We will build it..

They will come

Presenting the EMR Field of Dreams.

Ingredients for a Successful EMR Implementation
Pranjal Shah

Game Rules

Put your phone on mute (when not speaking) so that everyone can hear the speaker Please introduce yourself when asking questions so everyone knows who you are. Honor each others timeif you have follow up questions write them down so we can correspond after the webinar Please speak into your microphone so all can hear

The Takeaway: Hitting it out the park

1. Understanding different phases and challenges within those phases of an EMR implementation 2. Discussing how the methodology was applied to a particular EMR implementation 3. Outlining the Change Management Initiatives and Risk Mitigation Strategies 4. Describing the Training Methodology for a project involving so many different parties 5. Discussing the Clinical Content Management process and Communication Plan

Introduction Why is Implementation of EMRs so challenging?

Electronic Medical Records (EMRs) can change: Current Documentation Method(s) Workflows Billing Practices Scheduling Patient Follow up methods Communication/ messaging Etc This usually requires re-engineering current systems and can dramatically change the way a hospital runs.

Planning Phase Fail to Plan; Plan to Fail

Identify goals and base your planning strategies around these goals Decide what data needs to be retrievable Be aware that Free Text may not be reportable Phased Implementation is highly recommended Create timelines but be flexible Perform a workflow anaysis

Staff Consideration and Planning

Appoint a physician champion Appoint an in-house Project Manager Communicate to the staff the hospitals desire to acquire an EMR before the purchase Be aware that support staff may feel that they could be replaced by an EMR

Staff Consideration and Planning

Have end-user staff be involved in the system set-up Map out Workflows utilizing current staff members Learning curves are usually underestimated

Testing Phase

Software Testing Test software extensively before implementation Perform Volume Testing, if possible Ask for a list of known bugs from the vendor for the version you are about to install

Testing Phase

Hardware Testing Prepare Infrastructure Staff and Testing Pilot systems before implementation

Training Phase

Not enough time is allocated for training Training should be performed outside of clinical work sessions Set-up training room for staff to practice Appoint Superusers Miscommmunication risk with Train the Trainer method Evaluate Staffs readiness for go-live

Go-Live Phase

Schedule the go-live in close proximity to the end of the training sessions Reduce provider schedules Provide Adequate Resources

Post Go-Live

Post Go-Live Assessment is necessary Evaluate the Go-Live with Staff Provide on-Going training and support

Crackerjack Break - Vital Statistics

Q: What is the largest inpatient chart for a single patient? (may have multiple volumes) Hint: its measured in feet A: 4 feet Q: What is the average number of inpatient charts created per year? A: approximately 15,000 Q: About how many different inpatient paper forms are there? A: approximately 400 Q: What is the average number of days to complete an inpatient record (including coding and physician signatures) A: 40-50

days

The Dugout Case Study: Enterprise Implementation

Inpatient and Optime 2009 Radiology

ED
CPMAR Prof Billing Website Pharmacy ADT

Surgery
Billing Manage d HIM care Ambulatory 2004

Prelude

Benefits Engine

Scheduling

Portals

Reporting

aking us to the home stretch Supporting our Strategic Vision

People/Culture--Providing the right information, at the right time, to make the best decision (avoiding duplication, delays and rework) ServiceShowing that We Know You QualitySupporting safe, evidence based care and the data to prove it FinanceEmbedding a standardized, compliant revenue cycle GrowthKnock the socks off of our competitors!!

