Southwestern Hospital requires implementation of a new electronic health records (EHR) system to replace their outdated current system. A consulting team recommends purchasing the Allscripts off-the-shelf EHR product due to its low upfront costs, flexibility, and ease of use. Allscripts would streamline processes, enhance patient record tracking, and optimize efficiency at the hospital. It is designed for mid-sized hospitals like Southwestern and has a short implementation timeline. The recommendation addresses costs, benefits, risks and mitigation strategies of both in-house and off-the-shelf options. Allscripts is shown to successfully address Southwestern's needs while mitigating common implementation risks.

1. Southwestern EHR Implementation Project
Student International Business Council
University of Notre Dame
December 2, 2016

2. Fall 2016 Deloitte Consulting Project Team
Andre Elbling
Finance
Class of 2019
Jasmine Madrigal
Finance & Psychology
Class of 2019
Chris Jung
ITM & Chinese
Class of 2018
2
Frank Chung
Accounting
Class of 2019
Arturo Prestamo
Mechanical Engineering
Class of 2019
Marina Hrosz
Finance & ACMS
Class of 2019
Matteo Muehlhauser
Political Science
Class of 2019
Kibaek Lee
Accounting
Class of 2018

3. Case Overview: Southwestern Hospital requires the
implementation of a new EHR system
3
What Who
How Why
• Assist upgrade in Electronic Health
Records
• End-to-end plan
• Current system is outdated,
inefficient and lacks robustness
• Streamline core business processes
• Enhance patient record tracking
• Optimize efficiency and
performance in hospital
• Southwestern Hospital:
• Chicago-based
• Change averse
• Understaffed
Significant volunteer staff
• Proposing software solution and
implementation strategy
• Outline requirements and risks of
method
Considerations
Cost, ease-of-use, flexibility, scalability, reporting and
forecasting capabilities

4. 4
Executive Summary
Recommendation
Southwestern hospital should purchase the Allscripts product, an off-the-shelf EHR solution
with low upfront costs, huge flexibility, and systematic simplicity.
Analysis
Definition of EHR Types of Product Implementation
Benefits Risks In-House
Off-the-
Shelf
Risk
Mitigation
Staff
Training
Allscripts

5. 5
Recommendation
Southwestern hospital should purchase the Allscripts product, an off-the-shelf EHR solution
with low upfront costs, huge flexibility, and systematic simplicity.
Analysis
Definition of EHR Types of Product Implementation
Benefits Risks In-House
Off-the-
Shelf
Risk
Mitigation
Staff
Training
Allscripts

6. Southwestern’s new EHR system should increase the efficiency of health record storing processes, yet
needs to be customized for change-averse employees to avoid potential malfunctions caused by
inexperienced manipulation of the system.
6
Successful EHR implementation should satisfy the specific
expectations and preferences of the client
Sources: School Health Center
The client is looking for:
New EHR system is
expected to:
The client additionally
prefers:
- A system that is not
prone to user-entry
errors and poorly
structured data
- A system that does not
include the
complicated manual
processes of the
hospital’s current
system
- Improve current
operational efficiency
and customer-based
relationships
- Introduce the user-
friendly training
materials
- A system that requires
minimal amount of
staffs, as the current
health record database
department is
understaffed
- A system that is not too
much different from the
current system, as the
staffs are accustomed
to the old system and
change-averse

7. Source: Allscripts
Today’s web-based EHR will change the way health record
is shared and boost the data accessibility
7
Benefits of
Web-based
EHR
C. User Friendliness
- Most web-based EHR
system offers mobile and
desktop applications on
Apple and Windows
devices
- Users can easily be
added onto the existing
technical infrastructure
A. Mobile Integration
- Integrate all types of
mobile devices,
including phone, tablet,
and laptop computers
- Users can manage daily
activities and updates
status remotely
- e.g. Allscripts Wand
D. Increased Connectivity
- Users can securely log
on to their system with
just a gadget and the
internet connection
- Web-based EHR
provides better
connectivity with clinical
healthcare and patients
B. Cost-saving Features
- Web-based EHR doesn’t
need the installation of
hardware, software and
expensive maintenance
- Web-based EHR doesn’t
have the risk of losing
data due to hardware
malfunctioning

8. Sources: IBISWorld, Yahoo! Finance
The implementation process should address the
operational, financial, and technological risks
8
Breakdown of
Potential Risks
Operational Financial
Technological
- Security breach: electronic records are at risk of being
stolen, while health records are up to 10 times more
valuable than a credit card number for hackers
- Advanced security will be needed if EHR is
implemented
- Delayed return on initial
investment can expose the
client to potential
bankruptcy problem
- Disrupted workflows can
increase the operating cost
- Redesign of infrastructure is
necessary, including billings
and program coding

