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Lecture 1B
- 1. Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b This material (Comp 11 Unit 1) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
- 2. Migration to an Electronic Health Record System Learning Objectives - 1 • Describe the process of initial planning, including identification of stakeholders, champions, management and implementation teams, and determining appropriate members for a steering committee (Lecture a) 2
- 3. Migration to an Electronic Health Record System Learning Objectives - 2 • Develop a timeline for choosing and implementing an electronic health record, including defining the scope of implementation, budget estimates, and additional critical steps to build a basic strategic plan for implementation (Lecture a, b) 3
- 4. Migration to an Electronic Health Record System Learning Objectives - 3 • Develop functional requirements, including a workflow analysis and a gap analysis, and recognizing when to bring in expertise (Lecture a) 4
- 5. Migration to an Electronic Health Record System Learning Objectives - 4 • Develop and applying criteria for selecting an appropriate vendor for the electronic health record including (Lecture b): – Generate an RFI/RFP – Select an appropriate system, including utilizing an appropriate ranking model – Generate interface requirements – Compare and contrast EHR solutions (e.g. locally hosted versus cloud solutions) 5
- 6. Migration to an Electronic Health Record System Learning Objectives - 5 • Negotiate a contract (Lecture b) • Develop a training plan (Lecture b) 6
- 7. Migration to an EHR • Develop and apply criteria for selecting an appropriate EHR vendor – Generating RFI and RFP – Selecting an appropriate system o Using an appropriate ranking model o Generating interface requirements o Comparing and contrasting EHR solutions – How to negotiate a contract – How to develop a training plan 7
- 8. Identify The Leaders • Who will make the decisions regarding system purchasing and implementation? • Who are the champions? • Who will manage the process? 8
- 9. Select Requirements Specifications • This stage asks “what elements of the EHR are needed?” • Essential in the vendor selection process • Helps to determine what is essential • RFI (Request For Information) can be issued if more information needed – Tool to ask vendors about their products 9
- 10. Write the Request For Proposal (RFP) - 1 • Open request to vendors – Tells vendors about the organization – How to respond with the specific information about product • Criteria should include questions regarding: – Specification of vendor system – Criteria and federal certification processes – Cost for implementation – Interoperability – Vendor support 10
- 11. Write the Request For Proposal (RFP) - 2 • Answers the questions of how a vendor will meet individual organization needs • It should include a summary of – Costs – Training – Support of project from beginning to post implementation – Implementation methodology – Post implementation assessment tools 11
- 12. System Selection - 1 • Need to narrow the field of contenders before demonstrations – Does product meet requirements? – Does product have favorable ratings? – Is product suitable for size and operations of organization? • Schedule vendor demonstrations – Prepare a selection tool (ratings form) – Have vendors demonstrate scenarios in addition to features 12
- 13. System Selection - 2 • Check references – Discuss with other organizations that have used the vendor’s product – Conduct site visits • Rank vendors • Select the final vendor/product 13
- 14. Interface Requirements • Software that integrates an EHR with other software • Need to specify interface requirements • Specify interaction with disease registries or health information exchanges • Interface with laboratory or practice management modules 14
- 15. Comparing EHR Features • Every EHR has a feature set • Identify essential feature sets • Specify the desirable characteristics of the feature • Contrast comparable feature sets between EHRs 15
- 16. Negotiating A Contract • Define terms • Negotiate product features • Obtain legal assistance! 16
- 17. Developing A Training Plan - 1 • Analyze workflows • Different types of training – Live (in person) – Online (distance) • Different learning groups – Large groups – Small groups – One-on-one 17
- 18. Developing A Training Plan - 2 • Different Types of Sessions – In a classroom – At-the-elbow • Different timings for sessions – During work hours – During evenings, nights and weekends • Different models of compensation – CME for providers 18
