The following article is written by Ann O'Neill, director of clinical operations, Regent Surgical Health.
This is the third and final installment regarding ASCs and EHR Systems. The first article, "Electronic Health Records: What Does it Mean and Do We Have to Go There?" discussed the CMS definition of EHR, the looming mandate for EHR Systems and how to select the right system for your center. The second article, "ROI on EHR" identified the quantitative and qualitative considerations of an EHR system project. Now, we will give you an outline for successful implementation of that carefully selected EHR system.
With the support of your project champion (usually a high level board member), you will move into the implementation phase of your EHR project. The keys to success in this phase will be having the right resources, in the right place, at the right time to complete the deliverables. You will need an implementation team. Additionally, now is the time for IT support, vendor support and the endusers to come on board with the project. Here is a table which describes at a high level the steps that must be included in your EHR system roll-out plan.
|
Objective |
Purpose |
Who |
When |
|
Form an EHR System Implementation (Project) Team |
· Oversee project roll-out ensuring all needs are identified, all tasks are assigned, and each deliverable is completed on time · This group is chartered with defined purpose and goals · The Implementation Team reports back to the project stakeholders keeping all informed of progress |
Members selected based on needs of project. Representatives from: · Vendor · IT · At least one representative from the Superusers · System Administrator · Administration · Business Office · Clinical expert from each patient care area (must know patient flow, workflow, and documentation requirements- they will work on configuration of system to meet patient and provider needs) |
Weeks to months before kick-off meeting for project roll-out (preparation for the implementation) |
|
Project Kick-off |
Onsite meeting to: · Achieve common understanding of project scope · Review and approve implementation plan in detail, assign tasks, and timeline · Establish communication plan · Establish issues resolution plan · Document a formal project plan with objectives, tasks, assigned resources, and timeframes for each. (A draft one is usually provided by the vendor as a starting point.) |
· Vendor · Implementation Team · Project Champion |
At the start of the implementation phase of the project |
|
Status Meetin |
· Early communication. Regular updates from each involved area (IT, Vendor, Clinical, etc.) · Document status reports · Report back to champion and to staff and providers |
· Implementation Team · Vendor |
· Weekly through implementation · More often during go-live and immediately post go-live · Weekly post go-live until all issues are resolved |
|
Site Preparation |
· Cabling and building structure for: o Computer Room o Communication Closet o Patient Care Area PC’s/ Devices o VPN set-up · Facility walk-through |
· Vendor · IT |
Post kick-off through projected time needed for construction |
|
Hardware and Software Installation |
· Install and configure servers · Deliver hardware · Install VPN · Test wiring systems |
· IT |
Post Site Preparation |
|
System Administrator Training |
· At least one staff person needs to learn how to troubleshoot hardware and software, as well as how to set-up users in the system and to assign user roles · Be involved with system roll-out and post go-live support · Learn how to build reports in the system |
· ASC staff member with strong computer skills |
Post Hardware and Software Install |
|
Device Installation and Configuration |
· Install/connect devices that will interface with EHR system. i.e. patient monitors, signature pads, printers, etc. |
· IT · Clinical Expert |
Prior to Documentation Configuration |
|
Documentation Configuration |
· Configuration Workshop - to train clinical configuration folks on how to analyze workflow, determine configuration needs, test configuration changes |
· Clinical Experts/Superusers |
Post install of Hardware, Software, and Devices |
|
System Interfaces |
· ADT (Admission, Discharge, Transfer, Scheduling Software) o Set-up/Map o Test · Laboratory o Set-up/Map o Test |
· IT · Clinical · Business Office · EHR Vendor · ADT/Business Software Vendor · Laboratory Software Vendor |
Post Configuration |
|
Report Building |
· Determine what clinical and business data you want to extract from the system in the form of reports · Configure reports · Test reports |
· System Administrator · Clinical · Business Office · Administration |
Post configuration documentation |
|
Final Configurations |
· Conduct QA on configurations (try to break the system) · Fix Issues · Freeze Configuration until post go-live · Start post go-live issues list |
· Clinical Superusers assigned to run test scripts · Business Office Superusers assigned - run test scripts · Vendor – run test scripts · System Administrator - run test scripts |
Post all configuration building |
|
Super User Training |
· Super Users are staff members who function primarily for training of others and to give ongoing support during and after go-live (this is the train-the-trainer method) · Recommend one Super User for every eight Endusers |
