www.openminds.com n 15 Lincoln Square, Gettysburg, Pennsylvania 17325 n 717-334-1329 n info@openminds.com

How To Find The Right Electronic Health Record: The OPEN MINDS Seminar On Best Practices In EHR

Selection & Contracting

T h e 2 0 1 8 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 eO c t o b e r 2 2 , 2 0 1 8 | 1 : 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

© 2018 OPEN MINDS

AgendaI. 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

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The Big Picture On Behavioral Health EHR Implementations

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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!

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Key Findings

1• 85% of the providers surveyed have purchased an EHR

2• 73% of providers with an EHR define their EHR as fully implemented, with most

having implemented their system in 6-12 months

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• 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

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• When implementation was not fully complete, the clinical, scheduling, and billingmodules were the major functionalities reported as being fully implemented with the reporting module just over halfway complete

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Group #1: The Imperfect

EHR

Group #2: EHR

Disasters

Should We Change EHR Systems & Vendors?

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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

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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!

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

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Key Vendor Evaluation Areas

Functionality

Customer Support & Service

Implementation Expertise

Company Stability

Cost

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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

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Phase 1:

Organizational Assessment & EHR Vendor Research

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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

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Phase

1

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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

• 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

Get an overview of what products and services are available

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Phase

1

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Advantage Of Researching

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.”

Phase

1

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Determine If You Have Any Vendor ‘Knock-Out’ Factors

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.

Phase

1

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Commonly Used Knock-Out Factors

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

Phase

1

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Phase 2:

Preliminary EHR Vendor Selection

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Develop & Release A Competitive Request For Proposal (RFP)

Develop a detailed listing of your organization’s

functional needs

• Incorporate any knock-out factors

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

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Phase

2

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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

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Phase

2

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Vendor Overview

This Section Provides A Basic Understanding Of The Vendor’s Business

Company Customers Services

Key Qualifications

Offered To Meet Your

Technology Needs

Phase

2

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Technical Information & Infrastructure Requirements

This Section Should Contain Detailed Questions From The Technology Staff About Needs For:

Hardware Software NetworkTelecommunications Set-up Needed Or

Recommended

Software Platform/Database

(Any Near-Term Plans For

Upgrading?)

Recommended Staffing To

Support The Application

Once Implemented

Phase

2

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Training, Implementation, Support, Data Conversion, & Software Upgrades

• Training

• Implementation

• Support

• Data Conversion

• Software Upgrades

In This Section, Describe Your Organization’s Typical Approaches To:

• 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

Include The Following Detailed Information In This Section:

Phase

2

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Configurable Form & Field Capability

• 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?

In This Section, Ask The Vendor To Detail:

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Phase

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Report Writing Functionality

• Report writing capability of its technology solutions

• A listing and description of standard reports

• Export capabilities

• Compatibility with other applications

• Ease of use, etc.

In This Section, Ask The Vendor To Describe:

Phase

2

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Desired Reporting Functionality

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

Phase

2

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Additional Business Intelligence Tools

• Additional business intelligence tools for reporting executive and management metrics

• Partner(s) that provide these tools

• Functionality in detail

In This Section, Ask The Vendor To Detail:

Phase

2

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Scanning, Document Management & Record Release Capabilities

• 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 partiesBoth in paper and secure electronic formats

In This Section, Ask The Vendor To Describe:

Phase

2

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Software Interface & Data Exchange Capabilities

• Expertise in interfacing with common general ledger and human resource applications

• Helping provider organizations share data with other providers and stakeholders

In This Section, Ask The Vendor To Describe:

Phase

2

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Experience In Local Market

• Experience in the local market

• Support for your state’s versions of electronic billing forms

• Interfacing with state systems

In This Section, Ask The Vendor About:

Phase

2

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Overall Software Development Plans & TechnicalDirection

• Plans for continued software and business development

• Technical directions the vendor is taking with its products and servicesInclude both short-and long-term roadmaps about product

enhancements or other initiatives

In This Section, Ask The Vendor To Describe:

Phase

2

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Mobile Solutions

Ability to securely connect its software to smartphones, tablets, or other mobile devices.

What functionality is available?

Phase

2

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Disconnected Database Functionality

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.

Phase

2

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Consumer/Family/Other Care Provider Portals

What “portal” capabilities its software has for outside parties to securely

access the system?

