Health Record: The OPEN MINDS. Selection & Contracting

Transcription

1 How To Find The Right Electronic Health Record: The OPEN MINDS Seminar On Best Practices In EHR Selection & Contracting T h e O P E N M I N D S T e c h n o l o g y & I n f o r m a t i c s I n s t i t u t e O c t o b e r 2 2, : 0 0 p m 4 : 0 0 p m J o s e p h P. N a u g h t o n - T r a v e r s, E d M, S e n i o r A s s o c i a t e, O P E N M I N D S W a y t t D e l a n e y, C o n s u l t a n t, O P E N M I N D S 15 Lincoln Square, Gettysburg, Pennsylvania info@openminds.com

2 Agenda I. Steps For Vetting EHR Vendors, Their Products, & Services Phase 1 Organizational Assessments & EHR Vendor Research Phase 2 Preliminary EHR Vendor Selection Phase 3 Vetting Finalists & Making A Final Selection Phase 4 Contract Negotiation & Implementation Preparation II. EHR Costs & Budgeting III. Key Elements Of An EHR Implementation IV. Best Practices: Workflow Mapping & Project Management V. Questions & Discussion 2

3 The Big Picture On Behavioral Health EHR Implementations The Good There is consensus among behavioral health providers that implementation of an electronic health record (EHR) system brings value when things go right The majority of providers report implementing an EHR in 6-12 months The Bad Challenges include lack of involvement from executive leadership, staff engagement, poor planning and project management, and failure to identify and fully implement the key components of the EHR system The Ugly 12% reporting implementations of two years or longer! 3

4 Key Findings % of the providers surveyed have purchased an EHR 73% of providers with an EHR define their EHR as fully implemented, with most having implemented their system in 6-12 months 25% of those with incomplete implementation attribute the delay due to internal causes, and 34% report that it was a combination of delays from the vendor and their own organization When implementation was not fully complete, the clinical, scheduling, and billing modules were the major functionalities reported as being fully implemented with the reporting module just over halfway complete 4

5 Group #1: The Imperfect EHR Should We Change EHR Systems & Vendors? Group #2: EHR Disasters 5

6 Group #1: The Imperfect EHR EHR mostly implemented by your organization, but there are problems: Key features such as billing, scheduling, mobile use, and clinical forms are not fully functional and easy-to-use Management reporting and analytics not sufficient Poor vendor support Staff not delighted with the system Not getting key benefits expected from the EHR Likely next steps: Evaluate EHR system and vendor alternatives as well as evaluate if you can improve your current implementation OPEN MINDS estimates that 75% of providers will switch systems after this process, with roughly 25% choosing to stay with the current vendor 6

7 Group #2: EHR Disasters These are the (not-so-rare) situations where the EHR implementation has failed altogether or the system has been implemented with very minimal functionality. Likely next steps: Evaluate EHR system and vendor alternatives as well as evaluate very frankly where your agency may have failed in the selection and implementation of the current EHR OPEN MINDS estimates that 100% of providers will switch systems after this process! 7

8 I. Steps For Vetting EHR Vendors, Their Products, & Services 8

9 Key Vendor Evaluation Areas Functionality Customer Support & Service Implementation Expertise Company Stability Cost 9

10 Key Phases In EHR Vendor Selection & Contracting Phase 1 Organizational Assessment & EHR Vendor Research Phase 2 Preliminary EHR Vendor Selection Phase 3 Vetting Finalists & Making Final Selection Phase 4 Contract Negotiation & Implementation Preparation 10

11 Phase 1: Organizational Assessment & EHR Vendor Research 11

12 Organizational EHR Readiness Assessment Review organizational strategic plan and role of technology & EHR in achieving key strategic and operational objectives Assess staff readiness for an EHR Assess IT infrastructure readiness Phase 1 12

13 Preliminary EHR Vendor Research One of the keys to successfully selecting a software application is knowing what functionality your business needs, or, from what software it would benefit Phase 1 Get an overview of what products and services are available Trade shows where vendors exhibit Request marketing and promotional materials from vendors Issuing a Request For Information (RFI) to gather basic information about functionality and services 13

