EMR Implementation Challenges

7/28/2019 EMR Implementation Challenges

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Ingredients for a Successful EMRImplementation

We will build it.. They will come

Presenting the EMR Field of Dreams.

Pranjal Shah


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Game Rules

Put your phone on mute (when not speaking) so thateveryone can hear the speaker

Please introduce yourself when asking questions so

everyone knows who you are.Honor each others timeif you have follow up

questions write them down so we can correspond

after the webinar

Please speak into your microphone so all can hear


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The Takeaway: Hitting it out the park

1. Understanding different phases and challenges within thosephases of an EMR implementation

2. Discussing how the methodology was applied to a particular

EMR implementation

3. Outlining the Change Management Initiatives and RiskMitigation Strategies

4. Describing the Training Methodology for a project involving

so many different parties

5. Discussing the Clinical Content Management process andCommunication Plan


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Introduction Why is Implementation of EMRs so challenging?

Electronic Medical Records (EMRs) can change: Current Documentation Method(s)

Workflows

Billing Practices

Scheduling Patient Follow up methods

Communication/ messaging

Etc

This usually requires re-engineering current systems andcan dramatically change the way a hospital runs.


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Planning Phase Fail to Plan; Plan to Fail

Identify goals and base your planning strategiesaround these goals

Decide what data needs to be retrievable

Be aware that Free Text may not be reportable Phased Implementation is highly recommended

Create timelines but be flexible

Perform a workflow anaysis


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Staff Consideration and Planning

Appoint a physician champion

Appoint an in-house Project Manager

Communicate to the staff the hospitals

desire to acquire an EMR before thepurchase

Be aware that support staff may feel that they

could be replaced by an EMR


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Staff Consideration and Planning

Have end-user staff be involved in the systemset-up

Map out Workflows utilizing current staff

members Learning curves are usually underestimated


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Testing Phase

Software Testing

Test software extensively before

implementation

Perform Volume Testing, if possible

Ask for a list of known bugs from the vendor

for the version you are about to install


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Testing Phase

Hardware Testing

Prepare Infrastructure

Staff and Testing

Pilot systems before implementation


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Training Phase

Not enough time is allocated for training Training should be performed outside of clinical

work sessions

Set-up training room for staff to practice

Appoint Superusers

Miscommmunication risk with Train the Trainermethod

Evaluate Staffs readiness for go-live


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Go-Live Phase

Schedule the go-live in close proximity to theend of the training sessions

Reduce provider schedules

Provide Adequate Resources


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Post Go-Live

Post Go-Live Assessment is necessary

Evaluate the Go-Live with Staff

Provide on-Going training and support


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Crackerjack Break - Vital Statistics

Q: What is the largest inpatient chart for a single patient? (may havemultiple volumes) Hint: its measured in feet

A: 4 feetQ: What is the average number of inpatient charts created per year?

A: approximately 15,000Q:About how many different inpatient paper forms are there?

A: approximately 400Q: What is the average number of days to complete an inpatient record (including

coding and physician signatures)

A: 40-50 days


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The DugoutCase Study: Enterprise Implementation

SchedulingreludeManage

dcare

WebsitePortals

BenefitsEngine

ADT

HIMrof Billing

Pharmacy

Reporting Ambulatory

Inpatient and Optime

Billing

2004

2009

CPMAR

ED Surgery

Radiology


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aking us to the home stretch

Supporting our Strategic Vision

People/Culture--Providing the right information, at the right time, to make the bestdecision (avoiding duplication, delays and rework)

ServiceShowing that We Know You

QualitySupporting safe, evidence based care and the data to prove it

FinanceEmbedding a standardized, compliant revenue cycle

GrowthKnock the socks off of our competitors!!


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The Game Plan

Leverage Other Customer Learning

Access to model system with best practices Conduct deep dive sessions for the different areas

Reporting

VDB Sessions more on Validation and less on Design

Build prior to Validation Session

Tell us why what was built will not work and is it

critical

Change Control

Prototype will be the baseline for tracking changes

Department Managers/SMEs/Chiefs involvement

Workflow signoff

Change Management

Go Live Support

Sandbox

Demos

Practice area after training

Dress Rehearsal

Optimization after go live part of the plan

Physician Order Entry (CPOE)

Clinical Documentation (Clin Doc)

Peri-Operative Documentation

ASC Documentation

Hospital Service DepartmentsDocumentation (e.g. GI, ATC, etc.)

