Project Plan

Practice Fusion: Cloud Based EHR

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Document Control

Document Information
©

Information
Document Id HCIN 542: Project_Plan_Aditi
Document Owner Aditi Marathe
Issue Date 05/23/2022
Last Saved Date 06/27/2022
File Name Practice Fusion: Cloud-Based EHR

Document History
Version Issue Date Changes
1.0 05/23/2022 1.1 Project Charter, 1.2 Project Scope
1.3 Milestones, 1.4 Phases, 1.5 Activities, 1.6 Tasks, 1.7 Effort,
2.0 05/30/2022 1.8 Resources, 2.1 Gantt Chart, 2.2 Assumptions, 2.3
Constraints
Added EHR Testing Plan and FMEA to Appendix (C & D,
3.0 06/07/2022
respectively)
4.0 06/20/2022 Stakeholder Analysis, G0-Live Checklist
Interview Questions, Post Implementation Plan, Finalized Plan
5.0 06/27/2022
& Plan & Appendices

Document Approvals
Role Name Signature© Date
Project Sponsor Prof. Tennille
Gifford 05/23/2022
Dr. Waverly, A.B
Project Manager
Aditi Marathe 05/23/2022

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Table of Contents
1 Planning Basis....................................................................................................................................... 2
1.1 Project Charter.............................................................................................................................................2
1.2 Scope............................................................................................................................................................2
1.3 Milestones....................................................................................................................................................2
1.3.1 Milestones..................................................................................................................................................3
1.4 Phases..........................................................................................................................................................3
1.5 Activities.......................................................................................................................................................4
1.6 Tasks............................................................................................................................................................5
1.7 Effort............................................................................................................................................................6
1.8 Resources.....................................................................................................................................................6

2 Project Plan.......................................................................................................................................... 7
2.1 Schedule (Gantt chart)...................................................................................................................................7
2.2 Assumptions..................................................................................................................................................7
2.3 Constraints.....................................................................................................................................................7

3 Quality and Test Plan............................................................................................................................ 8

4 Project Closure Report........................................................................................................................ 11

5 Appendix............................................................................................................................................ 11
Practice Fusion: Cloud Based EHR.................................................................................................................12
Project Charter..............................................................................................................................................12

A. General Information............................................................................................................................... 12

B. Purpose.................................................................................................................................................. 12

C. Constraints and Assumptions.................................................................................................................. 13

D. Project Scope Statement......................................................................................................................... 13

E. Resource Requirements.......................................................................................................................... 13

F. Risks....................................................................................................................................................... 14

G. Success Metrics: Criteria for Evaluating Project Success and Milestone....................................................14

H. Key Stake Holders................................................................................................................................... 15

I. Executive Summary.................................................................................................................................. 15
Gantt Chart....................................................................................................................................................16
Work Break Down Structure.........................................................................................................................16
System Test Plan............................................................................................................................................16
Failure Mode Effects Analysis........................................................................................................................19

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Project Stakeholder Analysis.........................................................................................................................21

Influence/Interest Grid..................................................................................................................................22
Guidance Notes:............................................................................................................................................23
Considerations:..............................................................................................................................................23
Post Implementation Evaluation...................................................................................................................24
1. Introduction..........................................................................................................................................24
2. Evaluation Summary.............................................................................................................................24
3. Analysis and Implementation...............................................................................................................25
4. Outputs.................................................................................................................................................26
5. Security.................................................................................................................................................26
6. Computer Operations...........................................................................................................................27
7. Maintenance Activities.........................................................................................................................28
Post Implementation Staff Interview/Questionnaire....................................................................................29

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1 Planning Basis

1.1 Project Charter

See Appendix A

1.2 Scope
The purpose of this project is to help the Waverly Family Health clinic change to a web based
EHR called Practice Fusion with the skill of their work force. The idea is to shift from paper-
based health records and move to a digital platform. The Waverly Health clinic has been
accredited by the Joint Commission and uses paper charts for accessing patient information.
The clinic provides services with electronic transmission of insurance claims, billing of
health services and insurance follow. Practice Fusion is cloud-based ambulatory EHR
platform providing low-cost healthcare services to doctors, patients, and partners. It provides
easy to use solutions, personalized workflow charts, effectively manage prescriptions,
effortlessly exchange information across various platforms like laboratories, imaging centers,
and tools integrated into the EHR and provide with workable billing options. Practice Fusion
also helps to streamline participation in quality analysis.

1.3 Milestones
 Project Charter concept developed
 Feasibility study and technical review*
 Outline Project Charter
 Assign and manage stakeholders
 Appoint a team
 Assemble Project office
 Examine Stage Gate
 Construct Project plan for approval*
 Work Breakdown approved*
 Establish resources, finances, and communication plan
 Develop risk management strategy
 Design quality plan and acceptance criteria
 Procurement strategy
 Perform Stage gate
 Practice Fusion installation*
 Network and firewall configuration
 Fix firewall concerns
 Records transfer*
 Physician and healthcare providers training*
 Administrative staff training*
 Performance review
 Conduct Stage-gate
 Medical coding and billing proficiency review*
 Complete documentation and processes
 Clinical review*
 Closure communication
 Release resources

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1.3.1 Milestones
Milestone Description Final Completion Date
Project Charter The Project Charter proposal has been 05/23/2022
approval approved by the Project Key
stakeholders.
Technical Review of Wi-Fi access and high speed 05/23/2022
Requirement review has been reviewed
Work Break Down WBS approved 15/10/2022
Structure (WBS)

