Question

Select an EMR/EHR. Based on your knowledge, what potential affect, if any, can your organization’s strategic plan play in their selection of transitioning EMR/EHRs? Why does this need to be a part of the strategic plan?

Answer 1

An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs are a vital part of health IT and can:

• Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
• Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
• Automate and streamline provider workflow

One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built to share information with other health care providers and organizations - such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics - so they contain information from all clinicians involved in a patient’s care.

The potential affect of an organization's strategic plan in their selection of transitioning EMR/EHR and the reasons why it needs to be a part of strategic plan are:-

1. Effective and Frequent Communication:

Communication begins on Day 1. Use this initial step in the process to bring all executives to the table to ensure every work item is addressed for each department as appropriate and clear strategic goals are identified. IT, operations, revenue cycle, and clinical staff should all be included in this discussion. A conflict between these departments can occur if common goals and a clear vision are not established and agreed upon by everyone up front, which can ultimately result in paralysis when the time comes for a final decision.

IT staff may advocate for a system that is easiest to manage from a technical standpoint (one that reduces risk of technical error, requires fewer end user staff, or needs less maintenance). Conversely, clinical staff may be purely focused on a system that has an easy-to-use user interface that will be less time consuming to learn and more efficient to navigate compared to the user interfaces of other potential vendors. The Central Business Office (CBO) may prefer another vendor. It is important to identify each department’s agendas and needs prior to beginning the system selection process so that they can be discussed and addressed. It is more difficult to resolve conflicts of interest later in the decision-making process.

Some questions that should be asked during initial vendor selection discussions include:

• What are the goals of each department for selecting a new PM or EHR system?
• What is the timeline for selecting and implementing the new system?
• What is your organization’s budget for a new system?
• What are the critical components of a system that will make or break your decision?
• What is the overall vision for how the new system will benefit your organization?
• How does this new system fit into your overall organizational plans and initiatives going forward?

Active communications must continue throughout the entire project. After the selection process has kicked off, coordinate weekly meetings with the core work group to discuss progress and address any concerns identified that week. Make sure to frequently bring all main stakeholders back into this conversation to keep them in the loop. Communication is a critical component to success. You cannot stress this piece enough during the system selection process.

2. Detailed Project Plan:

Developing a project plan is a great method for brainstorming all necessary components of a project and understanding how each piece will fit together as the project develops. The project plan should include the basic components of a system selection process, including:

• Analysis of the current PM or EHR system to identify the functionality that is missing from the current system and confirm the reasoning for moving to a new vendor
• RFP development that incorporates any technical and functional requirements that the new system will need to include
• Vendor demonstrations and site visits to view the functionality of each system
• Evaluation of the vendor pricing and contract negotiations to view the feasibility of purchasing and implementing the chosen vendor given your budget and revenue

Additionally, the plan should mention any items specific to your organization, such as interface planning and scoping out the technical requirements if your practices are located in numerous locations.

As you work through the system selection process, refer back to the project plan frequently to ensure that you are on track. If you find yourself drifting from the initial timeline, bring the concerns to the main stakeholder group and consider the need to modify the timeframe. Critically think about the reasoning for the extension of the timeline and be prepared to make adjustments accordingly. Make sure that the decision to push out the timeframe is approved by all appropriate executives and stakeholders involved in the project. Update the project plan and re-distribute the plan to members of the selection team, identifying any items that are impacted by this change and proposing a plan for addressing those impacted areas.  

3. Sufficient Due Diligence:

Once a common vision and comprehensive communication plan has been established that incorporates all departments and stakeholders, due diligence must be performed to identify any problems areas that need to be resolved before a new system selection is implemented. It is a common misconception that putting in a new PM or EHR system will resolve all problems your organization is experiencing. A new system may solve many of the problems; however, the fundamental organizational and operational issues need to be addressed first for these resolutions to be successful.

Completing due diligence prior to initiation of the system selection process will help ensure that you are achieving the most out of your new system. Some questions you should consider during the due diligence process include:

• What are the main areas of concern currently in your organization?
• Are these problems related to the current system or are they due to operational or organizational challenges that can be resolved without implementing a new system?
• What areas need to be addressed prior to selecting and implementing a new system? Which areas will require a longer term effort and can wait until after the system selection process to be addressed?
• What are the workflows that require manual intervention or workarounds that are not resolved by implementing a new system?

Answering these questions will help you avoid reaching the end of the system selection and implementation process only to realize that your problems prior to the new system still persist.

4. Appropriate Plan to Address Issues:

Even if you have completed a detailed project plan, outlined a comprehensive communication plan, and performed proper due diligence, issues may still arise during the system selection process. An appropriate plan for issue management can help you resolve those problems that may arise and stay on your feet making targeted progress toward your goal. This plan could include reaching out to the executive sponsors of the project, scheduling a meeting with all stakeholders, and identifying the appropriate individuals to complete each task so the resolution process can be timely and effective. Be sure to develop an escalation plan for issues that will significantly impact the project timeline.

These four components create a foundation for your organization to conduct a successful system selection process. As each organization is different, each process will be unique. It is up to you to choose or modify the strategy to best fit your organization.

