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ELECTRONIC HEALTH
RECORDS
Implementation Planning for Success
Presented By: Nancy McClanahan
VP Operations Planning Synergies, Inc.
PLANNING FOR SUCCESS System 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 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%
PLANNING FOR SUCCESS System 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 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%
PLANNING FOR SUCCESS Other 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
SESSION GOALS Keep implementations of EMR/EHRs on
the right side of the negative statistics
Help them think through the key HER implementation decisionsUnderstand the optionsUnderstand the risks
Position them all to be enable the implementation success
The EHR Adoption Process
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
Step 1 – Implementation TeamKey Participants
Physician/Clinician Champion Skilled & Knowledgeable Project
Manager Network/Technical Analysts Trainer Designers, Builders, Testers &
Implementers
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?
Step 3 – Establish Implementation Strategy & Scope
Phased vs. “Big Bang” Implementation Incremental functionality vs. full system
implementationPhased users vs. immediate full practice
Historical Medical Chart Information NeedsHow much data?What formats?
Communication Strategy “Go-Live” Date Constraints & Planning
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
allocatedWhat functions do we want/need immediately? In what sequence should we add the other
functions?Over what period of time?
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
Implementation Strategy & Scope – Phased vs. “Big Bang” Approach
Phased 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?
Implementation Strategy & Scope – Phased User Considerations
Physician Cross-over/CoveragePatientsSitesPrograms
Clinical TeamsNurse/MA support across physicians
Maintenance of Mixed Paper/Electronic ChartsLaborError Rates
Implementation Strategy & Scope – Medical Records Conversion Approaches
Abstracting and manual entry Scanning Electronic conversion
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
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?
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?
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
Develop the Implementation Plan – Documenting the Plan
Milestones Tasks Dependencies
VendorPractice Individual
Time Requirements
Develop the Implementation Plan – Defining the Detailed Tasks & Responsibilities
Medical Records Conversion Contingency Planning
System back-upDisaster recovery Interim workflow planning
Develop the Implementation Plan – Defining the Detailed Tasks & Responsibilities
Go-Live PlanningPatient schedulesSupportDress RehearsalGo/No-Go decision
Flipping the switch Celebrating Stabalization
Develop the Implementation Plan – Setting a Realistic Timeline
Bottom up EstimationLet the task and Resources drive the
timeline ORProvide the resources to support the tasks
for the timeline Remember Schedule Constraints Set a “Go-Live” that is Achievable Communicate it
Step 5 - Emphasize Communication
Internal CommunicationEnlist full supportEase concerns
Job security Technical learning support
Tell them what to expect & When
Emphasize Communication
Patient CommunicationTell them what you are doing & whyProvide consistent answers to
questions & concernsKeep them informed on progressCommunicate enthusiasm & confidence Include them in EHR success
celebrations
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
PLANNING FOR SUCCESS