Software Firewall and software installed, admin 06/17/2022

Implementation and networking setup achieved
Transfer of healthcare Patient medical records transferred to 07/22/2022
and medical records EHR
Training for Practice Fusion training provided 09/16/2022
physicians and
healthcare providers
Technical training for Staff is proficient with EHR 10/21/2022
administrative staff
Medical coding and Determine coding accuracy for billing 11/18/2022
billing proficiency purposes
review
Final Clinical Evaluation of EHR implementation after 11/23/2022
assessment 6 months

1.4 Phases
 Initiation Phase
 Planning Phase
 Execution Phase
 Closure Phase

Major Project Activities

Phase Description© Sequence
Initiation Defining and drafting Project Charter, Phase 1
Phase conducting a feasibility study and technical
review, managing stakeholders, selecting a
team, establishing a Project Office, and
monitoring any crucial changes.
Planning Designing a project plan by creating a work Phase 2
Phase breakdown structure, generating a plan for
resources, finances and communication with
vendors and stakeholder. Constructing a risk
management strategy, developing a quality plan
and acceptance criteria along with a
procurement strategy and performing a stage-

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gate
Execution Setting up Practice Fusion, network, and Phase 3
Phase firewall. Fixing bugs and other software issues,
uploading patient records, training physicians,
and healthcare providers, reviewing
performance and conducting a performance
review
Closure Phase Evaluating medical billing and coding for Phase 4
proficiency, performing final clinical review,
releasing resources, and conveying closures
with the stakeholders and vendors

1.5 Activities
 Project Charter development and approval.
 Developing a Project Plan.
 Install Practice Fusion
 Records Transfer
 Technical training
 Medical coding and billing review

Major Project Activities

Phase Activity Description© Sequence
Project Project Approval and development of the It is a preliminary
Initiation Charter Project Charter is critical before activity prior to
planning for the project. This phase planning phase
includes conducting a feasibility study
and technical review. It also comprises
of seeking approvals from
stakeholders and vendors, selecting a
team, and putting up an office for
work.
Project Developing Constructing a plan includes designing After the initiation
Planning a project a work breakdown structure (WBS) phase. This is the initial
plan which includes developing resources step in planning phase
like software purchase, managing and is conducted before
finances, fabricating a communication developing a WBS.
plan, risk management and
procurement strategy, quality plan and
acceptance criteria. It also
encompasses performance assessment
Project Install Practice Fusion installation and After the planning
Execution Practice network and firewall set up. phase. Installation is
Fusion crucial before transfer
of records and training
of healthcare providers
and administrative staff
Project Records Transfer of records from paper-based Before technical

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Execution Transfer to a digital platform. It includes patient training and after

personal history, admissions, and installation of Practice
surgeries. Fusion.
Project Technical Train physicians and healthcare providers Technical Training occurs
Execution training and administrative staff for seamless after records transfer. It is
transition and proficiency of the EHR required for a seamless
transition to a digital
platform.
Project Medical Medical coding and billing assessment 6 Final phase of the project.
Closure coding and months before and after EHR Review is conducted for
billing implementation approaching any potential
review issues while working of
the project.

1.6 Tasks
Phase Activity Task Sequence
Project Project Approval and development of 1st
Initiation Charter Project Charter. 2nd
development Conduct feasibility and technical 3rd
review. 4th
Enlist stakeholders 5th
Designate a team
Performance review
Project Work Design a work break down structure 1st
Planning breakdown Determine purchasing cost for 2nd
structure software. 3rd
Develop resources planning, 4th
finances, and risk management
strategy.
Identify a quality plan and
acceptance strategy
Project Install Network and firewall setup 1st
Execution Practice Identify software issues 2nd
Fusion
Project Records Transcribe patient paper records. 1st
Execution transfer Create medical records including 2nd
investigation reports. 3rd
Fabricate patient accounts with
profiles
Project Technical Train physicians, healthcare 1st
Execution Training providers and administrative staff
Project Coding and 6 months pre and post EHR coding 1st
Closure billing accuracy. 2nd
analysis Billing review for cost-risk

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1.7 Effort
Task© Effort
Approval and development of Project Charter. 1 day
Conduct a feasibility and technical review. 1 day
Enlist stakeholders 2 days
Designate a team 2 days
Performance review 1 day

Design a work break down structure Determine purchase cost for 3 days
software. 1 day
Develop resources planning, finances, and risk management 5 days
strategy. 2 days
Identify a quality plan and acceptance strategy
Network and firewall setup 2 days
Identify software issues 14 days
Transcribe patient paper records. 33 days
Create medical records including investigation reports. 33 days
Fabricate patient accounts with profiles 33 days and as required
Train physicians, healthcare providers and administrative staff 87 days
6 months pre and post EHR coding accuracy review. 12 days
Billing review for cost-risk 12 days

1.8 Resources
Task© Resource
Approval and development of Project Charter. Personnel
Conduct a feasibility and technical review. Personnel
Enlist stakeholders Personnel
Designate a team Personnel
Performance review Personnel
Design a work break down structure Determine purchase Personnel/Budget
cost for software. Personnel/Budget
Develop resources planning, finances, and risk management Personnel/Budget
strategy. Personnel
Identify a quality plan and acceptance strategy
Network and firewall setup Computer Software
Identify software issues Computer Software
Transcribe patient paper records. Personnel/EHR
Create medical records including investigation reports. Personnel/EHR/Tech
Fabricate patient accounts with profiles Personnel/EHR

Train physicians, healthcare providers and administrative Personnel

staff
6 months pre and post EHR coding accuracy. Personnel/EHR
Medical billing pre and post review for cost-risk Personnel/Records

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2 Project Plan

2.1 Schedule (Gantt chart)

See Appendix B

2.2 Assumptions
 Patient health information would be easily accessed once Practice Fusion is fully
functional within six months. This would help to deliver patient-centric care more
efficiently with the new digital platform.
 A cloud based EHR would help to provide automatic updates, flexible billing,
scheduling and provide patient chart on any device along with patient engagement.
 Provide patients with instant access to health records, lab results and prescriptions.
 Connect with more providers for coordinating care services.

