Greenway Medical Technologies: The Pace-Setting David of Electronic Health Records

This report explores Greenway Medical Technologies from the perspective of strategies, benefit realization, ethics, investments, and limitations. It covers the SWOT analysis, key recommendations, and the strategic context of the company.

Greenway Medical Technologies:
The Pace-Setting David of
Electronic Health Records
Contents
Background............................................................................................................................................1
Executive summary...............................................................................................................................2
Key Recommendations..........................................................................................................................2
Strategic Context...................................................................................................................................2
Analysis of the investment....................................................................................................................4
Benefits Realisation...............................................................................................................................4
Ethical and Social Implications...............................................................................................................6
Limitations.............................................................................................................................................7
Conclusions............................................................................................................................................7
References.............................................................................................................................................7
Background
Patient care is of prime importance for any medical systems that operate in the country. In
traditional systems, everything including the administrative procedures and documentation of
health records of patient was handled manually. However, this had problems of legibility,
possibilities of errors and difficulties in retrieving of the information about patients while a
decision has to be taken by the doctor for prescription. Another challenge is that the data that
is stored in the systems becomes obsolete fast and thus, have to be kept updated from time to
time which can be very tedious in a manual process.
EHR can hep improve these services by solving these challenges by automating some
procedures reducing the possibilities of errors and making it easier for the company to keep
the records updated. It can also help doctors by combining the biomedical information with
the health reports involving patients in the process which can help doctors take better
decisions on the course of actions to take.
Electronic Health Records are used in hospitals for clinical purposes and it is an essential part
of patient healthcare delivery system. A significant concern is the recovery from the cost that
is incurred in procuring and maintaining EHR systems (Eysenbach, 2014).
The open-ended survey conducted with the stakeholders of Greenway Medical technologies
revealed some critical insights in the area of this business. It was found that doctors majorly
earn for the consulting service and with good treatment and relationship offered, a repeat
business is a possibility. Also, through word of mouth, the name of the doctor spreads and

more patients are received. Patient referrals play an important role in the healthcare system.
Thus, system that is to be implemented at the hospitals must be patient centric to ensure a
good experience for them.
Executive summary
In this report the data that is collected from the doctors and the on the software solution offered by
the company, this report could be developed addition to the existing information available from the
company and the other resources. The report explores the company from the perspective of
strategies, benefit realization, ethics, investments and limitations. The report covers the SWOT
analysis which reveals major strengths and weaknesses of the company. It has some
recommendations made for the company to improve upon its services. It also covers details of the
ethical concerns that EHR practice can raise. The report has been prepared by exploring previous
literature on the subject and analysing the responses of a survey that is conducted with the doctors,
pharmacies, and other healthcare professionals.
Key Recommendations
Based on the data that was collected from the doctors and company representative revealed some
good insights that can be used to develop recommendations for the company. These include:
 As the company is majorly serving patients through its application although it is going
through pharmacies, doctors and hospitals, the company should involve patients while
planning new features for the solution so that it can help the healthcare sector to serve
them better. This can be done by constructing a survey with patients that would help
understand their needs better and thus, create plans for refining features of the software to
better the patient care.
 The company can have a set flow of information defined for specific entities like healthcare
or pharmacy and use it to create features that are supportive to the systems. These could be
a flow like resources to answers to questions to clinical inquiries to integration and creation
of a knowledge base. Based on this flow, the system can create a knowledge warehouse for
the entities concerned (Greenway health, 2019)
 The company can provide additional healthcare services such as remote download of testing
results, out of office engagement with the patients and so on which can enhance the
services and thus, bring in more patient satisfaction. Moreover, with additional services
offered, there would be more avenues opened for revenues
 The company must create a workflow for managing operations at a hospital and customize
the software accordingly so that it works best for a hospital. For this, it would be important
for them developers to understand how the systems in a selected hospital work which is
possible through engagement with the staff. Thus, hospital should allow the representative
from Greenway to survey the hospital staff to get more details of the work flow
Strategic Context
The mission of Greenway Medical Technologies is to expand the possibilities in healthcare and
contribute to the customers in better ways. The company offers designing solutions and healthcare
restoration services to doctors and hospitals. SWOT analysis can be used to understand where the

