This document discusses planning for successful implementation of electronic health records (EHRs). It notes that EHR implementation projects often fail, with failure rates as high as 70%. To achieve success, the document recommends: 1) establishing an effective implementation team, 2) finalizing goals and priorities, 3) developing an implementation strategy and scope, 4) creating a detailed implementation plan and timeline, 5) emphasizing communication, and 6) establishing benchmarks to measure success. By following these steps, practices can keep EHR implementations on track to realize the benefits of digitization.

1. Electronic Health Records Implementation Planning for Success Presented By: Nancy McClanahan VP Operations Planning Synergies, Inc.

2. Planning for Success System implementation projects, in general, experience low success rates: 28% of project meet full success 49% of projects are fully completed, but over budget, over schedule, and lack full scope of planned functionality 23% of projects experience complete failure or are cancelled EMR/HER system implementations have even higher failure rates. Industry studies reveal failure rates of 50% others as high as 70%

3. Planning for Success System implementation projects, in general, experience low success rates: 28% of project meet full success 49% of projects are fully completed, but over budget, over schedule, and lack full scope of planned functionality 23% of projects experience complete failure or are cancelled EMR/HER system implementations have even higher failure rates. Industry studies reveal failure rates of 50% others as high as 70%

4. Planning for Success Other contributing factors to implementation failures are: Believing the vendor will assume responsibility for all tasks Hoping the vendor/system will fix your operational and personnel problems Fear of change Fear of technology

5. Session Goals Keep implementations of EMR/EHRs on the right side of the negative statistics Help them think through the key HER implementation decisions Understand the options Understand the risks Position them all to be enable the implementation success

6. The EHR Adoption Process

7. Implementation Planning-Steps to Success Establish an Effective Implementation Team Finalize HER Goals & Priorities Establish Implementation Strategies and Scope Develop the Implementation Plan with a Realistic Timeline Emphasize Communication Establish Benchmarks to Measure Project Success

8. Step 1 – Implementation TeamKey Participants Physician/Clinician Champion Skilled & Knowledgeable Project Manager Network/Technical Analysts Trainer Designers, Builders, Testers & Implementers

9. Step 2 – Finalization EHR Goals & Priorities What is the vision for the system? What is it to help the practice achieve? Improved care/quality of care for patients Clinician ease & productivity Lower Costs Higher revenues Competitive advantage Be in compliance with Regulatory Requirements Other? Which features & functions support these goals?

10. Step 3 – Establish Implementation Strategy & Scope Phased vs. “Big Bang” Implementation Incremental functionality vs. full system implementation Phased users vs. immediate full practice Historical Medical Chart Information Needs How much data? What formats? Communication Strategy “Go-Live” Date Constraints & Planning

11. Implementation Strategy & Scope – Phased vs. “Big Bang” Approach Incremental vs. Full System Functionality Do we want/need all functions available “Day One”? Can we absorb that level of change at one time? Can we take on that level of implementation work at one time? If not: Based on the priorities of EHR/EMR goals Based on the time and resources that can be allocated What functions do we want/need immediately? In what sequence should we add the other functions? Over what period of time?

12. Implementation Strategy & Scope Example – Incremental Functionality Phasing Viewing of lab and diagnostic results Prescription management Current medications Allergies/sensitivities Telephone messaging Lab and diagnostic order entry/results reporting (OE/RR) Correspondence Medical charting Trending, analysis & reporting Patient management Population management

13. Implementation Strategy & Scope – Phased vs. “Big Bang” Approach Phased Users vs. Immediate Full Practice Will we be ready for everyone to “Go Live” at the same time? Can we absorb that level of change at one time? Can we support everyone on “Day One”? If Not: Who/What areas should go first? What impacts will this mix of paper vs. electronic have on the other processes within the practice? In what sequence should we add the others? Over what period of time?

14. Implementation Strategy & Scope – Phased User Considerations Physician Cross-over/Coverage Patients Sites Programs Clinical Teams Nurse/MA support across physicians Maintenance of Mixed Paper/Electronic Charts Labor Error Rates

15. Implementation Strategy & Scope – Medical Records Conversion Approaches Abstracting and manual entry Scanning Electronic conversion

16. Implementation Strategy & Scope – Communication Strategy & Approach External Promotional Patient Reaction Patient Perceptions of the Business and locals Fear of loosing the doctor that I see now Ensure the quality of services Internal Employee Reaction Job Loss Role change Technical challenges Stakeholders

17. Implementation Strategy & Scope – Implementation Date When is the least busy time of the year? Are there key resource constraints? Are there any other practice activities to plan around?

18. Step 4 – Develop the Implementation Plan with a Realistic Timeline Based on the goals and strategies set for the system: What specific tasks need to be done? By whom? When? How long will all this take to complete?

19. Develop the Implementation Plan – Conduct Detailed Vendor Planning Meetings Communicate practice vision, goals, strategies & approaches Establish overall project structure & parameters Contacts Escalation Build relationships Confirm requirements Establish agreement on: Task Roles and responsibilities Time Requirements

20. Develop the Implementation Plan – Documenting the Plan Milestones Tasks Dependencies Vendor Practice Individual Time Requirements

21. Develop the Implementation Plan – Defining the Detailed Tasks & Responsibilities Medical Records Conversion Contingency Planning System back-up Disaster recovery Interim workflow planning

22. Develop the Implementation Plan – Defining the Detailed Tasks & Responsibilities Go-Live Planning Patient schedules Support Dress Rehearsal Go/No-Go decision Flipping the switch Celebrating Stabalization

23. Develop the Implementation Plan – Setting a Realistic Timeline Bottom up Estimation Let the task and Resources drive the timeline OR Provide the resources to support the tasks for the timeline Remember Schedule Constraints Set a “Go-Live” that is Achievable Communicate it

24. Step 5 - Emphasize Communication Internal Communication Enlist full support Ease concerns Job security Technical learning support Tell them what to expect & When

25. Emphasize Communication Patient Communication Tell them what you are doing & why Provide consistent answers to questions & concerns Keep them informed on progress Communicate enthusiasm & confidence Include them in EHR success celebrations

26. Step 6 – Establish Benchmarks to Measure Project Success Measurements based upon goals Increase revenues through improved E & M coding Reduced claims rejection Insurance plans understanding and possibly acceptance of different types of insurance or third party payer services Reduced Expenses: Medical Chart supplies Staff costs Transcription reduction/elimination Increased patient visit volumes Physician/clinician productivity Additional exam/treatment rooms Improved preventive & chronic care compliance/outcomes Improved patient satisfaction New patient increase

27. Planning for Success