2.3 Constraints
 Transfer of patient health records may require more than two months to upload to the
web based EHR.
 Time taken by the staff to adapt to Practice Fusion could be more than three months.
 Some members of the healthcare ecosystem including clinical labs and pharmacies
may not partner with Practice Fusion.
 Patients may have challenges while transitioning from paper-based records to a digital
platform.

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3 Quality and Test Plan

System Test Plan (Project Test Plan)

 Appendix C

Quality test planning comprises of four crucial test phases. Every test phase consists of a
detailed approach.
 Unit and Functional Testing
 System Testing
 Integrated Testing (simulates live environment)
 Performance and Stress Testing

Failure Mode Effects Analysis (Project Quality Plan)

 Appendix D

The process function for the failure mode effect analysis (FMEA) would be hardware and
software component testing for Practice Fusion implementation. The severity, occurrence,
and detection ratings provide the potential effects and causes of failure. The performance
review is conducted through recommended actions. The recommended actions will determine
the performance review and provide quality assurance check needed before the Practice
Fusion implementation. Modification could be done if there are any issues that come up
while implementing recommended actions.

Go-Live Checklist

Responsibility
Events Milestone Date Allocation

Set a timeline to go-live in the following week.

Notify the vendor about the set date.
Focus on implementation schedule or timeline.
Use the set timeline for backward scheduling of
Go-Live activities required for the plan to go live.
Organize a schedule to complete activities before 6/10/22 Aditi
Planning
the timeline. Recognize any possibilities or
future events.
Revisit the estimated EHR budget, ROI, and
measurable goals.
Ascertain a rollout strategy.

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Inform other key stakeholders including

physicians and other individuals. Notify and
engage vendors like labs, and billing company as
they are the drivers at this stage.
Evaluate results of systems and testing for
seamless transition. Assess devices, security, and
connectivity.
Review results from computers, navigational
devices, servers, universal power supply (UPS),
storage and back-up servers.
Analyze for any issues with interfaces including
lab, billing, admission, and transfers.
Assess evidence from software for system build
and data pass from one function to another
Examine improvisations in the process and
workflow by documentation.
Confirm with the staff for proficiency on device
usage by providing completion certificates.
Create a brief process to ensure that the training
Williams
is provided. Review policies and goals with key
Several Henry
stakeholders
Days Prior 10/31/22 Aditi
Set clear expectations regarding working of the
to Go-Live Wright
software during the first week of the EHR
Lawrence
implementation just in case there are any
glitches.
Seek vendors assistance for any issues that come
up EHR implementation and address any staff
problems that come up while using the digital
platform.
Modify staff schedules, huddle with the manager
for ensuring each member get sufficient time to
address the EHR issues while working on it.
Ensure staff has received specialized knowledge
to perform the tasks involved while operating
EHR.
Provide ID and password to each member of the
staff and backup for any issues with the system.
Inform patients prior to go-live.

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Provide incentives to the users for their efforts,

support, and appreciation. Prioritize meetings,
and schedule breaks.
Review the role of each member of the staff.
Recognize people who have the capacity to
initiate crucial system modifications.
Consider the procedures for escalation in the
event of a crisis depending on the intensity of the
Dr. Waverly
problem.
Dr. Jones
Ensure that all the systems including computers
Mrs. Jones
are fully working.
Day Prior Aditi
Assess internet service provider connection 11/22/22
to Go-Live Henry
(ISP) and speed.
Williams
Confirm if all the users connect to the main
Lawrence
network.
Wright
Preparing records for transferring into EHR.
Verify that all users are up to date with their
schedules and address any issues prior to the go-
live day.
Communicate with the champions in the team.
Notify all the users, patients and people from the
coding and billing team regarding the
implementation of EHR.
Day of Go- Staff 11/23/22 Aditi
Live All team members have been asked to arrive Mrs. Jones
early to prepare for the first patient. Felps
Staff is proficient in using the EHR has Henry
undergone training including updating medical Williams
reports into the EHR. Wright
An end-to-end “dry run” has been done by the
staff to be able to identify any bugs or setbacks
that can delay the working of the EHR.
The staff has been provided with sample data
testing documentation, chart data conversion
templates, and individual assistance.
Staff has been appropriately trained for sufficient
time to comprehend the functioning of the new
system and has signed off confirming that they
understand the new rules and procedures.
Hardware
All systems have been checked for low RAM,
overheating of motherboard and low disc space.
All computers have been checked for incorrect
firewall configuration and misconfigured DNS
settings.
The computers have been evaluated for EHR
application and any glitches that arrive while
uploading patient sensitive data.
The EHR application has also been tested for

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system interfaces.
Downtime Procedures
System back-ups have been executed. Backup
storage have constructed for avoiding downtime
procedure execution.
Procedures for downtime have been laid out.
Physical copies of the patient forms and
templates are available during downtime.

