2. EMR Implementation
Before You Implement
Implementing a new system into an organization is a process that should be thought out
completely before starting allowing the organizational leaders to minimize mistakes that could
ruin an organization. There’s a list of proper precautions and tasks that must be carried out
before implementation can be initiated. These tasks include researching similar organizations
that have already experienced the implementation process to sorting through different
Electronic Medical Record systems to see which would best fit your organization.
When implementing a new EMR system the organizational leader(s) should research the
top EMR vendors analyzing everything about that company. The company history should be
reviewed in that it would determine the stability of the organization and their ability to execute
when dealing with different projects. If the organization has been around for a long period of
time one could conclude that they are providing a decent quality product and exceptional
services to their clientele which allows them to remain in business. One should also consider
reviewing other aspectssuch as the product’s functionality future growth strategies, product
functionality, as well as customer support and pricing. A full examination of the company is vital
being that the success of their company could determine the success of one’s own company.
Within one’s own organization there are a number of processes that should also be
completed before implementing an EMR system. A team consisting of the organization’s
leadersand other onboard members should be assembled. Inside a company there are always
people who will be more welcoming to new technology within the company. Those will be the
people who like the use of technology and other people who know that adding technology
could help make their lives easier if used properly. This team will ensure that the plan is carried
out and convince anyone who is not onboard with the new change. People often resist change
especially when dealing with technology due to the fact that a lot of people don’t understand
technology and have a difficult time making the adjustment. This team’s implementation
strategy will include determining a budget, the equipment needed, and making the decisions on
which vendors to consider.
Once a team has been assembled an analysis of the current state of the organization
should be completed. This analysis will allow each member of the company to express their
opinions about what they believe should be changed within the organization and how they
think the EMR system will affect them and the company. The analysis should determine what
can be improved about the company and if implementing an EMR system is the resolution to
better performance. A lot of companies see other organizations switching to EMR systems and
think that they should go ahead and follow suit believing it will fix their problems. At times
3. other problems exist within an organization that adding an EMR system would not solve but
only add to their problems.
If it is decided that an EMR system will prove more beneficiary to include in the
organization the selected vendors should be invited to a luncheon for a demo of their products
to decide which is the best. When the top 3 vendors that best fit the organization are selected a
negotiation should ensue seeing which one will offer the most for your money. The scoring
matrix should be based on performance, shared-risk between the two companies, and
reciprocations for things such as lack of service and risk loss. In past experiences I’ve observed
that vendors don’t often provide high quality support for their products leaving their clientele
in a bind when their products start to malfunction. With that knowledge it is best to find a
champion for the organization who can learn the product’s functionality inside and out so if the
product happens to malfunction they can fix the problem themselves or help assist with it. The
champion will also help lead the training sessions for other members of the organization. The
vendor should also show the organization which hardware they believe is best fit for their
product and organization should have a consultant on hand to help decide if what they say is
the best choice. In fact it is best to have a consultant accompany the organization during the
entire process if there isn’t a champion present.
Keys To Success
In the keys to success the author doesn’t mention properly allocating funds for the
budget of the whole project. Without a budget for the project every other plan is pointless. In
some of the case studies from Exploring Physician Adoption the leaders of the organization
failed to properly plan for the budget and in return some went as much as 65% over their
budget (Randeree, 2007). Going this much over budget wouldn’t bankrupt the organization but
it would definitely be a substantial loss for the company.
The article also failed to mention choosing a EMR vendor that will provide everything
the company needs after contracts are closed. Most vendors have poor customer service and
after the initial contact and signing of contracts fail to properly assist medical facilities. If they
do assist them they charge them for every little piece of advice given even if it was a simple fix.
Some vendors will provide support one time in the initial stages and you will never hear from
them again. These medical facilities will tend to fail and eventually revert back to the paper
record system. These actions prove why it is smart for medical facilities to hire IT professionals
to help maintain the systems allowing them save a lot of money.
The “Keys To Success” should include bringing IT professionals into the organization. IT
staff will help keep the organization running saving valuable time and money. Calling in an
outside source or the vendor because you didn’t know how to change the view of a window is
not worth it. Having IT staff in office would solve most problems being that most are technology
4. literate and could easily pass the knowledge on to the other staff. Even if the other staff didn’t
grasp the knowledge at the time the IT staff would still be there to tell them again and it
wouldn’t cost anything extra for the organization. In one of the case studies from Randeree’s
article employees people were asking simple questions like “how do I print” which are
questions you would hate to ask a vendor because it’s going to be a million dollar question.
Implementation Timeline
When implementing an EMR system it is important to consider the time frame it will
take to implement the entire system. When reading the article I noticed that in the cases the
organizations underestimated the time it would take to carry out the entire process. Physicians
grew tired of trying to keep up with process and some gave up and decided to stick with using
paper records to run their office. They believed it would be completed between 1 to 2 years
which is not the case. The initial process takes that amount of time but the paper archiving
process can last for years beyond the initial implementation. The training and maintenance
process is also ongoing and could last for several years. Vendors will constantly improve the
system correcting programming and functionality glitches in the system. Staff will have to be
trained when an old component is changed or something new is added.
I agree with the author that proper steps have to be taken within an alotted amount of
time when adding a new EMR system to your organization. What ever time line is decided in
the initial process should be double to allow for different complications that are bound to arise
during the process. Downtime is in evitable and should be planned accordingly. It possible the
process should be started during the slowest part of the season so that there will be enough
time for training and setting up the whole system. This will minimize the amount of revenue
lost for the organization.