· Clinical staff · Business staff · System Administrator
|
Four to six weeks prior to go-live |
|
End User Training |
· Ensure all users have adequate exposure and practice on the system prior to go-live · Mandatory didactic and practice sessions, with specific objectives depending on individual use of system (usually 2-4 hours classroom and 4 hours of hands on practice is sufficient) |
· Training performed by Super Users · Anyone touching the system needs training: o All clinical staff o Physicians o Business Office staff o Administration
|
Two weeks prior to go-live (if training is done too far in advance, training information is forgotten causing need for more support at go-live) |
|
Go-Live |
· Formal start date and time where all end users begin using the EHR system · Superuser help readily available · Need to staff up to accommodate for lower productivity during go-live |
· Superusers assigned to specific tasks and times for supporting Endusers · System Administrator readily available onsite · IT onsite · Vendor onsite |
Usually a one to two week timeframe, defined in the project plan
|
|
Post Go-Live |
· Usually a period of two to four weeks after go-live where Endusers are adjusting to system. · Issues will most likely be found and will need to be added to the Issues List |
· Implementation team · Vendor · Superusers |
Up to one month post go-live |
|
Post Go-Live Fixes |
· Consolidate issues list and work with vendor to resolve |
· Implementation team · Vendor |
Four to six weeks post go-live |
|
Post Go-Live Test |
· Test any configuration changes and make adjustments until satisfied |
· Clinical Superusers assigned to run test scripts · Business Office Superusers assigned - run test scripts · Vendor – run test scripts · System Administrator - run test scripts |
Four to six weeks post go-live |
|
Post Go-Live Finalize Configuration |
· Finalize configuration · Train Endusers on changes · Implement changes |
· Superusers · Endusers · System Administrator |
Four to six weeks post go-live |
|
Evaluation of Project |
· Formal evaluation of project with vendor and implementation team · Resolve any outstanding concerns · Plan for future of EHR System |
· Implementation team · Vendor · Project Champion |
Six to eight weeks post go-live |
|
Implementation Complete |
· Move into ongoing support phase of project |
· Administration · IT · System Administrator |
|
|
Celebration |
· Give recognition to a job well done · Media opportunity · Medical community PR opportunity |
· Administration · Board |
|
Bring together an implementation team with pre-defined structure and purpose and use a formal project plan. This group will take the project through EHR go-live. Some of these team members will continue in supporting roles after the EHR system is in use. Use the written detailed project plan for reference to avoid misunderstandings.
Early and often communication to your stakeholders will ensure their commitment. Free flow of project information with staff and physicians about the progress of the project and what to expect going forward will help minimize barriers during go-live. Your project champions need to stay informed so they can support the project at the board level and with your physician-owners.
Failures in EHR system implementation often arise from lack of planning, lack of resources and/or lack of ownership. Highly functioning EHR systems are pricey in capital outlay and resources required to implement and support. Thoughtfully detailed project organization will smooth the transition from conception through go-live, while being mindful of resource utilization. Being a good steward of your EHR system project requires going to these elemental levels in planning and execution. Ready … set … go-live.
Learn more about Regent Surgical Health.
More Articles Featuring Regent Surgical Health:
How to Determine Average Hours Per Case: Q&A With Joyce (Deno) Thomas of Regent Surgical Health
Tips for Proper Surgery Center Billing and Coding
10 Metrics for Measuring Physician Performance
|
Objective |
Purpose |
Who |
When |
|
Form an EHR System Implementation (Project) Team |
· Oversee project roll-out ensuring all needs are identified, all tasks are assigned, and each deliverable is completed on time · This group is chartered with defined purpose and goals · The Implementation Team reports back to the project stakeholders keeping all informed of progress |
Members selected based on needs of project. Representatives from: · Vendor · IT · At least one representative from the Superusers · System Administrator · Administration · Business Office · Clinical expert from each patient care area (must know patient flow, workflow, and documentation requirements- they will work on configuration of system to meet patient and provider needs) |
Weeks to months before kick-off meeting for project roll-out (preparation for the implementation) |
|
Project Kick-off |
Onsite meeting to: · Achieve common understanding of project scope · Review and approve implementation plan in detail, assign tasks, and timeline · Establish communication plan · Establish issues resolution plan · Document a formal project plan with objectives, tasks, assigned resources, and timeframes for each. (A draft one is usually provided by the vendor as a starting point.) |
· Vendor · Implementation Team · Project Champion |
At the start of the implementation phase of the project |
