Any EHR project must be based a clear commitment in time and resources by management and doctors. In too many cases, EHR projects focus on the technical project aspects rather than the transformational strategies and commitment needed to succeed. In the final analysis, the project must be supported by effective empowerment and governance.
Planning, analysis and design is woefully inadequate for most EHR projects. As a practical matter, practices need to create a clear and complete plan backed by good project and implementation design efforts to succeed. The components that you need to address include:
Implementation Plan –
Although your vendor may have a standard implementation plan with details about the vendor side of the project, you need a complementary implementation plan that covers practice efforts as well as other vendors such as communication companies or your hardware support people. An internal implementation plan should include training modules, rollout by function (Ex. Prescriptions, orders, etc), and office by office planning documents. Each plan item should be detailed in an appropriate document. For example, a training plan should be supported by a training manual, training stages and techniques, office by office changes, and assigned staff to mentor new users. A hardware plan should address the staging of various hardware components to insure that hardware is available as new users start training. Office specific plans should be designed to account for operational and service differences as well as the project to date. For example, in multiple office practices, employees and doctors may work out of offices that have already implemented an EHR as a transition strategy. Operational differences may be based on different equipment or even subspecialties of the doctors that work out of that office. For example, perhaps some doctors perform ASC procedures in the same building in one office, but in the attached hospital in another office.
Supporting Policies – EHRs require new policies that drive the use of the system and transition to the EHR. From a cost containment perspective, the practice may need to establish policies that avoid paying for multiple clinical processes and multiple setups for a single condition or problem. For example, some practices will add text options or clinical choices to clinical content that is already in the EHR, but stylistically differs from how a particular physician would have phrased the finding. From a patient care perspective, doctors need to establish a standard that clearly defines the expected introduction of a patient in the EHR. For example, the doctors need to define what information is needed to initially describe the patient to the EHR (Ex. Allergies, and previous surgical procedures.)
Clinical Content – Clinical content consists of the various forms, documents and setups in the EHR for your practices. Clinical content should be a key reason that the practice bought that particular EHR. However, the doctors need to understand how to document patient care using the clinical content as well as how the EHR will represent the practice to patients. In order to verify that the clinical content fairly and accurately represents the clinical services and care, the doctors should verify the operation of the clinical content to assure that the doctors know how to use the EHR as well as what happens when they use the EHR to document patient care. For example, doctors need to understand how a patient record looks on the screen as well as how the printed note will be structured. The practice needs a formal mechanism to verify and maintain the clinical forms, and documents. For example, new releases of clinical content may be reviewed and tested before use.
Workflow Design – In many projects, practices may install changes and deal with effects of the EHR as the project proceeds. This is analogous to building a new office without a blueprint or a general contractor: you will have to constantly rip out just completed efforts as you proceed to work in the new office. In an EHR project, you will encounter a wide array of issues and challenges that will require analysis and design before you start rolling out the EHR. For example, workflow without a paper record will differ from the current paper record centric operations. If you no longer have a paper record, how will doctors and staff know about incoming messages or when a patient is ready for a procedure? Additionally, what tools will you use to understand the current situation in the office since there will be no “chart piles” to check? Workflow design should accommodate transitional issues including how and when a patient is initially entered in the EHR. In order to address these issues, the practice should base the EHR setup and use on an operational “blueprint.” Such a blueprint should cover the effect on each process and identify the EHR setup issues, staffing issues, and flow issues to serve your patients. For example, if all patient information will be in the EHR, will there be sufficient workstations or tablets for a particular doctor or staff person to do their job. Workflow design can identify opportunities to improve patient service as well as staffing needs. For example, if patient information will be taken over the Internet, appropriate staff will be needed to review and accept the information into the patient EHR record.
EHR implementation is a demanding process that challenges the most sophisticated of practices. EHRs require a level of coordination and strategic thinking that many practices have never had to face. However, establishing the strategic basis and operational design in advance of EHR deployment will help you avoid problems and smooth the transition to EHR.
(c) Sterling Solutions, 2011
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