The Game Plan

Leverage Other Customer Learning
Access to model system with best practices Conduct deep dive sessions for the different areas Reporting Build prior to Validation Session Tell us why what was built will not work and is it critical Prototype will be the baseline for tracking changes Workflow signoff Change Management Go Live Support Demos Practice area after training Dress Rehearsal

Physician Order Entry (CPOE) Clinical Documentation (Clin Doc)

VDB Sessions more on Validation and less on Design

Peri-Operative Documentation
ASC Documentation Hospital Service Departments Documentation (e.g. GI, ATC, etc.) Medication Administration Bar Coding with Pyxis Lab Labels for Specimen Collection

Change Control

Department Managers/SMEs/Chiefs involvement

Sandbox

Optimization after go live part of the plan

Phase 1: Planning Goals

Project Staffing Obtain application knowledge Initiate workflow analysis Identification of Partner Organizations content to be utilized Transformation of schedules and trackers

Plan
Kickoff and build visits by Epic staff Attend training

Deliverables
Customer specific project plan Project team certification System built out with leveraged content

Phase 2: Validation

Goals
Workflows validated to meet business needs

Plan
Validation sessions to evaluate complete build System configured to support workflows

Deliverables
Documented workflows, policies for training Build complete System ready for testing

Phase 3: Testing and Training

Goals
Workflow and build tested End users prepared for go-live

Plan
Workflow-based testing and training Training plan executed (Epic helps train first round)

Deliverables
Documented test plans and scripts Training materials produced and distributed All users through required training classes

GO LIVE

Goals
Smooth process for bringing clinical applications live Comprehensive support plan for go-live

Plan
Early planning and analysis of user community Series of preparation meetings Go-live readiness meetings

Deliverables
Detailed conversion plan for all systems Support plan for all customer and Epic staff

Phase 4: Support and Optimization

Goals
Successful transition of data, patients, and users onto HealthConnect

Plan
Detailed Go Live support schedule and processes Well organized Command Center in place Communication plan between project team and leadership Rapid response to tracking and resolution of issues

Deliverables
Detailed support schedule Contingency plans, issue reporting tools, and reports

Post Live Support Visits

Goals
Initial site problems resolved Plan for optimization identified

Plan
Onsite go-live assistance Post-live follow up meetings Refresher training events

Deliverables
Post-live reports End user happiness surveys

The 3rd Inning.

Where we are now

May08

Jun08

Jul08

Aug08

Sept -08

Oct08

Nov08

Dec08

Jan09

Feb09

Mar09

Apr09

May09

June -09

Jul09

Aug09

Sept -09

Core Team Kick-off 4/15

Project Team Kick-off 07/15

Radiant Go live 10/25

Workflow Walkthru 11/04 &11/05

Go-Live 06/14

ASC Go-Live

Build Prototype

Validation Session Requirement Definition

Post VS work
Development

Testing
UAT

User Training

Post Go-Live Support & Optimization

The Team
Sponsors: Hospital Chair: Nursing Chief Nursing Officer Physician Champion Chief Medical Officer D3 Business Leads
Inpatient Mgr Clin Apps Mgr CC/SA/Trg Mgr
Pharmacy/ Barcoding Manager OpTime Lead

Physician Leads Inpatient: Physician Champion OpTime: Surgeon Champion Change Mgt. & Comm Ambulatory: Champion

Business Partners IT Director Inpatient Manager

Business Process Manager

ClinDoc& CPOE Lead

Realization Team Leader Chief Nursing Officer Michelle Edgecomb Nursing Supervisor Mike Nurse Christenson Champion IT Project Manager Implementation Coordinator

Labor Coordinator:

Interface Development Environment Mgt & Support

ClinDoc AC

OpTime AC
ED AC D1 ACs Pharm AC (Hosp Bill HIM ADT, etc.) Appl Managers & Appl Coordinators

Ancillaries (Lab, Radiology, Testing Etc.) TBD Manager

24

Roles and Responsibilities

Business Sponsor and Designee

Supports the team through the life cycle of the project; accountable for validating resource commitments with Org Director; work closely with the business process manager and IT project manager to meet goals and objective

Inpatient Manager
responsible for the quality of the business areas deliverables and for performing the business processes, such as user acceptance testing, that produce those deliverables; to ensure that the business requirements are defined and that the program realizes the Business Plan objectives.