14 Advantage Of Researching Phase 1 The goal in this step is not to evaluate the vendors, but rather to gain a better understanding of how technology could benefit your organization, so that you are able to detail the functional specifications based on both current operations and needs, as well as what could be. 14

15 Determine If You Have Any Vendor Knock-Out Factors Phase 1 For this preliminary screening of vendors, we recommend using knock-out factors that are driven by your organization s business needs and management and purchasing choices. 15

16 Commonly Used Knock-Out Factors Phase 1 Whether the vendor has or requires a hosting or application service provider (ASP) option or software as a service (SaaS) option Vendor experience with local market or specific service types The vendor s software technology platform and database Lack of mission critical functionality Whether the vendor offers wireless or disconnected database technologies 16

17 Phase 2: Preliminary EHR Vendor Selection 17

18 Develop & Release A Competitive Request For Proposal (RFP) Develop a detailed listing of your organization s functional needs Incorporate any knock-out factors Phase 2 Exact functional specifications vary from organization to organization Common areas of functionality to review to determine which specifications are most important for meeting your needs 18

19 Sample RFP Sections Vendor Overview Technical Information & Infrastructure Requirements Training, Implementation Support, Data Conversion, & Software Upgrades Customer Support Approach Data Conversion, Customization & Software Upgrade Processes EHR Capability & Implementation Experience Software Functionality Report Writing Scanning, Document Management, & Record Release Capabilities Mobile Solutions Data Import/Export & Software Interface Capabilities Experience In Local Market Compliance Plans Integration With Primary Care Customer Reference Contact Information Cost Phase 2 19

20 Vendor Overview Phase This Section Provides A Basic Understanding Of The Vendor s Business 2 Company Customers Services Key Qualifications Offered To Meet Your Technology Needs 20

21 Technical Information & Infrastructure Requirements Phase This Section Should Contain Detailed Questions From The Technology Staff About Needs For: 2 Hardware Software Network Telecommunications Set-up Needed Or Recommended Software Platform/Database (Any Near-Term Plans For Upgrading?) Recommended Staffing To Support The Application Once Implemented 21

22 Training, Implementation, Support, Data Conversion, & Software Upgrades Phase 2 In This Section, Describe Your Organization s Typical Approaches To: Training Implementation Support Data Conversion Software Upgrades Include The Following Detailed Information In This Section: Number of full-time equivalent (FTE) staff members you have in each of these operational areas Information on typical implementation services Include key tasks, timelines, and staff members involved both from your organization and the purchaser Help desk operations Include information on 24/7 availability, how calls are prioritized, response times, whether the caller has routine access to live staff, and all other information of interest to a customer Experience in converting data from other EHR systems Information about user groups Information about how customers are involved in the software enhancement decision process Frequency of upgrades 22

23 Configurable Form & Field Capability In This Section, Ask The Vendor To Detail: Phase 2 How is the creation of electronic health record forms supported? What if other electronic data forms are needed? How can end-users (rather than the vendor) customize the electronic health record? 23

24 Report Writing Functionality In This Section, Ask The Vendor To Describe: Phase 2 Report writing capability of its technology solutions A listing and description of standard reports Export capabilities Compatibility with other applications Ease of use, etc. 24

25 Desired Reporting Functionality Phase 2 A report-writer that is comprehensive and easy to use, allowing reporting on all data elements in the system Ability to write custom reports and write and use stored procedures Data-warehouse and data mining capabilities A data dictionary and supporting documentation An extensive library of reports, with commonly used queries and sorts, which can be easily customized as needed by the customer Ability to save and name report templates Ability to run reports in batches Ability to run reports or report batches at scheduled times Ability to create management information dashboards Ability to create graphs or charts 25

26 Additional Business Intelligence Tools In This Section, Ask The Vendor To Detail: Phase 2 Additional business intelligence tools for reporting executive and management metrics Partner(s) that provide these tools Functionality in detail 26

