Question

Describe how you would approach the implementation of an Electronic Health Record (EHR), create a list of tasks that need to be done (project milestones) to achieve this implementation. Who are the subject matter experts that need to be included in this decision-making process?

Develop a high-level implementation plan that includes the project milestones (key tasks) that will need to be accomplished. Discuss how long you project this project will take by preparing a timeline for your tasks. Include a discussion of the role of the vendor in accomplishing this implementation.

Answer 1

Implementation of the Electronic health records (EHR) -

Five steps involves in the implementation of the EHR

1. Advantage preparation.
2. System selection and installation.
3. Implementation.
4. Training and maintenance.
5. Go live.

All these steps can be explained as follows -

1. Advantage preparation -

1. Define your need - what do you want EHR can do for you ?

• Reduction of paper.
• Reduction in the transcription expenses.
• Better access to charts.
• More legible data.
• Improve tracking and recording.
• Acheive efficiency by planning carefully implementations and use of EHR system.
• Using certified EHR which can measured significantly in quality and in quantity as well.
• Provide seamless communication.

Constraints -

• Cost
• IT resources
• Clinical staff support.
• Project management skills/ internal Expertise.

2. Determine practice readiness -

• Are physicians and all staff members supportive of adopting EHR ?
• Is any physician leader committed to make health IT work for practice ?
• Is an office administrator committed to make health IT work for practice ?
• How does EHR implementation fit with other practice priorities ?

3. Talk to peers - take advantage of ASCRS and ASOA resources in helping to determine what kind of EHR might be best for for your practice size.

4. Map out your workflow process -

• List daily, weekly, or monthly tasks and duties.
• Calculate time of completion for each task.
• Conduct a few model patients visits. Walk the charts through each handoff and document needed.

5. Personnel roles - it depends on size and skill sets.

• Physician/ executive leaders - define and sell vision.
• Project manager - assist with IT support system selection.
• IT analyst - built and support health IT network, deploy hardware.

6. Budget - develop detailed budget outlining expenses in each category.

• Health IT software and services.
• Hardware/ network
• Additional implementation expenses.
• Temporary decline in productivity provider.
• Financing expenses.
• Equipment upgrades.

2. System selection and installation - many choices of hardware available. Compare and select the advantage and disadvantage with each set up.

• EHR must be certified for meaningful certified technological vendor.
• Create and research short list of vendors who meets technological requirements.
• Prepare technological requirement through workflow analysis.
• Evaluate criteria to maintain consistency while ranking vendors.
• Involve Representatives from different areas of practice in decision making.
• Consider doing your own independent site visit while observing clinic workflow and system performance.
• Set up test environment to test and use all product and peripherals together.
• Finally, install all hardware you depolyed.

Security - after setting up EHR system, consider carefully who on your staff have Access to which data and who maintain it.

Back up - Have multiple mathods of back up and recovery.

3. Implementation - Have implementation team evaluate what customisation Will be needed to your EHR software by following steps -

• All exams layouts.
• All drop- down lists.
• Optional " EHR notes " section where additional information can be entered.
• Assessment and plan pick list.
• HPI list and complaints.
• Template for the training procedure.

Patients and staff areas - understand of what patient and staff flow will be when EHR system functioning in existing space. Plan to place new EHR equipment.

Performance detail analysis -

• Analyse flow of data, document and patients.
• Opportunities for improved efficiency.
• Be detailed in your analysis and document every action or process.
• Watch peripheral hardware or system might interact with new system.
• Accept the staff will have to do things differently.
• Think about physical changes.
• Keep in mind implementation of EHR is a work in progress and improved process will continue to evolve.

4. Training and maintenance - comprehensive training plan is needed.

• Who need to be trained.
• Who Will be posting and coding the exam visits.
• Is your clinical staff trained for this.
• Who Will do training.

Once customize EHR system implementation and trained to staff, all staff practice with real patients data. The practice session should accomplish -

• Identify problem and then implementation necessary changes.
• Become EHR module proficient.
• Get real medical record information loaded into EHR records.
• Improve speed and accuracy.

5. Go live - EHR is an ongoing process not an event.

• Have vendor trainer.
• Schedule lightly for first week so to allowing more time between patients.
• Have contingency plan when problem occurs with EHR.
• Display signage in the office to explain the use of new computer software.

Points to be asked from vendor while selecting them -

1. Is your EHR system designed specially for ( example opthalmologist)?
2. How many opthalmologist use your system?
3. Do you employee trained staff and certified EHR?
4. Describe training and support offered by you to ensure our practice will be successful.
5. Can I add data like

• Patients demographics.
• Medical records.
• Eyewear orders.
• Contact lens order.
• Claim info.

6. Can I defines my audit report?

• Charts with missing information.
• Information entered incorrectly.
• Bonus opportunities. Etc......