NURS 718 Week 3 Case Study 1 on Strategic Information System Planning Example

Case Study 1: Three Projects and One Budget, Strategic Information System Planning for a Rural Three-Hospital System

Case Summary

Shenandoah Valley Health is a not-for-profit system of three hospitals in a rural region: a 240-bed regional medical center, a 60-bed community hospital and a 25-bed critical access hospital. Its stated mission is excellent care that keeps patients in their own communities. The board has approved $1.4 million in information technology capital for the coming year and has received three proposals: a telestroke network linking all three emergency departments to a comprehensive stroke center, at about $650,000; an upgrade of the patient portal with mobile scheduling, at about $500,000; and a new supply chain management system, at about $900,000. Last year, 31 of the system's patients with suspected stroke were transferred out, and median time from arrival to thrombolytic treatment at the two smaller hospitals exceeded national targets.

Question 1: How Should Information System Strategy Relate to the Mission?

Tan and Payton (2010) argue that information system planning must follow organizational strategy rather than lead it, so that technology serves the mission rather than the reverse. For Shenandoah Valley Health, whose mission is high-quality care close to home, the test for any project is whether it helps patients receive good care without leaving the region or helps the system remain financially able to provide that care. All three proposals can be linked to the mission, but they connect to it differently: the telestroke network directly expands specialty care close to home, the portal improves access and convenience, and the supply chain system strengthens finances indirectly.

Question 2: What Does the Current Environment Show?

Internally, the system has a shared electronic record, reliable bandwidth at the regional center but weaker connectivity at the critical access hospital, a small information technology staff stretched by last year's record transition, and emergency nurses who have experience with video interpreting but none with telemedicine consultation. Externally, stroke care is moving toward regional systems. A 2026 review describes a persistent gap between patients eligible for reperfusion therapies and those who receive them in time, driven by delays in prehospital identification, destination decisions and transfer between hospitals (Royan et al., 2026). Telestroke programs are spreading, and practices such as ambulance prenotification to teleneurologists have been associated with shorter door-to-needle times and higher treatment rates (Sambursky et al., 2026). Rural digital health programs, however, face barriers in connectivity, cost and workforce (Sahakyan et al., 2026).

Question 3: Which Project Should Come First?

Four criteria, weighted by the steering committee's priorities, were applied to each project on a scale of 1 to 5.

The telestroke network ranks first. It aligns most directly with the mission, offers the largest patient benefit because minutes matter in stroke, and fits within the budget with room for the portal's first phase. Its readiness score reflects the critical access hospital's connectivity and the staff's lack of telemedicine experience, risks that the plan must address rather than ignore. The supply chain system, although financially attractive, exceeds the remaining budget and should be planned for the following year. The ranking is sensitive to the weights: if the committee weighted financial return at 40%, the supply chain system would rise to second place, which is why the weights themselves should be debated and approved before any project is scored. Weighted criteria do not make a decision for leaders, but they make the reasons for a decision visible and open to challenge.

Risks of the Recommended Project

Choosing the telestroke network carries risks that the plan must manage. Weak connectivity at the critical access hospital could interrupt video consultations at the worst moment, so a network assessment and a backup connection are prerequisites. Emergency nurses have no telemedicine experience, so training and simulated cases must precede go-live. The comprehensive stroke center's contract must specify response times, credentialing and how quality data will be shared. Finally, the information technology department's limited staff could delay the project, which argues for a vendor implementation team and a phased rollout beginning at the community hospital.

Question 4: How Should Decisions Be Governed?

The system currently approves technology projects through the chief financial officer and the information technology director. Tan and Payton (2010) emphasize the need for structures that align information systems with organizational strategy, and that requires broader representation. An information system steering committee should include the chief executive, chief nursing officer, chief medical officer, chief financial officer, information technology director, a nurse informaticist and one frontline clinician from each hospital, reporting to the board's quality and finance committees. Projects should be submitted with a business case, scored against the published criteria and reviewed after implementation against their promised results. Publishing the criteria in advance discourages decisions driven by whichever department argues loudest, and the post-implementation review creates accountability that the current process lacks, since no project from the last five years was formally evaluated after go-live.

Question 5: What Is the DNP's Role, and What Principles Apply?

A DNP-prepared nurse can contribute in three ways. First, by building the clinical case: translating stroke outcome data into the patient benefit score and explaining how telestroke would change care at each hospital. Second, by representing nursing workflow, since emergency nurses will run the telestroke cart, coordinate with the remote neurologist and manage thrombolysis. Third, by leading evaluation, defining measures such as door-to-needle time and transfer rates that will show whether the investment worked. The DNP can also connect the project to the nursing quality agenda, for example by tracking dysphagia screening and early mobility for stroke patients kept locally, so that the network's value is measured in nursing outcomes as well as transfer statistics. Zaccagnini and White (2017) describe this blend of clinical, technological and leadership competence as central to the DNP role.

Stewardship guides the recommendation. Jesus described a builder who estimates the expense of a tower before laying its foundation, so that he is not mocked for leaving it half finished (English Standard Version Bible, 2001/2016, Luke 14:28-30). Counting the cost of each proposal, and choosing the one that does the most good within the means available, is a faithful use of resources entrusted to a not-for-profit system.

Conclusion

Shenandoah Valley Health should fund the telestroke network first, with the first phase of the portal upgrade, and plan the supply chain system for the next cycle. A steering committee with clinical and nursing representation should govern future decisions using explicit, weighted criteria.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Royan, R., Stamm, B., & Prabhakaran, S. (2026). Optimizing acute ischemic stroke systems of care: Current state and future directions. Stroke, 57(9), 2925-2934. https://doi.org/10.1161/STROKEAHA.126.052584

Sahakyan, S., Akseer, S., Abrahamyan, L., Metcalf, O., Allin, S., Chenhall, R., & Seto, E. (2026). Barriers and facilitators to implementing digital health technologies for remote management of NCDs in rural areas: Mixed methods systematic review. Journal of Medical Internet Research, 28, Article e93875. https://doi.org/10.2196/93875

Sambursky, J. A., McDonald, M., Mayer, L., Vidgop, Y., Figurelle, M., McCoy, M., Collins, O., Gao, L., & Sevilis, T. (2026). EMS prenotification to teleneurologists and continuous evaluation: The impact on telestroke metrics. Telemedicine Reports, 7. https://doi.org/10.1177/26924366261456445

Tan, J. K. H., & Payton, F. C. (2010). Adaptive health management information systems: Concepts, cases, and practical applications (3rd ed.). Jones and Bartlett.

Zaccagnini, M. E., & White, K. W. (Eds.). (2017). The doctor of nursing practice essentials: A new model for advanced practice nursing (3rd ed.). Jones & Bartlett Learning.