4 Project Closure Report

Post Implementation Evaluation Report
 Appendix F
Post Implementation Staff Interview/Questionnaire
 Appendix G

5 Appendix
Documents referenced in the project plan
 Appendix A
o Project Charter Document
 Appendix B
o Gantt Chart
 Appendix C
o EHR System Test Plan (Project Test Plan)
 Appendix D
o Failure Mode Effects Analysis, FMEA(Project Quality Plan)
 Appendix E
o Stakeholder Analysis
 Appendix F
o Post Implementation Evaluation
 Appendix G
o Post Implementation Staf Interview/Questionnaire

Appendix A

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Practice Fusion: Cloud Based EHR

Project Charter
A. General Information
Project Sponsor: Prof. Tennille Gifford
Dr. Waverly, A. B.
Project Manager: Aditi Marathe
Prepared by: Aditi Marathe
Date: 05/23/2022

B. Purpose
Scope:
The purpose of this project is to help the Waverly Family Health clinic change to a web based
EHR called Practice Fusion with the skill of their work force. The idea is to shift from paper-
based health records and move to a digital platform. The Waverly Health clinic has been
accredited by the Joint Commission and uses paper charts for accessing patient information.
The clinic provides services with electronic transmission of insurance claims, billing of
health services and insurance follow. Practice Fusion is cloud-based ambulatory EHR
platform providing low-cost healthcare services to doctors, patients, and partners. It provides
easy to use solutions, personalized workflow charts, effectively manage prescriptions,
effortlessly exchange information across various platforms like laboratories, imaging centers,
and tools integrated into the EHR and provide with workable billing options. Practice Fusion
also helps to streamline participation in quality analysis.

Goals:
The goal of the project is to provide the clinic with an uninterrupted transition from paper
charts to a digital platform for delivering patient-centric care by using lean methods with the
help of their staff.

Objective:
Overall, the project is expected to achieve a complete transfer of health records into the EHR
in around two months, educate the members of the healthcare facility through individualized
training in three months, and provide effective services in six months. 

Appendix A

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C. Constraints and Assumptions

Constraints:
 Transfer of patient health records may require more than two months to upload to the
web based EHR.
 Time taken by the staff to adapt to Practice Fusion could be more than three months.
 Some members of the healthcare ecosystem including clinical labs and pharmacies
may not partner with Practice Fusion.
 Patients may have challenges while transitioning from paper-based records to a digital
platform.

Assumptions:
 Patient health information would be easily accessed once Practice Fusion is fully
functional within six months. This would help to deliver patient-centric care more
efficiently with the new digital platform.
 A cloud based EHR would help to provide automatic updates, flexible billing,
scheduling and provide patient chart on any device along with patient engagement.
 Provide patients with instant access to health records, lab results and prescriptions.
 Connect with more providers for coordinating care services.

D. Project Scope Statement

Scope:
The Practice Fusion EHR implementation would create a seamless flow of clinical data
between patient information systems and ambulatory practices. This would provide for better
patient care and provide clinical data solutions to improve outcomes.

Timeframe:
The time required for the project to be completed would be 6 months. Approximately 2
months would be required for physicians and other healthcare providers to be competent with
the software. The administrative staff could begin training once the digital platform is
accessible. They would be provided with additional personalized training for one month to
become habitual and proficient for seamless workflow.

Cost:
The price of Practice Fusion is $ 149 per provider for each month along with flexible licenses
for each practice needs. It incorporates implementation, training, and customer support. One
provider license contains 3 signing staff and unlimited non-signing staff.
E. Resource Requirements
Financial:
Budget is $40,000 for successfully executing this plan. The cost per provider is $149 for each
month.

Personnel:
Doctor, physician assistant, medical assistant, front office clerk, project, and I.T manager for
an effective workflow.

Appendix A

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Technical:
A workstation for every member of the staff along with an uninterrupted high-speed internet,
a telephone and communication tools for technical support would be provided.
F. Risks
Positive Impact:
Unified Practice: Practice Fusion promotes unified practice management systems. This would
encourage interoperability between different healthcare facilities for providing better patient
outcomes.

Customize EHR: Practice Fusion provides with an e-prescribing system for getting the
medications faster and create personalize charts from any supported device. Practice Fusion
allows for flexible billing options along with tailored solutions at a low cost.

Negative Impact:
Usability: It would be difficult for a healthcare facility to learn the EHR without proper
training. Initially it would be more difficult to use EHR than a paper-based system.

Security and Privacy Violations: Physicians and staff members still face the legitimate worry
about data breaches caused by ransomware and cyber security hacks.

G. Success Metrics: Criteria for Evaluating Project Success and Milestone

Success Metrics
The table below discusses project milestones along with final delivery dates.
Estimated date has been provided as an approximate date.
The final delivery date takes into account the estimated date along with a buffer.

