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EHR – The Implementation Process
Clayton Gillett
Stages of EHR Implementations
Assessment
Planning Part I – Getting Started
System Selection
Implementation Process
Working Towards Transformational Change
Improvement / Optimization
Aspects of Assessment
• Determine Organizational Needs • Identify Required Functionalities• Determine Measures of Success• Identify Appropriate Resources• Identify Approach to Meet Business Needs
Assessment: Identify Organizational Needs
Return on Investment(May not be financial)
Change Manageme
nt
Productivity
Quality
Aspects of Planning and Preparation
• Refine Goal Setting • Assemble The Stakeholders• Develop a scope
Service LinesInterfacesFunctionalityImplementation Options
• Gather and analyze resources• Determine Selection Process
Assessment: Identify Organizational Needs (Cont.)
• QualityPopulation Management
• Disease Management• Preventive Care
Improved DocumentationReduced Errors Clinical Decision Support
• Active• Passive
Clinical Coordination Across SitesClinical Coordination with Hospital or Other Systems
Assessment: Identify Organizational Needs (Cont.)
• Productivity and Billing Improved Documentation for BillingCapitalize on Grants or Technology FundsReduced Dependence on TranscriptionReporting
• Transformational CarePersonal Health RecordsHealth Risk AppraisalsAutomatic Lab Notification
Assessment:Identify Required Functionalities
• Computerized Physician Order Entry• Connections to External Systems (Interfaces)• Connections to Internal Systems
Devices Lab / Radiology
• Scanning• E-Prescribing• Specialties to Consider
Mental HealthOral Health
Assessment: Develop Measurements of Success
• Productivity Pre and Post Implementation• Clinical Quality• ROI?• Provider Satisfaction• Patient Satisfaction
Assessment:Identify Resources
• Implementation Funding
• Maintenance Funding• Appropriate Space
ACPower Backup Secured LocationHigh Speed Internet
Capabilities• Clinical Content
Development
• Internal Staff RequiredAvailability of Trained
StaffTraining and
Maintenance Costs of Staff
Help Desk Support Interface
Management
Assessment: IdentifyApproach to Meet Business Needs
Vision• Organizationa
l Needs• Required
Functionality• Measures of
Success
Resources• Staff Support• Staff Turnover• System
Requirements• Implementati
on Funding• Maintenance
Funding• Physical
Facility• Culture /
Content
Identify Approach• Build It
Yourself• Customize a
Vendor Product
• Identify Proven Vendors
• Software as A Service
• Health Center Controlled Network
• Collaborative
Stages of EHR Implementations
Assessment
Planning Part I – Getting Started
System Selection
Implementation Process
Working Towards Transformational Change
Improvement / Optimization
Planning and Preparation:Refine Goal Setting• Tie project goals to organization’s strategic goals where possible
EHR as an enabler• How will goals be measured?
Pre-EHR: manual chart audits, undocumented workflows With EHR: electronic chart audits, documented workflows,
reporting• Think broadly
Clinical• Ex: HbA1c and Health Maintenance Alerts
Operational• Ex: 2 areas of PI (rx refills, referrals)
Project related• Ex: Immediate access to patient’s chart at time and location
needed• …and short term before long term
Be realistic Goals can be phased
Planning and Preparation:Assemble the Stakeholders
• Medical, operations, information technology Sponsors
• Leadership/decision makers: providers, clinic management, nursing staff, medical records, IT, front desk and financial operationsClinical Implementation Team
• Supervisors/leads/subject matter experts: lab, x-ray, pharmacy, referrals…..Targeted planning discussions, workflow reviews,
communications, communications, communications
Internal – Identify and engage them in the process
Planning and Preparation:Assemble the Stakeholders
• Patients In-clinic communications, mailers
• Hospitals Service coordination
• PharmaciesElectronic (eg, SureScripts), new script look
• Lab Agencies Interface, requisitions
• Radiology Services• Supply houses, referrals
External – Identify, engage where needed, and communicate changes
Planning and Preparation:Develop Scope
• Service LinesPrimary Care SpecialtiesMental HealthPublic Health
• InterfacesEssential, desired, options Lab, pharmacy, radiology, Scanning State databases (immunizations), Federal health
disparities collaboratives (BPHC PECS)
Planning and Preparation:Develop Scope
• FunctionalityProgress notesOrdering labs, x-rays, meds, referrals InBasket Decision supportCare team communicationsReferrals managementChart trackingReporting Integration with front office and billing/claimsConnectivity to internal and external systems Scanning
Planning and Preparation:Develop Scope
• Beta – an essential• Big bang
All functionality, all locations Reduces dual process timelines Start realizing benefits more quickly Can your organization manage this much change at once? Requires more resources
• Paced All functionality, clinic or group of clinics at a time Learn from previous clinic with potential for
improvements Organizational change may be more manageable Resource requirements are spread out
Implementation Options
Planning and Preparation:Develop Scope
Scope
Resources Time
• Balancing the plan…..
