Project Management Techniques to Keep your EHR Implementation on Track

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Project Management Techniques to Keep your EHR
Implementation on Track

• VITL Summit
• September 25, 2009

Elise Ames, MS, PMP Senior Project Manager
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Project Management Basics

• EHR implementation project success is more
  dependant on people and process than it is on
  software and hardware.
• Successful EHR project management requires
  frequent, effective communication between all
  parties.
• You need clear goals and realistic expectations

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Understand the Project Phases
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Initiating Steps
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Commitment from your Team

• Buy-in from all staff who will use or whose
  workflow will be affected by - the system is
  critical.
• You will need a physician champion
• You will need a project manager.
• In small offices, typically the practice manager
• Larger offices may require external help
• You will need a technology partner especially
  if using an in house server model

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How to Get Buy In

• Involve the team in the selection process they
  should review functionality with an eye to what
  is important to them. Give everyone a voice and a
  vote.
• Involve the team in the workflow redesign process
  they will understand how the system will affect
  their work and they will have the best ideas on
  process improvements

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Define the Scope

• Project Scope Statement is a document delineating
  what is included in the project and what is not
  included.
• For example
• Practice Management and EHR or EHR only
• In-house servers or remotely hosted solution
• Dictation vs. voice recognition vs. structured
  data entry with templates
• ePrescribing
• On-line eligibility checking
• Drivers license scanning
• Patient Portal

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The Importance of Scope Definition

• It helps you not overbuy or under buy.
• It is the foundation of your schedule, budget and
  resource planning.
• No surprises!

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Plan the Approach

• Practice Management and EHR

• EHR Only

• Pros
• Integrated system
• One database (depending on the product)
• One vendor to manage
• Cons
• Longer timeframe to implement
• Risk to A/R when changing billing systems
• Requires more data conversion

• Pros
• Shorter implementation timeframe
• Lower cost
• Less risky than implementing a new billing system
• Cons
• Requires interface to/from existing PM system
• Higher complexity
• Multiple vendors to manage

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Plan the Approach

• In-house Server Environment

• Remote Hosted or SaaS

• Pros
• Control of your data
• Less reliance on Internet connection speed and
  availability
• Cons
• Higher upfront cost
• On-site servers require care and feeding
  (backup, patches, configuration, disaster plan)

• Pros
• No server headaches
• Predictable monthly cost
• Cons
• Pay forever and never own equipment
• More reliance on Internet connection speed and
  reliability

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Planning Steps
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Solidify the Approach

• Phased in or big bang?
• All providers, all patients at once or gradually.
• How will paper records be converted?
• How much customization to forms, templates, etc
  will be included (Less customization is better)
• What interfaces to external systems will be
  needed? For example, lab, registries, etc.

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Understand the Vendors Methodology

• Ask for a sample implementation work plan as an
  exhibit to your contract.
• Services agreement should clearly state how many
  hours of training and implementation services are
  included
• Should also specify how services are to be
  delivered for example webinar training, on site
  training, will they be on site to support you
  during go-live?

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Define Goals and Measures of Success

• Quantifiable goals clearly stated.
• For example not go paperless but 95 of
  patient encounters will be electronically
  documented by all providers by March 1, 2010
• Many potential measures
• of prescriptions sent to the pharmacy
  electronically
• of chart pulls
• Number of phone calls from Pharmacies

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Plan the Schedule
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Plan the Schedule

• Negotiate with the vendor do not be pushed into
  an implementation schedule that is too
  aggressive, or doesnt work with other events you
  have planned.
• Get dates from the vendor in writing for items
  such as software delivery, training and go-live
  support.
• Communicate the schedule throughout the practice

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Plan the Budget

• Understand how much the system will cost.
• Not only the upfront costs, but also ongoing
  maintenance, subscriptions and other fees.
  (Dont forget travel costs often overlooked and
  can add up fast!)
• Include additional staff costs for training and
  back loading data.
• Plan for lost productivity due to provider time
  to get up to speed.
• Add 10 contingency.

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Redesign the Workflow

• Document the existing workflow for key processes
  that will be affected by the system
• Scheduling, check-in, eligibility, telephone
  encounters, patient communication, test ordering,
  prescription writing, report sign off, etc.
• Review this workflow documentation with the
  vendor at training ask them to explain how the
  workflows will be changed once the system is
  implemented.
• Update the work flows and communicate with staff

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Executing Steps
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Procure and Install Infrastructure

• Working with a technology partner, buy and
  install IT infrastructure.
• Wireless networks most common.
• Get buy in from providers for end user device
  choices, tablets, laptops, etc.
• Make sure network and infrastructure is tested
  and working before software delivery.
• Have a plan in place for infrastructure failure.
• Consider a support contract with your technology
  partner
• Avoid the do it yourself (or using your
  nephew) approach to technology support

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Customization

• You will be inventorying existing chart forms,
  templates, flow sheets, etc. to determine what
  customization to the EHR will be needed.
• Keep an open mind about using as many out of the
  box forms and templates as possible when going
  live especially for the first few months.
• Specifically limit provider specific
  customization collaborate to develop practice
  wide standards.
• Test all customization! Have providers agree
  that a template or flow sheet is working.

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Training

• Different levels of training are offered
• Larger groups will benefit from super user
  training
• Make sure you allocate enough time for users to
  practice using the system before live.
• Consider one on one training for providers
• Use pre-loading (of schedule and charts) to help
  users practice.
• Consider user competency tests.

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Data Load

• Combination of document scanning and data entry
  of structured data.
• Approach must be planned carefully to maximize
  productivity.
• May need to backfill staff

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Testing and Validation

• Many systems do not have a test environment or
  want to charge more for a test environment
  forcing you to test in the live environment.
• Before live, test each template, screen, function
  to make sure it functions as advertised in the
  user manual.

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Go-Live Preparation

• Dress rehearsal test work flow
• After hours, provide food
• Communicate with patients and staff
• Assign specific staff to assist with the go-live.
  Document issues as they come up, prioritize and
  resolve.

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Closing Steps
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Turnover to Support

• Understand the timeframe after live during which
  your vendor trainers will be available for
  questions.
• Designate a person in your practice (not a
  provider) to be the liaison to the vendor support
  on an on-going basis.

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What if Things Dont Go as Planned?

• If the schedule slips, regroup and plan for a
  realistic timeframe.
• Dont sacrifice quality to the schedule.
• Pro-actively manage risks
• Work with your vendor to escalate issues as
  needed.
• Work with your staff to understand their concerns
• Communicate!