company stands on the strategic front and what are its strengths, weaknesses, opportunities and
threats.
Strengths of the company are:
 The company has a well-known and established brand that has a goodwill in the market
which can be a positive thing when promoting services
 The company has clear values and practice ethical leadership which is encouraging to
patients as well as to the staff of the company
 The company has the capability to innovate through 1000 technology, marketing, financial
and clinical experts to support. These experts help company understand the needs of
healthcare and thus, plan how their solution can serve them and thus, it can be enhanced to
crease the scope of deliveries.
 The software supplied by the company provides all major features that can help hospitals,
pharmacies, and doctors including charting, prescribing, order tracking, clinal alerts, and so
on
 Greenway has some major customers like Walgreens that had its solution installed in its
8000 stores. This makes a good case for the company and can help in promotions
The weaknesses of the company and the business in general are:
 The company has a lack of staff and is in need of more but due to the investments required,
the company is reluctant to expand
 The company is currently using manual system and thus, the staff is not familiar with online
systems which would need the company to arrange for training which could be a cost
 The company may face some resistance from the staff as the introduction of EHR would
bring major cultural changes in the organization that the staff has to accept (Shahmoradi, et
al., 2017)
Opportunities that company can use to grow in the market include:
 The company can tie up with more large pharmacy stores to sell its solutions and expand its
portfolio
 The company can tie up with doctors to come up with better solutions
 There are only 5% of the primary care providers that are using EHR which leaves a scope for
expansion for the company
 The company can use patients who can refer the doctor the hospital service to others to get
more patients coming
 There are opportunities to engage a patient beyond the doctors visit such as through
pharmacy, through real time online engagement, and more. Thus, the solution can
incorporate features to allow these provisions which would help the company sell more as
well as help the healthcare system achieve more
 The solution can be sold not just to hospitals but also to other smaller healthcare units such
as clinics, pharmacies, and testing labs
 Once a customer has purchased the solution, the company can keep on analysing the way
their solutions are used and come up with plans for upgrade or upselling the same customer
organization to generate more revenues (WINTER', et al., 2000)

The threats that are faced by the company include:
 The company can face competition from other companies that also produce EHR services
 The company can also face threats from the alternate solutions that may not be
comprehensive but are available at cheaper price such that the healthcare system can
continue to use them without investing into EHR
 A bad word of mouth from one dissatisfied customer can affect the reputation of the
company and thus, make it difficult to sell (Pereira, et al., 2013)
Analysis of the investment
The software would have a license fee that would have to be paid once in the first year for
implementation and post that there would not be any cost till the license has to be renewed. The
hospital or the healthcare organisation would also get the support from the staff of Greenway
against the fixed license fee. This would be the major investment for the hospital. Besides this, the
company may also incur cost in hiring people to run the show and providing training to the staff to
follow EHR systems. Greenway can weigh the cost of development and other services based on
which the price of the license is decided so that the company can keep a god profit margin. The
company would have fixed cost in development but post that it would also incur cost in maintaining
the staff involved in serving customers. Thus, the license cost should have considerations of not just
the initial cost but also the recurring expenses that occur during the course of time.
Benefits Realisation
Implementation of EHR systems would bring several benefits to patients as well as the healthcare
system. These include:
 The information of the patient can be accessed from remote location easily by the doctors
which can help the doctor in diagnostics and thus providing support to the patient based on
the information
 With remote available system, the doctor or healthcare practitioner would be able to take
decisions more efficiently and effectively. Clinical alerts and reminders would also help in
ensuring that doctors are able to keep track of their time and work.
 With all the details of the case recorded through EHR documentation, administrative tasks
like billing become easy and more accurate leaving no scope for error
 EHR systems can provide interface to healthcare and patient information for multiple users
including the patient, doctor, healthcare practitioner and the family members of the patient
which makes it very convenient for each of them to keep one informed about the patient’s
health status and treatment details.
 With records taken electronically once the patient visits, the patient would not need to keep
filling the form on every visit as the records would be available to any doctor attending the
patient at the time through the electronic documentation maintained.
 With these systems, the e-prescriptions can be created and can be sent to the pharmacy by
the doctors internally such that when the patient arrives a pharmacy to get the medicines,
the pharmacy would also have the ordered processed and thus, can provide the medicine to
the patient fast.