The timeline in the article by Paul Smith was a five year process that I believe could
have been decreased significantly. On the timeline it took 3 years to find a proper vendor which
I believe is entirely too long. I’m not sure if it’s because not too many EMR systems existed so
the decision was a little harder or the BFM Clinic was just moving at a very slow pace. I think it
would take about year to find a proper EMR system. This timeline should be cut down to about
3 years instead of being five years long.
Orthopedic Timeline
Team Formation
o Should consist of organizational leaders, onboard members, champions of the
organization, and an IT consultant.
Evaluate Needs
5. o Perform a needs analysis/workflow analysis on the organization to see what
problems the organization has:
Functional needs
Operational needs
Performance needs
Define Goals
o Decide what you want the organization to accomplish, problems that need to be
solved, if and the EMR system is what your.
Determine Budget
o Create an initial budget for the implementation of the EMR system. After the
budget is created it should be doubled to account for any unforseen expenses.
Search for Vendors
o The best vendors should be researched from every aspect
Create a Scoring Matrix to sort through vendors to find the best fit for
the organization.
Select a Vendor and Negotiate
o Narrow the vendors down to three selections then enter a negotiation phase to
see which vendor will offer you the most for your money.
Hire IT Technician and an Information Management Team
o Hire an IT Technician to help manage the system. It will save a lot of time and
money in the long run helping the operation run more smoothly. Information
Management team will be mostly responsible for scanning in documents and
creating digital copies.
Choose Vendor and Start Product Training
o After a vendor is chosen the implementation process has began it is important to
start training promptly. Training sessions should be held 2 or 3 times a week
initially and then moved to once 1 week after staff become more comfortable
with the system.
o Install necessary software and hardware needed to run the system
Networking compents, Security components, etc.
Initiate Paper Reducing Process
o This process converts paper records into digital records. This is an ongoing
process and could take years to complete. It will be carried out over time.
Perform Backups Often
o Backups of all data will be performed daily.
Performance Maintenance
o The organization will always come across problems that did not present
themselves initially so each one has to be addressed accordingly.
6. The initial process of planning for the new technology which includes details from determining
a budget to finding the right vendor will take about 1 to 2 years. Managing the paper records
and the performance management aspect are processes that will last for an extended period of
time.
Part 4
Initiate
In this initial process they elect to first educate the organization on what an EHR system
is. I think this process will prove beneficial in the beginning. Most people don’t use EHR systems
and don’t know what exactly they are capable of and how they can improve the performance of
the medical facility. In my approach it was assumed that anyone working in an medical facility
has some knowledge of what an EHR system is so time was not set aside to give staff members
a history lesson. As decided in my process, they decided to first gather the organizational
leaders because even though some might not even work for the organization they make all the
decisions.
HSA’s decision to hire IT staff was closely aligned with my approach. Hiring IT
technicians seems like the most logical decision when implementing technology that manages
information using computers. IT staff will help make the transition easier and help with
maintaining the software. Having an outside party come in every time something goes wrong
with the system will prove costly in the short and long run. Calling in a specialist requires them
to be brought in which a fee will be charged for each visit. EHR systems crash often so fees will
quickly accumulate.
Identifying Subject Matter Experts in each area considered sounds a little confusing and
one might not understand what is meant in this section of the process. I believe it means to
find a champion to help run the system but I’m completely sure. If that is what HSA is referring
to I think that is also a great idea. Finding a champion will help bring other members onboard
within the organization. The champion is usually someone that the employees already know
and trust so convincing them won’t be much of a challenge because trust has already been
established.
Plan
As I mentioned, the proper planning can save valuable time and money if everything
aspect is properly thought out before the execution. HSA shares the same view as I do on this
topic. HSA includes a sort of work flow analysis in this step of their process. I believe it should
have been completed a little bit earlier in the process. The choice to update the timeline is a
7. very smart idea because things can change quickly. This allows everyone to remain on the same
page and keep the ultimate goal in perspective. I don’t think the stakeholders and owners
should be brought in so late during the process. Since they own the company I believe they
should be throughout the whole decision process. Being a stake holder I believe they would
want to know what their money was purchasing before it was bought not find out the cost
when items have already been ordered.
Execute
This step of the process was thought out a little more carefully than the previous steps
and I agree with every component of this process. The system should be tested repeatedly with
the aim of trying to break the system. This will determine the durability of the system and also
help point out any flaws that can be fixed before the system goes live. Trying to break the
system will also give the champions a chance to learn how the system works which serves as
training opportunities. I believe the champions should start the training process first but
eventually they should be training the other employees as they learn simultaneously. The best
way to learn a system is to teach someone else as you learn it essentially helping them learn
together. I believe this part of the process will work out perfectly for this portion of the
implementation. Some things on the list may need to be modified or explained further in detail
for users to understand what they actually mean, but altogether this would work fine.
Control
This stage involves monitoring the system to see how well it’s operating and creating
logs about the system. I believe this is something that will be done continuously not just one
time. HSA should make note of that so users don’t think that it is a onetime ordeal and it will
continue on from then on out. The system has to be monitored at all times to ensure there are
no security breaches which will minimize risks. I didn’t see it mentioned yet but hopefully by
this time the system as already gone live if not I believe HSA's approach is slightly behind. I also
believe that it’s a good idea to continually keep the owners updated on the progress which HSA
does.
Close
The best part of the implementation process where all deals are finalized and contracts
are closed. A demonstration of the live system is given to the owners of the organization and a
celebration occurs. One thing that should’ve been included is that this is the part of the process
8. where the management of the system really begins because the vendors will no longer be
around to assist the organization.
Timeline
The time that HSA predicted seem reasonable but it’s hard to understand whether some
of those steps can be completed simultaneously or if they have to be completed
chronologically. If each step has to be completed in chronological order I believe the timeline is
a little extensive and could possibly be shortened.
