Full EHR Implementation Roadmap 02082006

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  • 8/8/2019 Full EHR Implementation Roadmap 02082006

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    EHR Implementation Roadmap

    Information

    Technology

    1.Complete anApplication toParticipate

    2.Complete:

    PracticeReadinessAssessment

    Practice profile(IT)

    Office staff skillsassessmentsurvey

    HardwareInventory

    3. Select projectTeam hold regularTeam meetings

    4. DOQ-IT LearningandTeleconference/WebEx sessions

    1.Review practicedata:

    PracticeReadinessAssessment

    Practice profile(IT)

    Office staff skillssurvey

    2.Define EHRimplementationgoals

    3.Identify andtargetimprovementopportunities

    4.Team meeting5.DOQ-IT Learning

    andTeleconference/WebEx sessions

    1.Define EHRsystemrequirements:

    Review EHRsystemsconfiguration

    Develop EHRselectionprocess and

    goals Evaluate DOQ-

    IT EHR vendorsand solutions

    2.Team meeting3.Select EHR

    system4.DOQ-IT Learning

    andTeleconference/WebEx sessions

    1.Create EHRsystemimplementationplan andtimetable withVendor

    2.EHRimplementation

    Install & configurehardware

    Install & configureEHR systemsoftware

    Begin staff training

    System testing3.Keep a Journal of

    experience/processes

    4.Team meeting5.Begin using EHR

    system6.DOQ-IT Learning

    andTeleconference/WebEx sessions

    1.Conduct postimplementationreview

    2.Update Journal ofexperience/processes

    3.Team meeting4.Validate, capture

    and submission of

    selected DOQ-ITclinicalperformancemeasures

    1. Modify EHR perStage 5 reviews

    2.Team meeting

    PracticeDeliverable

    Sign participationagreement

    Completeassessments

    Completebaseline survey

    Attend learningsession

    Conduct staffskills assessmentsurvey

    Analysis practiceworkflows

    Start weeklymeetings Attend learning

    session

    Determinepreferred EHRsolution setup

    Select a vendor Attend learning

    session

    Create a vendorImplementationTimeline

    Set a date tobegin using EHRsystem

    Attend learningsession

    Completeevaluation survey Submit

    measurable to CMSdata warehouse

    Highlight areasfor improvement

    Tools, templates, and training will be provided to participants throughout the duration of the project.

    Stage 1Assessment Stage 2Planning Stage 3Selection

    Stage 4Implementation

    Stage 5Evaluation Stage 6Improvement

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    CareManagement &QualityImprovement

    1.Assess thedelivery systemdesign of practice:

    Conduct practicereadinessassessment

    Conduct officesystems survey

    Conduct staffskills assessment

    Review clinicaloperations

    2.Conduct asimulation ofpatientexperience in thepractice. Identifybottlenecks.

    3.Review resourcesfor designingexpandedservices

    4.Identify practicedemandsincluding patient:

    DemographicsConditions

    Visit types &volumes

    5.Determine staffcapacity toaddress demands

    6.Conduct regularstaff meetings

    1.List and map allhigh volumeactivities

    2.Review workflowredesign optionsto eliminatewaste

    3.Identify and planfor expandedservices of focus(e.g., plannedvisits, groupvisits, staff

    huddles, etc.)4.Review current

    caremanagementsteps for chronicconditions tounderstand howan EHR will beintegrated intoworkflow

    5.Determine clinicaldecision supportneeds

    6.Conduct regularstaff meetings

    1.Create workflowsolutions andimplications forstaff and patients

    Define practiceredesignrequirements

    Developprotocols forselectedinterventions

    2. Evaluate EHR

    systems forpopulationmanagement andclinical decisionsupportfunctionalitiesbased on topdiagnoses forpractice

    3. Conduct regularstaff meetings

    1.Modify EMR tocaptureappropriate dataelements andgenerate reports

    2.Implementexpandedservices / caremanagementstrategies

    3.Use tool tomeasureoutcomes and

    share results4.Utilize EHR to

    practice evidence-based medicine

    5.Conduct regularstaff meetings

    1.Conduct postimplementationreviews of clinicalprocess

    2.Utilize EHR datafor analysis

    3.Capture andsubmit DOQ-ITselected clinicalperformancemeasures

    4.Document changeprocesses

    5.DOQ-IT LearningandTeleconference/WebEx sessions

    6.Conduct regularstaff meetings

    1. Reviewimpact of EHRimplementationon the practice

    2. UtilizeDOQ-IT qualityreporting andanalyses forimprovement

    3. Plan for additionalexpandedservices

    4. Identify and plan

    for a qualityimprovementproject based onDOQ-IT measureswith opportunitiesfor improvement