Information Technology (IT) Project Manager

responsible for developing the plans to utilize IT resources; responsible for maintaining an enterprise, cross-IT view during their participation on the initiative; works in conjunction with the RTL to realize the objectives of the Business Plan.

Roles and Responsibilities

Subject Matter Expert (SME)

provide the subject expertise and working with the application leads to ensure that functional deliverables meet the requirements

Application Coordinator (AC) Hawaii and National

focuses on designing, configuring, unit testing, and supporting solutions, based on business requirements

Health Information Management (HIM)

Assure build configuration meets the by-laws for hospital. HIM director to support the business sponsor.

Vendor
provide the subject expertise and working with the application leads to ensure that functional deliverables meet the requirements

Change Management Plan April 2008:

Establish Governance Structure

May 2008:
Sponsors identified, educated about their role, and plan for their activities completed Communication plan completed and vetted with inpatient leadership Sponsor plan completed and vetted with Sponsors Plan for Tiger team engagement for in preparing system users for change Video completed and vetted Key role map completed and validated Defined Communication Plan to managers and SMEs

Welcome to the next phase of work to implement D3 applications Why we are moving to an electronic medical record What inpatient clinical will mean to patients, staff and the Region

Change Management Plan (cont.)

June 2008
Reminder to Managers and Tiger team of the Validation Sessions for July and August 2008 Deployment Meeting Communication to Department of Nursing, HIMC, and Hospital Mgmt team

July 2008
Participate in Validation Sessions

Aug 2008
Participate in Validation Sessions

Sep 2008
Practice environment made available Readiness assessments conducted

Project Communication Plan

IT E M # DUE COM M UNICA DATE/ TION FREQ VEHICLE COM M UNICATIO N LEVEL TARGETED?

TARGET AUDIENCE Department Managers and Subject Matter Experts (SME) MMC Staff Project Team Sponsors Hospital Leadersip Physician Leadership Leadership Impacted Departments

Jul-08

Newsletter

Awareness

Jul-08

Newsletter Steering Committee Email HIMC Mtg Meeting IP Deply Mtg Demo -

Awareness Awareness Awareness Awareness Awareness Sponsorship Buy-in

M ESSAGE OWNER Welcome to the project; Why we are moving to electronic Nurse C, Dr medical record; What will it C, IP Mgr mean to patients, staff & region Nurse C, Dr TBD C, IP Mgr Project Status Project Status Project Status; Change Requests; Issue Escalation Project Status Issue Escalation System Functionality Leads Comm Mgr Inpatient Manager Physician Champion Nurse C, Dr C, IP Mgr Nurse C, Dr C, IP Mgr

3 Monthly 4 Weekly

5 Monthly 6 Monthly 7 8 Biweekly Nov-08

Environment Timeline & Plan

April Week1 Week2 Week3 Week4 Week1

May Week2 Week3 Week4 Week1

June Week3 Week4 Week1 Week2

July Week2 Week3 Week4 Week1

August Week2 Week3 Week4 Week1

September Week2 Week3 Week4 Week1

October Week2 Week3 Week4 Week1

November Week2 Week3 Week4 Week1

December Week2 Week3 Week4 Week5

Activities PRODUCTION BETS

SPRING '07 IU2

BETS inTest Env Sp07

Radiant's VDB, Build/Config (Sandbox) in Bld Env - Sp07

RADIANT

Pre-Build in Test Env - Sp07 Testing Prep Radiant Testing Test Env (Activate Code June 30th) Go - Live Copy SCAL into Test Env Validation sessions and config/builld in Bld Env

D3 IP CPOE/CLIN DOC, Optime, Wireless Carts, Bar Code Readers/Printers, Lab Printers

Build in Test Env D3 testing in Test Env to 5/30/2009

IP MD Content Process
Order sets Obtain SCAL paper downtime OrderSet forms Send to SME leads to review/edit content Collect - share with team to build/revise Make WORD documents for other providers to review Face-to-face to review in system with domain SMEs