- 19. The Culture Of Change • Develop an organization development (OD) plan • Manage people and technology • Ensure cooperation and “buy-in” of all users • Identify champions and super users • Develop a training plan 19
- 20. Change Management • Who will lead the process of change management? • What will be the components of the change management program? • When will the program be implemented? • Where and in what ways will the discussion about change take place? • How will the program be operationalized? 20
- 21. Leading The Process Of Change • Change occurs at the very beginning of the process • Include all employees in the changes that are anticipated • Change continues after EHR implementation • Focus on communication • Listen to employees • Encourage respect between people • Operationalize the change process using teams and tools • Manage expectations 21
- 22. Migration to an Electronic Health Record System Summary – Lecture b • Vendor selection • RFI and RFP generation • System selection • EHR solutions – compare and contrast • Contract negotiations • Training plan 22
- 23. Migration to an Electronic Health Record System Summary - 1 • The process required to move from a paper- based health record to an EHR system or from one EHR to another • Aspects of initial planning • How to determine a timeline for system selection and implementation • How to develop a set of functional requirements, a workflow analysis, a gap analysis, and recognize when to bring in expertise. 23
- 24. Migration to an Electronic Health Record System Summary - 2 • The process of vendor selection, and identified criteria to be used to generate a request for information (RFI) and request for proposal (RFP). • Developing interface requirements and selecting an EHR • The basics of contract negotiation, training plan development, and change management 24
- 25. Migration to an Electronic Health Record System References – Lecture b References Abdelhak, A, Grostick, S, Hanken, M, Jacobs, E. Health Information: Management of a Strategic Resource, 4th Edition: Saunders. Adler KG. How to select an electronic health record system. Fam Pract Manag. 2005 Feb;12(2):55-62. Amatayakul, Margret K. Electronic Health Records: A Practical Guide for Professionals and Organizations. 4th Edition. AHIMA. Johns, M. PhD, RHIA. Health Information Management Technology: An Applied Approach 2nd edition AHIMA Press 2007. Lorenzi, N, Kouroubali, A, Detmer, D, Bloomrosen, M. How to successfully select and implement electronic health records (EHR) in small ambulatory settings. BMC Medical Informatics and Decision Making, published on line 2009, v 9, 15. Lowes R. EMR Success: Training is the Key. Med Econ 2004 May 7Z;81(9):TCP11-4. The RFP Process for EHR Systems. Journal of AHIMA 78, no. 6 (June 2007): 73-76. 25
- 26. Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. 26
Editor's Notes
- Welcome to Configuring Electronic Health Records, Migration to an Electronic Health Record System. This is lecture b. The component, Configuring Electronic Health Records, provides a practical experience with a laboratory component, utilizing the VistA for Education Program that will address approaches to assessing, selecting, and configuring electronic health records, EHRs, to meet specific needs of customers and end users.
- The objectives for Migration to an Electronic Health Record System are to: Describe the process of initial planning for migration to an electronic health record, EHR, including identifying stakeholders, champions, management and implementation teams, and determining appropriate members for a steering committee
- Develop a timeline for choosing and implementing an EHR, including defining the scope of implementation, budget estimates, and additional critical steps to build a basic strategic plan for implementation
- Develop functional requirements, including a workflow analysis and a gap analysis, and how to recognize when external expertise is needed.
- Develop and apply criteria for selecting an appropriate vendor for the electronic health record including: Generate a request for information (RFI), request for proposal (RFP) Select an appropriate system, including using an appropriate ranking model Generate interface requirements Compare and contrast EHR solutions (e.g. locally hosted versus cloud solutions)
- Negotiate a contract Develop a training plan
- This lecture will discuss how to develop and apply criteria for selecting an appropriate vendor for an EHR system. Topics will include generating an RFI and RFP; selecting an appropriate system, including using an appropriate ranking model, generating interface requirements; and comparing and contrasting EHR solutions, such as, locally hosted versus cloud solutions. Finally, this lecture will cover how to negotiate a contract and develop a training plan.