27 Scanning, Document Management & Record Release Capabilities Phase 2 In This Section, Ask The Vendor To Describe: Supports for scanning and managing documents that are created by other parties so that they can be included in a case or medical record Supports for releasing parts or all of the case or electronic records to other parties Both in paper and secure electronic formats 27

28 Software Interface & Data Exchange Capabilities Phase 2 In This Section, Ask The Vendor To Describe: Expertise in interfacing with common general ledger and human resource applications Helping provider organizations share data with other providers and stakeholders 28

29 Experience In Local Market Phase 2 In This Section, Ask The Vendor About: Experience in the local market Support for your state s versions of electronic billing forms Interfacing with state systems 29

30 Overall Software Development Plans & Technical Direction In This Section, Ask The Vendor To Describe: Phase 2 Plans for continued software and business development Technical directions the vendor is taking with its products and services Include both short-and long-term roadmaps about product enhancements or other initiatives 30

31 Mobile Solutions Phase 2 Ability to securely connect its software to smartphones, tablets, or other mobile devices. What functionality is available? 31

32 Disconnected Database Functionality Phase 2 Does software application have the functionality to support disconnected use of the system in instances where internet or wireless is unavailable or unreliable? If so, detail what functionality is available with the disconnected solution. 32

33 Consumer/Family/Other Care Provider Portals Phase 2 What portal capabilities its software has for outside parties to securely access the system? Detail what functionality is available with the various portals. 33

34 Meaningful Use Certification & Compliance Plans Phase 2 What is the software s current status with regards to Meaningful Use as prescribed by the Centers for Medicare & Medicaid Services (CMS)? What plans are in place for supporting requirements under Stage 2 and Stage 3? 34

35 Experience With Integration With Primary Care Phase 2 Describe experience with aiding behavioral health providers with integrating with primary care providers through data exchange. 35

36 Cost Detail The Cost For Its Software Technology Solution Phase 2 Clearly distinguish between one-time and on-going costs Be complete enough (along with the information from the Technical Requirements section) for you to develop a five-year budget for the proposed solution Provide The Number Of Users To Vendor (Named As Well As Simultaneous) So Vendor Can Respond With Cost Information 36

37 Software Functionality Ask The Vendor Whether Its Product Supports The Detailed List Of Functional Specifications Phase 2 Included An Appendix As Part Of The RFP Vendors can indicate Yes/No to the functional specifications list and make comments 37

38 Customer Reference Contact Information Phase 2 Ask For List Of At Least 25 Customer Contacts (Needed to evaluate vendor on customer service) Ask Vendor To Highlight Customers Similar To Your Organization Or Will Reflect Satisfaction With The Vendor 38

39 Additional Information Phase 2 Include an optional section where vendors have an opportunity to share any other information they feel would be helpful to you in the selection process 39

40 Appendices I. Customer Market Information II. Pricing Template (Excel Spreadsheet) III. Functional Specification Checklist IV. Customer Reference Information Form Phase 2 Give the vendors 30 days to respond to the RFP. 40

41 Phase 2 41

42 Phase 2 42

43 Phase 2 43

44 Conduct Preliminary Vendor Screening From RFP Responses Receive all responses from software vendors Develop preliminary 5- year budget for each vendor Include any required technology infrastructure upgrades and changes in staffing so that you can begin to compare cost Phase 2 Score vendors on how well they meet your functional needs 44

45 Functional Specifications Scoring Example Vendor A Vendor B Vendor C Functional Specification Weight 1=Yes/0=No Weight 1=Yes/0=No Weight 1=Yes/0=No Weight A. Core Electronic Health Record Functionality A1. Referral Call tracking & Disposition Data A2. Admission, Transfers, & Discharge Information A3. Standard & Program Specific Consumer Demographic Data A4. Consumer Photo A5. Family & Relationship Tracking A6. Waitlist Tracking A7. Discharge Planning & Referral Tracking A8. DSM & ICD Diagnoses A9. Master Individual Service Plans A10. Program-Specific Service Plans A11. Care Provider Tracking A12. Consumer Electronic Signature A13. Staff Electronic Medical Record Signature Standard Compliance A14. Support For Multiple Signature Requirements & Progress Note Roll-Up A15. Configureable Progress, Telephone, & Shift Notes A16. Group Notes A17. Aftercare Monitoring A18. Supervisor Monitoring Tools A19. Internal Referral Process Support Total Score Percentage Score 100% 100% 100% 100% 45

