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