- As discussed previously, a critical task in the process of migrating to an EHR system is to identify the leaders responsible for its implementation early in the process. The organization needs to decide who will make the important decisions regarding purchasing and implementing the system. It needs to identify champions to guide and manage the process of selecting and implementing the EHR. Selecting the most able leaders will help the team achieve a successful implementation, even when challenges arise.
- Before an EHR system is selected, the appropriate specifications required for the organization must be determined. Determining what elements are and are not essential to the organization is also a fundamental step in the vendor selection process. An RFI is a document issued to vendors when more information is needed. The RFI asks vendors for specific details about their products. Vendor responses to the RFIs allow organizations to build a knowledge base about the systems that will compete in the selection process.
- Once the requirement specifications have been determined, the organization can write an RFP. This document is an open request to vendors explaining what they need to know about the organization and how to respond with information about their product. The RFP gives vendors an opportunity to provide specific information tailored to the needs of the organization. It also gives vendors an opportunity to adapt their products to the organization's unique requirements. For example, some organizations may already have basic electronic functions, such as, billing, coding, or scheduling, at the time of EHR purchase. Other organizations may want to incorporate paper documents into electronic systems, usually by scanning them into the EHR. Some organizations may have an interest in prioritizing electronic documentation systems and online order entry systems. The RFP allows vendors to compete using the characteristics specified by the organization. And, it helps the organization find an EHR vendor that can adapt to its unique specifications. The RFP should include questions that elicit how the vendor plans to meet the organizations specifications. For example, it should include questions about how the vendor plans to meet meaningful use criteria and federal certification processes, the cost of implementation, interoperability issues (especially if the organization already has a pre-existing EHR), and the extent of vendor support during the planning, implementation, and post-implementation phases.
- A vendor's response to an RFP should answer questions about the system and services sold by the vendor and how they will meet the organization's specific and individual needs. The response should also include a summary of costs for new and upgraded hardware and the cost for software, including interface and system software. A basic summary of the training offered in the pre-implementation, implementation, and post-implementation phases should also be included. Vendors should offer product support throughout implementation, beginning with the pre-implementation stage and extending through the post-implementation stage. The vendor response to the RFP should include a detailed plan for the EHR implementation, as well as post-implementation assessment tools it will use to gauge the level of success. Since the RFP and its response usually leads to a legally binding contract, it is important that the final document is accurate and complete to protect both the organization and the vendor.
- Once all responses to the RFP have been received, the organization can begin the process of selecting an EHR system. The first step in the selection process is to narrow the field of contenders to a short list, because it is impractical to compare a large number of EHRs, and extremely time-consuming for the selection committee to attend multitude product demonstrations. Therefore, using a robust model to narrow the field of vendors will save both time and resources. By considering several questions, the field of contenders can quickly be narrowed. For instance, does a product meet all the organization's requirements? Does it have favorable ratings? Is it suitable for the size and operational scope of the organization? When a manageable number of vendors have been selected, the organization should schedule demonstrations of the selected EHR products. Before the actual demonstrations, it is prudent to develop a ratings form that can be used to compare and contrast the various features of the EHR products under consideration. During the demonstrations, ask vendors to simulate a variety of clinical scenarios in addition to system features. Requesting the same scenarios from each vendor allows identical workflows to be compared.
- It is also important to check the vendor's references during the selection process. Find other organizations that have used the vendor's EHR product to get third-party impressions of both the vendor and the product. The vendor may have a list of customers who can serve as references. After product demonstrations have been completed, the organization can begin to rank the vendors. It is best to use a robust selection tool for this process, one that employs objective evaluations of the system rather than subjective interpretations of the reviewers. For example, an objective evaluation would compare computerized physician order entry (CPOE) modules between different EHRs using a ranking list for the absence, presence, or excellence of an essential feature. Conversely, a subjective evaluation would merely note whether a reviewer likes or dislikes that particular feature. A subjective scoring strategy may be more appropriate under some circumstances, for example, when evaluating usability. During the evaluation process, the organization may want reviewers to conduct site visits at other institutions that have deployed the EHRs under consideration, to see the system “live”. If visiting sites are not possible, it may be advantageous to talk remotely with other organizations that have implemented the EHR under consideration. After analysis and discussion, the organization is ready to select a vendor and a product.
