NURS 718 Week 6 HMIS Project Part 1 on the Vision and Goals of a Health Information System Example

HMIS Project Part 1, Introduction: A Vision of Stroke Care Close to Home Through a Regional Telestroke Network

Introduction

Last winter, a 66-year-old man arrived at our critical access hospital with sudden weakness in his left arm and leg, about an hour after his symptoms began. The emergency physician recognized a stroke, but no neurologist was available to confirm that the patient was a candidate for thrombolysis, and the physician was reluctant to give the drug alone. The patient was transferred by ambulance to the regional medical center, 52 miles away, and received treatment there more than three hours after his symptoms started. He survived with weakness that ended his work as a carpenter. Every clinician involved acted reasonably. The problem was not the people but the system: the hospital closest to the patient had no way to bring a stroke specialist to the bedside in time.

This paper introduces a health management information system designed to solve that problem, a telestroke network linking the emergency departments of Shenandoah Valley Health's three hospitals to a comprehensive stroke center. It describes the organization and its mission, the problem the system addresses, the system itself, the vision and goals that will guide it, the stakeholders, and the project's scope. Part 2 of the project will present the detailed plan, and Part 3 will describe implementation and evaluation.

The Organization and Its Mission

About 280,000 people live in the rural region Shenandoah Valley Health serves. Its largest hospital, a regional medical center of 240 beds, holds primary stroke center designation; the other two are a community hospital with 60 beds and a critical access hospital with 25. The two smaller hospitals are 34 and 52 miles from the regional center, and the nearest comprehensive stroke center, which offers thrombectomy, is 95 miles from the critical access hospital. Its mission commits the system to excellent care delivered near where patients live, and its current strategic plan names three priorities: access to specialty care close to home, quality and safety, and financial sustainability.

The system has a shared electronic health record across all three hospitals, implemented two years ago, and a small information technology department of 22 staff, most of them based at the regional center. Emergency nurses at the smaller hospitals have experience with video interpreting services but none with telemedicine consultation. Neurology coverage is limited to two neurologists at the regional center who do not provide coverage overnight or at the smaller hospitals.

The Problem: Stroke Care at a Distance

Stroke treatment is a race against time. Thrombolysis and thrombectomy can reduce disability, but their benefit falls with every minute of delay, and many eligible patients do not receive them in time. Royan et al. (2026) describe a persistent gap between the number of patients eligible for reperfusion therapy and those treated, driven by delays in recognizing stroke before arrival, choosing where to take the patient and transferring between hospitals. Those delays fall hardest on rural patients. Chang et al. (2024), analyzing national death data from 1999 to 2020, found that rural areas consistently had more stroke deaths per 100,000 people than urban areas, a gap that narrowed little over two decades and was largest in the South.

Access to neurology expertise appears to matter. In a cross-sectional study of 52 community emergency departments, Shi et al. (2026) found that mean 30-day stroke mortality was 13.1% where neurologists were available in person, 14.0% where they were available by telestroke and 15.2% where neurology involvement was by telephone only or absent. After adjustment, telephone-only access was associated with significantly higher mortality than in-person access, while telestroke was not significantly different from in-person care. Rural location was independently associated with higher mortality. Our two smaller hospitals currently fall into the telephone-only category. The expansion of stroke infrastructure has also not reached rural communities equally: Shen et al. (2026) found that between 2009 and 2019, newly certified stroke centers opened within reach of 50% of higher-income rural communities but only 30% of lower-income ones, and the authors called for implementation strategies focused on equity.

Our own data reflect these national patterns. Last year, 31 patients with suspected stroke were transferred from the two smaller hospitals to the regional center or the comprehensive stroke center. The median door-to-needle time for the few patients treated at those hospitals was 74 minutes, well above the widely used 60-minute target, and several patients who might have been eligible for thrombolysis were transferred untreated because no specialist was available to support the decision. Our smaller hospitals do not lack skilled clinicians; they lack a reliable way to bring a stroke specialist into the room within minutes.

The Proposed System

Tan and Payton (2010) define a health management information system as an integrated system of people, processes and technology that gathers and processes data to support managerial and clinical decisions, and they stress that such systems must adapt to the organizations they serve. A telestroke network fits that definition. Its technology is the visible part: high-definition video carts in each emergency department, a secure connection to the comprehensive stroke center, and the ability for the remote neurologist to view brain imaging in real time. But the system also includes new processes, such as a stroke alert that pages the telestroke team and starts a consultation within minutes, standard order sets for thrombolysis, and protocols for deciding which patients stay local and which are transferred. It includes people in new roles, among them a stroke coordinator, emergency nurses trained to present patients on video and a remote neurologist who shares responsibility with the local physician.

The network also generates data. Each consultation records time stamps, stroke severity scores, treatment decisions and transfer outcomes, which feed the stroke registry and support the quality reviews that Tan and Payton (2010) describe as part of an adaptive system. Telestroke programs in other regions have shown what this structure can achieve: when ambulance crews alerted the teleneurologist ahead of arrival, patients were treated sooner and more of them received thrombolysis (Sambursky et al., 2026), and a World Stroke Organization statement emphasizes that telestroke must be organized around local resources, with quality assurance built in from the start (Tunkl et al., 2026).

