The document discusses key considerations for successfully implementing an electronic health record (EHR) system. It emphasizes that EHR implementations require involvement from clinical, business, and IT stakeholders. The implementation process should begin with evaluating current workflows, establishing metrics to define success, and implementing changes in a phased approach to avoid potential harms. Technical requirements like hardware, network infrastructure, data storage, and security must all be addressed to support an EHR system and mobile access. Outsourcing help from experienced implementation partners can increase the chances of a successful EHR transition.

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

2. NETSPECTIVE
Who is Shahid?
•
•
•
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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”
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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.
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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.
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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.
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5. NETSPECTIVE
Why are you implementing an EHR?
Most obvious, dangerous
Most noise, least attention
Most promising
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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
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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??
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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
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EHR
Project
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9. NETSPECTIVE
Staff Involvement Guidelines
Successful EHR Projects
20%
10%
Leadership
Business
35%
35%
Clinical
IT
Typical (usually
unsuccessful)
2%
19%
69%
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10%
Leadership
Business
Clinical
IT
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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
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11. NETSPECTIVE
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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).
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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.
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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.)
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14. NETSPECTIVE
Practical IT Considerations
User to
hardware ratio
System
downtime and
DR
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Hardware types
flexibility
Mobile access
Interfacing &
integration
How do you
get out of a
system?
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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
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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
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Clinical groupware
Patient registry and
CCR bulletin boards
Hospital website
and portal
integration
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17. NETSPECTIVE
Hardware Considerations
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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
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Handhelds
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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
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• Will medical devices feed into the EHR?
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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
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20. NETSPECTIVE
Consider Virtualization
• Before moving into EHRs, consider
virtualization:
– Servers
– Desktops (VDI)
– Storage
– Networks
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21. NETSPECTIVE
Mobile & Wireless Devices
Your EHR implementation must support remote devices, BYOD and mHealth
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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
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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?
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24. NETSPECTIVE
Confronting EHR Myths
Broken processes
are automatically
fixed by an EHR.
Loose reports are
no longer a
problem.
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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.
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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.