MMHA 6601 Week 11 Final Adoption Proposal Example

Recommended With Conditions: A Final Proposal to Adopt Ambient Documentation Across Ridgeway Health Partners

Student Name

Walden University

MMHA 6601: Technology and Innovations in Healthcare

Instructor Name

Month Day, Year

Recommended With Conditions: A Final Proposal to Adopt Ambient Documentation Across Ridgeway Health Partners

Recommendation

This proposal recommends that Ridgeway Health Partners, the invented fourteen-practice network studied all term, roll out ambient documentation to every physician and nurse practitioner who wants it, subject to five conditions. It integrates the work of the term: the screening criteria from Week 1, the evidence appraisal, the cost analysis, the NASSS barrier assessment, the governance rules developed for patient-facing technology and the draft reviewed by the technology review group in Week 9. That group's comments, and the results of a twelve-week pilot with 20 clinicians, have been incorporated. Pilot figures in this paper are illustrative.

The Problem, Restated

Ridgeway's clinicians were spending a median of 1.4 hours a day on record work outside scheduled hours, and more than a third of notes were signed more than two days after the visit. Documentation was the leading complaint in the engagement survey, and two physicians who left last year named it in exit interviews. Outside studies find the same imbalance; in direct observation of office practice, screen and paperwork time ran at nearly double the time physicians spent with patients (Sinsky et al., 2016). Ridgeway's own figure translates into roughly seven unpaid hours a week for a full-time clinician, much of it after children are in bed.

What the Pilot Showed

The results are consistent with the larger deployment reported by Tierney et al. (2024), in which clinicians described less after-hours work and more attention to patients. As in that report, drafts were not error-free, which is why review remains a clinician responsibility.

Table 1

Pilot Results, 20 Clinicians, 12 Weeks (Illustrative)

All thresholds were met. The two uncorrected errors, a wrong laterality and a medication listed as current that had been stopped, were reviewed and traced to long visits with several topics.

Costs and Value

Rolling out to all 110 clinicians would cost an illustrative $1.9 million over five years, including licenses, integration, training and support. The proposal makes no claim that the tool pays for itself through billing; documented levels did not change in the pilot. The value case rests on clinician time and retention. If after-hours time falls by half an hour per clinician per day across the network, that is roughly 55 hours a day returned to clinicians. Preventing even two physician departures over five years would offset a large share of the cost, given the expense of recruiting and the revenue lost during vacancies. That argument depends on retention effects the pilot was too short to measure, so the evaluation plan below tracks them.

Barriers and Countermeasures

The NASSS assessment found the adopter domain complex: clinicians and patients differ in trust of the tool (Greenhalgh et al., 2017). The pilot confirmed this. Four of the 20 clinicians used the tool for fewer than half their visits, mostly for visits involving mental health or sensitive topics. Rather than treating this as failure, the rollout will make per-visit choice explicit: clinicians decide visit by visit, and patients can decline at any time.

Table 2

Remaining Barriers and Countermeasures

Each barrier from the pilot has a countermeasure, and none requires changing the decision to adopt.

Implementation Plan

Rollout will proceed in three waves of about 35 clinicians each over six months, beginning with practices whose clinicians volunteered first. Pilot clinicians will serve as peer trainers in the first wave, since colleagues trust a fellow clinician's account of review time more than a vendor's. Clinicians who choose not to use the tool will face no pressure, and their documentation methods will remain fully supported. Each wave includes a two-hour training, a week of on-site support and a champion at every practice. Implementation research suggests attending to the inner setting, leadership engagement and the characteristics of individuals as much as to the intervention itself (Damschroder et al., 2009), so practice managers will be briefed before clinicians.

Evaluation

The evaluation tracks the pilot measures quarterly for two years, adds clinician retention and intent to leave, and continues the coder review at 30 notes per practice per quarter. Implementation outcomes such as adoption, fidelity and sustainability will be reported separately from clinical and financial outcomes, which helps distinguish a tool that does not work from a tool that is not being used (Proctor et al., 2011).

Governance

The governance rules from the Week 10 review apply. Patients are told when the tool is in use. Audio is deleted after signing. The vendor may not use Ridgeway data to train its models. Model updates require advance notice and testing. Clinicians remain responsible for every signed note, and errors are reported through the existing safety process.

The Five Conditions

Adoption is recommended on these conditions: the data agreement is signed with the terms above; use is voluntary and decided visit by visit; quality sampling continues for two years; the network may exit with 90 days' notice and full data deletion; and the operating committee reviews results after the first year before renewing.

Conclusion

Ambient documentation met every threshold the network set for it in a pilot of 20 clinicians, while confirming that drafts need careful review. It addresses the problem clinicians name most often. Its costs are real and its value rests partly on retention not yet proven. Adopting it with conditions, voluntary use, firm governance and continued measurement, lets Ridgeway capture the benefit while keeping the ability to stop.

References

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50. https://doi.org/10.1186/1748-5908-4-50

Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19(11), e367. https://doi.org/10.2196/jmir.8775

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7

Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., Westbrook, J., Tutty, M., & Blike, G. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165(11), 753-760. https://doi.org/10.7326/M16-0961

Tierney, A. A., Gayre, G., Hoberman, B., Mattern, B., Ballesca, M., Kipnis, P., Liu, V., & Lee, K. (2024). Ambient artificial intelligence scribes to alleviate the burden of clinical documentation. NEJM Catalyst Innovations in Care Delivery, 5(3). https://doi.org/10.1056/CAT.23.0404