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EHR Adoption Process

HealthInsight is committed to supporting the adoption of health information technology (HIT) and electronic health record (EHR) systems in physician offices and other health care settings to improve health care through enhanced access to patient information, decision support, and improved patient-clinician communications.

Whether your clinic is preparing to adopt an EHR in the near future, is currently shopping for an EHR system, or is looking for ways to use your existing EHR system more effectively, HealthInsight offers you tools, links to resources, and suggestions for increasing the likelihood of a successful and complete EHR implementation.

Clinics that use their EHR systems to improve the quality of patient care they provide will be best able to capitalize on potential incentive and pay-for-performance initiatives.

Process of EHR Adoption:

EHR Planning / Assessment of Clinic Readiness

Planning for Success

Planning is critical to your success in purchasing and successfully implementing an EHR.

The EHR Implementation Roadmap lists the steps for successful planning and use of your EHR

Clinic Assessment Tools:
For clinics currently without an EHR
For clinics currently with an EHR

Goals

What do you want from an EHR? What do your partners want? What does the staff want?

Have your staff complete the Personal Goals List
Use the Practice Goals to compile a master list of goals for your clinic
To help clarify your priorities you can also use the Prioritization Matrix

Determining Your Return on Investment

Use these worksheets to compute the costs and financial benefits of an EHR:

Estimated Costs and Savings Worksheet
EMR Estimated Costs Worksheet

Workflow Analysis

Our free Workflow Software can help you evaluate your current workflow. Click here to download the software and for the installation instructions. Use the workflow assessment guide and hints to frame
your workflow assessment.

You may choose to repeat the workflow analysis after your EHR is implemented to see if your goals have been met.

Guiding Your Progress

Outlook Associates has produced two useful guides (Evaluating and Selecting an EMR System and Implementing an EMR System) that are available for purchase on their website.
Go to www.outlook-associates.com and select the store section.

EHR Workflow Software

Workflow Software and Download Instructions

Instructions for downloading and installing:

  1. Click here to download a self-extracting file.
  2. Click the browse button to choose where to save the files on your hard drive. (Note: this is not where you will save the program, just where you will save the files listed below)
  3. Click “unzip” to download the files
  4. Open the file “Instructions for Installing Microsoft Net Framework.doc” (you will have just saved it) and follow the instructions to install
  5. Find the file “setup.exe” and double click it to run the program. Follow any on-screen instructions
  6. You’re done! A shortcut is now on your desktop and Start menu for “Workflow 4.1 ” For help on how to use the software, refer to "Help", "Instructions" in the software

Files included in the self-extracting executable file:

  • Installation files (setup.exe, .ini, .msi)
  • Instructions for Installing Microsoft Net Framework.doc
  • Sample Clinic.wkf “(a set of completed workflow process maps that you may open from the workflow program)
  • Legend.pdf (for interpretation of workflow process maps)

Use the workflow assessment guide and hints to frame your workflow assessment. Problems or questions? Contact David Cook, director of operations, HealthInsight.

Disclaimers:

By using the workflow software tool, you agree to hold the HealthInsight harmless from all damages arising out of your use of this tool, including general and consequential damages that you may experience.

Vendor Selection

Vendor Selection

Once you know what you want from an EHR you can begin to compare products. Use the following tools to help you make your choice efficient and successful. The EHR Implementation Roadmap has details about our consulting services.

Identifying the Functonality You Need

Identifying the Functionality You Need

The information provided below is a sample of important considerations related to how your practice will be using an EHR. A complete checklist for review is available in Evaluating and Selecting an Electronic Medical Record System (revised October 2004) available through Outlook Associates, Inc.

Will the system be used in multiple office locations?

Which workflow management tools will you need?

  • Provider schedules
  • Prioritized task list by user
  • Method to track patient visit status on-screen
  • Customized workflow by provider/clinician

Is the practice management system integrated or is an interface required?

Are there other interfaces available (lab, radiology, etc.)?

  • Electronic payer connectivity
  • Support for HIPAA standards for electronic transactions
  • Support for HL7 interface standards

How will you be documenting encounters/information?

  • Notes templates
  • Customized templates (by practice or provider)
  • Rree text option
  • Drop down lists
  • Check boxes
  • Speech recognition
  • anatomical drawings
  • Rree-hand sketches
  • Scanned images
  • Video imaging, etc.

Do you wish to track episodes of care, risk factors, or care processes?

Do you want support for error checking within data entry?

What types of result reporting documents do you require?

  • Chart notes for visits
  • Phone calls
  • Emergency room reports
  • Laboratory results
  • Radiology reports
  • Consultation reports
  • Discharge summaries
  • Medication lists
  • Allergy lists
  • Problem lists
  • Growth charts
  • Patient telephone messaging
  • Vital signs, e.g., blood pressure lying, sitting, standing
  • Pulse: oral, radial, pedal, femoral
  • Temperature: Fahrenheit, Celsius; Height: feet / inches, centimeters

Do you need to generate forms? If yes, what forms do you require?

  • Referral letters
  • Letter summaries for referring physicians
  • Summaries for patients
  • Test report letters to patients
  • Prescriptions

Is it important to be able to modify these forms / letters by provider, practice or location?

Do you want to create custom forms for any purpose?

How will information from the EHR be displayed in addition to text?

  • Tables
  • Flowsheets
  • Graphics
  • Free-hand drawing
  • Stored images

How easily can the EHR be searched?

  • By patient identifiers such as health plan member number, patient name, social security number (patient’s or responsible party’s), or account number
  • By date, problem, text, or encounter type

What prompts or reminders would you need or like?

