Background
Many businesses have thrived due to the integration of information technology with business operations in the companies. This technology can bring about a lot of change in the company based on how operations run and how projects are carried out. However, integration of this technology is not implemented if the company executives don’t prove that it could lead to the generation of benefits or return of investment (ROI). New technology could also lead to a competitive advantage for these industries if used well. Delays by the company executives of approval as they await this technology to be implemented in other companies could lead them to this loss. Therefore, this problem is solved by developing a good business case that shows the benefits, costs, and risks of using this new technology. A good business can show chief financial officers and chief technology officers in an institution whether funding a particular information technology investment could lead to a return of investment.
Introduction
Business cases alone are a solution only if the benefits of the IT investment are achieved, leading to the project’s success. Studies have proved that many IT investments are not delivering the benefits stated during the project’s start, especially if they set unachievable ones. Such benefits are mostly stated and exaggerated so that people in charge of implementing the project can obtain funding from the executives. After researching how various industries implement IT business cases, an approach with six stages has been used to help identify the costs, risks, benefits, and return on investment comprehensively.
The total cost of ownership framework also helps compare, understand, and manage direct and indirect costs involved during the implementation of these investments. Using TCO, industries can emphasize direct costs and minimize indirect costs. Developing TCO may be complex, especially if the organization using the technology becomes very large. TCO measures the expenses brought about by acquiring these investments and then provides a way to minimize these costs, obtaining all expenses that could be unrecognized as the plan for investment was being made. By combining the six-stage business case approach with a total cost of ownership framework, costs and benefits are obtained to prove whether implementing a project can succeed in terms of investment return.
NYU Langone Medical Center
NYU Langone Medical Center is famous for offering the best clinical care, medical education, and research in biomedical areas due to its quality patient-oriented services, which distinguish it from other centers worldwide. It comprises four different hospitals that offer treatment for various categories of people and illnesses. Apart from these hospitals, it also has a school providing education for physicians and scientists who have helped in Laura and Isaac Perlmutter Cancer Center. This medical center generally teaches, serves, and researches patient care issues and offers suitable medication. NYU Langone Medical Center has had the slogan “technology first,” which has led to the expansion of the enterprise with the help of technology (Wood, 2019). Recently, the Electronic Health record has been put into place and has helped by laying out the technological infrastructure in the medical center. However, technology has not been fully implemented in the institution, which has led to the subsequent implementation of IT investments. The paperless patient registration project was implemented and became a success in 2016. This paper is a business case for the NYU Langone Medical Center.
Step 1: Business Drivers and Investment Objectives
NYU Langone Medical Center has been having a problem registering patients using clipboards and blank forms before undergoing treatment. Often, a patient visiting the hospital several times repeats the same process of filling out blank forms, including with the birthday and name on them placed on a clipboard. The process is very repetitive and wastes a lot of time for most people attending the hospital. One of the patients who received treatment in the hospital was made to fill the forms multiple times the same day and wondered why the hospital didn’t know that he had repeated the process. Before attending the hospital, they had to book appointments, and the hospital staff needed the exact details. Besides being tedious, this registration process was also costly and time-consuming for patients who required immediate medical attention (NYU Langone Medical Center, 2018). There could always be a queue as people fill out their names on the blank forms.
External and internal drivers are evident in this situation. To maintain a competitive advantage over other medical institutions, NYU Langone Medical Center had to implement the paperless patient registration project that could make them outstanding from competing hospitals. This competition from other hospitals is the external driver. The internal driver was brought about by a patient who battled cancer for some time who, after making many observations on the filling of papers again during the same day, wanted to know why the hospital hadn’t recognized him. He realized that no system could replace the tedious and repetitive process and decided to change the experience by reaching out to his colleagues at NYU Langone and Samsung. However, the patient found a solution with the help of Hyland that the hospital needed the paperless patient registration project that required the use of tablets to replace clipboards and blank forms.
The primary investment objectives for the project were as follows:
- To minimize the cost of using the blank forms each time a patient comes for an appointment with a doctor.
- To improve customer experience by reducing the amount of time spent filling in forms for each patient who has an appointment with a doctor, especially for patients who require immediate attention.
