Guaranteeing successful EHR
implementations
EHRs implementations are difficult, don’t go it alone
Shahid N. Shah, CEO
NETSPECTIVE

Who is Shahid?
•
•
•

•

20+ years of software engineering and multisite healthcare system deployment
experie...
NETSPECTIVE

Why listen to me?
No
Adopt the EHR
implementation
ideas I’m proposing
Tell your boss this is the
best EHR pre...
NETSPECTIVE

We can help your project today
• EHR implementations are very difficult and you will
probably need help. Your...
NETSPECTIVE

Why are you implementing an EHR?
Most obvious, dangerous

Most noise, least attention

Most promising

www.ne...
NETSPECTIVE

Where are you in your journey?
Made the decision to go to an EHR
Created the leadership team
• IT, Clinical, ...
NETSPECTIVE

How do you know you’re successful?
Demand success metrics early on

Adoption
• What are staff and physician
u...
NETSPECTIVE

EHRs are NOT IT projects
Non-IT
Leadership

Clinical &
Business

IT &
Systems

PMO
Governance
Decisions

Work...
NETSPECTIVE

Staff Involvement Guidelines
Successful EHR Projects
20%

10%

Leadership
Business

35%

35%

Clinical
IT

Ty...
NETSPECTIVE

Implementation Roadmap
Evaluate the current workflow

Define documents that will be electronic vs. paper
Figu...
NETSPECTIVE

www.netspective.com

The EHR is a tool to
care for patients and
the initial
implementation
should be as minim...
NETSPECTIVE

Transforming workflow before EHR

Reduce culture shock by doing the “human centered” work before technology i...
NETSPECTIVE

IT Implementation Roadmap
Visit existing sites serviced by EHR vendor

Define the staff to hardware ratios an...
NETSPECTIVE

Practical IT Considerations
User to
hardware ratio
System
downtime and
DR
www.netspective.com

Hardware types...
NETSPECTIVE

Paperless document management

Create a matrix of every document you work with to see how it should be handle...
NETSPECTIVE

Ancillary Software Considerations
EHRs aren’t enough

E-mail integration

E-Prescribing

Microsoft Office and...
NETSPECTIVE

Hardware Considerations
•

•
•
•
•
•
•

If you’re going paperless, you’ll need
much more hardware than you th...
NETSPECTIVE

Network Considerations
Wired

• Does every room with a device have a network drop?
• Consider bandwidth and w...
NETSPECTIVE

Data storage considerations
Storage isn’t just about hard drives. It’s really about all the different kinds o...
NETSPECTIVE

Consider Virtualization
• Before moving into EHRs, consider
virtualization:
– Servers
– Desktops (VDI)
– Stor...
NETSPECTIVE

Mobile & Wireless Devices

Your EHR implementation must support remote devices, BYOD and mHealth

www.netspec...
NETSPECTIVE

EHR Security Considerations
Your EHR MUST support all of the following

Role-based access
control to patients...
NETSPECTIVE

IT Security goes beyond encryption
• What level of access do technical staff—both internal staff and vendor—
...
NETSPECTIVE

Confronting EHR Myths
Broken processes
are automatically
fixed by an EHR.
Loose reports are
no longer a
probl...
Visit
http://www.netspective.com
http://www.healthcareguy.com
E-mail shahid.shah@netspective.com
Follow @ShahidNShah
Call ...
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Guaranteeing successful EHR implementations

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EHR implementations are very difficult and going it alone with just an EHR vendor will not be enough.

