Planning Your EHR Implementation

WebinarSchedule
PlanningforyourEHRImplementation October27and30 SelectingyourEHR January26and29 SuccessfullyImplementingyourEHR February23and26 Optimizing O ti i i yourEHRfor f Quality Q lit Improvement March23and26

LookingforMoreInformation?
CCMEEHRAdoptionWorkshopSeries Live,comprehensive,6partseriesoneach phaseofEHRadoption Limitingseriesto40participants SeriesstartsDecember11inRaleigh,NC ContactEHRservices@thecarolinascenter.org @ g formoreinfoandtoregister

SessionObjectives
Developspecific,measurablegoalsforEHR adoptionandqualityimprovement Formulatestrategiesforstaffcommunication andchangemanagement Developstrategiesformeetingtheproposed g usecriteria meaningful Createapracticespecificworkplanforthe EHRimplementation Formulatethespecificfeatures/functionality thattheEHRmusthavetobesuccessful

WhyPromoteEHR/HIE?
EffectiveEHR/HIEImplementationwill: Improvepatientqualityofcare Preventmedicalerrors Reducehealthcarecosts Increaseadministrativeefficiencies Decreasepaperwork Expandaccesstoaffordablecare

EHRAdoptionSteps
Prework Assessment Planning EHRsystemselection EHRsystemimplementation EHRpostimplementationevaluation Clinicalsystemimprovement

Review:PreworkSteps
1. 2. 3. 4. 5 5. 6. 7. Performfinancial/ROIassessment Confirmseniorlevelcommitment Assign g ap physician y champion p SelectEHRimplementationteam Learntoconducteffectivestaffmeetings LearnEHRhardwareandsoftwareterms ReviewrecommendedEHRfunctionalities

Review:AssessmentSteps
Performreadinessassessment Assesspracticeculture l Evaluatetheenvironmentforchange Assesscomputerskillsofallemployees Assesspatientsatisfaction Evaluatehardwareandnetworkingneeds Perform f workflow kfl analysis l i

EHRAdoption d i Step3 Pl Planning i Y YourEHR I l Implementation t ti

PlanningStep Includes
Createplans:Turnassessmentfindingsinto actionable ti bl information. i f ti Planforbackloadingandscanningpapercharts DetermineImplementationApproach DraftinternalprojectplanforEHR implementation DefineEHRImplementationgoalsand measurements

Step1 St CreatePlans

TurningAssessmentintoAction
Createdocumentedplansfor: resourceassignment g matrix Trainingneeds(computerskills,other) hardwareandsoftwareneedsandinventory communications Interfaceandconversionneeds Functionality ywishlist/vendor / selectionmatrix processimprovementplanspre/postEHR thebudgetandfundingsources

ResourceAssignmentMatrix
Plancomponents Tasks k required d f forthe h implementation l that h requireinternalresources Resourcesavailableforimplementationtasks backfillresourcesforstaffp pulledintothe implementation Outstandingresourcerequirements Planforacquiringadditionalresources

TrainingPlan
Plancomponents Basic B i computer t skills kill and dtyping t i training t i i needed d d Staffneedingtraining Communityorotherresourcesavailable Costsassociated Schedulesforstafftraining

HardwareandSoftwarePlan
Plancomponents: Detailedinventoryofprinters,faxes, workstations,etc newhardwareneeded(andcosts) newnetworkdrops(ifnecessary) newelectricaloutlets(ifnecessary) wirelessnetworkneedsincluding gsuggested gg placementofaccesspoints EHRaccessmethod(ASP,inhouse,hosted)

CommunicationsPlan
Plancomponents Stakeholdercommunications Projectsponsorcommunications Implementationteammeetingschedule Staff St ffcommunications i ti Requirementsforwrittenv.verbal communication

InterfaceandConversionPlan
PlanComponents Detailedaccountoftheinterfacesneeded includingpriority PlanforcurrentPMsystem(keeporreplace) Detailedaccountofneededdataconversions

FunctionalityWishList
Plancomponents Basedonyourassessments assessments,what functionalityisimportanttoyourpractice? Reporting R ti requirements i t PlanforassuringCCHITandmeaningfuluse criteriaareincludedintheEHR Creationofavendorselectionmatrix,oralist ofquestionsthatwillbeaskedofevery vendorandamethodforcomparingresults

ProcessImprovementPlan
PlanComponents Detailedaccountoftheissues,bottlenecks, papertriggers triggers,nonvalueaddedactivities Basedonyourworkflowanalysis,whatissues need dtobe b addressed dd dpreEHR? WhichissuescanberesolvedwiththeEHR?

BudgetandFundingPlan
Plancomponents Estimateddirectcostofimplementation Estimated i d i indirect di costof fi implementation l i Estimatedrevenueincreases Estimatedrevenuesavings InformationlearnedfromROIcalculations Fundingplans

Step2 DetermineImplementationApproach

Approach1BigBang
TheBigBangapproachentailsthatallEHR systemfunctionsareturnedonatgoliveand allphysicians, physicians nurses nurses,andadministrative supportstaffusetheEHRastheirsolemeans ofdocumentingpatientvisitsandperforming otherpatientrelatedtasks.

