Discussion Replys (100 words each)

Discussion 1:

A health care organization has a vested interest in patient privacy and safety as well as a vested interest in profit, loss, and expansion. You are tasked with transitioning your organization to a new electronic health record. Identify the four outcomes of vendor negotiation.

Negotiation is the “process of bargaining with another individual”¹. The vendor is the one that sells and the customer is the one that buys the goods and/or services from the vendor. When it comes to vendor negotiating, there are four possible outcomes. First is when both parties, the vendor and seller, win, where both parties meet each of their own and shared needs. The second is where the salesperson wins, while losing the customer, and third is when the customer wins, but the salesperson loses. Lastly, the fourth outcome is when both parties lose and no sales are made. Since customer-vendor relationships “occur over a continuum of time” ¹, and is a “symbiotic relationship” ¹, where both parties benefit from each other, a win-win situation for both ends is the most desirable.

Expand on what steps you would implement to achieve the best outcome possible for the electronic health record investment.

Electronic health record systems “can compromise data integrity and confidentiality for the sake of greater business efficiency”². Teams creating EHR systems will face ethical issues that relate to technology, privacy and confidentiality, patient care quality and organization goals and advocates ². Therefore, the HIM professional needs to do the following to achieve the best outcome possible for the EHR investment.

• Create an RFP or request for proposal: A RFP is a formal document that is used for the acquisition or use of hardware or software¹. The RFP should have compliance risks associated with possible laws, rules, and regulation violations. It should identify operational risks “such as loss of data resulting in privacy issues or losses from failed processes or systems” ¹. Having an RFP gives the organization a bargaining power and it will serve as a a reference for future problems.
• Enhance vendor relationships: Since relationships with vendors are not a one time event, it is the organization’s best interest to enhance their relationship, by interacting more with the vendor, providing good and bad feedback, sharing statistics on improvements and customer satisfaction,etc.
• Have a clear, concise, yet detailed negotiation contract: The contract should be specific when it comes to the scope of services or products, expectations, standards set by appropriate experts, confidentiality, warranties and liabilities, technical and business requirements, and complaint or dispute resolution procedures¹. It should have SLA, or service-level agreements, which covers the performance of the product and the vendor.
• Create a corporate compliance program: Both ends need to establish a compliance program that promotes ethical and responsible behavior, and the values of the company.

1. Olenik K. Chapter 24: Vendor Management. In Laurinda Beebe Harman and Frances Cornelius. Ethical Challenges in the Management of Health Information, 3rd Edition (p.631-660). Burlington, MA: Jones & Bartlett Learning. 2017.

2. Cornelius FH, HArman LB, Mullen VL. Chapter 26: Future challenges and opportunities. In Laurinda Beebe Harman and Frances Cornelius. Ethical Challenges in the Management of Health Information, 3rd Edition (p.703). Burlington, MA: Jones & Bartlett Learning, 2017.

Discussion 2:

Part 1:

The four outcomes of vendor negotiation include:¹

1. Lose-Lose: Both sides were unwilling to compromise and the deal is lost
2. Win-Lose: One-sided battle where only one party receives benefits
3. Stalemate: Both sides aggressively defend their positions and no side wins or loses
4. Win-Win: Both sides are satisfied with their interests and needs met

Part 2:

The first step I would do is assess the needs of my health care organization, which is to have an EHR vendor that will protect patient privacy & safety and support expansion. I would then create a list of non-negotiable criteria that I would have for my ideal vendor and use that to help in my selection. Next, I would research EHR vendors and evaluate their accomplishments, references, costs, technical standards, implementation and integration strategies, and short and long term investments.

After selecting an EHR vendor, I would obtain their proposal and review their terms. If the vendor is non-negotiable, costly, and does not meet my organizations needs, I would decline their services and seek other EHR vendors. If there are vendors willing to negotiate, I would request a list of contractual documents from them. From there, I would confer with a healthcare consultant and healthcare attorney for legal advice, and outline a list of things that I feel need to be discussed or negotiated (cost, performance, training & support, integrity, cybersecurity, etc.). After negotiation and careful consideration, I would ensure that both of our needs are met and that we reached a balanced agreement for a win-win.²

References:

1. Gardenier M, Olenik K. Chapter 23: Entrepreneurship. In Laurinda Beebe Harman and Frances Cornelius. Ethical Challenges in the Management of Health Information, 3rd Edition (p.597-621). Burlington, MA: Jones & Bartlett Learning, 2017.