Project Milestone Description Estimated Date Final Delivery

Date
Project Charter The project has been 05/23/2022 05/23/2022
approved approved by the Project
Sponsor
Technical High speed internet with 05/23/2022 05/23/2022
Requirement Review Wi-Fi access has been
reviewed
Work Break Down WBS approved 06/10/2022 15/10/2022
Structure (WBS)
Software Software installed, 06/13/2022 06/17/2022
Implementation networking and admin
setup achieved, and
firewall installed
Transfer of patient Patient medical charts 07/18/2022 07/22/2022
health records transferred to EHR
Physician and Training regarding 09/12/2022 09/16/2022
healthcare providers Practice Fusion software

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training provided
Administrative staff Staff is proficient with 10/17/2022 10/21/2022
technical training EHR
Medical coding and Decide on coding 11/14/2022 11/18/2022
billing review accuracy for billing
purposes
Final clinical review Review after 6 months of 11/21/2022 11/23/2022
EHR implementation

H. Key Stake Holders

Key Stake Holders:
Below is the staff needing an access to EHR including key stakeholders, and project team
members

Key Stake Holders

 Dr. Waverly, clinic owner and medical director
 Dr. Jones, physician, and clinic partner
 Mrs. Jones, clinic director

Project Team Members

 Aditi Marathe, project manager
 Mrs. Johnson, physician assistant
 Mrs. Wright, MSN, NP, nurse practitioner (previous experience with installing EHR)
 Ms. Smith MA, back office medical assistant
 Mr. Lawrence, clinic accounts and billing
 Ms. Felps, front office clerk

I. Executive Summary
The Practice Fusion plan is executed to benefit Waverly Family Health Clinic migrate from a
paper-based format to an entirely digital web-based platform for delivering better care
services to patients. The sole purpose is to provide unique customizable solutions to patients,
physicians, and partners with features like e-prescribing, flexible billing and improve patient
satisfaction. Practice Fusion would be implemented in the first month and providing
individualized training to all personnel and adapt to a fully functional cloud-based platform
by the end of six months. The positive and negative risks have been identified for a seamless
workflow on a long-term basis. A budget of $40,000 has been identified with $149 being the
cost per provider including budget, labor infrastructure and stakeholder.

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Appendix B

Gantt Chart

Work Break Down Structure

Appendix C
System Test Plan

Electronic Health Record (EHR) System Test Plan

Exhibit 1: Table of Components to be tested

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Components Date Responsibility Accepted

Unit & Each major function works as expected 6/17/22
Functional according to the user manual. Aditi
Testing
Changes/customizations to the design are 6/17/22
present and work as requested. Document all William
changes for reference. Aditi

Screens appear as expected (content and 6/17/22

placement of fields, codes, drop down menus, Wright
and messages).
No errors in spelling or color changes. 6/17/22
Readable icons. Wright

Appropriate representation of content for legal 6/17/22

purposes can be printed if necessary Lawrence
William

Accurate display of the entries that have been 6/17/22

corrected with their corrections William
Wright

Fields edits (e.g., valid values, options, 6/17/22

defaults) function as expected. William

Appropriate reminders and prompts for alerts 6/17/22

and clinical decision making. Use scripts to William
test various scenarios.
System Appropriate sending and receiving of data 6/17/22
Testing through workflows between systems (e.g., Wright
between EHR and pharmacy or billing, PMS Lawrence
messages and EHR). Use scripts to test various
scenarios.
Interfaces between applications move data 6/17/22
correctly and completely. Test both sending William
and receiving when interfaces are bi- Henry
directional.
Connectivity with external organizations is 6/17/22
accurate and complete as authorized (e.g., William
portal access to/from hospital/clinic, continuity Henry
of care record to referrals, personal health Wright
records for patients, disease management
to/from health plan).
System access is appropriate per assigned 6/17/22
privileges. Test attempts to gain access when William
not authorized.
Data are processed accurately, in graphs, 6/17/22
tables, claims, client summaries, reports, etc. William
Henry
Lawrence

Data correctly populate registries, reporting 6/17/22

warehouses, etc. William
Henry
Lawrence

Integrated Ensure all system components that share data 7/3/22

Testing or depend on other components work together Henry
(Simulates properly. Wright
live

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Components Date Responsibility Accepted

environment Ensure that workflows reflect actual new 7/3/22
) processes and workflows. William
Henry
Aditi

Ensure that usage is defined in and follows 7/3/22

policies and procedures. Reinforce training as Wright
applicable. Lawrence

Ensure that help desk, support personnel, and 7/3/22

other aids function properly. William
Lawrence
Felp

Ensure that EHR works with all forms of 7/3/22

human-computer interface devices and Henry
modalities being used (e.g., tablets, PDAs, William
voice recognition, and speech commands as Wright
applicable).
Attempt to break the system by testing mission 7/3/22
critical and high-risk functions, such as William
situations requiring exception logic (e.g., Henry
overrides to clinical decision support), Lawrence
handoffs from one process to another, and Wright
when you may have a series of events over a
period of time (e.g., assessments performed at
designated intervals).
Performance Measure response times for key transactions or 7/3/22
& Stress interactions with the system, and assure they William
Testing are within acceptable limits, which may be Henry
defined in the contract.
Simulate an extremely high volume of activity 7/3/22
on the system such as would exceed William
anticipated peak loads of system usage. Henry

Measure the time it takes to generate reports 7/3/22

and data dumps, and the impact on system William
performance. Henry

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Appendix D
Failure Mode Effects Analysis

FMEA
Process reviewed: Hardware and Software component testing for Practice Fusion
implementation.
 Operating system issues.
 Internet availability.
 Power failure.
 DNS server issues.
 Hardware issues.
 Security issues.

Team members:

Name Position
Aditi Marathe Program Designer/Project Manager
Dr. Jones Physician and Clinical Partner
Mrs. Wright EHR installation experience/nurse practitioner

Mr. Lawrence I.T Manager/clinic accounts/billing

Mr. Felps Front office clerk
Mr. Williams DevOps Engineer
Mr. Henry Network Engineer

The chart below is an FMEA process that indicates process function, potential failure mode
and the effects of potential failure. The severity level is on a scale of 1 to 10. It demonstrates
the occurrence, current controls, detection scale, actions suggested and the date of completion
along with responsibility allocation.

