFSS. This will redefine CFSS as a united organization providing continuous comprehensive personal care to each and every patient,

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whether the patient is a five year old getting their school physical or an octogenarian being discharge to assisted living. Portals connections will allow higher quality and more personal and timely care, thus patients and CFSS care team will also experience more value and satisfaction. CFSS will no longer be a group of silos, but will be one entity living its vision to provide high quality comprehensive care. This united communication provides additional intangible value to all providers, mostly because of improved efficiency and time saved for staff and physicians. There will be immense time saved for physicians communicating via E-consults, reducing repeat phone calls and difficulties deciphering each others handwriting. Reducing duplication of labs and tests also saves time for the patient and the providers and reduces adverse outcomes that result from false positive tests. Electronic prescriptions are another time saver for patients and physicians. Direct integration with CFSSs educational site not only saves time for providers via decision support and immediate online access to clinical resources such as Up to Date.com, it also enables physicians to provide higher value care (higher quality in less time).

Patients will experience improved value and time saved by using electronic scheduling and emails with their physicians. These time savings will also be experienced by all the staff who handle scheduling and phone calls.

The result of all these intangible efficiencies and time saved will increase staff and patient satisfaction. But more importantly, Portal enables all providers to bring one of CFSSs ultimate values to the patient- an opportunity to increase direct, face-to-face patient care.

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4.3 Organizational Impacts

CFSS Healthcares key stakeholders include patients, staff, physicians, Board members, investors and CFSS organizational executives. There are many important reasons that Portal should be implemented and these include the items discussed under the Tangible and Intangible Benefits sections. Our SWOT analysis revealed that while CFSS has many strengths and opportunities in the era of healthcare reform, we are also faced with significant external threats that can further compound our weaknesses. However, due to our strong model of physician involvement and the proven accomplishments of our physician-led executive team, we are perfectly positioned to successfully implement Portal. Specific organizational impacts before and after implementation are discussed below.

Impact of Development and Implementation Phase

Rapid and detailed communication to all team members will be imperative throughout the various phases of Portal implementation. Therefore, an effective plan for timely communication is a mandatory prerequisite. A clear timeline, an explanation of the training process, and an honest evaluation of the workload changes should also be openly disseminated in order to alleviate any preconceived barriers to successful implementation. Town hall meetings will provide a medium for staff communication and education. Additional resources have already been allocated for the necessary IT personnel to assist Portal CFSS users and patient access. The bilingual librarian will further enable patient access to Portal.

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Impact of Post-Implementation Phase

The role of marketing cannot be underemphasized, as patient utilization of Portal is the key to increasing market share. Ongoing funding for Portal marketing should be an integral part of CFSSs budget. The best method of ensuring patient use is by completely engaging the staff. If the staff is convinced that Portal will be beneficial to the patient, their enthusiasm will be sincerely conveyed to the patient.

Post implementation work flows should also be evaluated as there is learning curve to any new system and physicians and providers will become discouraged if they are delayed in providing patient care and face the risk of decreased revenue. Ultimately, provider efficiency will increase due to the decreased number of patient and other provider phone calls per day and improve availability of results. Furthermore, Portal will increase the ease of communication with patients about their diagnostic results. Each provider will need to evaluate which results can be transmitted electronically and which results require in-person reporting.

5. CONCLUSION
CFSS would like to be at the forefront of health information technology through the Portal initiative. Portal will transform CFSS into a united cohesive organization and will provide patients access to their providers, their personal health record, and to CFSSs robust education website. The SWOT and feasibility analyses suggest that CFSS should move forward with Portal implementation. Portal will allow us to better serve the needs of our patients and will ultimately improve outcomes by rapid and streamlined patient-focused quality care. CFSS remains committed to our primary mission of providing exceptional care, one patient at a time.