Detail what functionality is available with the various portals.

Phase

2

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Meaningful Use Certification & Compliance Plans

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?

Phase

2

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Experience With Integration With Primary Care

Describe experience with aiding behavioral health providers with integrating with primary care providers through data exchange.

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2

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Cost

• 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

Detail The Cost For Its Software Technology Solution

Provide The Number Of Users To Vendor (Named As Well As Simultaneous) So Vendor Can Respond With Cost Information

Phase

2

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Software Functionality

Ask The Vendor Whether Its Product Supports The Detailed List Of Functional Specifications

• Vendors can indicate Yes/No to the functional specifications list and make comments

Included An Appendix As Part Of The RFP

Phase

2

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Customer Reference Contact Information

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

Phase

2

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Additional Information

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

Phase

2

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Appendices

I. Customer Market Information

II. Pricing Template (Excel Spreadsheet)

III. Functional Specification Checklist

IV. Customer Reference Information Form

Give the vendors 30 days to respond to the RFP.

Phase

2

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Phase

2

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Phase

2

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Phase

2

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Conduct Preliminary Vendor Screening From RFP Responses

Receive all responses from software vendors

Score vendors on how well they meet your

functional needs

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

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Functional Specifications Scoring Example

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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 1 1 1 1 1 1 1

A2.Admission, Transfers, & Discharge Information 1 1 1 1 1 1 1

A3.Standard & Program Specific Consumer Demographic Data 1 1 1 1 1 1 1

A4.Consumer Photo 1 1 1 1 1 1 1

A5.Family & Relationship Tracking 1 1 1 1 1 1 1

A6.Waitlist Tracking 1 1 1 1 1 1 1

A7.Discharge Planning & Referral Tracking1 1 1 1 1 1 1

A8.DSM & ICD Diagnoses 1 1 1 1 1 1 1

A9.Master Individual Service Plans 1 1 1 1 1 1 1

A10.Program-Specific Service Plans 1 1 1 1 1 1 1

A11.Care Provider Tracking 1 1 1 1 1 1 1

A12.Consumer Electronic Signature 1 1 1 1 1 1 1

A13.Staff Electronic Medical Record Signature Standard Compliance 1 1 1 1 1 1 1

A14.Support For Multiple Signature Requirements & Progress Note Roll-Up 1 1 1 1 1 1 1

A15.Configureable Progress, Telephone, & Shift Notes 1 1 1 1 1 1 1

A16.Group Notes 1 1 1 1 1 1 1

A17.Aftercare Monitoring 1 1 1 1 1 1 1

A18.Supervisor Monitoring Tools 1 1 1 1 1 1 1

A19. Internal Referral Process Support 1 1 1 1 1 1 1

Total Score 19 19 19 19

Percentage Score 100% 100% 100% 100%

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Functional Specifications Scoring Example 2

B. Psychiatry, Nursing, & Primary Care Functionality

B1. Medical Conditions, Vital Signs, & Metrics 1 1 1 1 1 1 1

B2. Medication Monitoring 1 1 1 1 1 1 1

B3. Medication Administration Records (eMAR) 1 1 1 1 1 1 1

B4. Electronic Prescription Transmission 1 1 1 1 1 1 1

B5. Preferred Prescription & Orders Sets 1 1 1 1 1 1 1

B6. Links To Medication Information & Drug Interaction & Contraindications 1 1 1 1 1 1 1

B7. Formulary Support 1 1 1 1 1 1 1

B8. Laboratory Interface 1 1 1 1 1 1 1

B9. Laboratory Order Sets 1 1 1 1 1 1 1

B10. Laboratory Result & Medical Condition Alerts 1 1 1 1 1 1 1

B11. Injection Site Monitoring 1 0 1 1 1 1

B12. Pharmacy Inventory For Individual Consumers 1 0 0 1 1 0 0

B13. Pharmacy Inventory For Medication Samples 1 0 0 1 1 0 0

B14. Support For Tracking HEDIS Measures 1 1 1 1 1 1 1

Total Score 14 11 14 12

Percentage Score 100% 79% 100% 86%

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Vendor A Vendor B Vendor C

Weight 1=Yes/0=No Weight 1=Yes/0=No Weight 1=Yes/0=No Weight

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Functional Specifications Scoring Example 3

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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%