- When a system has been selected, an organization next needs to specify data interface requirements. An interface is software that integrates the EHR with another piece of software, such as, a practice management system, or with software at another organization, such as, an outside laboratory or another EHR in a health information exchange. The organization will need to determine whether the selected EHR needs to interface with a laboratory, practice management module, disease registries, or health information exchanges.
- Every EHR has a specific set of features. The organization needs to identify the essential features necessary for its implementation. For example, if the organization's prime criterion is that the EHR meets meaningful use criteria, the organization will need to ensure that its selection has CPOE functionality, a requirement of meaningful use criteria. When comparing EHR features, an organization may also want to specify the desirable characteristics of the features under consideration. For example, using the previous example of CPOE functionality, an organization may want CPOE order sets that allow clinicians to make multiple orders with one selection, to reduce the number of tedious tasks for the clinician. An EHR with this characteristic may increase clinician buy-in and reduce clinician resistance to change. If the EHR systems under consideration have several similar features, it may be helpful to consider other distinguishing factors, such as, usability and robustness of features.
- Contract negotiations are complex and often challenging for organizations. The full extent of contract negotiations is beyond the scope of this discussion, but some key features will be discussed in this lecture. From the beginning, the organization and the EHR vendor should clearly define, understand, and agree with the terms of purchase and service. Product features are often negotiable and should be factored into the overall process of system purchasing. The cost of adding additional modules or features should be included before final negotiations commence. An organization must remain aware that the final contract is a legally binding document. Therefore, it is prudent to obtain legal assistance when negotiating a contract with the EHR vendor.
- To develop a robust training plan, the organization should first analyze workflows to understand and define the different types of training needed for the EHR implementation program. The next steps in the training process are to appoint or hire trainers, locate a training venue, and then schedule the training. Trainers may be personnel within the organization, or they may need to be hired for the duration of the implementation. Many organizations develop their own on-site training protocols, and establish venues for training. Training can be conducted live, that is, in-person, or online as part of a distance learning program, using webinars or video teleconferencing. Managers of the training program will need to determine what types of learning groups will be needed. For example, some training can occur in large groups in a classroom setting, while other types of training may require individualized or one-on-one training.
- During business hours, it can be difficult to conduct EHR training for clinicians delivering care to patients. Therefore, individualized classroom sessions may need to be scheduled for these end-users. However, some clinicians may prefer "at-the-elbow" training in the clinical environment while continuing to care for patients. Trainers must be creative when scheduling training for clinicians. For example, training sessions may need to occur during periods when patients are not seen, or during evenings and weekends. To improve buy-in or cooperation for training, particularly during non-work hours, end users, especially clinicians, may need to be compensated for the time spent in training. There are many ways to compensate clinicians for the disruption to their clinical schedules imposed by the need to engage in EHR training. One method could be to provide continuing medical education or CME credits for physicians. Other organizations may want to financially compensate physicians for their loss in productivity, or determine other options to compensate clinicians for time lost from providing patient care.
- The concept of change and the culture of change are important to consider before an organization embarks on a major change. The introduction of an EHR is often the fulcrum around which significant change occurs within an organization. The culture of the organization will determine the ease with which change can be achieved. Within an organization, there will be vigorous forces that will resist change and motivated forces that will promote it. To manage these opposing forces, a robust organizational development or OD plan can be helpful. The OD plan should include both the technology and the personnel that need to be managed. It should also include ways in which the buy-in of end-users can be cultivated. As previously discussed, one way to achieve buy-in, is to identify champions and super-users to attract the interest of reluctant end-users. Developing a comprehensive training plan will also facilitate the process of change.