46 Functional Specifications Scoring Example 2 Vendor A Vendor B Vendor C Weight 1=Yes/0=No Weight 1=Yes/0=No Weight 1=Yes/0=No Weight B. Psychiatry, Nursing, & Primary Care Functionality B1. Medical Conditions, Vital Signs, & Metrics B2. Medication Monitoring B3. Medication Administration Records (emar) B4. Electronic Prescription Transmission B5. Preferred Prescription & Orders Sets B6. Links To Medication Information & Drug Interaction & Contraindications B7. Formulary Support B8. Laboratory Interface B9. Laboratory Order Sets B10. Laboratory Result & Medical Condition Alerts B11. Injection Site Monitoring B12. Pharmacy Inventory For Individual Consumers B13. Pharmacy Inventory For Medication Samples B14. Support For Tracking HEDIS Measures Total Score Percentage Score 100% 79% 100% 86% 46

47 Functional Specifications Scoring Example 3 VENDOR OVERALL A. Core Electronic Health Record Functionality B. Psychiatry, Nursing, & Primary Care Functionality C. Additional Bed & Slot-Based Program Functionality D. Additional Case Management, Care Coordination, Service Coordination & Crisis, & ACT Team Functionality E. Additional Outpatient Functionality F. Additional Behavioral Health Home Functionality G. Substance Use & Dependence Functionality H. Employment Services Functionality I. Family & Children's Functionality J.Child Day Care Services Functionality K.Compliance, Quality Assurance, & Medical Record Department Functionality L.Billing & Accounts Receivable (A/R) Functionality M.Other System Functionality Vendor A 92% 100% 79% 100% 100% 100% 75% 100% 60% 90% 100% 100% 92% 90% Vendor B 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Vendor C 91% 100% 86% 100% 100% 89% 100% 50% 80% 90% 83% 100% 85% 90% 47

48 Screening From RFP Responses Phase 2 Determine if any of the knock-out factors apply Select vendors to move to software demonstration phase Average is inviting 6-10 vendors for half-day software demonstrations 48

49 Conduct Software Demonstrations & Select Finalists Develop Likert scoring tool for your staff to use during the software demonstrations Narrow vendors to 2-3 finalists, based upon both functionality and userfriendliness In most instances, organizations come to a very quick consensus about finalists at this point in the process Phase 2 Scoring should be based on core areas of functionality from RFP 49

50 Phase 3: Vetting Finalists & Making Final Selections 50

51 A Structured Approach To Final EHR Demonstrations One- or two-day software demonstrations by your 2-3 vendor finalists Structured topics for the demonstrations with your staff subject area experts attending and scoring the vendors Phase 3 51

52 Phase 3 52

53 Web-Based Technical Reviews Phase 3 Have your technical staff do a web-based technical review of the two finalists Determine system configurability Reporting flexibility Any other technical factors deemed important by your team 53

54 Additional Vetting Of Vendor Finalists Phase 3 Reference Checks Current Customer Site Visits CEO & Management Team Interviews Financial Due Diligence 54

55 Phase 4: Contract Negotiation & Implementation Preparation 55

56 Contracting Phase 4 Select the best system available to meet your needs Have the contract reviewed by your attorney before changes and requests are presented to the vendor Finalize contract and begin implementation Some purchasers do this with the 2 finalists 56

57 Key Contract Areas To Review I. Contract Term & Termination Clauses II. Ensuring That All Agreed Upon Functional Specifications Are Included III. Warranties & Limitations IV. Support & Implementation Details V. Software Escrow VI. Costs & Cost Increases VII. Payment Terms & Timelines Phase 4 57