    5. Conduct patientsurvey

    6. Attend DOQ-ITLearning andTeleconference/WebEx sessions

    7. Conduct regular

    staff meetings

    PracticeDeliverable

    Completeassessments

    Identify practicedemands,

    including topchronicconditions,

    List of highvolume activities

    Mapped workflow

    of priority highvolume activities Complete CDS

    Planning

    Create anddocumentprotocols/process

    es Conduct vendor

    demonstrations Participate in

    Plan for datacollection

    Implement EHR

    based onchecklist

    Collect data onDOQ-IT qualitymeasures

    Analyze data and

    consider using forpopulationmanagement

    Office systemssurvey iteration

    Screenshots,

    policy manual orreports ofactivities such asplanned/ group

    Stage 1Assessment

    Stage 2Planning

    Stage 3Selection

    Stage 4Implementation

    Stage 5Evaluation

    Stage 6Improvement

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    patientdemographics,visit types, etc.

    Conduct a walk-through frompatientperspective

    DOQ-IT LearningSession

    Participate inDOQ-IT LearningSession

    visits. Practice-specific

    patient surveydata report

    Tools, templates, and training will be provided to participants throughout the duration of the project.

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    PatientSelfManagement

    1. Review and select resources and tools to assess patients forrisk factors, language preferences,

    2. Documentation of patient risk factors in individual records3. Review and select provisional educational resources for

    patients in English and any other languages of prevalence forthe practice

    4. Develop templates of patient action plans for prevalent chronicconditions

    5. Develop a communication plan for monitoring patientsprogress with their action plans including staffing anddocumentation requirements

    6. Review, identify and plan for expanded services of focus (e.g.,planned visits, group visits, staff huddles, etc.)

    1. Modify EMR to capture appropriate dataelements and generate reports

    2. Assess patients with chronic illnessesfor risk factors, language preferencesand readiness to change and log resultsin EMR or on paper

    3. Implement expanded services tomanage chronically ill patients

    4. Use patient action plans to guidepatients in managing their health. Logcommunications and progress in theEHR

    1. Plan foradditionalexpandedservices

    2. Develop andimplementpatient healthportal

    3. Develop andadministerpatient surveys

    PracticeDeliverable

    Office systems survey List of commonly seen patient conditions (at least 3), risk

    factors, languages Evidence of documentation of risk factors in patient records Educational materials & web links for common conditions and

    risk factors Chronic condition action plan template

    Office systems survey iteration Screenshot of individual EMR record

    with appropriate chronic conditions/ riskfactor data elements

    Report of practice-population basedconditions or risk factors or languagepreferences

    Screenshots, policy manual or reports ofactivities such as planned/ group visits,or self-management action plans for atleast one chronic condition

    Office systemssurvey iteration

    Screenshots,policy manual orreports ofactivities such asplanned/ groupvisits, or self-managementaction plans forat least a secondchronic conditionOR,

    Evidence ofpatient-physicianelectroniccommunicationssuch as de-identifiedexchange orscreenshot ofpatient healthrecord OR,

    Practice-specificpatient surveydata report

    Tools, templates, and training will be provided to participants throughout the duration of the project.

    Stage 1Assessment

    Stage 2Planning

    Stage 3Selection

    Stage 4Implementation

    Stage 5Evaluation

    Stage 6Improvement

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    Stage 1Assessment

    Stage Summaries

    Information Technology:

    Upon enrolment into the DOQ-IT project, participants will complete a readiness assessment to provide the DOQ-IT team with anoverview of the practices technology and clinical procedures. At stage 1 this document is reviewed and an understanding of where tostart on the implementation roadmap is established. Other key documents are also distributed to provide important feedback includinga more detailed practice analysis, which we refer to as a practice profile, staff skills survey and an IT hardware inventory. All of whichare reviewed in Stage 2. We also introduce the importance of forming a project team and to begin holding frequent team meetings tokeep communications open and the project in focus.Major Deliverable: Baseline Assessment - Before August 2006 practices within the Identified Participation Group (IPG) are required(mandatory) to complete a baseline assessment for submission to CMS. IPRO DOQ-IT team will supply and collect this assessmentform at the appropriate time.

    Care Management & Quality Improvement

    In addition to the practice assessments, practices will take this time to conduct a simulation of the patient experience in their practiceto determine bottlenecks and other opportunities for improvement. The practice will also review literature and tools on alternativedesign options for delivery systems, including such options as group visits and motivational interviewing techniques. The DOQIT teamwill also provide tools to help the practice determine its demands in terms of major demographics and chronic conditions relative to itsstaffing resources.