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Screening From RFP Responses

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

Phase

2

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Conduct Software Demonstrations & Select Finalists

Develop Likert scoring tool for your staff to use during the software demonstrations

Scoring should be based on core areas of functionality

from RFP

Narrow vendors to 2-3 finalists, based upon both

functionality and user-friendliness

•In most instances, organizations come to a very quick consensus about finalists at this point in the process

Phase

2

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Phase 3:

Vetting Finalists & Making Final Selections

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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

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Phase

3

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Web-Based Technical Reviews

• Determine system configurability

• Reporting flexibility

• Any other technical factors deemed important by your team

Have your technical staff do a web-based “technical review” of the two finalists

Phase

3

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Additional Vetting Of Vendor Finalists

Reference Checks

Current Customer Site

Visits

CEO & Management

Team Interviews

Financial Due Diligence

Phase

3

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Phase 4:

Contract Negotiation & Implementation Preparation

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Contracting

Select the best system available to meet your

needs

Finalize contract and begin implementation

• Some purchasers do this with the 2 finalists

Have the contract reviewed by your attorney

before changes and requests are presented to

the vendor

Phase

4

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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

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Contract Negotiation Tips

Present all major and minor contract change requests along with any pricing changes in a single memo

Determine ‘must-have’ versus ‘desired’ changes

• If both parties have clear, fair, and reasonable requests, the negotiation usually goes very quickly

Keep in mind that you are building a long-term relationship

Phase

4

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II. EHR Costs & Budgeting

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The CEO Perspective On Technology

“We are stuck with technology when

what we really want is just stuff that

works.” - Douglas Adams

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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

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Simple ROI Analysis:

Benefit $750,000

Cost $150,000

ROI Percent 500%

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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

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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

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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

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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

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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.

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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

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Sample Initial Pricing Information for EHR Purchases

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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

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III. Key Elements Of An EHR Implementation

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Four Groups Of EHR Implementation Tasks

• These are the typical elements of an EHR implementation that require time and focus, but are not complicated in and of themselves.Routine Elements

• These are the trickier areas of the implementation require much more attention and can be stumbling blocks if not managed carefully.

Complex Elements

• These are all the final tasks and steps before going-live with the new EHR.System “Freeze” & Final Preparation

• 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.

Expanding & Leveraging the EHR Implementation

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EHR Implementation

Routine Elements

1. Vendor training and implementation

2. Hardware

3. Data conversion

4. Mobile system use

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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

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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

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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?

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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

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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.)

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EHR Implementation

Complex Elements5. Workflows

6. Clinical content

7. System set-up

8. Billing testing

9. Reports

10. Interfaces

11. Meaningful use

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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EHR Implementation

System Freeze & Final Preparation

12. Final workflow testing

13. Training materials and execution

14. Final go-live preparation

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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!

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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

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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

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EHR Implementation

Expanding & Leveraging The EHR Implementation

15. Implementing more features

16. Leveraging data through business intelligence tools

17. Additional clinical and analytic use

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On-Going

Implementing more features

Leveraging data through business intelligence

Additional clinical and analytic use

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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

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IV. Best Practices: Workflow Mapping & Project Management

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Workflow Mapping Best Practices

Standardize Formulize Optimize

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Making The Workflows Standard

Before starting to map services, ensure

that all workflows have standard

• Shapes

• Colors

• Language

• Orientation/Layout

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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

Standardize

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Standard Workflow Shape & Layout Example

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NOTES

Standardize

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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

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Standardize

Form # Form Name Description Workflow 1 Workflow 2 Total

1Referral

Form

Tracking form

completed by upon

receiving referral

X 1

2Consent

Form

Informs clients of

overview of services

and consent for Tx

X X 2

3

Self-

Screening

Form

Assortment of

measures completed

by client at intake

X 1

4Progress

Note

Notes completed

during routine careX X 2

Example

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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

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Formulize

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

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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

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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

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Optimize

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

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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

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Optimize

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

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Sample Clinical Workflow Mapping & Optimization

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Building A Project Plan With Your Vendor & Your Team

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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

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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

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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.)

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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

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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?

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A Best Practice Project Plan Includes . . .

1. 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

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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 (www.basecamphq.com)

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Managing Towards Success, Averting Typical Obstacles

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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. ???

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Questions & Discussion

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