Step 2: Identify Benefits, Measures, and Owners
The paperless patient registration project offered many benefits that helped them achieve their goal for initiating the IT investment project. Time spent waiting for an appointment with the doctor could reduce since the repetitive registration process using blank forms and clipboards consumed most of it. The time spent during the registration process could be measured using the tablets used in the registration process. This time reduction also benefits from increasing the number of appointments made in one day with a particular doctor. It could lead to increased revenue for the NYU Langone Medical Center. The finance department could approve of this and would be used to measure these benefits.
Secondly, there would be a lot of patient satisfaction as the hospital shifted from using paper forms to a user interface on the tablet. This satisfaction would be brought about by patients not having to repeat the process of registration over and over and the stress of writing on a paper while in dire pain for the patients that would seek immediate medical attention. Satisfaction in using the paperless system would be measured by the receptionist, who would provide the patients with the tablet in the first place. She would observe the patients using the tablet while asking them questions about their experiences. It would give immediate and practical feedback to the hospital.
The third benefit experienced is that the registration process became less hectic for the patients using the paperless system and for the registrars who were required to scan and index registration forms for each patient who had an appointment. This benefit would be measured by the registrars who were no longer needed to deal with hard copies by keeping several registered patients in a working day. An increase in the number of patients served would prove that the process was not as hectic. Also, using the paperless patient registration system would help integrate this system with the Electronic Health Records, which had been set up before. Doctors using the EHR system would distinguish new patients from old patients just by typing the patient’s name in the EHR system. Data in the registration system is linked with the one from the EHR system making the whole process easy for the doctors if they need more information regarding a patient. The amount of time required to access the patient’s full details will be a measure of this particular benefit.
Lastly, paperless technology could save the hospital a lot of money required to produce the paper forms used for the registration of the patients (Lulejian & Cantor, 2018). It would be measured by the financial department based on the amount of money spent in all hospitals in NYU Langone Medical Center. Storing these paper forms and accessing them also poses a problem for the current paper registration system. Implementing this technology would be exceptionally advantageous since a paperless system would only require a virtual database to store patient details.
Step 3: Structure the Benefits
The benefits of using the paperless patient recording system can be structured into different categories, as seen in the structure table below. Some of the other benefits structures listed include: quantifiable, observable, measurable, and financial (Caldeira et al., 2012). Evidence is required when structuring the benefits of a proposed system to ensure that they coincide with the return of investment. It makes the business case development stronger. However, based on surveys done by ward et al. (2008), many industries do not show evidence relating to a particular benefit which makes their business cases disregarded by the executives in those companies.
In our case, the benefits given in the above section have been structured categorically. Patient satisfaction and integration of health records into the system are observable benefits. The less hectic registration process leads to an increase in the number of patients registered in a single day, which is a measurable benefit. Reduction of time used also led to an increased number of patients, which led to an increase in revenue generated within a single working day. This increase in revenue renders it a quantifiable benefit. The use of paperless technology leads to minimal use of papers in the hospital which is also a financial benefit in terms of saving on the amount of money used to produce them. While structuring the benefits, one must also state the business changes that ensure there are benefits in the proposed business case, as we shall see in the structure table.
Step 4: Identify organizational Changes enabling Benefits
When designing a robust business case, organizational changes that bring about benefits are also required. As Ward et al. (2008) explained, we see that help for the business case can be categorized into doing things better, stopping doing something, and doing new things. The paperless patient registration system is mainly implemented to avoid registering repetitively, increase the number of patients and provide better patient satisfaction categorized underdoing things better. As for stopping doing something, registration using blank forms was unnecessary since the new system performed the same purpose as these forms effectively and efficiently. Registrars were required to scan and index these paper forms in the former scenario; bringing in this new technology favored them by reducing their load hence reducing the time spent. It was also categorized under stop doing things.
Step 5: Determine the Explicit Value of each Benefit
Explicitness in the value of the benefits to the medical center is of great significance. Gifts that are structured in terms of financial weight and measure are more direct, unlike observable benefits. The economic value brought about by abolishing the use of paper and the increase in the number of patients registered is measurable. Furthermore, the rise in several patients leads to an increase in revenue, which can be measured in terms of revenue added per day, which is explicit. Observing patients’ satisfaction as they use the system is one type of benefit rendered as not straight.