    Patient Self management:

    Stages 1, 2 & 3 are combined into one long section to accommodate the change idea and also in consideration of the other aspects ofthe EHR implementation.

    DOQ-IT participants will learn to how to identify groups of patients with chronic conditions or risk factors using paper and electronicmethods. The participants will learn how to use this information to provide tailored education materials to patients. DOQ-IT practiceswill learn approaches to develop individualized patient self-management action plans. Participants will learn about methods tomaximize patient self-efficacy through office redesign and enhanced individual clinician-patient communication skills.

    In stages 1-3, practices will need to list common practice panel diseases and patient risk factors. Participants will implement a methodfor ongoing collection and evaluation of these conditions. Practices will provide education materials to patients for these conditions.

    60 Da s

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    Stage 2Planning

    Practices will develop action plan templates.

    NOTE:Stage 1 is a requirement for all practices regardless of where on the roadmap they are at the time they join DOQ-IT and sign upas an IPG member. Upon completion of this initial stage, each practice will be informed as to which stage of the roadmap we feel theyshould precede.Major Deliverable: For DOQ-IT IPGs only.

    60 Days

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    Stage 3Selection

    Information Technology:

    Having a clear understanding of why you want an EHR will help with the selection of an appropriate application. The EHR should helptarget quality improvement efforts, such as decrease pharmacy call backs, patient check in/out bottlenecks or improve diabetic patientcare, rather than be seen as a tool to increase revenue. Placing an EHR into a practice with failing or malfunctioning workflows will notincrease efficiency but simply provide for the same mistakes to be made and these results to be recorded electronically. Workflowevaluation provides a way for the processes to be mapped and evaluated. By doing so, inefficiencies can be visualized and streamlined,

    while new procedures and office redesigns can be experimented upon without adding to the stress of learning an EHR system at thesame time. We provide detail on workflow evaluation, sample workflows and suggestions on practice procedure redesign.

    Care Management & Quality Improvement:

    Planning for a major change like an EHR is crucial to the success of the change. Without planning for changes to key practiceprocesses prior to implementation, a practice runs the risk of automating bad processes. During the planning stage, practices shouldlist and map the workflow for major activities and determine unnecessary steps. In addition, now is the time to identify the deliverydesign changes that will be made and plan for them. Lastly, the practice should determine its clinical decision support needs, based onthe results of assessment of practice demands and the worksheets that the DOQ-IT team will provide.

    Patient Self management:

    See stage 1.

    120 Da s

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    Stage 4Implementation

    Information Technology:

    We will provide a monthly update of the DOQ-IT list of vendors; those that have signed a letter of agreement to facilitate into theirapplication the ability to submit data to CMS. Due to this requirement only DOT-IT approved vendors can be used for EHRimplementation on the DOQ-IT project. The list is comprehensive and includes most of the major EHR vendors, as well as some of themore regional smaller companies.

    In this stage we examine EHR systems in detail. What is the hardware configuration requirement and software function. The IThardware inventory form for stage 1 is reviewed and compared against the vendor supplied minimum system requirements. Practices,with the assistance of the DOQ-IT team, will begin to evaluate EHR vendors. We provide guidance tools on the most appropriate andeffective questions to ask an EHR vendor in order to get the most from a demonstration or sales inquiry. Practices are advised to usethese documents when beginning the evaluation of vendors, so that each vendor can be compared on an equal set of criteria. Inaddition, vendors have been asked to supply names of local physicians that have already implemented. Visits to these physicianchampions can be arranged if geographically achievable.

    It is also important to learn about contract negotiation and service level agreements (SLAs). We will provide an overview, notassistance, on what to be aware of when entering into a contract and SLA with a vendor. We will indicate what may be negotiable andwhen the vendor will most likely hold firm. Negotiation flexibility is most often determined by the size of the practice and the number oflicenses being purchased, however, individual practice needs will vary depending on the type of system being purchased. Our

    guidelines aim to help the practice in achieving the best contract for their situation, indicating what may be encountered, what toexpect and how much room there is to negotiate. Legal advice is always recommended.

    Care Management & Quality Improvement:

    When reviewing system functionalities and vendor demonstrations, take into consideration important capabilities, such as populationmanagement and clinical decision support functionalities, based on the top diagnoses for the practice. Be sure to ask the vendor totake you through these features.

    Patient Self management:

    See stage 1.

    150 Days

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    Stage 5Evaluation

    Information Technology:

    The implementation stage, as can be expected, heavily involves the selected vendor taking the lead in the project. Highlights of thisstage include, but are not limited to: install, testing, training, and data input & scanning strategies.