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Guaranteeing successful EHR implementations

  1. 1. Guaranteeing successful EHR implementations EHRs implementations are difficult, don’t go it alone Shahid N. Shah, CEO
  2. 2. NETSPECTIVE Who is Shahid? • • • • 20+ years of software engineering and multisite healthcare system deployment experience 12+ years of healthcare IT and medical devices experience (blog at http://healthcareguy.com) 15+ years of technology management experience (government, non-profit, commercial) 10+ years as architect, engineer, and implementation manager on various EMR and EHR initiatives (commercial and nonprofit) www.netspective.com Author of Chapter 13, “You’re the CIO of your Own Office” 2
  3. 3. NETSPECTIVE Why listen to me? No Adopt the EHR implementation ideas I’m proposing Tell your boss this is the best EHR presentation you’ve ever been to. www.netspective.com Do you have a well thought-out EHR implementation plan that will guarantee success? YES! Pat yourself on the back and try not to make fun of the rest of us mere mortals. Stay and tell me why I’m wrong or nod your head in agreement. 3
  4. 4. NETSPECTIVE We can help your project today • EHR implementations are very difficult and you will probably need help. Your EHR vendor will not be enough. • If you like what I presented, we are available to help with your EHR implementation efforts, especially where technology and clinical / business folks must communicate better. • Our contact information is at the end of this deck. www.netspective.com 4
  5. 5. NETSPECTIVE Why are you implementing an EHR? Most obvious, dangerous Most noise, least attention Most promising www.netspective.com 5
  6. 6. NETSPECTIVE Where are you in your journey? Made the decision to go to an EHR Created the leadership team • IT, Clinical, and Business participation is required Created the selection team Created the implementation team Implementation planned and ready to execute www.netspective.com 6
  7. 7. NETSPECTIVE How do you know you’re successful? Demand success metrics early on Adoption • What are staff and physician usage metrics? Service Performance Cost Savings • Have you defined how much faster /better clinical services will be provided? • Did you define reduction in tests, staff, malpractice insurance, data entry, etc.? Quality of care • What quality metrics have been defined?? www.netspective.com 7
  8. 8. NETSPECTIVE EHRs are NOT IT projects Non-IT Leadership Clinical & Business IT & Systems PMO Governance Decisions Workflow Documents Imaging Software Hardware Network Storage Interfacing www.netspective.com EHR Project 8
  9. 9. NETSPECTIVE Staff Involvement Guidelines Successful EHR Projects 20% 10% Leadership Business 35% 35% Clinical IT Typical (usually unsuccessful) 2% 19% 69% www.netspective.com 10% Leadership Business Clinical IT 9
  10. 10. NETSPECTIVE Implementation Roadmap Evaluate the current workflow Define documents that will be electronic vs. paper Figure out whether care standardization is possible Redefine and plan for new EHR workflows Evaluate whether staff and physicians are ready for culture shock www.netspective.com 10
  11. 11. NETSPECTIVE www.netspective.com The EHR is a tool to care for patients and the initial implementation should be as minimal as possible so that it can be see as a success without harming patient care or causing staff revolts. Plan for change Your EHR implementation will not be “born” all at once and must be implemented in stages. First, do no harm Phased approach Resist the “big bang” approach There is a beginning for your EHR project but probably no end – assume and plan for routine reconfiguration as the organization adapts to the system (don’t let people create manual workarounds for system problems). 11
  12. 12. NETSPECTIVE Transforming workflow before EHR Reduce culture shock by doing the “human centered” work before technology implementation EHR implementation is a perfect opportunity to optimize your clinical and business processes. Do not try to change processes and simultaneously try to deploy a new system and configure it “on the fly”. Always repeat a process manually before you attempt to automate it. If the first time you try out a new workflow process is after you install an EHR then the EHR will get all the blame and it will take longer to implement the change. www.netspective.com 12
  13. 13. NETSPECTIVE IT Implementation Roadmap Visit existing sites serviced by EHR vendor Define the staff to hardware ratios and usage patterns Plan network bandwidth, wireless / wired networking upgrades Plan data interfacing and data storage (NAS, SAN, etc.) upgrades Plan hardware upgrades (clients, servers, scanners, etc.) www.netspective.com 13
