This case examines the adoption and implementation of an electronic health record in a regional medical center in Midwest, USA. A background of the organization is provided, including a discussion of the organization’s inception, financials, and organizational structure. A brief literature review of technology adoption, use, and performance is presented, followed by a discussion of data analysis techniques and results. A detailed overview of specific technology, management, and organizational concerns is presented along with challenges and solutions. The objective of this case is to highlight the challenges and opportunities during electronic health record adoption and implementation. The hope is that educators and students alike will appreciate the complexity of health information technology adoption and implementation through specific examples of challenges and solutions. While the information contained in this case is indeed specific to one organization in the USA, the lessons learned are broadly applicable to healthcare organizations throughout the world.
TopOrganization Background
Like so many others, the genesis of this health care organization arose due to escalating costs and advances in medical technology in the U.S. during the 1970s. In 1973, the region had two competing hospitals and the feasibility of maintaining both came into question. A seven-member Hospital Action Committee was formed to explore the possibility of merging the two hospitals. Incorporated in July of 1973, the organization began with 80 physicians on the Medical Staff and 280 licensed beds.
Since 1973, the organization has in fact evolved into a health system, comprised of many different units and facilities. In 2011, the health system is comprised of five regional hospitals, five specialty care centers (including, hospice, cancer care, behavioral health, rehabilitation, and surgery), thirty-two regional clinics, five regional care centers, home medical equipment and home medical services, and a number of partnerships and management agreements with other regional community care facilities.
The services provided by this organization span three U.S. states. As a whole, the health system demonstrated significant capacity in 2010 with a total of 88,816 inpatient days, 66,014 emergency room visits, and 2597 births. The health system has grown substantially since its beginning and as of 2010 has 4,427 health team members, $246,111,000 in payroll and benefit obligations, $59,796,000 in bad debt, charity care, and unreimbursed Medicaid payments. Table 1 shows the organization’s approximate financial summary for the fiscal year 2010 (July1, 2009 – June 30, 2010).
Table 1. Health system financial summary
| Financial Summary (in 2000s) |
| Revenue and Expenses | Fiscal Year 2010 |
| Net patient services revenue | $466,300 |
| Other operating expenses | 25,350 |
| Net Operating Revenues | $491,800 |
| Operating Expenses: | |
| Payroll and Benefits | $246,100 |
| Medical Supplies | 63,878 |
| Purchased Services | 43,595 |
| Bad Debt | 27,518 |
| Other Operating Expenses | 35,470 |
| Depreciation | 25,676 |
| Interest | 3,848 |
| Total Expenses | $446,097 |
| Net Revenue | $45,716 |