Communication Management’s Planning & Role In EHR Success

While an organization implementing an electronic health record might be so fortunate as to have a thorough and well defined contract, support of its leadership, and a committed and capable team, all that is likely to be for naught without a carefully structured communication plan.It would be unreasonable for an organization's leadership to expect a successful outcome from any meeting without first providing participant's adequate notice of the gatherings site, date, timeline, and agenda. In like manner, forging ahead with an EHR implementation that does not thoroughly communicate key components of the process to the entire organization is setting the endeavor up for serious setbacks with the potential of outright failure.

GOALS

An EHR communication plan must recognize the substantial change the entire organization is about to go through. It must take into account that an EHR implementation is so much more than a technical endeavor and therefore must consider the substantial impact on the individual. Doing so takes the project to the level which is necessary for front line employees to adequately vest in the process.The goals of the communication plan, therefore include: demonstrating the need for and the rationale behind the EHR implementation, allaying fears, encouraging and facilitating participation, creating and maintaining enthusiasm for the project, and anticipating and/or averting obstacles. This review will outline a communication plan we recommend be used a template for health care organizations as they traverse the many challenges inherent to an EHR implementation.

CHARACTERISTICS OF AN EFFECTIVE COMMUNICATION PLAN

To be effective an EHR communication must contain a number of fundamental components:

• First, it needs to provide a thorough and accurate assessment of the current state as well as a rational justification for the expected or proposed change. The communication should acknowledge that the task ahead and that currently being engaged in is not expected to be easy; however, the aim of the change is to optimize the quality of care provided to the organizations patients.
• Second, the message(s) should be repetitive and presented through redundant channels.
• Third, the format of the message(s) should be both "push" and "pull" in nature.
• Fourth, the message(s) need to be clear and understandable to a disparate audience.
• Fifth, some tailored message(s) should be included for specific audiences.
• Sixth, the message(s) should provide timely updates so as to avoid surprises which only stoke an already anxious organizational membership.
• Seventh, the plan should avoid stops and starts; that is, it needs to be reliably presented throughout the course of the EHR implementation process.

SCHEDULE

Part of the EHR proposal will out of necessity include aspects of the communication plan including a timeline. Early identification of a communication schedule is necessary for budgetary considerations and coordination with multiple organizational units beyond operations (e.g. marketing, human resources, and others). The overall EHR project schedule can be used as a strawman for developing the detailed communication schedule.

It is essential that the plan be scheduled so as to coordinate with the major cycles of the project (i.e. vendor selection, planning, requirements, design, build, testing, training, implementation, and post-go live adoption).Being able to satisfactorily communicate plans for such cycles to the staff is dependent on there being well orchestrated communication among the EHR project and executive teams as well. Given all of the above, a formal communication strategy needs to be well in place at a minimum of one year prior to the go-live.

COMMUNICATING VENDOR SELECTION

It has been previously indicated that perhaps the single most important aspect of a successful EHR implementation is selection of the correct software solution. Even more than the audit process, solution selection requires cooperative effort by both operations and IT. We suggest that IT facilitate the process and provide technical guidance; however, operations make the functional fit decision. As such, appropriate representation takes into account the entire spectrum of disciplines, interest, and expertise in the organization. Part of the process of identifying the selection team should include consideration and instruction on how these same individuals can continue the process of communicating with staff that they are in fact representing in this critically important aspect of the EHR implementation. Ongoing communication during a selection process expected to take several months and thousands of hours, helps to ensure that the solution selected is consistent with the culture and business processes of the organization.

FACT SHEET

Initial announcement of plans for an EHR generally elicits substantial questions from stakeholders. It is difficult for the leadership to at all times be adequately prepared to answer widely disparate questions, particularly as they come from the diverse constituents which make up a health care organization. As such, it is generally useful to prepare an EHR fact sheet/laminated card which can be easily referred to by those same leadership but may also be distributed widely across the organization.

STANDARD MEETING REPORTS

Even greater levels of detail concerning EHR activity needs to be a regular report at administrative leadership, senior operations, clinical leadership team, medical staff, and department head meetings. These reports should include specific EHR presentations with updates on status, plans, structural issues, etc.

PATIENT COMMUNICATION

Communication of an organization's change to an EHR is particularly important during the go-live and immediately post go-live period so as to allay fears from the evident disruption, even minor, that invariably occurs. Such communication can be verbal from areas as diverse as registration to lab and nursing. Providing small "script" cards to these individuals can ensure a common explanation and expectation and as a bi-product, serve as a useful communication to the stakeholders themselves. It is often useful to place patient friendly posters around the organization in anticipation of the go-live.

This not only avoids the patient being caught off guard when their care provider begins documenting in a computer rather than a paper chart, but can be used to promote the benefits of the EHR in optimizing the patients health care experience.

TRAINING

When the EHR implementation project reaches the stage where training plans are being finalized, the need to communicate that message becomes necessary if only for scheduling purposes. However, this portion of the communication plan provides an opportunity to communicate substantially more than simply ensuring stakeholder compliance with attendance. Training sessions become a venue to demonstrate system capabilities and thereby build energy and enthusiasm. This message can be delivered in a number of forms but is most often given as presentations by super-user staff. The training materials can be used as a communication vehicle in addition to their evident educational support. Such materials can include instructional CD's, manuals, slide shows.