Acquisition of an electronic patient record system.

S unnybrook Health Science Centre in Toronto recently conducted an extensive cost-benefit analysis to evaluate the merits of implementing an Electronic Patient Record System. The following describes some of the calculations which were essential to the decision-making process. As a first step, the organization underwent a rigorous strategic planning process. The resulting plan identified a number of strategic reasons why Sunnybrook Health Science Centre should embark on an electronic patient record implementation process. A portion of the plan identified the stakeholders of the Electronic Patient Record and the benefits of the proposed system to each stakeholder group. This strategic plan suggested that among the benefits of the project would be improved quality of care and better risk management. Unfortunately, it was not easy to quantify specific benefits with dollar values. The costs, by contrast, were much easier to enumerate and calculate. For instance, the plan recommended a phased-in approach to the overall implementation (to last approximately five years) with a multi-million-dollar requirement applied to the project in its first year. It was generally outlined that economic benefits might be derived from more efficient patient and process management, but financial returns were not anticipated during the first five years. The Electronic Patient Record strategic plan was approved at the most senior levels of the organization. As a background, two additional systems-related challenges faced the hospital at this time. First, the year 2000 was rapidly approaching, necessitating the remediation or replacement of all non-Year 2000 compliant systems, including the mainframe patient care system. Second, Ontario hospital restructuring had begun and Sunnybrook Health Science Centre was made aware that there would be significant-systems integration challenges as a result of any proposed changes. Finally, the Electronic Patient Record strategic plan was designed to replace the main hospital clinical care systems, which were not Year 2000 compliant. Following the approval of the Electronic Patient Record strategic plan Sunnybrook Health Science Centre embarked on a vendor selection process. The focus of this process was on finding a commercially available system that multiple stakeholders agreed would meet their needs and that fitted with Sunnybrook Health Science Centre's strategic direction. At the end of this process, a vendor was selected and both Year 2000 and restructuring issues were dealt with in subsequent contractual negotiations. The next step was to obtain organizational and Board-level approval of the budget required for this project. A five-year budget was developed. Cost line …