  14. 14. NETSPECTIVE Practical IT Considerations User to hardware ratio System downtime and DR www.netspective.com Hardware types flexibility Mobile access Interfacing & integration How do you get out of a system? 14
  15. 15. NETSPECTIVE Paperless document management Create a matrix of every document you work with to see how it should be handled All paper charts Mostly paper charts Some paper charts No paper charts •This is pre-EHR for some •Even after EHR for others •Even after EHR, charts are printed before handling •Staff task management and email help here •Most charts are eliminated but without CPOE not all can be •Need nursing automation tools •Physician documentation tools •Signed documents, faxes, correspondence are still tricky so scanning is the only option www.netspective.com 15
  16. 16. NETSPECTIVE Ancillary Software Considerations EHRs aren’t enough E-mail integration E-Prescribing Microsoft Office and Google Apps (scheduling, document sharing) Document imaging and scanning Health Information Exchange (HIE) Physician Communications Clinical content repository Electronic lab reporting Electronic transcriptions Speech recognition www.netspective.com Clinical groupware Patient registry and CCR bulletin boards Hospital website and portal integration 16
  17. 17. NETSPECTIVE Hardware Considerations • • • • • • • If you’re going paperless, you’ll need much more hardware than you think Regular desktops on the existing cabinetry (which may not have room for the desktops Laptops on the existing cabinetry Tablets Mobile devices COW carts with desktops or laptops Wall mounted or pole mounted computers/monitors or laptop stations Workstations Servers Printers Scanners Barcode wands Cameras Biometrics Touchscreens Input devices Wall displays www.netspective.com Handhelds 17
  18. 18. NETSPECTIVE Network Considerations Wired • Does every room with a device have a network drop? • Consider bandwidth and wall jack locations Wireless on Campus • Can WiFi be used for securely for business- and safetycritical work? • Consider bandwidth, coverage, etc. Wireless off Campus • Is the EHR securely and easily available on cellular networks? • Consider size of data and app UX (screens, etc.) Med Device Connectivity www.netspective.com • Will medical devices feed into the EHR? 18
  19. 19. NETSPECTIVE Data storage considerations Storage isn’t just about hard drives. It’s really about all the different kinds of data and how you will collect, store, extract, interface, retain, and manage it. Define Collect Validate Store Online Extract / Transform Interface Retain? Store Offline Structured data Coded data Semistructured data Unstructured data Electronic images Scanned images Faxes Audio Video Chat logs E-mail logs Audit logs www.netspective.com 19
  20. 20. NETSPECTIVE Consider Virtualization • Before moving into EHRs, consider virtualization: – Servers – Desktops (VDI) – Storage – Networks www.netspective.com 20
  21. 21. NETSPECTIVE Mobile & Wireless Devices Your EHR implementation must support remote devices, BYOD and mHealth www.netspective.com 21
  22. 22. NETSPECTIVE EHR Security Considerations Your EHR MUST support all of the following Role-based access control to patients, encounters, and documents “VIP” patients and encounters Patient and encounter aliasing Restricting patient records to caregivers assigned to case Restricting caregiver access to specific areas of a chart Redaction of certain data when releasing information www.netspective.com 22
  23. 23. NETSPECTIVE IT Security goes beyond encryption • What level of access do technical staff—both internal staff and vendor— need to support the system? • Does system support require access to the application database where patient data are stored? • Can all sensitive information be blocked from support staff’s view and access? • Can troubleshooting be achieved through the use of test data rather than live records? • What means are used for remote support? • For systems hosted by vendors, what audit trails are in place to monitor vendor staff activity? Does the vendor provide access to these logs? • Are audit trails of routine maintenance available? www.netspective.com 23
  24. 24. NETSPECTIVE Confronting EHR Myths Broken processes are automatically fixed by an EHR. Loose reports are no longer a problem. www.netspective.com You won’t need to reconcile charts anymore. You will never lose charts again. EHRs will eliminate staff. You don’t need to store records anymore. 24
  25. 25. Visit http://www.netspective.com http://www.healthcareguy.com E-mail shahid.shah@netspective.com Follow @ShahidNShah Call 202-713-5409 Thank You. Hire us.

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