58 Contract Negotiation Tips Phase 4 Present all major and minor contract change requests along with any pricing changes in a single memo Determine must-have versus desired changes Keep in mind that you are building a long-term relationship If both parties have clear, fair, and reasonable requests, the negotiation usually goes very quickly 58

59 II. EHR Costs & Budgeting 59

60 The CEO Perspective On Technology We are stuck with technology when what we really want is just stuff that works. - Douglas Adams 60

61 ROI In Technology Simple ROI% = net benefit / total cost Advantages: o Simple - easy to calculate o Easy to understand o Buyers use it frequently Disadvantages: o No consideration for the timing of the cash flows o No consideration of the time value of money o Not sensitive to the magnitude of the project Simple ROI Analysis: Benefit $750,000 Cost $150,000 ROI Percent 500% 61 61

62 Major ROI Analysis Components Technology system costs Quantifiable financial savings and benefits of technology Intangible and unquantifiable financial benefits of new systems to organization and stakeholders 62

63 System Costs Hardware costs: Capital investments in workstations, printers, networks, etc. Software licenses or user fees Installation costs Staff training costs Software maintenance, system upgrades, and customization Hardware maintenance, repair, and service On-going user support and troubleshooting Data migration costs Additional IT staff Consulting services 63

64 Quantifiable Financial Savings & Benefits Of System (EHR Example) Meaningful use incentive dollars Reduced data entry time (elimination of duplicate data entry) Record transcription time and records access costs Increased professional productivity and net billing (due to reductions in record search and manual recording time) Reduced admin and professional staff time correcting chart deficiencies 64

65 Quantifiable Financial Savings & Benefits Of System (EHR Example) Improved collections rate (due to improved documentation) Decreased payment lag time Reduced compliance cost and improved risk management (due to better and faster information) Reduced accreditation costs 65

66 Typical Timeframe For ROI Cost Analysis Most organizations calculate ROI for technology purchases in two ways: Return on Investment (ROI) over five-year period Actual ROI payback period (i.e. how many years does it take for the financial benefits to equal the costs) o If done over one year, this is knows as the annual or annualized rate of return. 66

67 Mostly Likely Areas For Significant Financial Return Increased billable staff productivity Increased fee-for-service billing and collection Reduced payment retraction due to problems with medical records Reduced staff numbers due to automation 67

68 Sample Initial Pricing Information for EHR Purchases Request For Proposal Software Vendor Pricing Return To Summary Tab Section #1: One-time costs Year One Year Two Year Three Year Four Year Five Total Software License $ 55,000 $ - $ - $ - $ - $ 55,000 Training $ 16,000 $ - $ - $ - $ - $ 16,000 Implementation $ - $ - $ - $ - $ - $ - Data Conversion $ 14,000 $ - $ - $ - $ - $ 14,000 Other: FormBuilder $ 55,000 $ - $ - $ - $ - $ 55,000 Other: State Reporting $ 13,000 $ - $ - $ - $ - $ 13,000 Other: BI Module $ 70,000 $ - $ - $ - $ - $ 70,000 Other: Inpatient $ 70,000 $ - $ - $ - $ - $ 70,000 Other: Direct Messaging $ 2,000 $ - $ - $ - $ - $ 2,000 Other: Secure Hosting $ 3,000 $ - $ - $ - $ - $ 3,000 Section #1 TOTAL $ 298,000 $ - $ - $ - $ - $ 298,000 Section #2: On-going costs Year One Year Two Year Three Year Four Year Five Total Maintenance $ - $ - $ - $ - $ - $ - Other: Monthly Users (Assume 6 Month Implementation) $ 80,000 $150,000 $150,000 $150,000 $150,000 $ 680,000 Other: Monthly Training Domain $ 5,000 $ 6,700 $ 6,700 $ 6,700 $ 6,700 $ 31,800 Other: Monthly Billing Module $ 1,000 $ 25,000 $ 25,000 $ 25,000 $ 25,000 $ 101,000 Other: Monthly Mobile Module $ 5,000 $ 9,600 $ 9,600 $ 9,600 $ 9,600 $ 43,400 Other: Monthly Inpatient $ 6,000 $ 8,100 $ 8,100 $ 8,100 $ 8,100 $ 38,400 Other: Monthly Housing $ 30,000 $ 30,000 $ 30,000 $ 30,000 $ 30,000 $ 150,000 Other: Annual FormBuilder $ - $ 10,000 $ 10,000 $ 10,000 $ 10,000 $ 40,000 Other: Annual elabs $ - $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 12,000 Other: Annual erx $ - $ 4,000 $ 4,000 $ 4,000 $ 4,000 $ 16,000 Section #2 TOTAL $ 127,000 $ 246,400 $ 246,400 $ 246,400 $ 246,400 $ 1,112,600 TOTAL (Sections 1 & 2) $425,000 $246,400 $246,400 $246,400 $246,400 $ 1,410,600 68