Medication Administration Bar

Coding with Pyxis

Lab Labels for Specimen Collection


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Phase 1: Planning

Goals Project Staffing Obtain application knowledge

Initiate workflow analysis

Identification of Partner Organizations content to be utilized

Transformation of schedules and trackers

Plan Kickoff and build visits by Epic staff

Attend training

Deliverables Customer specific project plan

Project team certification

System built out with leveraged content


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Phase 2: Validation

Goals Workflows validated to meet business needs

Plan Validation sessions to evaluate complete build

System configured to support workflows

Deliverables Documented workflows, policies for training

Build complete

System ready for testing

Ph 3 T i d T i i


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Phase 3: Testing and Training

Goals Workflow and build tested

End users prepared for go-live

Plan Workflow-based testing and training

Training plan executed (Epic helps train first round)

Deliverables Documented test plans and scripts

Training materials produced and distributed

All users through required training classes

GO LIVE


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GO LIVE

Goals Smooth process for bringing clinical applications live

Comprehensive support plan for go-live

Plan Early planning and analysis of user community

Series of preparation meetings

Go-live readiness meetings

Deliverables Detailed conversion plan for all systems

Support plan for all customer and Epic staff

Ph 4 S t d O ti i ti


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Phase 4: Support and Optimization

Goals Successful transition of data, patients, and users onto HealthConnect

Plan Detailed Go Live support schedule and processes

Well organized Command Center in place

Communication plan between project team and leadership

Rapid response to tracking and resolution of issues

Deliverables Detailed support schedule

Contingency plans, issue reporting tools, and reports

P t Li S t Vi it


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Post Live Support Visits

Goals Initial site problems resolved

Plan for optimization identified

Plan Onsite go-live assistance

Post-live follow up meetings

Refresher training events

Deliverables Post-live reports

End user happiness surveys

Th 3rd I i


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The 3rd Inning.

May-

08

Jun-

08

Jul-

08

Aug-

08

Sept

-08

Oct-

08

Nov-

08

Dec-

08

Jan-

09

Feb-

09

Mar-

09

Apr-

09

May-

09

June

-09

Jul-

09

Aug-

09

Sept

-09

Build Prototype Validation Session Testing

User TrainingPost Go-Live Support

& Optimization

Core Team

Kick-off 4/15

Project Team

Kick-off 07/15

Workflow Walkthru

11/04 &11/05

Go-Live 06/14ASC Go-Live

UATRequirement

DefinitionDevelopment

Where we

are now

Radiant Go

live 10/25

Post VS work


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24

Michelle Edgecomb

Mike Christenson

Business Partners IT Director

Inpatient Manager

ClinDoc& CPOE Lead

OpTime Lead

Physician Leads

Inpatient: Physician ChampionOpTime: Surgeon Champion

Ambulatory: Champion

Change Mgt.

& Comm

Pharmacy/

Barcoding

Manager

ClinDoc AC

OpTime AC

ED AC

Pharm ACD1 ACs

(Hosp Bill

HIM

ADT, etc.)

Interface Development

Business Process Manager

IT Project Manager

Implementation Coordinator

Realization Team Leader

Chief Nursing Officer

Nursing Supervisor

Nurse Champion

Testing

Manager

Environment

Mgt & Support

Labor Coordinator:

Ancillaries

(Lab,

Radiology,

Etc.) TBD

D3 Business Leads

Inpatient Mgr

Clin Apps Mgr

CC/SA/Trg Mgr

Appl

Managers &

Appl

Coordinators

Sponsors: Hospital Chair: Nursing

Chief Nursing Officer

Physician ChampionChief Medical Officer

The Team

R l d R ibiliti


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Roles and Responsibilities

Business Sponsor and Designee Supports the team through the life cycle of the project; accountable for

validating resource commitments with Org Director; work closely with thebusiness process manager and IT project manager to meet goals and objective

Inpatient Manager responsible for the quality of the business areas deliverables and for performing

the business processes, such as user acceptance testing, that produce those

deliverables; to ensure that the business requirements are defined and that theprogram realizes the Business Plan objectives.