9. 9
Recommendation
Southwestern hospital should purchase the Allscripts product, an off-the-shelf EHR solution
with low upfront costs, huge flexibility, and systematic simplicity.
Analysis
Definition of EHR Types of Product Implementation
Benefits Risks In-House
Off-the-
Shelf
Risk
Mitigation
Staff
Training
Allscripts

10. Sources: IBISWorld
Considering the key factors in the choice of EHR software, e.g. streamlining tasks, reducing errors, and
saving implementation costs, an Off-the-Shelf software is the better choice for Southwestern.
10
Off-the-Shelf software has strong competitive advantages
over its In-House software rival
Advantages
• Readily available
support staff
• Level of customization
available
• User-friendly interface
Shortcomings
• Lack of knowledge to
handle errors and bugs
• Hard to maintain up-to-
date technological
trends
Advantages
• Readily tested by other
companies
• Fast deployment
• Smooth integration with
current system
Shortcomings
• High support and
maintenance costs
• Price can fluctuate by
vendors
• Long waiting period for
technical support
Develop In-House Software Purchase Off-the-Shelf Software

11. 11IBIS World, Google, Yahoo! Finance
Allscripts stands out among other Off-the-Shelf products
with low costs and short installation period
Cost-saving
Time-saving
Factors Taken Into Account:
• Length of implementation
• Cost of implementation
• Cost of
implementation:
~$40,000 per
physician
• Length of
implementation: 3-6
weeks
• Cost of
implementation:
~60,000 per
physician
• Length of
implementation:
1-2 months
• Cost if
implementation:
~150,000 per
physician
• Length: 1-2 months
• Cost of
implementation: $90
million for 500 beds
• Length: 2-5 months
• Cost of implementation: $1.5
billion over 5 years (2015)
• Length of implementation: 3-6
months
Allscripts is the ideal provider with the lowest average implementation costs as well as a very short
implementation time period. Allscripts is also heavily focused on small/mid-size hospitals, ensuring the
satisfaction of Southwestern hospital.

12. Source: Allscripts, Black Book Rankings
Allscripts offers many features that cement its place among the best EHR software. Its interconnectivity
capabilities, cost-effectiveness, flexibility, and ease of use make it a viable target of purchase.
• Has many templates
catering to varying medical
specialties
Templates
• Prescribing application
connected to over 50,000
pharmacies and
laboratories.
• Cloud capabilities
Connectivity
• Offers a Patient Portal
• Patients can access
records, appointments, and
billing
Patient Use
Unique Features
Relevant to Southwestern
• Designed for medium size clinics and
hospitals
• Flexible and easy to utilize
• Scalable
• Cost-effective
• Interconnectivity and cloud-capabilities
• Headquarters located in Chicago
12
Designed for small and mid-sized hospitals, Allscripts can
satisfy every expectation of Southwestern
Upgrade Costs
0%
10%
20%
30%
40%
50%
Allscripts Cerner Epic

13. Source: Modern healthcare
Example from Catholic Health Initiatives presents potential
success of Allscripts within Southwestern’s infrastructure
Scored the
highest in
customer
satisfaction for
large hospitals
Aimed towards
mid-sized
hospitals, but has
various large
clients
Ranked “Best of
the Best” in
Interoperability &
Communications
in 2014
Lower price
compared to the
market rivals
Allscripts has smaller market share than other players in the EHR industry, however they have a
relatively short implementation timeline and works well in hospitals like Southwestern Hospital.
13
Case Study: Catholic Health Initiatives
- Signed for ambulatory EHR run by Allscripts in 2010
- Has 75 hospitals nationwide with annual revenue of 8.6 Billion & over 1050 doctors
- Catholic Health Initiative decided to expand its relationship with Allscripts in 2015, allowing it to
provide complete support
- Overall very positive partnership, showing potential successful partnership with Southwestern

14. 14
Recommendation
Southwestern hospital should purchase the Allscripts product, an off-the-shelf EHR solution
with low upfront costs, huge flexibility, and systematic simplicity.
Analysis
Definition of EHR Types of Product Implementation
Benefits Risks In-House
Off-the-
Shelf
Risk
Mitigation
Staff
Training
Allscripts