69 III. Key Elements Of An EHR Implementation 69

70 Four Groups Of EHR Implementation Tasks Routine Elements These are the typical elements of an EHR implementation that require time and focus, but are not complicated in and of themselves. Complex Elements These are the trickier areas of the implementation require much more attention and can be stumbling blocks if not managed carefully. System Freeze & Final Preparation These are all the final tasks and steps before going-live with the new EHR. Expanding & Leveraging the EHR Implementation These are the often forgotten tasks of continuing to implement other and evolving features of the EHR application to leverage the technology for all possible benefits. 70

71 EHR Implementation Routine Elements 1. Vendor training and implementation 2. Hardware 3. Data conversion 4. Mobile system use 71

72 1. Vendor Training & Implementation Days This includes all of the training and support from your vendor partner these items are often included in the vendor s standard project management template The number of training and implementation support days and the vendor s approach vary significantly from vendor to vendor 72

73 2. Hardware & Infrastructure Changes This is for all tasks related to making sure that our hardware and infrastructure is configured correctly and works for implementing the new system; it also includes making all required hardware and software purchases 73

74 2. Hardware & Infrastructure Changes Checklist File servers and related infrastructure Connectivity and internet access Wireless cards or mobile hotspots Laptops and other portable devices Signature pads High-speed scanners Portable printers Kiosks Other? 74

75 3. Data Conversion This is for all tasks related to planning and executing a data conversion of data from the old software package to the new one Key decisions: What data elements to convert from the old system to the new one Which consumers to include in the data conversion 75

76 4. Mobile System Use Planning This is for testing and planning the use of the EHR in community- or home-based settings Vendors may offer connected and/or disconnected mobile EHR solutions, each of which should be tested thoroughly, using all related equipment (such as signature pads, portable printers and scanners, etc.) 76

77 EHR Implementation Complex Elements 5. Workflows 6. Clinical content 7. System set-up 8. Billing testing 9. Reports 10. Interfaces 11. Meaningful use 77

78 5. Workflow Process Mapping This is for all tasks related to doing the workflow reviews and documentation (typically with VISEO software), identifying opportunities for improvement, and modifying them to represent how things will work in the new system 78

79 6. Clinical Form Content Decisions This includes all tasks that revolve around reviewing clinical forms that will be part of the EHR, the technical design and review, and system set-up Vendors typically have form libraries and/or allow customers to share forms 79

80 Key Elements For Clinical Form Development For each new form: Initial form review and approval of content Technical form design or modification Form review and feedback for changes Final form sign-off, completion, and hanging in the system 80

81 7. System Table & Structure Set-Up This is for all system set-up tasks, it is usually very comprehensive and ultimately affects how the overall system and reporting works Cost center, programs, locations Service codes and payers Other key system table files 81

82 8. Billing Set-Up & Testing This is for all tasks to set up billing in the new system as well as for thorough testing to ensure it works correctly 82

83 Billing Set-Up & Testing Tasks Develop a task for all set-up items for the billing system Develop a full testing plan to confirm that the system creates a correct bill for all services and all payers Conduct the testing plan Correct any errors and re-test necessary items Do an electronic billing test for all payers that accept electronic claims (set these up as separate tasks) If possible, do an electronic remittance test; in order to do this, you may need to duplicate a REAL billing run from the old system in the new system so that you can load the electronic remittance for testing in the new system Develop detailed instructions for billing and accounts receivable staff on using the new system, including a schedule of daily, weekly, and monthly activities 83