Vision Statement

The vision for the network is a single sentence that every participant should be able to remember: every person in our region who has a stroke will be seen by a stroke specialist within 15 minutes of arriving at any of our hospitals, and will receive the right treatment in the right place without unnecessary transfer. The vision expresses the mission in concrete terms. It focuses on patients, not technology; it applies to all three hospitals equally; and it contains measurable elements that the goals can track.

Goals and Objectives

Five goals translate the vision into commitments that can be measured. Each has a baseline drawn from last year's data, a target and a date, so that Part 3 can evaluate the system against them.

The goals are deliberately few. Goals 1 and 2 address the hyperacute phase, where minutes matter most. Goal 3 addresses the gap between eligibility and treatment that Royan et al. (2026) describe. Goal 4 addresses the mission's emphasis on keeping patients close to home, but it is framed as reducing avoidable transfers, since some patients, such as those needing thrombectomy, must be transferred. Goal 5 reflects the evidence that people are part of the system: clinicians surveyed in a Greek island stroke network believed in telemedicine more than they believed it suited their daily routines, and over a third had never watched it used (Chatzidaki et al., 2026).

Alignment With Mission and Strategy

Each goal connects to the strategic plan. Rapid specialist access and fewer avoidable transfers advance the priority of specialty care close to home. Faster treatment and more eligible patients treated advance quality and safety. Prepared staff supports both. Financial sustainability is served indirectly: patients who are treated locally remain in the system, and avoided transfers reduce ambulance costs. The project also fits the role Zaccagnini and White (2017) describe for the DNP-prepared nurse, who evaluates and selects information systems and technology to improve and transform care. As the project lead, I will translate clinical needs into system requirements and define the measures by which the system will be judged.

Stakeholders

The project affects many people, and naming them early helps plan for their involvement. Patients and families are the primary stakeholders. Emergency physicians and nurses at the two smaller hospitals will use the system at the bedside, and their workflow will change most. The comprehensive stroke center's neurologists and telestroke coordinators will provide consultations. The regional center's neurologists and radiologists will support imaging and inpatient care. Emergency medical services crews will be asked to prenotify the hospital. The information technology department will install and support the equipment, and the finance office, compliance officer and board will approve and oversee the investment.

Scope

The project includes video carts and connectivity for the three emergency departments, the telestroke contract with the comprehensive stroke center, stroke alert processes, order sets, training and data collection for the stroke registry. It does not include inpatient telestroke rounding, mobile stroke units or new imaging equipment, although the network could later support inpatient consultation if the first phase succeeds. Limiting the scope in this way keeps the project within the approved budget of about $650,000 and allows the implementation to be completed within one year.

Christian Worldview

The project rests on a conviction that every patient's life has equal worth, whatever the distance from a city hospital. In the parable of the good Samaritan, the man who proved to be a neighbor was the one who crossed the road to help the injured traveler where he lay (English Standard Version Bible, 2001/2016, Luke 10:30-37). A telestroke network does something similar: it carries specialist care to the patient rather than requiring the patient to travel to it. Stewardship also matters. A not-for-profit system must invest its limited resources where they will do the most good, which is why the goals are measurable and the scope is limited.

Conclusion

Rural patients in our region face longer delays and fewer treatment options for stroke than patients near a major center, and our smaller hospitals currently rely on telephone advice that the evidence links to worse outcomes. A telestroke network, understood as an integrated system of people, processes and technology, offers a way to bring specialist decisions to the bedside within minutes. The vision and five measurable goals presented here will guide the detailed plan in Part 2 and the implementation and evaluation in Part 3.

References

Chang, D., Ibrahim, R., Pham, H. N., Sainbayar, E., Shahid, M., Makkieh, M., Abbad, H., Lee, J. Z., Mamas, M. A., & Lee, K. (2024). Rural-urban stroke mortality gaps in the United States. Journal of Stroke and Cerebrovascular Diseases, 33(8), Article 107762. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107762

Chatzidaki, S., Anargyros, K., & Xanthos, T. (2026). Human readiness for stroke telemedicine in a Greek island network: A cross-sectional study. Telemedicine and e-Health. Advance online publication. https://doi.org/10.1177/15305627261492660

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

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

Shen, Y. C., Spencer, M., & Hsia, R. Y. (2026). Stroke technology diffusion in rural settings: Differential exposure to certification levels by community income levels. Neurology, 106(4), Article e214644. https://doi.org/10.1212/WNL.0000000000214644

Shi, A. C., Rothenberg, C., Sharma, P. B., Venkatesh, A. K., & Zachrison, K. S. (2026). Cross-sectional analysis of emergency department neurology access and 30-day stroke mortality in community hospitals. Journal of Stroke and Cerebrovascular Diseases, 35(9), Article 108690. https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108690

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

Tunkl, C., Carbonera, L. A., Hubert, G., Agarwal, A., Adcock, A. K., Liberato, B., Yperzeele, L., Roushdy, T., Collantes, E. M., Bonifacio Delgadillo, D. M., Bladin, C., & Ranta, A. (2026). Telestroke care in resource-limited settings: A World Stroke Organization scientific statement. International Journal of Stroke. Advance online publication. https://doi.org/10.1177/17474930261480603

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.