Electronic Health Records Implementation
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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.
Electronic Health Records Implementation
- 1. Electronic Health Records Implementation Planning for SuccessPresented By: Nancy McClanahanVP Operations Planning Synergies, Inc.
- 2. Planning for SuccessSystem implementation projects, in general, experience low success rates:28% of project meet full success49% of projects are fully completed, but over budget, over schedule, and lack full scope of planned functionality23% of projects experience complete failure or are cancelledEMR/HER system implementations have even higher failure rates. Industry studies reveal failure rates of 50% others as high as 70%
- 3. Planning for SuccessSystem implementation projects, in general, experience low success rates:28% of project meet full success49% of projects are fully completed, but over budget, over schedule, and lack full scope of planned functionality23% of projects experience complete failure or are cancelledEMR/HER system implementations have even higher failure rates. Industry studies reveal failure rates of 50% others as high as 70%
- 4. Planning for SuccessOther contributing factors to implementation failures are:Believing the vendor will assume responsibility for all tasksHoping the vendor/system will fix your operational and personnel problemsFear of changeFear of technology
- 5. Session GoalsKeep implementations of EMR/EHRs on the right side of the negative statisticsHelp them think through the key HER implementation decisionsUnderstand the optionsUnderstand the risksPosition them all to be enable the implementation success
- 6. The EHR Adoption Process
- 7. Implementation Planning-Steps to SuccessEstablish an Effective Implementation TeamFinalize HER Goals & PrioritiesEstablish Implementation Strategies and ScopeDevelop the Implementation Plan with a Realistic TimelineEmphasize CommunicationEstablish Benchmarks to Measure Project Success
- 8. Step 1 – Implementation TeamKey ParticipantsPhysician/Clinician ChampionSkilled & Knowledgeable Project ManagerNetwork/Technical AnalystsTrainerDesigners, Builders, Testers & Implementers
- 9. Step 2 – Finalization EHR Goals & PrioritiesWhat is the vision for the system?What is it to help the practice achieve?Improved care/quality of care for patientsClinician ease & productivityLower CostsHigher revenuesCompetitive advantageBe in compliance with Regulatory RequirementsOther?Which features & functions support these goals?
- 10. Step 3 – Establish Implementation Strategy & ScopePhased vs. “Big Bang” ImplementationIncremental functionality vs. full system implementationPhased users vs. immediate full practiceHistorical Medical Chart Information NeedsHow much data?What formats?Communication Strategy“Go-Live” Date Constraints & Planning
- 11. Implementation Strategy & Scope – Phased vs. “Big Bang” ApproachIncremental vs. Full System FunctionalityDo 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 goalsBased on the time and resources that can be allocatedWhat 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 PhasingViewing of lab and diagnostic resultsPrescription managementCurrent medicationsAllergies/sensitivitiesTelephone messagingLab and diagnostic order entry/results reporting (OE/RR)CorrespondenceMedical chartingTrending, analysis & reportingPatient managementPopulation management
- 13. Implementation Strategy & Scope – Phased vs. “Big Bang” ApproachPhased Users vs. Immediate Full PracticeWill 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 ConsiderationsPhysician Cross-over/CoveragePatientsSitesProgramsClinical TeamsNurse/MA support across physiciansMaintenance of Mixed Paper/Electronic ChartsLaborError Rates
- 15. Implementation Strategy & Scope – Medical Records Conversion ApproachesAbstracting and manual entryScanningElectronic conversion
- 16. Implementation Strategy & Scope – Communication Strategy & ApproachExternalPromotionalPatient ReactionPatient Perceptions of the Business and localsFear of loosing the doctor that I see nowEnsure the quality of servicesInternalEmployee ReactionJob LossRole changeTechnical challengesStakeholders
- 17. Implementation Strategy & Scope – Implementation DateWhen 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 TimelineBased 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 MeetingsCommunicate practice vision, goals, strategies & approachesEstablish overall project structure & parametersContactsEscalationBuild relationshipsConfirm requirementsEstablish agreement on:TaskRoles and responsibilitiesTime Requirements
- 20. Develop the Implementation Plan – Documenting the PlanMilestonesTasksDependenciesVendorPracticeIndividualTime Requirements
- 21. Develop the Implementation Plan – Defining the Detailed Tasks & ResponsibilitiesMedical Records ConversionContingency PlanningSystem back-upDisaster recoveryInterim workflow planning
- 22. Develop the Implementation Plan – Defining the Detailed Tasks & ResponsibilitiesGo-Live PlanningPatient schedulesSupportDress RehearsalGo/No-Go decisionFlipping the switchCelebratingStabalization
- 23. Develop the Implementation Plan – Setting a Realistic TimelineBottom up EstimationLet the task and Resources drive the timeline ORProvide the resources to support the tasks for the timelineRemember Schedule ConstraintsSet a “Go-Live” that is AchievableCommunicate it
- 24. Step 5 - Emphasize CommunicationInternal CommunicationEnlist full supportEase concernsJob securityTechnical learning supportTell them what to expect & When
- 25. Emphasize CommunicationPatient CommunicationTell them what you are doing & whyProvide consistent answers to questions & concernsKeep them informed on progressCommunicate enthusiasm & confidenceInclude them in EHR success celebrations
- 26. Step 6 – Establish Benchmarks to Measure Project SuccessMeasurements based upon goalsIncrease revenues through improved E & M codingReduced claims rejectionInsurance plans understanding and possibly acceptance of different types of insurance or third party payer services Reduced Expenses:Medical Chart suppliesStaff costsTranscription reduction/eliminationIncreased patient visit volumes Physician/clinician productivityAdditional exam/treatment roomsImproved preventive & chronic care compliance/outcomesImproved patient satisfactionNew patient increase