84 9. Report Needs Assessment & Development This is for all tasks for report development for the programs being implemented Key tasks for each new report or report modification: Initial report specifications for the programmer Report development Review, feedback, and revisions Queries, sorts, defaults defined Reports hung in system 84

85 State Reporting & Other Required Or Compliance Reporting Most often, this is monthly reporting of consumer demographic, service delivery, and outcome data In some instances the data is cumulative (such as, fiscal year-to-date data which can complicate data conversion and go-live planning) 85

86 10. Software Interface Needs Assessment & Development This is for all tasks related to identifying all interfaces that need to be built for the new software application as well as the detailed plans for developing and testing the interfaces For each interface, create four tasks Planning the interface Developing the interface Testing the interface Planning implementing of the use of the interface 86

87 Typical Interfaces Or Data Exchanges GL/Accounting software applications Payroll applications HR applications CRM applications Laboratories and pharmacies State, county, or other systems Other payers Other providers 87

88 11. Meaningful Use Registration & Implementation This is for all tasks related to implementing meaningful use requirements as well as obtaining meaningful use federal dollars under the incentive program 88

89 EHR Implementation System Freeze & Final Preparation 12. Final workflow testing 13. Training materials and execution 14. Final go-live preparation 89

90 12. Final Workflow Testing Once the entire system has been set-up, it must be frozen so that the final workflow testing can be completed You can t finalize the workflows and develop training materials until the entire system is set- up! 90

91 13. End User Training Material Development & Plan This is for all tasks related to developing best-practice training materials and executing the training plan for end users prior to go-live for each program Key tasks include: Define training groups, anticipated number of attendees for each groups, and list of key things to train each group Develop model for handling all training logistics Develop training material development plan 91

92 14. Go-Live Planning This is for all remaining tasks related to preparing for the final Go-Live Typically, they include: Final data conversion and possible duplicate new client entry for a short period of time Identifying all post-data conversion data entry that needs to occur and developing a plan for execution (e.g. caseloads, appointments, updated diagnoses, medication information, etc.) Planning the roll-out of treatment plan data entry into the new EHR On-site staff support for Go-Live date 92

93 EHR Implementation Expanding & Leveraging The EHR Implementation 15. Implementing more features 16. Leveraging data through business intelligence tools 17. Additional clinical and analytic use 93

94 On-Going Implementing more features Leveraging data through business intelligence Additional clinical and analytic use 94

95 EHR Implementation Routine Elements Vendor training and implementation Hardware Data conversion Complex Elements Workflows Clinical content System set-up Billing testing Reports Interfaces Meaningful use Mobile system use planning System Freeze & Final Preparation Final workflow testing Training materials and execution Final go-live preparation Expanding & Leveraging the EHR Implementation Implementing more features Leveraging data through business intelligence Additional clinical and analytic use 95

96 IV. Best Practices: Workflow Mapping & Project Management 96

97 Workflow Mapping Best Practices Standardize Formulize Optimize 97

98 Standardize Making The Workflows Standard Before starting to map services, ensure that all workflows have standard Shapes Colors Language Orientation/Layout Standardizing the workflow look and layout can improve understanding of the service flow as well as reduce the chance of confusion for someone who is unfamiliar with the service itself 98

99 Standardize Standard Workflow Shape & Layout Example NOTES 99

100 Standardize Develop A Standard Form Tracking Tool Create a standard tracking tool with the goal of identifying which forms are utilized within which service processes Ensure that a master tool will be available for teams to update as they begin to create the workflows Form # Form Name Description Workflow 1 Workflow 2 Total Referral Form Consent Form Self- Screening Form Example Tracking form completed by upon receiving referral Informs clients of overview of services and consent for Tx Assortment of measures completed by client at intake X 1 X X 2 X 1 4 Progress Note Notes completed during routine care X X