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Appendix E
Project Stakeholder Analysis

Stakeholder Interview

Category Name Objectives/Questions

 Dependencies: Accounting and billing

Ms. Felps software.
Non-clinical Staff Mr. Lawrence  Influence: Accounting and billing
Mr. Williams processes.
Mr. Henry  Actions required: Hardware
procurement and contracts.

 Dependencies: Save time for patient

record management and cost saving.
Clinical Staff Dr. Jones  Influence: Driving the business
Dr. Waverly requirement and patient care.
 Actions required: Budget approval.

Administrative Staff Mrs. Jones  Influence: Clinic processes and

administration.

 Dependencies: Responsible for

Outside personal or agencies Mr. Williams software integration. Ensuring workflow
Mr. Henry reflects actual new processes.
Responsible for installing firewall, and
other networking setup.

 Dependencies: Success depends on

Vendors performance and quality of software.
Practice Fusion Representative  Special Interests: Responsible for
meeting the software needs and bug
resolution.

 Responsible for generating policies

Finance Mr. Lawrence and parameters that will drive ROI for
Dr. Waverly the clinic.
Dr. Jones  Responsible for providing timely
payments to the staff.
 Responsible for accurate coding for
patients and insurance billing.

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Appendix E
Influence/Interest Grid

Below is the influence/interest grid for stakeholder prioritization.

High
Dr. Jones Dr. Waverly

INFLUENCE

Ms. Felps Mrs. Jones

Low Ms. Smith Mrs. Wright
Mrs. Johnson Mr. Lawrence

Low INTEREST High

The influence/interest grid above has been divided into four sections. The X-axis determines
the interest of the stakeholders, and the Y-axis determines the influence/power of
stakeholders. Please refer to the ‘Guidance Notes’ below for reference.

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Appendix E

Guidance Notes:

Position of the stakeholders on the grid above using the following guidelines:

 High influence/interested people (Manage closely): These are the people who are
actively engaged and make the most effort. In this case, Dr. Waverly is the person
with high influence and high interest.

 High Influence/less interested people (Keep satisfied): Individuals to whom

sufficient information is provided to ensure they are up to date but not overwhelmed
with data. Dr. Jones is the individual with high influence and with less interest.

 Low influence/interested people (Keep informed): Discussions and information has

adequately been provided to these people to make sure no major issues arise. These
individuals can help with the detail of the project. Mrs. Jones, Mrs. Wright, and Mr.
Lawrence would come under this grid.

 Low influence/less interested people (Monitor): Individuals are provided minimal

communication to prevent boredom. Ms. Felps, Ms. Smith, and Mrs. Johnson are the
people low influence and with less interest.

Considerations:

 Do they have any financial or emotional interest in the outcome of your work – is it
favorable or negative?
 What motivates them most of all?
 What are your expectations in terms of support from them?
 What information do they want from you?
 What is the best method of communicating your message to them?
 What is their current opinion of your work and is good communication the basis for
it?
 Who affects their opinions in general, and who shapes their opinion of you
specifically?
 Do some of these influencers therefore become important stakeholders in their own
right?
 If they are not likely to be positive what will win them round to give their support?
 How do you manage opposition if you are not likely to win around?
 Are there any individuals who would be influenced by their opinions and decide
whether they need to become stakeholders in their own right?

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Appendix F

Post Implementation Evaluation

1. Introduction

1.1 Project Identification

HCIN 542 Practice Fusion: Cloud Based HER

1.2 System Proponent

Dr. Beverly Waverly

1.3 History of the System

Practice Fusion is an electronic cloud based EHR platform founded in 2005 with a
vision to enhance healthcare. It is the very first cloud based ambulatory EHR
technology in the United States, assisting 30,000 medical offices in providing 5
million patients with improved care each month. Practice Fusion is dedicated to
providing small, independent medical practices with intuitive and simple-to-use health
IT solutions and has a best-in-class satisfaction rate2. Additionally, Practice Fusion
provides solutions for all that benefits clinical labs, pharmacies, imaging facilities,
health systems, and other organizations in the healthcare ecosystem. These
collaborators make use of the Practice Fusion platform to coordinate care and create
cutting-edge initiatives that enhance patient satisfaction, lower costs, and improve
healthcare outcomes.

Functional System Description and Data Usage:

Data availability and cloud-based software

2. Evaluation Summary
2.1 General Satisfaction with the System
Users have provided favorable feedback despite minor concerns during the initial
month of using the digital platform. Several staff and providers have reported that
they experience reduced stress than before and are getting accustomed to the digital
system. The stress created by paper-based forms has reduced and satisfaction has
increased as the members of the healthcare are getting accustomed to the new system.
It has been possible to stay current continuously through automatic updates, and
access to chart on any device. Patients have been able to access the free patient portal.
There has been improvement in areas like physician-patient communication and the
healthcare facility has been able to deliver better health outcomes with increased
productivity. The new system offers flexible billing, scheduling, and task
management. The providers have expressed great satisfaction as they no longer have
to work with outside suppliers.

2.2 Current Cost-Benefit Justification

The annual operating cost or the on-going cost was more before the implementation
of the EHR. The operating cost for the current number of staff has significantly

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Appendix F
reduced. The operating cost for a member to manage paper-based record monthly
would be $3925. The verification of the eligibility automatically and the simplified
billing and coding services has been beneficial for providing patient turnovers and
enhanced patient encounters. The interoperability between different partnered services
has eliminated vendors. This has helped to bring down costs and help patients and
healthcare facility.

