ELECTRONIC

HEALTH RECORDS
Implementation Planning for Success
Presented By: Nancy McClanahan
VP Operations Planning Synergies, Inc.

PLANNING FOR SUCCESS

System implementation projects, in general,

experience low success rates:
28%

of project meet full success

49% of projects are fully completed, but over
budget, over schedule, and lack full scope of
planned functionality
23% of projects experience complete failure or
are cancelled

EMR/HER system implementations have even

higher failure rates. Industry studies reveal
failure rates of 50% others as high as 70%

PLANNING FOR SUCCESS

System implementation projects, in general,

experience low success rates:
28%

of project meet full success

49% of projects are fully completed, but over
budget, over schedule, and lack full scope of
planned functionality
23% of projects experience complete failure or
are cancelled

EMR/HER system implementations have even

higher failure rates. Industry studies reveal
failure rates of 50% others as high as 70%

PLANNING FOR SUCCESS

Other contributing factors to implementation

failures are:
Believing

the vendor will assume responsibility

for all tasks
Hoping the vendor/system will fix your
operational and personnel problems
Fear of change
Fear of technology

SESSION GOALS

Keep implementations of EMR/EHRs on the

right side of the negative statistics

Help them think through the key HER

implementation decisions
Understand

the options
Understand the risks

Position them all to be enable the

implementation success

The EHR Adoption Process

Implementation PlanningSteps to Success

Establish an Effective Implementation Team

Finalize HER Goals & Priorities
Establish Implementation Strategies and
Scope
Develop the Implementation Plan with a
Realistic Timeline
Emphasize Communication
Establish Benchmarks to Measure Project
Success

Step 1 Implementation Team

Key Participants

Physician/Clinician Champion
Skilled & Knowledgeable Project Manager
Network/Technical Analysts
Trainer
Designers, Builders, Testers & Implementers

Step 2 Finalization EHR Goals &

Priorities

What is the vision for the system?

What is it to help the practice achieve?
Improved

care/quality of care for patients

Clinician ease & productivity
Lower Costs
Higher revenues
Competitive advantage
Be in compliance with Regulatory Requirements
Other?

Which features & functions support these

goals?

Step 3 Establish Implementation

Strategy & Scope

Phased vs. Big Bang Implementation

Incremental

functionality vs. full system

implementation
Phased users vs. immediate full practice

Historical Medical Chart Information Needs

How

much data?
What formats?

Communication Strategy
Go-Live Date Constraints & Planning

Implementation Strategy & Scope

Phased vs. Big Bang Approach

Incremental vs. Full System Functionality

Do

we want/need all functions available Day

One?
Can we absorb that level of change at one time?
Can we take on that level of implementation work
at one time?
If not:

Based on the priorities of EHR/EMR goals

Based on the time and resources that can be allocated
What functions do we want/need immediately?
In what sequence should we add the other functions?
Over what period of time?

Implementation Strategy & Scope Example

Incremental Functionality Phasing

Viewing of lab and diagnostic results

Prescription management
Current medications
Allergies/sensitivities

Telephone messaging
Lab and diagnostic order entry/results reporting
(OE/RR)
Correspondence
Medical charting
Trending, analysis & reporting
Patient

management
Population management

Implementation Strategy & Scope

Phased vs. Big Bang Approach

Phased Users vs. Immediate Full Practice

Will

we be ready for everyone to Go Live at

the same time?
Can we absorb that level of change at one time?
Can we support everyone on Day One?
If Not:

Who/What areas should go first?

What impacts will this mix of paper vs. electronic
have on the other processes within the practice?
In what sequence should we add the others?
Over what period of time?

Implementation Strategy & Scope

Phased User Considerations

Physician Cross-over/Coverage
Patients
Sites
Programs

Clinical Teams
Nurse/MA

support across physicians

Maintenance of Mixed Paper/Electronic

Charts
Labor
Error

Rates

Implementation Strategy & Scope

Medical Records Conversion
Approaches

Abstracting and manual entry

Scanning
Electronic conversion

Implementation Strategy & Scope

Communication Strategy & Approach

External
Promotional
Patient

Reaction
Patient Perceptions of the Business and locals

Fear of loosing the doctor that I see now

Ensure the quality of services

Internal
Employee

Reaction

Job Loss
Role change
Technical challenges

Stakeholders

Implementation Strategy & Scope

Implementation Date

When is the least busy time of the year?

Are there key resource constraints?
Are there any other practice activities to
plan around?

Step 4 Develop the Implementation

Plan with a Realistic Timeline

Based on the goals and strategies set for the

system:
What

specific tasks need to be done?

By whom?
When?
How long will all this take to complete?

Develop the Implementation Plan

Conduct Detailed Vendor Planning
Meetings

Communicate practice vision, goals, strategies &

approaches
Establish overall project structure & parameters
Contacts
Escalation

Build relationships
Confirm requirements
Establish agreement on:
Task
Roles

and responsibilities
Time Requirements

Develop the Implementation Plan

Documenting the Plan

Milestones
Tasks
Dependencies
Vendor
Practice
Individual

Time Requirements

Develop the Implementation Plan

Defining the Detailed Tasks &
Responsibilities

Medical Records Conversion

Contingency Planning
System

back-up
Disaster recovery
Interim workflow planning

Develop the Implementation Plan

Defining the Detailed Tasks &
Responsibilities

Go-Live Planning
Patient

schedules

Support
Dress

Rehearsal
Go/No-Go decision

Flipping the switch

Celebrating
Stabalization

Develop the Implementation Plan

Setting a Realistic Timeline

Bottom up Estimation
Let

the task and Resources drive the timeline OR

Provide the resources to support the tasks for the
timeline

Remember Schedule Constraints

Set a Go-Live that is Achievable
Communicate it

Step 5 - Emphasize Communication

Internal Communication
Enlist

full support
Ease concerns

Job security
Technical learning support

Tell

them what to expect & When

Emphasize Communication

Patient Communication
Tell

them what you are doing & why

Provide consistent answers to questions &
concerns
Keep them informed on progress
Communicate enthusiasm & confidence
Include them in EHR success celebrations

Step 6 Establish Benchmarks to

Measure Project Success

Measurements based upon goals

Increase

revenues through improved E & M coding

Reduced claims rejection
Insurance plans understanding and possibly acceptance of
different types of insurance or third party payer services
Reduced Expenses:

Medical Chart supplies

Staff costs
Transcription reduction/elimination

Increased

patient visit volumes

Physician/clinician productivity
Additional exam/treatment rooms

Improved

preventive & chronic care compliance/outcomes

Improved patient satisfaction
New patient increase

PLANNING FOR SUCCESS