Slide 1 - Community HealthCare Association of the Dakotas ...

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Slide 1 - Community HealthCare Association of the Dakotas ...

  1. 1. EHR – The Implementation Process Clayton Gillett
  2. 2. Stages of EHR Implementations Assessment Planning Part I – Getting Started System Selection Implementation Process Working Towards Transformational Change Improvement / Optimization
  3. 3. Aspects of Assessment • Determine Organizational Needs • Identify Required Functionalities • Determine Measures of Success • Identify Appropriate Resources • Identify Approach to Meet Business Needs
  4. 4. Assessment: Identify Organizational Needs Return on Investment (May not be financial) Change Management Productivity Quality
  5. 5. Aspects of Planning and Preparation • Refine Goal Setting • Assemble The Stakeholders • Develop a scope Service Lines Interfaces Functionality Implementation Options • Gather and analyze resources • Determine Selection Process
  6. 6. Assessment: Identify Organizational Needs (Cont.) • Quality Population Management • Disease Management • Preventive Care Improved Documentation Reduced Errors Clinical Decision Support • Active • Passive Clinical Coordination Across Sites Clinical Coordination with Hospital or Other Systems
  7. 7. Assessment: Identify Organizational Needs (Cont.) • Productivity and Billing Improved Documentation for Billing Capitalize on Grants or Technology Funds Reduced Dependence on Transcription Reporting • Transformational Care Personal Health Records Health Risk Appraisals Automatic Lab Notification
  8. 8. 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 Health Oral Health
  9. 9. Assessment: Develop Measurements of Success • Productivity Pre and Post Implementation • Clinical Quality • ROI? • Provider Satisfaction • Patient Satisfaction
  10. 10. Assessment: Identify Resources • Implementation Funding • Maintenance Funding • Appropriate Space AC Power Backup Secured Location High Speed Internet Capabilities • Clinical Content Development • Internal Staff Required Availability of Trained Staff Training and Maintenance Costs of Staff Help Desk Support Interface Management
  11. 11. Assessment: Identify Approach to Meet Business Needs Vision • Organizational Needs • Required Functionality • Measures of Success Resources • Staff Support • Staff Turnover • System Requirements • Implementation 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
  12. 12. Stages of EHR Implementations Assessment Planning Part I – Getting Started System Selection Implementation Process Working Towards Transformational Change Improvement / Optimization
  13. 13. 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
  14. 14. 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 operations Clinical 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
  15. 15. Planning and Preparation: Assemble the Stakeholders • Patients In-clinic communications, mailers • Hospitals Service coordination • Pharmacies Electronic (eg, SureScripts), new script look • Lab Agencies Interface, requisitions • Radiology Services • Supply houses, referrals External – Identify, engage where needed, and communicate changes
  16. 16. Planning and Preparation: Develop Scope • Service Lines Primary Care Specialties Mental Health Public Health • Interfaces Essential, desired, options Lab, pharmacy, radiology, Scanning State databases (immunizations), Federal health disparities collaboratives (BPHC PECS)
  17. 17. Planning and Preparation: Develop Scope • Functionality Progress notes Ordering labs, x-rays, meds, referrals InBasket Decision support Care team communications Referrals management Chart tracking Reporting Integration with front office and billing/claims Connectivity to internal and external systems Scanning
  18. 18. 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
  19. 19. Planning and Preparation: Develop Scope Scope Resources Time • Balancing the plan…..
  20. 20. 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
  21. 21. Planning and Preparation: Determine selection process • Options for a Stark donation Unique 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
  22. 22. Stages of EHR Implementations Assessment Planning Part I – Getting Started System Selection Implementation Process Working Towards Transformational Change Improvement / Optimization
  23. 23. Stages of EHR Implementations Assessment Planning Part I – Getting Started System Selection Implementation Process Working Towards Transformational Change Improvement / Optimization
  24. 24. 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.
  25. 25. Build an Effective Implementation Team • Organizational Leadership Executive Level Participation Operations Lead Clinical Leadership (MD) • Project Leadership • Site Specialists • Subject Matter Experts • IT Representation
  26. 26. 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
  27. 27. 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.
  28. 28. Implementation Team • Documentation of Team Roles and Responsibilities and Qualifications for: Project Manager Clinic Implementation Manager Site Specialists Etc…
  29. 29. 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
  30. 30. 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
  31. 31. Project Approach • On Site Kick Off Meeting Scope Confirmation Project 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
  32. 32. Work Flow Documentation and Redesign • Based on Standard Workflows Identify Variation Determine Response • Engage billing and claims • Test with a complete walk through Document All Final Workflows • Train to Workflows
  33. 33. 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
  34. 34. 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 • Billing Grant Billing Specific Payor Rules
  35. 35. 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 results The need to fix a problem may seem small when the fix results additional problems.
  36. 36. Effective Change Management • Team Communication Tools Project Plan Training Documentation • Web Based Training • On Demand Resources Workflow Documentation • Clinical Communications Coop Current Clinic Communication Tools Demo Early To All Staff • Patient Communication
  37. 37. Efficient Testing • Test using the workflows. • Test in production prior to go live. Dressed Rehearsal Unit Testing of Each Change Require end user testing • Maintain workflows when testing uncovers the need to change. • Provide a mechanism to train users
  38. 38. Stages of EHR Implementations Assessment Planning Part I – Getting Started System Selection Implementation Process Working Towards Transformational Change Improvement / Optimization
  39. 39. Stages of EHR Implementations Assessment Planning Part I – Getting Started System Selection Implementation Process Working Towards Transformational Change Improvement / Optimization

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