SmartText/SmartPhrase Create domain specific for procedures Use ones developed for HI ED (these have been approved for HI through HIMC, coders, etc.) Look on community web Smart Links Review what exists in HI Look on community web
Leverage off of whats built for S. Cal and Northwest

IP Nursing Content Process

Flowsheets National Collaborative Build Hibernate rows that are not applicable to HI region workflows Validate as homework in tiger teams SmartText/SmartPhrase/Smart links Review what exists in SCAL/ NW Validate as homework in tiger teams Ordersets Review in tiger teams for clarity Add clarifiers / comments to send back to MD team

IP D3 Training Plan

Stage One: eLearning and Sandbox

Begin 6-7 months prior to go-live All courses on Intranet so we register and track student learning (required) Students do courses

on floor and/or scheduled in class at Hospital Trailer or Tower - 2 hour blocks

Formal practice exercises built and available using Sandbox - do eLearning module, then practice in Sandbox Time estimated is based on role - approx 4 -6 hours for Nursing staff and approx 2 - 4 hours for Physicians Following slides show what eLearning modules were available as of Dec 2007 - will need to be validated, and additional modules potentially created

IP D3 Training Plan

Stage Two: Instructor Led Training (although may include some web based training (WBT)
Begin 6 - 8 weeks prior to go-live Utilize Scal/NW curriculum as much as possible Estimated time -- Nursing = 16 hours and Physicians = 12 hours Important to have training facilities, projectors, trainers to do all 1000+ staff in 6-8 weeks

Stage Three: Stabilization/Optimization Training

Propose

Begin 8 -12 weeks after go-live Estimated time - Nursing = 4 hours and Physicians = 2 hours

IP D3 Training Plan Example of training week schedule

Status Reports

Status:
On track for completing domain (e.g. prototype for MedSurg). Other domains will be completed as we schedule them for VDB. Arrange for ACs to shadow a SME Meeting with xx department was successful; outstanding issues were addressed

On Track
On Track Watch Critical

Issues:
Waiting on national to complete content build for mental health

Found a bug in the navigator and Vendor is yet to deliver the code

Upcoming Milestones:
01/25/08 07/15/08 08/04/08 08/11/08 Prototype 1st VDB 2nd VDB 3rd VDB

Issue Escalation Process Issue for escalation should be reflected on the weekly status report as soon as identified Escalation Chain
Operations Lead/Team Lead Project Leadership (IP Mgr, Amb Mgt, IT Director) HIMC Sponsors/PMO

IP Coordinator is the keeper of the escalated issues list Nurse Champion, Physician Champion, and Inpatient Manager are responsible for communicating resolution to the team

Risk Plan Given the tight schedule and a huge scope, we have to manage risks very closely Risk can occur be at any level and that is why identification is everybodys responsibility Risks are weighted according to probability of occurrence and impact to the project if it happens Not all risks can/will be avoided Risk mitigation can be either of the following:
Avoid Control to minimize impact Transfer to appropriate group Assume consequences

Final Parting Shots Heres why this transformation is so vital to Patient Safety!

What Questions do you have?

Information about the Speaker BSEE from Georgia Tech Masters in Healthcare Systems from Georgia Tech PMP Certification 10 years of Healthcare Consulting experience Epic Implementation in over 15 hospitals throughout the nation

Sources

Histalk Blog HIMSS - Standards and Interoperability: The DNA of the EHR Other Pubs (2/21/2007) A Guide to the Project Management Body of Knowledge (PMBOK Guide) Third Edition Known Pitfalls and Proven Methods for a Successful EMR Implementation - by Ursula Pennell and Eric Fishman, M.D. (2005) Kaiser Hawaii Kickoff 2008 Presentation Pranjal Shah, Alison Miyasaki, Dr Dana Tom