    A realistic Go Live date, meaning the date the practice will begin using the EHR system, will be discussed and agreed upon, while

    other time line goals or milestones will be identified and mapped into the implementation plan. Key to a successful transition to anEHR is the training staff receives on the new system. The vendor will supply and execute a training plan; this should have beennegotiated and detailed at the contract stage. Also additional computer skills and competency training should have been addressedand accommodated in earlier stages. We will help determine a data input strategy; how much data (patient record content) should bescanned or keyed into the new EHR is a major consideration. A strategy that best suits the practice requirements on getting sufficientdata into the EHR system will be discussed. A comprehensive system test including patient encounter simulations, system backuptraining and downtime & recovery procedures, should be held before the practice should sign off on the implementation.

    Care Management & Quality Improvement:

    The implementation stage will likely be a hectic time for the practice. Its important to continue to have regular staff meetings during

    this time and to set aside a portion of the meeting to discuss issues and concerns that staff members may have. Any gaps in trainingshould be addressed, as well at this time. The practice will also begin to implement the expanded services it has been planning for,such as group visits.

    The practice should consider and plan for data collection and analysis.

    Patient Self management:

    Stage 4 & 5 are combined

    Practices will build upon the work done in stages 1-3. Participants will implement patient registries targeted to chronic diseases or risk

    factors. Practices will alter their office capability through implementing expanded services such as group visits and utilize at least onecondition-specific action plan.

    30 Days

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    Stage 6Improvement

    Information Technology:

    Now that the EHR is in place and has been running for a period of time, it is time to take a post implementation evaluation. We willprovide tools to address any gaps between the EHR system and the implementation goals and direction to continually evolve thepractice workflows. If applicable, the vendor will provide or practice may request, additional post implementation training. Rather thanswamp the end users with all the training at once it is advisable to receive training only on the areas of the EHR that is being used. A

    suggested implementation approach is to phase in or incrementally activate parts of the EHR, rather than go for a Big Banginstallation and utilization. As staff becomes more proficient and familiar with the application, additional training will be required forexample, advanced scanning techniques, template customization, or report and registry creation.Major Deliverables:Complete post-implementation evaluation: A post-implementation evaluation survey is required (mandatory) from all IPGpractices. The submission deadline is October 2007 and will be made available when released by CMS.Data Submission to CMS: In addition, practices will also be asked to capture and submit DOQ-IT chronic and preventive caremeasure data sets to the CMS data warehouse (Note: - NOT mandatory). Practices will be instructed on how to capture and submitchronic and preventive care measures to the CMS data warehouse. Those that have a non-EHR registry will also be instructed on howto submit data. This is the final requirement for DOQ-IT participation from practices.

    Care Management & Quality Improvement:

    See the Information Technology Module Summary

    The DOQ-IT Team will provide guidance and examples of data analysis reports for the practice, as well as training and support onsubmitting quality improvement data to the QIO Clinical Data Warehouse, should the practice choose to submit this data.

    Patient Self management:

    See stage 4.

    Major Deliverable: For DOQ-IT IPGs only.

    Ongoing

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    Information Technology:

    The focus of stage 6 is on patient care & quality improvement and patient self-management. Therefore, IT is no longer the focal point ofthe project as the emphasis shifts to using the EHR to enhance and generate value-added benefits to the patient encounter. Somesoftware fine-tuning may be necessary as requirements or gaps identified in stage 5 are addressed and corrected.

    With the emerging awareness to the capabilities of electronic patient records and the data that can be collected, reward systems such

    as Bridges to Excellence are being established and becoming evermore prevalent. As more physicians adopt IT, institutions and payersmay begin to offer incentives for electronic data submissions or patient/demographic diseases information. As these incentiveprograms immerge we hope to provide practices with details on how they can participate and use their EHRs or registry to generateadditional revenue.

    Care Management & Quality Improvement:

    The DOQ-IT team will provide a breakdown of the data being submitted to the QIO Clinical Data Warehouse. In addition, IPROs DOQ-ITteam will assist the practice in identifying and planning for further quality improvement projects that can be implemented and trackedwith the help of the EHR. The practice should continue to monitor and adjust its processes as it settles into using the EHR system.

    Patient Self management:

    Practices will expand the work in stages 4-5 to implement additional expanded services and patient self-management action plans.Participants in this stage may implement elements of practice-linked patient health record or develop and administer patient surveysregarding patient health status and patient satisfaction regarding their experience with care.

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    Example of a Project Timeline