EMR Implementation & HITECH Act Blog
A blog for doctors and medical office staff seeking assistance with EMR and the HITECH Act.
2009
Phases of an EHR Implementation: Steps to Building Success
The reality of electronic health record (EHR) implementation draws closer and medical staffs are ramping up. They wonder: what impact will this have on day-to-day practice? Some health care professionals tapped as project leaders are already planning the steps necessary to set up an EHR system. They’ve realized that an EHR implementation roll-out will take time and the investment of a team to coordinate the entire system.
The EHR system must be a benefit rather than a burden to the medical office. It’s not an easy task — as a best practices article published in the American Medical Informatics Association’s Annual Symposium Proceedings in 2006 indicates, only about 50% of EHR implementations are successful. Averting failure requires the proper alignment of people, processes and technology.
To achieve an effective EHR implementation, adoption can be organized into three phases, each of which has three steps.
Phase I: Organizational Phase
The initial phase of an EHR roll-out charts the course and gathers the people and technology needed to carry out the EHR implementation.
Step 1 — Planning
The planning step involves gathering (and possibly hiring) staff members who will participate in setting up the EHR system. Planning also involves identifying the needs of the users and casting a general vision of how the system will be used in the medical office. Although this step may seem less intense or time consuming than other steps, shortcuts or ineffective planning can have consequences that aren’t easy to fix later in the time line.
Step 2 — Identifying an EMR vendor
Finding an electronic medical record (EMR) vendor that will work with you, providing both user and technical support, is essential. Shopping around for the right company to match your needs is an investment for the long-term success of the EHR implementation. The information in an EHR system are too valuable for a medical practice to jeopardize with a company that lacks experience.
Step 3 — Installation
Whichever EMR company you choose, they should handle the installation of the hardware and software as well as ensuring the integrity and security of a network that must be accessible 24/7.
Phase II: Construction Phase
The construction phase begins with a heavy emphasis on learning the software and builds up to the launch of the system. During this phase, the focus should be on the details as the system is fine tuned and tested. Additionally, it is during this phase when the conversion of records takes place.
Step 1 — Customization
EMR software alone will not be enough to meet the needs of medical staff. Optimization of the EMR software means creating templates, hammering out protocols, and communicating with doctors and staff to ensure that the system provides the right information in the desired way.
Step 2 — Testing
The system must be tested and tested again. Remember: anything that can go wrong, will on a long enough time line. Fixing what is fixable and being prepared for what isn’t will improve the user experience.
Step 3 — Conversion
As part of an EHR implementation, all paper medical records will need to be entered in the system by converting them to digital records. This step may involve temporary hires.
Phase III: Operational Phase
The operational phase includes not only the launch of the system but also the ongoing support provided to staff and users. This phase never actually ends as training and maintenance will continue as needed.
Step 1 — Launch
A successful launch of the EHR system is contingent upon the effort that went into the first two phases. Getting the system live may take more than flipping a switch, so be prepared to contact your EMR vendor for assistance.
Step 2 — Staff Training
Integration of the EHR system into the day-to-day procedures of the office involves training. Since the system has been customized for the practice, it is best if the training is conducted by designated staff members who know your particular system well. Remember, it’s not necessarily those who know EMR software in general who will be best able to train your staff — training needs to be as customized as possible.
Step 3 — Maintenance and support
Ongoing technical maintenance will be necessary to keep the EHR system healthy. Over time, how the practice uses EHRs may shift or change dramatically. It’s important that support, both by internal staff and the outside vendor, is ready to help when a problem arises.
Overall, an EHR implementation may initially seem like a daunting task. Hopefully, following these steps will help medical offices avoid the common pitfalls that have contributed to EHR failure in the past.
David Hill
PC Healthstop Blogging Team
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2 Comments
Deborah Leyva
Posted November 19, 2009 at 9:47 am | Permalink
I agree with your “phased” components of an EHR implementation, but as a former technology person, I suggest that EHR implementations have a slightly different roadmap.
As with all technology implementations, across all industries, requirements should drive the implementation. In a practice, for example, these requirements take the form of an “As-Is” picture that describes the existing people, processes, workflow, and technologies used.
The target, or the “To-Be” position is the goal. If there is desire (and I expect there will be) to receive federal stimulus financial incentives, then the goal must meet the. as of yet, unfinalized meaningful use criteria. (Expectations are that these criteria will be finalized in 1Q10.)
That said, the current matrix describes many of the “new” reporting requirements to assess meaningful use with electronic health records. Regardless of the criteria’s current status, health professionals should become familiar with them in order to assess how their existing processes may be impacted via compliance. A huge area with significant impact, and one that is already in effect, are the “improved” HITECH / HIPAA Privacy & Security Rules.
Finally, when the starting and ending points are known, the “roadmap” can be developed and it will include many of the phases identified in your article. That said, EHR implementations are not a step-by-step process, but rather, they are an iterative process. This means that providers and/or facilities must recognize problems along the way, prioritize, iterate, fix or postpone the solution, educate clinicians, and assess results throughout the implementation. Once the system is successfully operational, then of course, maintenance and support follows.
For more information on EHR implementations you may be interested in a presentation I gave at the World Healthcare Technology and Innovation Congress on this topic at http://tinyurl.com/y87sjzr
PC Healthstop Blogging Team
Posted November 20, 2009 at 12:43 pm | Permalink
In most business contexts, the desired end-point is generally known. It may be a certain percentage of market share or a target return on investment. Generally the goals are quantifiable and progress is measurable.
But in the implementation of EMR/EHRs, meaningful use is an amorphous and moving target (and likely will be through 2Q10), which makes the selection of a software program problematic. CCHIT has already certified more than 200 products, but what happens if the ONC creates the definition of meaningful use and suddenly some or all of those EMR/EHRs can’t meet MU requirements? Now, you have two moving targets.
Let’s also say that I want to implement end-to-end encryption to be sure that all my data-at- rest and data-in-motion is secure. How do I know what compatibility problems that might create?
Studies have shown that these multiple uncertainties are among the major causes of the slow EMR/EHR implementation rates we are seeing.
Absolutely, implementation can be an iterative process, and it is possible to slice most of the mechanics of implementation down to manageable pieces and create an action plan to address them. But providers facing a months-long process that will alter the day-to-day operations of their practice seem to be a little skittish about making a commitment until they know more.
I think there may be an explosion of activity when the ONC finally definites meaningful use and vendors start saying – “Yes, our software will do that”.
Rich Silverman