Step 6: Identify Costs and Risks
The total cost of ownership is a critical part of a business case since it is used in managing and getting a deeper understanding of the direct and indirect costs involved in the IT investment project for the hospital (Woodward, 2017). It makes them essential in calculating the risks involved in implementing a project. Some of the direct costs involved during the business case implementation are hardware, upgrades, personnel, deployment of software and hardware, labor, and space. Likewise, indirect costs include training users, system downtime, and the inevitable change of platforms and technology. The cost and risk analysis table explains the different costs and risks involved in the process.
Conclusion
Finally, creating a business case requires that the benefits of the IT investment being incorporated into the industry be stated clearly and explicitly so that the return of investment can be understandable to the company executives. Many industries say benefits that a particular IT investment can deliver. However, few of them can realize the advantages once the business case is implemented. To develop a successful business case, one must ensure that they identify the benefits, quantify or measure them and finally review the project after implementation to know whether the listed benefits are realized.
References
Caldeira, M., Serrano, A., Quaresma, R., Pedron, C., & Romão, M. (2012). Information and communication technology adoption for business benefits: A case analysis of an integrated paperless system. International Journal of Information Management, 32(2), 196-202.
Lulejian, A., & Cantor, M. N. (2018). Measuring patient and staff satisfaction before and after implementing a paperless registration system. Journal of Healthcare Management, 63(3), e20-e30.
NYU Langone Medical Center Goes Paperless with OnBase by Hyland and Samsung. Ohio University MBA 6360. Retrieved from: https://drive.google.com/file/d/1SV2jUkKGKSrNOO4RlKufrSqxvPrlyE6_/view
Ward, J., Daniel, E., & Peppard, J. (2007). Building Better Business Cases for It Investments.” the Open University.
Wood, R. C. (2019). When information technology succeeds as good medicine and effective strategy. Strategy & Leadership.
Woodward, K. (2016). Measuring and Reducing Total Cost of Ownership. Faulkner Information Services.
Appendices
Paperless Patient Registration System Benefits
| Objective Type | Do New Things | Do Things Better | Stop Doing Things |
| Financial | Benefit: Using paperless patient registration
Measure: Saving costs and Total Cost of Ownership Benefit Owner: Finance Manager |
Benefit: No use of blank paper in the registration process.
Measure: Cash spent on the paper used per day. Benefit Owner: Finance Manager. |
|
| Quantifiable | Benefit: Reduction of time used before the appointment
Measure: Time used is measured by tablet Benefit Owner: Receptionist |
Benefit: Cessation of scanning and indexing files manually.
Measure: The amount of time spent by the registrar during daily scans and indexing Benefit Owner: Registrar |
|
| Measurable | Benefit: The registration process becomes less hectic
Measure: Number of people registered per day Benefit Owner: Registrar |
||
| Observable | Benefit: Integration of health records with the paperless patient registration system
Measure: Consecutive use of EHR with a Paperless patient registration system to confirm patient details. Benefit Owner: Doctor |
Direct and Indirect Cost of Investments
| Hardware Costs | $230000 |
| Maintenance fees | $80000 |
| Training costs | $15000 |
| System Downtime | $50000 |
| Software Costs | $400000 |
| Total | $775000 |
Explanation: The table above shows the direct and indirect costs of investments experienced with the use of IT investments in NYU Langone Medical Center in the first year.
Saved Finances for each Hospital
| The Hospital for Joint Diseases | $100000 |
| Rusk Rehabilitation | $100000 |
| Hessenfeld Children’s Hospital | $25000 |
| Laura and Isaac Perlmutter Cancer Center | $50000 |
| The dedicated inpatient Orthopedic Hospital | $25000 |
| Totals | $300000 |
Explanation: The table above shows the savings per hospital after the cessation of using paper forms per year.
Summary of Learning
When developing the business case for the NYU Langone Medical Center, I have learned that when stating the benefits of an IT investment for industry, one must have concrete evidence regarding them. It ensures that the benefits stated are achievable, unlike how the whole process is done in companies where they don’t have good experience for this task.
The 6-step approach involves comprehensive steps of evaluating the benefits for a particular investment on a company and should be used while developing any business case.
write