Approach1BigBang
Pros
Shorterimplementation time Shortenspainfulparallel paper/EHRoperational period Achievesreturnon investmentmuchquicker Lesslikelytogetstuckpart waytothegoal Takesadvantageofstaff enthusiasm

Cons
Higherriskoffailure Significantlyhigher productivity p yhitatg golive andsometimeafterward Stafforphysiciansunableto dealwithchangemayrebel Doesntallowfor g thep process tweaking basedonlessonslearned

Approach2Phased
ThePhasedapproachallowsphysiciansandstaff toeaseintotheEHR.Theofficegoeslivewith functionsperipheraltothepatientvisit(such asmessagingandprescriptionrefills)and workstowardelectronicchartingofpatient visits.

Approach2Phased
Pros
Reducesimplementation pains i toonegroup/function /f i atatime Spreadsoutcostsof hardwareandsoftware overalongerperiodoftime Lessrisk kof ffailure f l CANhelpbuildsupportina reluctantoffice Minimizeproductivityloss Allowstimetotweakthe process

Cons
Totalimplementationand training i i costsmaybe b higher hi h ROIisnotachievedas quickly Riskgettingstuckpartway tothegoal Canbeexhausting imparts thefeelingthatthingsare alwaysinflux Hybridpaper/EHRsystem canbeconfusing

PhasedApproachSuggestions
Phase1:eprescribing, prescribing medicationlists lists, allergies,problemslists,vitals,messaging,lab results patienteducationmaterials results, Phase2:prompts/reminders,orders,referrals, templatedphysiciandocumentation Phase3:advancedclinicaldecisionsupport, patient i health h l hmaintenance i modules, d l chronic h i illnessflowsheets/tracking

Step3 St Backloading gandScanning g

BackloadingandScanning
Scanningreferstotheprocessof electronicallyscanningyourpapermedical recordsintotheEHR. EHR Backloadingreferstotheprocessofmanually enteringinformationintosectionsofyour EHR.

BackloadingandScanningKey Considerations
Whichpaperchartswillbescanned?All charts?Activecharts? Whatorderwillthechartsbescanned? Whichpartsofthechartswillbescanned? Willindexingbeused? Whichpartswillbemanuallybackloaded? Whowillscan?Backload?AndWhen?

Moreconsiderations
Processfornew,incomingdocuments? Whattypeofscannerisneeded? Enoughspaceforahighvolumescanner? Willscanneddocumentsbe searchable/reportable? Postscanpaperdocumentstorage?

BackloadingandScanningTip
Ifpaperchartsaretobescanned, scanned youmayneed todevelopapapertoelectronictransition plansoyourstaffwillknowwheretolookfor apatientschart.Forexample,shouldthey lookontheshelforinthecomputerforthe patientschart?

Step4 DraftInternalProjectPlanfor Implementation

Hopeisnotaplan

WhyCreateaWorkplan?
Helpscommunicatetheimplementation activitiestothestaff toplanthetimingofspecificimplementation tasks k canbeusedtoplanresourceallocationfor eachimplementationtask Anaidinvendorcontractnegotiations. g Tomonitorandcontroltheimplementation

Ifyouh haveaclear l vision i i of fWHEN theimplementationneedsto occur,youcanaddspecific languagetoyourEHRvendor contracttomakesuretheEHRis livewhenYOUneedittobe.

SampleBaseWorkplan

CreatingtheWorkplan
StartwithabaseEHRimplementationplan thatincludesEHRadoptionsteps steps. Pluginyourdesiredlivedateandthenwork back ardstofillintherestofthedates. backwards dates Fillinwhowillberesponsibleforeachtask. Theworkplanwillneverbesetinstoneso anticipatechangestoyourworkplan. TheEHRvendoryouchoosemayalsohave steps p thatneedtobeaddedtotheworkplan. p

Step5 DefineEHRImplementationGoals andMeasurements

WhySetGoals?
Helpsdefinesuccessfortheimplementation and doverall llquality li improvement i Whenyoudefineyourgoals,youcandefine yourneedsandactions Wheny youdefineyour y needs, ,you y canselect anEHRsystemthatwillmeetyourneeds Helpswithstaffbuyinandfacilitatesopen communication

GoalSettingBasics
GoalDefinition: Setclear,measurablegoals forwhatcanbedonetoimprovetheexisting conditions. Action i Plan: l Foreach hgoal, l d define f aplan l of f actionforachievingthegoal.Whatspecific stepsdo d youneed dtotake k toreach hyourgoal? l? MeasuringSuccess: Determinehowyouwill measurethesuccessofyouractionplan.

SampleGoal
Goal: Decreasethenumberofpharmacy phonecallsregardingprescriptions ActionPlan: Usetheeprescribingfeaturein the h EHRtoeliminate l paperand dhandwritten h d prescriptions.Utilizethedruginteraction checking h k feature f of fthe h EHRtoguard dagainst druginteractions MeasureofSuccess:Intwomonths,havean 85%reductioninpharmacyphonecalls

SampleGoal
Goal:Decreasetranscriptionturnaroundtime andreducetranscriptioncost. ActionPlan:Useclinicalchartingwithinthe EHRtoeliminatetheneedfortranscription services. services MeasureofSuccess:Withintwomonthsof EHRli live,reduce d the h costof ftranscription i i b by 80%.

GoalSettingGuidingPrinciples
Keepitsimple!Dont Don tgethunguponstatistics statistics, samplesizeandcomplicatingfactors Setclear clear,measurablegoals Involveeveryoneinoffice brainstorm Defineaplanofactionforachievingthegoal Determinehowy youwillmeasurethesuccess ofyouractionplan

Contact CCME
TheCarolinasCenterforMedicalExcellence 9193809860asktospeakwithEHRServices YoumayvisitCCME www.thecarolinascenter.org/EHR Youmayalsoemail EHRServices@thecarolinascenter.org