emr implementation challenges
TRANSCRIPT
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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