- Many of the issues an organization needs to consider to define the process of change management involve the interaction between people and technology. The process of change management should begin by identifying key leaders. Leaders may be senior and mid-level managers, clinicians, human resource managers, and champions. The organization may need to hire consultants, such as, project managers or other types of consultants, if expertise is not available within the institution. It is important to understand that some people find change to be emotionally difficult, even change that occurs in a professional setting. The organization needs to recognize the emotional component in the process of implementing an EHR. Communication is key to the success of change. Champions and super-users can help to create buy-in throughout an organization by disseminating information about the value of an EHR to the end-users who will be using it. A formal change management program can help identify specific stages of the project that need to be managed in a comprehensive fashion. It will also help determine the areas of program implementation that need special attention. For example, an organization may determine that the change management program should be implemented at each stage of the process, that is, during EHR selection, implementation phase, and post-implementation assessment phase. Different change management strategies may be used during each phase. The change management plan should also address how to discuss change with end-users. For example, the plan should specify where the discussion will occur and what direction it will take. Another key element of the plan should describe how the change management program will be implemented. While, the culture of the organization will ultimately determine how change progresses, it will be important to remember that issues related to change management, for example, the emotional aspects of change, not be underestimated.
- Leading the process of change begins with an understanding that change begins well before the actual "go-live" stage of EHR implementation. In fact, change begins at the earliest stage, when the organization is conducting initial assessments of knowledge and attitudes about an EHR. Therefore, all employees need to be included in the change process from the very onset of the EHR selection. A change of this magnitude is a long process. It will not stop with the EHR implementation, but will continue into the post-implementation phase, too. Change will need to be managed until a steady state is reached. In planning for change management, it can be helpful to review the culture of the organization during past significant changes. This will help identify the types of communication and learning environments that have worked in the past, and identify the methods that were less successful. A strong commitment to communicating with personnel during all stages of EHR selection and implementation cannot be overemphasized. Throughout the process, the organization should discuss features of the system and the vendor with the end-users. An effective way to keep employees informed about the change process is to develop a newsletter detailing the process and progress of change, and discussing expectations for cooperation. Of course, effective communication is a two-way street. The organization should listen to the concerns of employees, and take them into consideration. Issues related to change, including emotional ones, should be discussed. Addressing the fears and concerns of employees, enlisting their collaboration, and rewarding their efforts are strong success factors in EHR implementation. Two-way communication will encourage dialogue and respect between the people implementing the system and the people using it. A spirit of collaboration will allow the end-users to understand the strategic direction and goals for migrating to the EHR. Conversely, a lack of respect for the concerns of employees can cause unnecessary financial loss due to resistance and delays, and should be avoided. Implementing the process of change using clearly defined teams and tools, and effectively managing expectations and user perceptions are the keys to achieving a successful EHR implementation. Expectations among personnel may differ, but having common goals and objectives can help to bridge misunderstandings.
- This concludes lecture b of Migration to an Electronic Health Record. In summary this lecture examined developing and applying criteria for selecting an appropriate vendor for an EHR system, including generating an RFI and RFP; selecting an appropriate system; comparing and contrasting EHR solutions; and negotiating a contract and developing a training plan.
- This also concludes Migration to an Electronic Health Record. In summary, this unit described the process of shifting from a paper-based health record to an EHR system or from one EHR to another. Topics examined were aspects of initial planning, such as, identifying stakeholders and champions, and determining appropriate members for a steering committee. Other topics examined were how to define the timeline for choosing and implementing an EHR, how to define the scope of implementation, and how to build a basic strategic plan. Additionally, how to develop a set of functional requirements, conduct workflow and gap analyses, and recognize when to hire external expertise was discussed.
- Selecting a vendor and generating criteria for an RFI and RFP was described. Interface requirements were defined, and how to compare and contrast EHR solutions, and select an EHR was discussed. Finally, the basics of contract negotiation, training plan development, and change management were described.
- References slide. No audio.
- No audio