Information Technology (IT) Project Manager responsible for developing the plans to utilize IT resources; responsible for

maintaining an enterprise, cross-IT view during their participation on theinitiative; works in conjunction with the RTL to realize the objectives of theBusiness Plan.

R l d R ibiliti


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Roles and Responsibilities

Subject Matter Expert (SME) provide the subject expertise and working with the application leads to ensure thatfunctional deliverables meet the requirements

Application Coordinator (AC) Hawaii and National focuses on designing, configuring, unit testing, and supporting solutions, based on

business requirements

Health Information Management (HIM) Assure build configuration meets the by-laws for hospital. HIM director to support thebusiness sponsor.

Vendor provide the subject expertise and working with the application leads to ensure that

functional deliverables meet the requirements

Change Management Plan


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Change Management Plan

April 2008: Establish Governance Structure

May 2008: Sponsors identified, educated about their role, and plan for their activities

completed

Communication plan completed and vetted with inpatient leadership Sponsor plan completed and vetted with Sponsors

Plan for Tiger team engagement for in preparing system users for change Videocompleted and vetted

Key role map completed and validated

Defined Communication Plan to managers and SMEs

Welcome to the next phase of work to implement D3 applications

Why we are moving to an electronic medical record What inpatient clinical will mean to patients, staff and the Region

Change Management Plan (cont )


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Change Management Plan (cont.)

June 2008

Reminder to Managers and Tiger team of the Validation Sessions for July and August 2008 Deployment Meeting

Communication to Department of Nursing, HIMC, and Hospital Mgmt team

July 2008 Participate in Validation Sessions

Aug 2008 Participate in Validation Sessions

Sep 2008

Practice environment made available Readiness assessments conducted

Project Communication Plan


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Project Communication Plan

IT

E

M

#

DUE

DATE/

FREQ

COMMUNICA

TION

VEHICLE

TARGET

AUDIENCE

COMMUNICATIO

N LEVEL

TARGETED? MESSAGE OWNER

1 Jul-08 Newsletter

Department

Managers and

Subject Matter

Experts (SME)

Awareness

Welcome to the project; Why

we are moving to electronic

medical record; What will it

mean to patients, staff &

region

Nurse C, Dr

C, IP Mgr

2 Jul-08 Newsletter MMC Staff Awareness TBDNurse C, Dr

C, IP Mgr

3 MonthlySteering

CommitteeProject Team Awareness Project Status Leads

4 Weekly Email Sponsors Awareness Project Status Comm Mgr

5 Monthly HIMC MtgHospital

LeadersipAwareness

Project Status; Change

Requests; Issue Escalation

Inpatient

Manager

6 Monthly MeetingPhysician

Leadership

Awareness Project StatusPhysician

Champion7

Bi-

weeklyIP Deply Mtg Leadership Sponsorship Issue Escalation

Nurse C, Dr

C, IP Mgr

8 Nov-08 Demo -Impacted

DepartmentsBuy-in System Functionality

Nurse C, Dr

C, IP Mgr

Environment Timeline & Plan


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Environment Timeline & Plan

ActivitiesWeek1

Week2

Week3

Week4

Week1

Week2

Week3

Week4

Week1

Week2

Week3

Week4

Week1

Week2

Week3

Week4

Week1

Week2

Week3

Week4

Week1

Week2

Week3

Week4

Week1

Week2

Week3

Week4

Week1

Week2

Week3

Week4

Week1

Week2

Week3

Week4

Week5

PRODUCTION

BETS

Copy SCAL into Test Env

Validation sessions and config/builld in Bld Env

December

SPRING '07 IU2

NovemberAugust September OctoberMay June JulyApril

D3 IP CPOE/CLIN DOC, Optime,

Wireless Carts, Bar Code

Readers/Printers, Lab Printers

Go - Live

RADIANT

Radiant Testing Test Env (Activate Code June 30th)

Radiant's VDB, Build/Config (Sandbox) in Bld Env - Sp07

Pre-Build in Test Env - Sp07

Testing Prep

Build in Test Env D3 testing in Test Env to 5/30/200

BETS inTest Env Sp07

IP MD Content Process


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IP MD Content Process

Order sets

Obtain SCAL paper downtime OrderSet forms

Send to SME leads to review/edit content

Collect - share with team to build/revise

Make WORD documents for other providers to review

Face-to-face to review in system with domain SMEs

SmartText/SmartPhraseCreate domain specific for procedures

Use ones developed for HI ED (these have been approved for HI through HIMC, coders, etc.)