  • Spellchecking
  • Provider alerts for missing charting elements
  • Electronic team messaging
  • Prescribing alerts for allergies and interactions
  • Care management, disease management, or prevention (may include clinical decision support tools, reports, and reminder systems)

Does the practice want to have clinical decision support built into the system?

Is it important to have support for medication/prescription writing?

  • Examples include a drug database, formularies linked to patient benefits, dosage algorithms, drug-allergy checking, drug-drug interaction checking, drug-food interaction checking, weight-based dosing, prescription renewal, co-signature required based on security, fax and remote printing of prescriptions

Would your practice need functions to support order management?

  • Examples include on-line ordering, order cancellation, automatic suggestion of orders required to satisfy protocols, notification to provider for tests not completed within specified time frame, trending and graphing of discrete results data, graphing of results to medications and other clinical data

Would it be necessary to print or transmit all or portions of the patient record? Is the system capable of meeting the need of the practice? Can it produce a continuity of care document (CCD)?

Is it important for the system to support coding or validation of codes related to current diagnosis and procedures?

What are the needs of the practice related to security (signing/authorization and access) and confidentiality?

  • Considerations include electronic signatures, authorization required for electronic signatures, sign individual sections, records locked after signature, co-signature, authentication required when medications are ordered or when transmitting ordersConsiderations include limited access to portions of record based on job functions, access limited by patient record type, password protection, required password changes, screen time-outs, HIPAA compliant access audit trail

Hardware Comparison

Guidelines for Evaluation

Guidelines for Evaluation

Guidelines summarize these steps:

Review your Personal Goals List and Practice Goals List.

Keep your goals in mind when you compare the vendor products.

Ask other practices, contact HealthInsight, or visit websites like www.centerforhit.org to narrow your vendor choices.

Ask for a demonstration from your top four or five vendors.

Ask the vendor to use the Sample Scenario for EHR Evaluation. This will structure the
demonstrations and facilitate comparisons.

Use the Vendor Evaluation Matrix to document your impressions of each vendor’s product.

Narrow your selection to two or three. Ask your vendor or HealthInsight about other clinics using the product, then visit and ask them about their experience. See your HealthInsight facilitator for tools to guide your site visit.

Interoperability of product (established standards - Certification Commission for Healthcare Information Technology - CCHIT).

Guidelines for Evaluating EHR Vendors.

Vendor Relationships

Vendor Relationships

As you negotiate the contract, you will be establishing a relationship with the vendor. An attorney familiar with software contracts is a valuable resource. This document has some tips to consider when negotiating a contract with a vendor. Your HealthInsight facilitator can help you access other resources to represent your interests when negotiating a contract.

Consider:

  • Are updates included as part of the contract?
  • What about periodic training with updates?
  • Are there additional costs for technical assistance, training, updates or interoperability of the system with outside organizations?

The relationship with the vendor does not end once you have implemented the EHR. On-going support is critical for successful implementation and use of an EHR.

  • Maintain a single point of contact in your office to interact with the contact person for the vendor.
  • During implementation, hold progress meetings on a regular basis with the vendor point of contact. This helps keep implementation on track.
  • After implementation is completed, continue meeting on a less frequent basis to discuss concerns, challenges with the system, planned updates, or other important topics.
  • Current point of contact information needs to be maintained on both sides.

EHR Implementation / Office Redesign / Workflow

EHR Implementation / Office Redesign / Workflow

Review the section on common implementation problems to help you anticipate problems early and work to avert them during your implementation.

Outlook Associates produces a useful guide (Evaluating and Selecting an EMR System) available for purchase directly from Outlook. Please see the store section at www.outlook-associates.com.

Moving from paper to an electronic system requires a decision about data conversion. Refer to Document Management, Scanning and Back Loading Tips, and tips from a Utah clinic.

Common Implementation Problems

Leadership is a key component of successful EHR implementation. Identify champions for adoption among physicians and office staff. They usually become the “super-users” who are a key resource for other staff. Support these individuals as they engage others in the implementation process.

Decreased productivity is to be expected during the implementation phase. Plan for it.

Staffing needs may change as implementation progresses. Workflow redesign, system integration, and network support are areas often overlooked by the practice.

Click here for a list of Common Implementation Problems and Potential Solutions.

Workflow Analysis

A close examination of current workflow in your office can prepare you for changes that your EHR will necessitate. For those not implementing an EHR, workflow analysis will reveal inefficiencies in your current workflow and allow you to redesign processes, gaining efficiency, patient/staff satisfaction, and compliance with processes/procedures.

Our free Workflow Software can help you evaluate your current workflow. Click here to download the software and for the installation instructions. Use the workflow assessment guide and hints to frame your workflow assessment.

You may choose to repeat the workflow analysis after your EHR is implemented to see if your goals have been met.

Office Redesign

Implementation of an EHR will result in planned office redesign if implementation is to be successful. Workflow analysis will support identification of areas to be redesigned.

Some offices may not be ready to adopt an EHR, but still interested in redesigning the office to improve efficiency, value to the patient and staff, safety, communication, and/or satisfaction.

Steps:

  1. Decide where to start – can you (as a team) think of something that is not smooth and effortless in your practice?
  2. Working together, find out more about the identified area. Explore causes for poor performance in the identified area. Identify barriers, bottlenecks, and breakdowns. Gather data as a baseline measurement of the current process.
  3. Consider possible changes that will make it easier to achieve the desired outcome. Identify how your team will measure the change to know if the change is an improvement. Remember that not all changes are an improvement and fixing one problem may unintentionally create several more problems.
  4. Conduct a small test of the change idea (i.e., with one patient, one provider) and decide if the change is better.
  5. Modify the change idea if necessary and retest on a small scale. After refining the change idea, move forward with spreading the change within your practice.