2. CokerGroup. Vendor Selection and Negotiating EHR Vendor Contracts. Published Aug 9, 2018. Available from https://cokergroup.com/vendor-selection-and-negoti…

Discussion 3:

Four Types Of Negotiating Outcomes:
Lose-Lose: Neither side achieves a desirable result. Both parties are worse off. Failed negotiations are frequently lose-lose.
Win-Lose: One side of the negotiation profits at the other’s expense. One side of the negotiation comes out ahead.
Stalemate: Neither side wins or loses and after a long negotiating session, both sides are at the exact same place that they started off at
Win-Win: The negotiators find mutually beneficial common ground. Both sides are in a better position than before the negotiation.¹

The benefits of electronic medical records in outpatient practice include improved patient care and office efficiency, as well as potential financial benefits. Obstacles to electronic medical records include costs; lack of standardization of EHR products for large practice environments and design of supplier systems; resistance to change; initial difficulties in system use leading to reduced productivity; and accrued benefits to society and payers rather than providers.² 10 steps for successful implementation of electronic health records (EHR): 1) establish your electronic health record (EHR) implementation team; 2) prepare software; 3) determine your hardware needs; 4) consider the layout of the patient’s treatment room; 5 ) Transfer data; 6) Create workflow; 7) Prepare for occasional failures; 8) Develop a training plan; 9) Determine how to start-“Big Bang” or incremental? 10) Collect feedback for continuous improvement.³

References:

1 Harman LB, Cornelius FH, eds. Ethical Health Informatics: Challenges and Opportunities. Burlington, MA: Jones & Bartlett Learning; 2017

2 Ajami S, Bagheri-Tadi T. Barriers for Adopting Electronic Health Records (EHRs) by Physicians. Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766548/. Published 2013.

3Hodgkins M. Electronic Health Record (EHR) Implementation. AMA STEPS Forward. March 2015. https://edhub.ama-assn.org/steps-forward/module/2702512.

Discussion 4:

Question 1:

Types of outcomes that may take place at the conclusion of a negotiation are the negotiation outcomes. All the negotiations wind up with one of four potential results: one side wins and the other loses, both parties lose, fail or gain. Obviously, the aim of cooperative negotiations is to fulfil both party’s needs. Get to know the four possible outcomes of the negotiations and make it your goal to obtain a mutually beneficial outcome.

• Lose-Lose:

Ego is interested in this kind of result that thwarts the negotiation process. Both sides take their positions and are reluctant to negotiate. Ultimately, both sides lose in the deal. The outcome gives rise to animosity between the two sides and it is unlikely that they will ever meet again. For example, A trade union declined an offer and went on strike before demands had been met. This form of bullying technique is rejected by the organization and its status is not budgeting. Finally, workers return to work without a rise and loss of income, and the corporation loses a great deal of profits, and customers lose because they have to raise rates to pay for their losses.

• Win-Lose:

One side win and the other side loses in this kind of result. With a win-lose result there is no compromise. It is a one-sided battle, with all your needs on one side, and none on the other. Although the winner can be very happy about the result, the loser is very resentful about the deal because they did not meet any of their needs. It generally ends all possible talks and ends the relationship. For example, In win-lose negotiations, a street battle is the ultimate. There is one group which wins with physical violence and the loser has no choice but to be defeated.

• Stalemate:

Neither side wins nor loses with such a result and both sides are exactly where they started after a long negotiation session. It is because you cannot deal with desires and roles alone. Stalemates arise when both sides defend their positions in an offensive manner when both sides cannot make a difference. The dealer quotes a price too high for you. For example, You buy a car and you quote. You are reluctant to make a budget and the salesman is reluctant to accept his quote. You then leave the dealership to find another dealer and the seller moves to the next customer.

• Win-Win:

This is the kind of outcome you aim for when negotiating on Lane. Both sides are moving away from their goals and needs in this sort of outcome. Both sides are happy that they are leaving the negotiation table as they are more than they had started. Relationships are established because the two parties cooperated to find a reasonable solution to the problem. This finding further increases confidence in future talks between the two sides since the partnership has been successful. For example, A hostage agent decides to surrender and release his hostages with the Police negotiator. The negotiator agrees that the SWAT team will not open the doors or kill the hostage agent, in exchange. In this case, the hostage agent takes care of his survival needs and the negotiator is satisfied without any bloodshed with his needs to avoid the possible deadly confrontation.

Bibliography:

1. Loo T. What Are The Four Types Of Negotiating Outcomes? Accessed from http://negotiation234.50webs.com/51763.html

Question 2:

In clinical settings the use of electronic health records (EHR) is considered crucial to a health-care system based on a patient. In primary care practices however, uncertainty in cost recovery remains a major concern in EHR investment. Due to the difficulty of the majority of EHR projects, this study has followed a retrospective, multi-stage design, mixed methodology approach. Data from community primary health care clinics with EHR systems were collected. It was found that EHR can have a good ROI for primary care clinics. The analysis of the time variance needed for cost recovery from EHR investments shows that when an EHR is introduced, a positive ROI does not immediately emerge, and the clinic continues to play its role in exploiting the EHR for the improvement in the process. Potential policies that support the success of EHR-enabled modification in primary care practices may ease the realization of positive ROI from EHR in primary care practices such as support to clinical workflow optimization through EHR.

Bibliography:

1. Jang Y, Lortie MA, Sanche S. Return on investment in electronic health records in primary care practices: a mixed-methods study. JMIR Med Inform. 2014;2(2):e25. doi:10.2196/medinform.3631