101 Formulize Formulating The Service Flow Mapping a service line requires staff to be present that have a deep understanding of What the actual service process looks like from admission to discharge/transfer Which specific forms are utilized in the service When there are deviations from the usual service flow It is recommended that staff who are familiar with how the service is delivered on a daily basis be present and provide input during the workflow mapping process 10 1

102 Formulize Mediating The Workflow Mapping Discussion Ensure that the discussion stays on a linear path from service start to service finish Ask probing questions to reveal deviations from the standard service flow Don t get bogged down by improvement discussions prematurely 10 2

103 Optimize The Opportunity To Move From Actual To Ideal Review the current workflow opportunities to improve service delivery, such as: Identifying areas to utilize new technologies and future EHR system capabilities Clipping obsolete or redundant steps Revising inefficient processes Mapping how the service is actually delivered initially can provide an opportunity for staff to critically evaluate how the process can better support their work and the individuals your organization serves 10 3

104 Optimize Form Tracking & Optimization The form tracking tool provides opportunity to quickly view the total number of forms utilized across the organization, a particular service, and how often a particular form is used across services. Leverage form tracking tool data to: Remove duplicate forms from the service delivery process Identify forms that are outdated or barely used Reviewing the form tracking tool provides an opportunity for staff to brainstorm where current form data collection can be improved and transferred from paper to electronic collection 10 4

105 Sample Clinical Workflow Mapping & Optimization

106 Building A Project Plan With Your Vendor & Your Team 10 6

107 Creating A Vision For Your EHR Implementation A sense of urgency and the right implementation team are necessary for implementing the major changes that software implementations represent, but they are not sufficient Successful transformation requires a sensible vision with clear objectives A clear and compelling statement of where all of this change is leading 10 7

108 The Right Implementation Team... Is not just comprised of IT staff Is comprised of operational staff from all department areas effected Includes management & non-management positions Is not expected to do another full-time job while they are also implementing the new software application Includes a full-time project manager 10 8

109 The Implementation Team Is The Guiding Coalition For Change Senior management MUST be active supporters of the project! The change coalition must be powerful in terms of title, expertise, reputation, relationships, and leadership capacity Oftentimes, more complex implementations have groups or tiers of teams (steering committee, implementation team, program area teams, etc.) 10 9

110 Implementation Planning Software vendors have extensive experience in planning and helping to manage software implementations What is their standard approach and how might it be modified to meet your agency s objectives? Ask if they have customers like your organization who have recently implemented their system Contact those customers to find out what their approach was, what timelines they used, and what suggestions they may have 11 0

111 Big Bang Versus Incremental EHR Implementations Big Bang Implementing use of the EHR for all services and programs as of a single date of service Incremental Rolling out the use of the EHR by site or program over a period of time What are the advantages and disadvantages of each of these? 11 1

112 A Best Practice Project Plan Includes Timeline and tasks for all the elements of the EHR implementation 2. Clearly assigned responsibilities for the various tasks 3. Balances an aggressive implementation with enough breathing room to address problems 4. Re-tooling work processes and staff job descriptions as needed 5. A clear plan for communicating progress and changes to the entire organization 11 2

113 Project Management Software You ll need to use project management software to organize tasks, timelines, and assignments, and to communicate with team members Commonly used project management software: Microsoft Project BaseCamp ( 11 3

114 Managing Towards Success, Averting Typical Obstacles 11 4

115 Common EHR Implementation Problems 1. Wrong team and insufficient resources 2. Poor system set-up 3. Insufficient billing testing 4. Poor clinical form decision-making process 5. Poorly designed forms and workflows 6. Lack of sufficient leadership guidance 7. Hardware and other tech problems 8. Poor end-user training and support 9. Not enough testing after system freeze 10.??? 11 5

116 Questions & Discussion 11 6

117 Turning Market Intelligence Into Business Advantage OPEN MINDS market intelligence and technical assistance helps over 550,000+ industry executives tackle business challenges, improve decision-making, and maximize organizational performance every day 15 Lincoln Square, Gettysburg, Pennsylvania