 The information availability of the system is high as it is available through a central system
that can be accessed from anywhere which allows a doctor to serve the needs of the patient
anytime from anywhere and guide the patient into actions for health-related issues
 EHR systems can help doctors take effective decisions through improved aggregation and
analysis, diagnostic support, and some built-in safeguards that can help prevent against the
anticipated events that can affect the patient health. The Greenway application would also
have some reminders and alerts that can be used in such cases so as to inform the doctor
about any such possibilities so that proactive action can be taken by the doctor to handle
problems of the patients.
 With EHR systems, the administrative staff would also find it convenience to process the
data of the patient and provide linked services like sending prescriptions lab report, and
providing medicine. For instance, a pharmacy person can already be ready with the required
medicine before the patient arrives at the pharmacy saving the time of the personnel as well
as of the patient
 With EHR, the patient would also be able to gain access to the full medical history of own
which can help the patient keep a track of own health and understand what is happening at
any time.
 Following up with patients is easier with EHR for the doctor as the system would keep
sending alerts and reminders for patient visits This can also help the administrative staff
remind the patient of the appointment such that the coordination between the doctor,
patient and the hospital staff is improved.
 There is also an administrative relief for a hospital as it would not have to maintain the
physical records of the patients which can be bulky and tenuous. Instead all records can be
stored in the system can be retrieved anytime. Searching for specific information is also easy
with the electric records and what staff would not have to spend time saving and
maintaining physical documents.
 Maintaining of the clinal workflows in a hospital would become simpler with the use of EHR
system as it would not just keep the records of the patient care but would also provide links
between systems and processes within a hospital enabling management of the flow of data
between different departments for ease of functioning
 The software can also be used as a medium of communication between the hospital staff or
doctor and the patient such that the patient can be more actively involved in diagnostics and
patient care services. It would make it easier for the doctor to identify symptoms of the
patient and suggest remedies accordingly. The patient would be able to submit the
information about the health status to the doctor through the EHR system without any face
to face interaction also and the doctor would be able to provide guidance accordingly
 Since the data is available online in the system, in case a doctor who have been treating the
customer is unavailable, the case can easily be taken over by another doctor without the
need of the patient to explain the problems to the new doctor again. There would be a
smooth transition between patient care scenarios with the software
 The software provides the analysis of the patient data which can reveal safety concerns
proactive so that doctor can take immediate steps to the protect the patient and prevent
any emergencies form happening. With this the healthcare is improved and the patient is
better taken care of
 EHR not only provides benefit to single patient but also the whole community of patients
who may be suffering from similar diseases. This can be made possible by sharing the data
on treatment scenarios and solutions applied. The risk factors and precautions that patient

community would need could be revealed which would help even other patients in
improving healthcare
 Healthcare providers would be able to better understand the patient profiles and in general
what is happening in the healthcare space. With the use of EHR, a practitioner would know
who many patients are suffering from a specific disease such as hypertension or diabetes
and the risks associated. It would help the provide understand the case intricacies of such
patients and help devise better plan to help the community of patients with better care
 If a patient has been helped by a medicine or a treatment already, the other patient in the
same category can also be helped by the doctors as they would be able to access the related
intelligence and help the information learned from one case to another patient’s case
Ethical and Social Implications
Electronic health records (EHRs) have benefits for physicians, clinical experts, and patients.
However, they also raise ethical concerns. To understand them, there is a need to understand
the impacts of HER on the patient. EHR should be able to facilitate the patient care and
strengthen patient’s relationship with a doctor or a practitioner. EHR is used to handle a
number of operational functions of the healthcare system including documentation, billing,
administration, research, and regulatory requirements. For it to fulfil the needs of the patient,
the system should match the patient expectations. It the responsibility of the healthcare
profession to ensure that this match is created and if there is any mismatch identified then it is
corrected.
In healthcare provisions, needs for documentation can put time pressure on doctors for patient care.
A typical patient visit would take about 15-20 minutes in a hospital which is followed by a process of
documentation that would take a similar amount of time. To compensate for this, doctors try to
minimize the time for visit and to keep it restricted to 15 minutes only. This time may not be
sufficient to build trust between the doctor and the patient. The ethical principle of patient
beneficence suggests patient well-being should guide the actions of doctors and health practitioners
always which suggests maximizing the time spent with patient instead of spending it on
documentation. Thus, HER documentation raises this ethical concern.
More ethical concerns are raised in the application of EHR as reflected in the RAND report that
reflects upon the frustration of patients resulting from the practice of EHR. These include time
consuming data entry, interference in the personal interaction, and poor usability. It also affects the
clinical productivity of a doctor by increasing documenting pressure that can result into a burn out. If
HER is made more patient centric, it can help reducing the documentation and thus, also prevent
doctors or practitioner’s burnout.
Another ethical concern is raised when the question arises on the ability of a system to understand
the emotions of patients and interact with one accordingly. Some features may have some
superficial clinical thinking embedded so that some of the answers to common clinical questions can
already be answered which can reduce the need for the patient to enter details but this still does not
match the empathy needs of the patient.
Privacy and confidentiality of the patient information is also needed as unauthentic information
disclosure of the patient’s private information can cause problems for the patient. Thus, it is
important that efforts are taken to ensure that the patient data is fully protected and secured. If the