Look on community web

Smart Links

Review what exists in HILook on community web

Leverage off of whats built for S. Cal and Northwest

IP Nursing Content Process


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IP Nursing Content Process

Flowsheets

National Collaborative BuildHibernate rows that are not applicable to HI region workflows

Validate as homework in tiger teams

SmartText/SmartPhrase/Smart linksReview what exists in SCAL/ NW

Validate as homework in tiger teams

Ordersets

Review in tiger teams for clarity

Add clarifiers / comments to send back to MD team

IP D3 Training Plan


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IP D3 Training Plan

Stage One: eLearning and Sandbox Begin 6-7 months prior to go-live All courses on Intranet so we register and track student learning (required)

Students do courses

on floor and/or

scheduled in class at Hospital Trailer or Tower - 2 hour blocks

Formal practice exercises built and available using Sandbox - do eLearningmodule, then practice in Sandbox

Time estimated is based on role - approx 4 -6 hours for Nursing staff andapprox 2 - 4 hours for Physicians

Following slides show what eLearning modules were available as of Dec2007 - will need to be validated, and additional modules potentially created

IP D3 Training Plan


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IP D3 Training Plan

Stage Two: Instructor Led Training (although may

include some web based training (WBT) Begin 6 - 8 weeks prior to go-live

Utilize Scal/NW curriculum as much as possible

Estimated time -- Nursing = 16 hours and Physicians = 12 hours

Important to have training facilities, projectors, trainers to do all 1000+ staffin 6-8 weeks

Stage Three: Stabilization/Optimization Training Propose

Begin 8 -12 weeks after go-live Estimated time - Nursing = 4 hours and Physicians = 2 hours

IP D3 Training Plan Example of training week schedule


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IP D3 Training Plan Example of training week schedule

Status Reports


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Status Reports

Status: On track for completing domain (e.g. prototype for MedSurg).Other domains will be completed as we schedule them for VDB.

Arrange for ACs to shadow a SME

Meeting with xx department was successful; outstanding issues

were addressed

Issues:Waiting on national to complete content build for mental health

Found a bug in the navigator and Vendor is yet to deliver the

code

Upcoming

Milestones:01/25/08 Prototype

07/15/08 1st VDB

08/04/08 2nd VDB08/11/08 3rd VDB

On Track

On Track Watch Critical

Issue Escalation Process


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Issue Escalation Process

Issue for escalation should be reflected on the weeklystatus report as soon as identified

Escalation Chain Operations Lead/Team Lead

Project Leadership (IP Mgr, Amb Mgt, IT Director)

HIMC

Sponsors/PMO

IP Coordinator is the keeper of the escalated issues list

Nurse Champion, Physician Champion, and InpatientManager are responsible for communicating resolution to

the team

Risk Plan


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Risk Plan

Given the tight schedule and a huge scope, we have to

manage risks very closely Risk can occur be at any level and that is why

identification is everybodys responsibility

Risks are weighted according to probability of occurrence

and impact to the project if it happens Not all risks can/will be avoided

Risk mitigation can be either of the following: Avoid

Control to minimize impact

Transfer to appropriate group

Assume consequences


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Final Parting ShotsHeres why this transformation is so vital to Patient Safety!

What Questions do you have?


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What Questions do you have?

Information about the Speaker BSEE from Georgia Tech

Masters in Healthcare Systems from Georgia Tech

PMP Certification

10 years of Healthcare Consulting experience Epic Implementation in over 15 hospitals

throughout the nation

Sources


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Sources

Histalk Blog

HIMSS - Standards and Interoperability: The DNA of the EHR -Other Pubs (2/21/2007)

A Guide to the Project Management Body of Knowledge

(PMBOK Guide) Third Edition Known Pitfalls and Proven Methods for a Successful EMR

Implementation - by Ursula Pennell and Eric Fishman, M.D.(2005)

Kaiser Hawaii Kickoff 2008 Presentation Pranjal Shah,

Alison Miyasaki, Dr Dana Tom
http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66600

EMR Implementation Challenges

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