Adopting Electronic Health Record software is the ultimate digital transformation project. It’s as complex as it can be with tons of legacy processes and records having to be digitized and adequately coordinated with the hospital’s existing workflow and too often facing the staff ‘s resistance.
In our previous article about the functions of an Electronic Health Record system, we explained what options you have when going for an EHR. We then went on to explain the problems hospitals face in operating EHRs. This time we’d like to tackle the implementation itself. Where to start, how to select the software suiting your practice’s needs, and how to get the system up and running while smoothing the introduction for the staff.
You know you are in need of an EHR system but are you prepared for it? Before diving in, assess your organization’s readiness: IT infrastructure, staff skills as well as attitudes. You can conduct a practical assessment in the form of a survey. For example, taking a
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The form lets you evaluate your readiness on a scale of “Not Yet Prepared” to “Moderately Prepared” to “Highly Prepared.” The more checks in “Moderately” and “Highly Prepared” you have, the more prepared you are. If there are still many checks in the “Not Prepared” column, use statements from it to understand the problem areas and work on them.
Stratis Health also offers an EHR Beliefs Assessment (.doc) designed to understand the attitudes and beliefs of both administrative and clinical staff. Its outcome also affects training and helps figure out how to encourage sustained use of the software in the future.
Derived from the previous step, workflow demands specific attention. Clarifying the processes in your organization, you’ll be able to determine the exact organizational and technical criteria for your future EHR software.
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Analyzing present workflow. Mapping your existing processes, assess them in terms of their effectiveness. Which processes are well-established and what makes them so efficient? What practice goals do they help you reach? Then do the same questioning but with your weak areas to direct you to ideas for their improvement.
Planning future workflow. Now, think about the ways EHR features will technically support your practice and boost its productivity. Identify the EHR features you need to boost your processes.
Let’s map the office visit workflow, as an example. A patient arrives at the office and checks in through the encounter close out in the EHR. Then, the staff interacts with the patient. EHR reminds them of any patient considerations so they can improve the quality of care and patient safety. The staff navigates the patient to the doctor who measures the patient’s vital signs, updates medications, and gathers complaints, and then – examines the patient. In the end, the doctor enters all the info into the EHR.
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That’s a general workflow description but we can already see how EHR’s front office management tools together with the physician support tools greatly upgrade the patient’s experience.
If the assessment stage confirms that you’re ready, start planning. At the planning stage, the primary task is to outline all the processes that need to be executed by your team of physicians, practice managers, IT staff, and even patients. For this purpose, you can use a roadmap.
A roadmap is a table-like document where you can put down the stages of your EHR product’s development. Having a roadmap will help you align EHR technology with the actual needs of your hospital. As a result of filling out a roadmap, your EHR implementation strategy and utmost goals are taking shape.
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A roadmap is where you also diagram all your tasks and risks and calculate the expected implementation budget. Read on how to create a roadmap in our dedicated article.
Depending on the complexity, it can also be a checklist, a matrix, or a template. You can use tools like simple Google Sheets or more advanced ones for flexible project management like Trello, Wrike, and Asana. If you’re working with an IT consultant to drive your implementation efforts, they will suggest the most fitting tools and will prepare a roadmap with you.
Using the information gathered in the assessment and planning phases, you’ll be able to select a fitting EHR for your organization. This system should streamline the processes in place and work with them, not against them.
Pdf] A Process Model Leading To Successful Implementation Of Electronic Health Record Systems
Hosting. There are solutions hosted on the cloud (called Software-as-a-Service) and those located on-site. If you want it local, you’ll have to take care of its servers, make sure you have space and resources to maintain them, both financial and IT. Another way is to purchase it as a SaaS solution along with maintenance and support services. You can see a more detailed comparison below. No option is better than the other, but for smaller healthcare providers, it’s more practical to get a cloud product and start using it right away. Larger hospitals aiming for customization will likely choose more expensive options.
Devices support. Physicians require an easy connection to the EHR system to access and input information. In this case, computer hardware plays a key role for a convenient use. Make sure the EHR is available via different devices like desktops, tablets, or smartphones.
Interoperability. Enabling health information exchange is a critical aspect as hospitals and practices must share data electronically with labs, radiology providers, public health registries, and syndromic surveillance systems. So, an EHR needs to work seamlessly across several platforms and technologies. As interoperability standards and rules become a healthcarerequirement, be sure your software supports them.
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Compliance. There is a range of rules the EHR app should comply with to enable normal operation. They include HIPAA for the US and GDPR for Europe. Also, there is the ONC Health IT Certification Program aimed at ensuring patient safety and improving the overall usability of EHR apps. So, make sure the vendor you choose is compliant with the standards.
Once you have your pool of suitable vendors, make the final choice. For this purpose, you may use Health IT’s pricing template (.xlsx) and comparison and matrix table where you can prioritize the options by scoring their usability characteristics:
Once you’ve settled for an EHR product, the next step is to configure and adjust its functioning to your workflow. This can take up a considerable amount of time, especially for a large organization. The New York City Health and Hospitals Corporation, for instance, faced delays during their second phase of EHR implementation because it took them more time to act on the insights learned from the first phase.
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Why is it so difficult to adapt EHR to your practice? It requires rethinking your models of care with regard to EHR technology. The adaptation works both ways. First, you tailor the EHR to match key processes. And then, you modify your non-key operations to work smoothly with the system.
The nuances will depend on your specific practice. Necessary settings range from medication management to patient history settings and billing updates with new codes and consents. Also, your physicians may need specific templates to support documentation.
Don’t forget about integrations. Working closely with insurance companies, laboratories, and pharmacies, you’ll most probably need to integrate your EHR with their software. You should think of external data you’ll need to import such as demographics from the practice management software (PMS), computerized order entry (COE), and treatment regimens/protocols.
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Finally, you can proceed to schedule the implementation. A few weeks before the launch, plan every go-live activity in detail. It involves:
Choosing a launch approach. Launching the system, you can boldly roll it out for all patients and functions on the same day. Although this scenario minimizes time spent managing paper records and the system in parallel, it can be quite disruptive if small problems start popping out. So, many organizations prefer a slower approach introducing one function at a time or implementing the EHR in separate departments first.
Pre-go-live dress rehearsal. Simulating a patient visit prior to the go-live date can help spot unintended consequences and fix unseen problems. Some of the most important scenarios to simulate are patient check-in and check-out, rooming, vital signs collection, lab orders and medication refills processing, immunization orders, referral management, follow-up orders, and billing.
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Issue resolution plan. If the staff needs help, they should know who to contact. During the contract negotiation phase, make sure to ask your vendor for support during go-live. Make them aware of your schedule, so they’ll be ready to provide virtual support if needed. In addition, assign leaders among the staff responsible for handling issues.
Go-Live day. The workflow will inevitably face some interruptions, so it makes sense to reduce the patient volume and warn them about the software transition. They’ll be more patient if they face any delay during their visit. Don’t overload your workers; better consider adding additional staff.
One of the primary reasons an EHR system doesn’t bring the expected results is poor user adoption. How practitioners and staff embrace the system hugely impacts the final ROI. A sustainable training program should include role-based training, clear communication channels with the support team, and feedback loops for the project management team to track the adoption progress.
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As researchers at Kaiser Permanente conclude, it’s
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