patient does not have the trust that his or her data is secure with the healthcare system then the
patient would not feel comfortable disclosing personal details as its leak can lead to consequences
like rejection in insurance, stigmatization or loss of an employment. As EHR involves electronic
sharing of records, the risks of losing data is a major concern already (Sulmasy, et al., 2017).
Limitations
With the EHR solution, there are also some limitations that the company has to deal with. These
include:
 As EHR involves recording of the critical and private data of the patients, it is important that
sufficient measures are taken to protect this data which would need additional procedures
that may not be within the scope of the system itself. Thus, the company may need to
consume IT security services and have added procedures to maintain security of the patient
data
 EHR system puts pressures of documentation on doctors thereby reducing patient care time
spent by the doctor. Even if the documentation procedures are adjusted to meet the time
demands of the doctors, it can still consume some time and thus, the patients could have
some personal disconnect with the doctor
 The EHR systems can use clinical information about the patient to facilitate virtual customer
care kind of environment in which the patient would feel that there the system knows the
patient to some extent. However, this type of information is very limited and EHR systems
cannot have empathy for patient embedded in them and thus, can never give the patient
the feel of a real doctor-patient interaction
 The hospital may have a limited budget assigned for installing EHR system which is not the
core of the company and thus, may take only a limited feature from the software company
when implementing it. This would leave limitations on the level of revenues that can be
gained from the project
Conclusions
The report explored the case of Greenway Medical Technologies which develops specialized
software solutions for healthcare industry. The study was conducted by surveying the healthcare
professionals and collecting data to understand the possibilities of promoting the service of EHR as
well as improving it to better suit the needs of the healthcare system. It was found that the
healthcare system was heavily influenced by the patient experiences as they run on the referrals and
word of mouth. Thus, the systems should be made patient focused such that every feature that is
planned in the software can help enhance the experience of a patient. A number of different
features were discovered including billing management, workflow management, and patient
engagement. There are several benefits that the software can bring to the doctors, pharmacies and
hospitals. Some of these were reduction in administrative efforts, availability of information about
patients in the real time, ability to retrieve history of patient enabling doctors to serve patients serve
better and take better decisions on the case.
References
Eysenbach, G., 2014. Return on Investment in Electronic Health Records in Primary Care Practices: A
Mixed-Methods Study. JMIR Med Inform. , 2(2), p. 25.

Greenway health, 2019. Greenway Health. [Online]
Available at: https://www.greenwayhealth.com/
[Accessed 21 April 2019].
Pereira, R., Salazar, M., Abelha, A. & Machado, J., 2013. SWOT Analysis of a Portuguese Electronic
Health Record, Braga, Portugal: Universidade do Minho.
Shahmoradi, L., Darrudi, A., Arji, G. & Nejad, A. F., 2017. Electronic Health Record Implementation: A
SWOT Analysis, Tehran, Iran: Tehran University of Medical Sciences.
Sulmasy, L. S., López, A. M. & Horwitch, C. A., 2017. Ethical Implications of the Electronic Health
Record: In the Service of the Patient. Journal of General Internal Medicine, 32(8), pp. 935-939.
WINTER', A. et al., 2000. Purpose and Structure of Strategic Plans for Information Management in
Hospitals. Medical Infobahn for Europe, pp. 880-884.