Planning and Preparation:Analyze and gather resources
• Equipment and Staff Resources Host hardware in secure and environmentally appropriate
space Connectivity Hardware/Software End user devices Software build/configuration Data architecture, management, reporting Interfaces Training Support System maintenance Optimization
• Vendor Product In-House• Application Service Provider (ASP)• Network
Planning and Preparation:Determine selection process
• Options for a Stark donationUnique requirements of FQHC?Stability of the donating organization?
• System selection direct to vendors• System selection to health center
controlled networks• Combination• Determine the need for external expertise
Stages of EHR Implementations
Assessment
Planning Part I – Getting Started
System Selection
Implementation Process
Working Towards Transformational Change
Improvement / Optimization
Stages of EHR Implementations
Assessment
Planning Part I – Getting Started
System Selection
Implementation Process
Working Towards Transformational Change
Improvement / Optimization
EHR Implementation
Implementing an EHR will be the single largest change that you will make in your
health center in the time that you are there.
The project is larger even than the relocation to a new facility.
Build an Effective Implementation Team
• Organizational LeadershipExecutive Level ParticipationOperations LeadClinical Leadership (MD)
• Project Leadership• Site Specialists• Subject Matter Experts• IT Representation
Implementation Team Example
• Project Manager• Providers (physicians
and mid-levels)• Nurses• Medical Assistants• IT Management• Clinical Management• Administrative
Management
• Patient Support Services (Reception, Billing)
• Quality Improvement• Data Management• Medical Records
Management• Behavioral Health• Case Management
Implementation Team Expectations
• Weekly Meetings• Team members are expected to
communicate to constituencies.• Not a consensus driven process but full
participation is expected.• Decisions that are made are
communicated as a team.• Team members have time allocated away
from their regular work.
Implementation Team
• Documentation of Team Roles and Responsibilities and Qualifications for:Project ManagerClinic Implementation ManagerSite SpecialistsEtc…
Project Manager Responsibilities
• Manage the project.• Develop and manage
project plan. • Provide leadership in
change management areas.
• Keep all stakeholders involved and up-to-date in the process.
• Coordinate and ensure on-going progress through all the EMR implementation tasks.
• Report to clinic leadership and vendor / network / collaborative leadership
Project Plan: Tasks and Timeline
• Readiness Assessment• Requirements for Each Application Module• Workflow Redesign• Down Time Procedures• Communication Plan• Training Plan• Data Conversion / Abstraction / Preload• Interface Development• Hardware Purchase and Implementation• Connectivity
Project Approach
• On Site Kick Off Meeting Scope ConfirmationProject Plan Vetted Initial Data Collection (locations, preference lists etc.)
• Workflow Review and Redesign (on site)• System Build (letters, handouts, clinical doc.)• Test• Dressed Rehearsal (on site)• Conversion• Go-Live
Work Flow Documentation and Redesign
• Based on Standard WorkflowsIdentify VariationDetermine Response
• Engage billing and claims• Test with a complete walk through
Document All Final Workflows• Train to Workflows
Workflow Redesign Pitfalls
• Not all variation requires an application change.Policy is still an
effective tool. Some variation is
appropriate.
• Do not attempt to address all current problems prior to implementation.Prioritize Standardize
Key Workflows
• Scheduling• Registration• Office Visits
Workman’s Comp Immunizations Family Planning
• Walk In Patients• Rx Refill Requests
• Phone Calls• Lab Only Visits• Referrals• Medical Records /
Release of Information
• BillingGrant Billing Specific Payor Rules
Effective IT Change Control
• Develop and follow and tool for effective change control in the system.Manage build across Test and Production
environments.Require signoff in each location.
• Weigh carefully the need to move outside the change control methodology.Complex systems can have unanticipated resultsThe need to fix a problem may seem small when the
fix results additional problems.
Effective Change Management
• Team Communication ToolsProject PlanTraining Documentation
• Web Based Training• On Demand Resources
Workflow Documentation• Clinical Communications
Coop Current Clinic Communication ToolsDemo Early To All Staff
• Patient Communication
Efficient Testing
• Test using the workflows.• Test in production prior to go live.
Dressed RehearsalUnit Testing of Each ChangeRequire end user testing
• Maintain workflows when testing uncovers the need to change.
• Provide a mechanism to train users
Stages of EHR Implementations
Assessment
Planning Part I – Getting Started
System Selection
Implementation Process
Working Towards Transformational Change
Improvement / Optimization
Stages of EHR Implementations
Assessment
Planning Part I – Getting Started
System Selection
Implementation Process
Working Towards Transformational Change
Improvement / Optimization