2.3 Needed Changes or Enhancements

Practice Fusion is a cloud based EHR. No changes or enhancements have been made
currently to the system as the platform is relatively new. Adjustments to the digital
platform could be made once the system is in use for some time.

3. Analysis and Implementation

3.1 Purpose and Objectives
The goal of the project was to create an uninterrupted transition from paper-based
charts to a digital platform for delivering patient-centric care by using lean methods
with the help of their staff. The analysis of the clinic indicated the need for migration
of the paper-based records. The physicians, healthcare providers and the
administrative staff were trained to use the digital platform and to address any issues
that come along the process. Although there were certain trivial issues initially, but
there was a seamless transition to a cloud-based platform.

3.2 Scope
The scope of this project was to help the Waverly Clinic transition to a web based
EHR. It also included transitioning the health insurance claims and providing medical
billing and coding options. The need and the urgency for transition was appropriately
established and the project plan progressed while meeting all the milestones set.

3.3 Benefits
The expectations were met after the implementation of the EHR. Some of the benefits
experienced by healthcare providers and staff were coordinated care with a unified
practice management, flexible billing, scheduling and comprehensive functionality,
and patient-centric care. The possibilities of the failures were evaluated beforehand
for increasing success outcomes.

3.4. Development Cost

The total budget for Practice Fusion was $40,000. The cost per provider is $149 for
each month. The total cost of the hardware, licensing, server, UPS, racks, bills, and
the network support was $21,000 and within budget.

3.5 Operating Cost

The operating cost of the project along with licensing and bills is $6000. The monthly
licensing cost is $300, and the cost of the bills is $200 per month. There was a
significant drop in the cost after the implementation of the EHR.

3.6 Training

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Appendix F
Sufficient training was provided to the physicians, healthcare providers and the
administrative staff to establish proficiency in this process. Timely training was
completed with the proposed design. Personalized training is needed for the
administrative staff for additional one month in response to the updates in the medical
field. Assistance could be provided to physicians in response to upgrades in the
medical and technological field.

4. Outputs
4.1 Usefulness
The physicians, healthcare providers and the administrative staff have noted that the
overall performance of the facility has improved. Meaningful use of the digital
platform has enhanced productivity. Coordination of care between the front-desk and
the back-office responsibilities can be done with integrated task management.
Communication between patients, providers and the staff can be done from the EHR.
The online patient scheduling and the automatic appointment reminders helps to avoid
long waits in the clinic. As a result, patient-centric care is made possible with better
outcomes. Customized charting can be done to fit the workflow. The staff has
reported to have increased accuracy with the medical billing and coding. Billing has
become simplified through streamlined electronic superbill feature that automatically
pulls the information from the patient charts. This has aided in saving time and
reducing double entry.

4.2 Timeliness
The timely availability of comprehensive patient health information has aided
providers to obtain a complete view of patient medical history. The physicians can
now track patient care and view a collated list of all lab reports and imaging studies to
monitor patient adherence. The healthcare providers can now analyse the patient
medical condition and review trend comparisons over time.

4.3 Data Quality

Data quality has remarkably enhanced the validity and reliability of patient health
outcomes. Health care providers can now view data in formats through a cloud-based
platform which was previously not possible with paper charts. The physicians can
now mark graphs of values like weight, blood pressure, cholesterol and track the
changes over time. This has led to better decision-making and improved patient health
outcomes.

5. Security
5.1 Data Protection
Security checks at various levels have been performed by experts to help recognize
any potential threats and security breaches. Firewalls and antivirus software have
been installed in the system to protect file system against unwanted programs and
keep attackers from getting access to the system. Every data security measure
complies with HIPPA regulations. Back-ups were performed at various levels to
ensure data safety. Providers can conveniently message patients on their devices with
secure texts through two-step authentication and HIPAA compliance.

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Appendix F

5.2 Disaster Recovery

Accessing and retaining data in the EHR on a consistent basis is essential for
providing better patient outcomes. An additional backup power back up has been
added to the system for uninterrupted power supply in cases of power failure, and data
loss. The network engineers have physical or remote access to data backups around-
the-clock. Generation of regular data backups is performed to prevent data loss.

5.3 Audit Trails

Clinicians regularly conduct assessments to maintain a high standard of care. A
regular third-party audit is performed to that the data is safe and follows compliance
standards and guarantee the organization is operating efficiently. Through audits, the
team can identify any process irregularities and build a consistent procedure. With the
help of the EHR system, it is feasible to submit accurate claims and create superbills
that comply with ICD-10. The EHR gathers necessary details to select the most
clinically relevant diagnoses and procedure codes. This aids in reducing errors.

5.4 System Access

The staff members have personalized IDs and passwords to login into the computer
before accessing Practice Fusion. The passwords are changed every week to ensure
the safety, security, and privacy of the EHR. A 2-factor verification is conducted, and
a security code is entered into the system to access the accounts. This process applies
to the staff as well as to the clients. Employees directly involved in patient care, or a
member of the patient care team are permitted to access patient information. Any
further access to information requires written consent from the patient that must be
recorded into their electronic health record (EHR). A HIPAA-compliant login process
is used to prevent data from being accessed, viewed, or shared without your express
consent. Any employee who discloses or misuses patient information will be
suspended immediately. Appropriate action will be taken as per law and policies. For
protecting patient privacy and safety, all electronic referrals are accessed within 14
days as a HIPAA precaution to prevent security breaches.