15. Sources: Norcal Mutual Insurance Co., Hitech Answers, Healthcare IT News.
Allscripts can successfully mitigate all the presented risks
that can be occurred during the implementation
15
Data Entry Errors
Breach of Confidentiality
“Curbside” Consultations
Inadequate EHR Training
Failure to Check EHRs
- Saving data in the wrong patient’s charts
- Checking the wrong box
- Typing the wrong dose
- Inconceivable level of potential data breach
caused by hacking, more severe compared to
old-fashioned paper records
- Easy access to patient database can let doctors
view colleagues’ patients for personal, unofficial
medical consultation
- Change-averse culture at Southwestern Hospital
- Lack of technical competency of the independent
contractors
- Turning off system’s warning messages
- Failure on behalf of patients to properly heed to
important news
Double checking, avoid abbreviations, regularly
update information, ensure proper EHR policy
on behalf of employees
Mitigation
Mitigation
Mitigation
Mitigation
Mitigation
Access restrictions, set up appropriate access
level, forbid password sharing, change
passwords frequently, audit usage of records
Formally consult with specialists when
necessary, include correspondence to
colleague doctors in patients records
Have a realistic and well communicated
transition plan, provide regular training and
testing, regularly assess mistakes
Develop a system that allows doctors to convey
their urgency, set up a policy describing how
frequently users must check their emails

16. Source: HealthIt.gov
Effective employee training is essential to the success of
an EHR implementation
Super User
Training
Super users have knowledge
of entire system
Role-Based
Training
Specific training sessions for
immediate responsibilities of
staff
Process-
Based Training
Helps staff understand new
workflows such as providing
clinical summaries to clients
Vendor
Training
Internal
Training
Cost-Effective
Training
Effective EHR System implementation should include different types of user training, especially the
“Super Users,” a small group of staff who know the entire system. Other staffs will receive specialized,
role-based training. Southwestern should take advantage of resources provided by the EHR vendor.
16

17. Sources: Allscripts, EHR intelligence
Southwestern should plan out the project through 24-
month time period for flawless systematic transition
1-12mo.
• Make a solid plan for training and other crucial steps
• Get support from the hospitals leadership
13-18mo.
• Decide on a project team, including an overall leader
• Provision necessary hardware and software needs
19-21mo.
• Install hardware (crucial to start at least at the 3 month benchmark)
• Assign super users, and start scheduling training sessions
22-24mo.
• Build and test interfaces, also should test readiness of the system
• Adjust staff, and patient schedules according to EHR
After
• Create a network for support and feedback with other hospitals
• Maintain a healthy relationship with vendor, to help the flow of the overall program
17

18. Conclusion
Implement Allscripts to streamline core business, enhance patient record
tracking, and optimize performance in Southwestern.
Ultimately
Strategic Rationale
Feasibility and Execution
• Purchase Allscripts, an off-the-shelf, flexible, cost effective, and
comprehensive EHR system that suits Southwestern’s needs.
• Follow 24 month plan of training and implementation strategies for
Southwestern staff.
• Carefully manage risks through mitigation strategies.
18

19. 19
Comparison of IRR assuming investment into Allscripts Vs. Epic in 5-year period
- Assumptions
- Allscripts and Epic have similar, basic functionalities, no difference in annual cost and saving
- Exclude detailed training fee for nurses and volunteers as cost varies in large spectrum
- Savings are primarily attributed to automating time-consuming paper-driven and labor-intensive
tasks, potentially take care of more # of patients in a given time (including potential revenue gain)
- Apply 10% annual growth rate since Southwestern is expanding rapidly within the US
- Initial Investments
- Epic EHR Software = $52M for a mid-sized (~150 beds) hospital * 7 (~1000 beds) = $364M
- Allscripts EHR Software = $5M for a mid-sized (~150 beds) hospital * 7 (~1000 beds) = $35M
- Annual Cost and Saving Breakdown
- Annual Cost = Monthly $1K per physician * 12 * 200 (Southwestern’s # of physicians) = $2.4M
- Annual Saving = Average $48M in 5-year period / 5 = $9.6M
- Annual Benefit = 9.6 - 2.4 = $7.2M per year
- Scenario 1. Southwestern purchases and implements Epic (w/ 10% annual growth)
- Scenario 2. Southwestern purchases and implements Allscripts (w/ 10% annual growth)
Year 0 1 2 3 4 5
Cash (364M) 7.2M 7.9M 8.7M 9.6M 10.5M
IRR -43.54%
Year 0 1 2 3 4 5
Cash (35M) 7.2M 7.9M 8.7M 9.6M 10.5M
IRR 7.58%
Appendix A: IRR Analysis of Allscripts implementation in
Southwestern presents the best potential financial return
Sources: Healthcare Financial Management