|
Status Meetings |
· Early communication. Regular updates from each involved area (IT, Vendor, Clinical, etc.) · Document status reports · Report back to champion and to staff and providers |
· Implementation Team · Vendor |
· Weekly through implementation · More often during go-live and immediately post go-live · Weekly post go-live until all issues are resolved |
|
Site Preparation |
· Cabling and building structure for: o Computer Room o Communication Closet o Patient Care Area PC's/ Devices o VPN set-up · Facility walk-through |
· Vendor · IT |
Post kick-off through projected time needed for construction |
|
Hardware and Software Installation |
· Install and configure servers · Deliver hardware · Install VPN · Test wiring systems |
· IT |
Post Site Preparation |
|
System Administrator Training |
· At least one staff person needs to learn how to troubleshoot hardware and software, as well as how to set-up users in the system and to assign user roles · Be involved with system roll-out and post go-live support · Learn how to build reports in the system |
· ASC staff member with strong computer skills |
Post Hardware and Software Install |
|
Device Installation and Configuration |
· Install/connect devices that will interface with EHR system. i.e. patient monitors, signature pads, printers, etc. |
· IT · Clinical Expert |
Prior to Documentation Configuration |
|
Documentation Configuration |
· Configuration Workshop - to train clinical configuration folks on how to analyze workflow, determine configuration needs, test configuration changes |
· Clinical · Experts/Superusers |
Post install of Hardware, Software, and Devices |
|
System Interfaces |
· ADT (Admission, Discharge, Transfer, Scheduling Software) o Set-up/Map o Test · Laboratory o Set-up/Map o Test |
· IT · Clinical · Business Office · EHR Vendor · ADT/Business Software Vendor · Laboratory Software Vendor |
Post Configuration |
|
Report Building |
· Determine what clinical and business data you want to extract from the system in the form of reports · Configure reports · Test reports |
· System Administrator · Clinical · Business Office · Administration |
Post configuration documentation |
|
Final Configurations |
· Conduct QA on configurations (try to break the system) · Fix Issues · Freeze Configuration until post go-live · Start post go-live issues list |
· Clinical Superusers assigned to run test scripts · Business Office Superusers assigned - run test scripts · Vendor – run test scripts · System Administrator - run test scripts |
Post all configuration building |
|
Super User Training |
· Super Users are staff members who function primarily for training of others and to give ongoing support during and after go-live (this is the train-the-trainer method) · Recommend one Super User for every eight Endusers |
· Clinical staff · Business staff · System Administrator
|
Four to six weeks prior to go-live |
|
End User Training |
· Ensure all users have adequate exposure and practice on the system prior to go-live · Mandatory didactic and practice sessions, with specific objectives depending on individual use of system (usually 2-4 hours classroom and 4 hours of hands on practice is sufficient) |
· Training performed by Super Users · Anyone touching the system needs training: o All clinical staff o Physicians o Business Office staff o Administration
|
Two weeks prior to go-live (if training is done too far in advance, training information is forgotten causing need for more support at go-live) |
|
Go-Live |
· Formal start date and time where all end users begin using the EHR system · Superuser help readily available · Need to staff up to accommodate for lower productivity during go-live |
· Superusers assigned to specific tasks and times for supporting Endusers · System Administrator readily available onsite · IT onsite · Vendor onsite |
Usually a one to two week timeframe, defined in the project plan
|
|
Post Go-Live |
· Usually a period of two to four weeks after go-live where Endusers are adjusting to system. · Issues will most likely be found and will need to be added to the Issues List |
· Implementation team · Vendor · Superusers |
Up to one month post go-live |
|
Post Go-Live Fixes |
· Consolidate issues list and work with vendor to resolve |
· Implementation team · Vendor |
Four to six weeks post go-live |
|
Post Go-Live Test |
· Test any configuration changes and make adjustments until satisfied |
· Clinical Superusers assigned to run test scripts · Business Office Superusers assigned - run test scripts · Vendor – run test scripts · System Administrator - run test scripts |
Four to six weeks post go-live |
|
Post Go-Live Finalize Configuration |
· Finalize configuration · Train Endusers on changes · Implement changes |
· Superusers · Endusers · System Administrator |
Four to six weeks post go-live |
|
Evaluation of Project |
· Formal evaluation of project with vendor and implementation team · Resolve any outstanding concerns · Plan for future of EHR System |
· Implementation team · Vendor · Project Champion |
Six to eight weeks post go-live |
|
Implementation Complete |
· Move into ongoing support phase of project |
· Administration · IT · System Administrator |
|
|
Celebration |
· Give recognition to a job well done · Media opportunity · Medical community PR opportunity |
· Administration · Board |
|