6. Computer Operations
6.1 Control of Workflow
Overall, the workflow has improved significantly with the implementation of the
EHR. The physicians, healthcare providers, and the staff have reported considerable
satisfaction after EHR use. There has been a seamless exchange between local
pharmacies, laboratories, imaging centers, and other tools integrated into the EHR
platform. Doctors can efficiently manage prescriptions including controlled
substances and those requiring prior authorization. The administrative staff has
reported reduced workload with the introduction of features like flexible billing
options. Verification of the insurance eligibility can now be done in the EHR before,
during, and after the visit.

a. Scheduling
Managing patient appointments efficiently from check-in to completion is achievable
with the help of Practice Fusion's complete scheduler. Customizing schedules,

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Appendix F
booking new appointments, updating existing appointments, and adding an intake
form to a new appointment can be done through the EHR. The staff can validate
insurance eligibility and respond to appointment requests from within the HER.

b. EHR User Interface

About 2,000 patient visits have been registered in the EHR. Patient encounter
information has been uploaded to the system with minimal errors. Physicians,
healthcare providers, staff, and patients have not reported any negative feedback.
Patients are notified via email if their appointment request is confirmed.
Appointments are processed and scheduled based on urgency.

c. Computer Systems
No hardware or software issues were noticed while using the EHR. Backups were
created before going live. The healthcare facility and the patients have not faced any
issues or challenges while operating the EHR to date. The EHR has been tested for
breaches and vulnerabilities. The computer systems have been tested for
incompatibility before installation, software version issues, inability to retrieve patient
data and data corruption. Hardware issues like low RAM and overheating of the
motherboard were assessed. Regular testing of the computer systems is done for any
challenges to ensure seamless workflow.

d. Peak Loads
The EHR has constantly been updated as per the feedback and practice needs.
Instructions manual is provided for troubleshooting during peak loads and downtime
release. The system is well equipped to perform under pressure and the healthcare
facility can carry out the tasks like e-prescribing, schedule access, patient charts, the
PHR, and more without any barriers.

7. Maintenance Activities
The goal is to assess maintenance activity for any issues with the EHR system
software and all hardware components

7.1 Activity Summary

Practice Fusion updates are constantly updated as per the feedback of the patients
and practice needs of the physicians, healthcare providers, and the administrative
staff. This has created a better experience for physicians and patients. Based on the
recent valuable feedback, the fields in the EHR can now expand to fit the full width
of the screen. The sections are easier to view with less scrolling and fewer clicks.
Maintenance activity is established on the scale of the system.

7.2 System Maintenance

System maintenance is performed outside of business hours to minimize the
interruption the workflow. A separate engineering team was appointed prior to the
implementation of the EHR. Maintenance of computer systems are regularly
maintained. The engineering team has provided assurance that all systems are
working smoothly.

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Appendix G
Post Implementation Staff Interview/Questionnaire

Interview questions prior to EHR implementation

1. CEO Question: What are your reasons for implementing an EHR?

Implementing an EHR has a two-folded purpose. The idea behind implementing an EHR
is to provide patient-centric care with enhanced health outcomes. Implementation of the
EHR would provide the healthcare facility with a vehicle to promote interoperability,
confidentiality, availability, and integrity of the patient health information data. It would
also ensure timely, accurate, and regulatory-compliant generation of reports. The EHR
would help in reducing staff workload as compared to using paper-based records and
minimize errors, reduce costs, and deliver better care with more patient inflow. The
introduction of features like automatic eligibility checks, time-saving super bills, flexible
billing options, and trained billing supports helps the staff to manage patients with
efficiency.

2. Members of the guiding team: Have you prepared your staff for the implementation
process? What has been their reaction?
One of the most challenging problems that any healthcare system faces in dealing with
change is more behavioral than technical. Previously the staff had faced challenges in
delivering care to the patients. As a result, the team was already aware of the urgency for
a system transformation and the significance of delivering better patient outcomes. The
EHR implementation training is crucial to realizing the full potential of the EHR. Three
training strategies have been used for preparing the staff for the implementation process
1. Super Users training 2. Role-based training 3. Process-based training.

Interview questions during the implementation process

3. CEO/Physician/Staff: Are your goals and expectations being met? Why/why not?
The goal was to provide patient-centric care by coordinating patient care with a unified
practice management system and improving workflow in the healthcare facility. The
analysis indicated the need for the migration of paper-based records. The EHR
implementation has helped to achieve our goals and expectations to a large extent. Using
a cloud-based system has aided in viewing patient charts on various devices, providing
flexible billing alternatives, automatic updates, and scheduling. The idea of engaging the
patient and the staff is possible with the cloud-based platform.

Interview questions 90-120 days after go-live

4. CEO/Physician: Who deserves credit for the success/or failure of the EHR project?
The EHR implementation was a success only because of the collective team effort put
forth by every member of the healthcare facility. The assistance provided by the
members of the Practice Fusion team has helped to implement EHR quickly. All the
clinicians, healthcare providers, and the administrative staff have provided the
willingness to adapt and the urgency to change the existing system. The key stakeholders

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of the healthcare facility had taken a deep interest throughout the entire process of the
implementation of the Practice Fusion.
Appendix G

Qualitative Interview Regarding use of Medication notices on EHRs

5. Guiding team members: Has the significance of the EHR project changed now that
the implementation is complete?
The healthcare facility had a vision in mind before the implementation of the EHR.
Creating patient-centered care and improving workflow were the priorities at the
healthcare facility. After the EHR implementation, the significance of the EHR project
has increased. There has been an increased level of satisfaction among all the clinicians
and the staff members. The features offered by the EHR have helped to streamline the
process for the facility and the patients.

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