1. Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a This material (Comp11_Unit1a) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Migration to an Electronic Health Record System Learning Objectives Describe the process of initial planning, including identification of stakeholders, champions, management and implementation teams, and determining appropriate members for a steering committee (Lecture a) Develop a timeline for choosing and implementing an electronic health record, including defining the scope of implementation, budget estimates, and additional critical steps to build a basic strategic plan for implementation (Lecture a, b) Develop functional requirements, including a workflow analysis and a gap analysis, and recognizing when to bring in expertise (Lecture a) Develop and applying criteria for selecting an appropriate vendor for the electronic health record including (Lecture b): Generate an RFI/RFP Select an appropriate system, including utilizing an appropriate ranking model Generate interface requirements Compare and contrast EHR solutions (e.g. locally hosted versus cloud solutions) Negotiate a contract (Lecture b) Develop a training plan (Lecture b) 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

3. Migration to an EHR Initial planning and project development –Identify of stakeholders –Determine appropriate members for a steering committee –Develop a timeline for electronic health record selection and implementation –Additional critical steps to build a basic strategic plan for implementation 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

4. Developing A Strategic Plan Review the mission and vision of the organization Consider the process of change and also how it will be managed Develop goals that are realistic, measurable and tactical 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

5. Guidelines For A Successful EHR Implementation Develop an effective needs assessment phase Need to have multidisciplinary buy-in Determine an appropriate timeline Plan for and contain costs effectively Manage people and logistics well Need to be flexible and troubleshoot issues that may arise 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

6. Identify Stakeholders Who are the institutional stakeholders? –Management –Project leaders –Clinicians Who are the community stakeholders? –Patients –Families –Policymakers –Public health community 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

7. Build The Team Develop a project team –Team makes decisions for the organization with respect to EHR implementation –Critical to success –Involves careful selection of team members –Needs appropriate leadership Three broad types of people need representation in the project team –Clinicians –Technologists –Administrators (such as project managers) 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

8. Identify Key People A CEO who is invested in the process CIOs and CMIOs with appropriate training and expertise Physician champions Project managers IT professionals with clinical informatics experience Consultants with additional expertise not available to the organization 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

9. Select A Steering Committee This committee has a substantial advisory capacity May oversee the process Needs to be interdisciplinary Members preferably need to have insight into both clinical and technical universes Needs to be representative of the organization’s culture 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

10. Conduct A Needs Assessment Determine the scope of project Identify if constituent units in an organization will individually determine their own needs Identify the critical aspects of EHR utilization that will drive implementation 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

11. Determine The Level of EHR Functionality Needed Tabula rasa or presence of preexisting legacy systems? What needs to be integrated to the new EHR? What current systems (hardware and software) are obsolete? 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

12. Determine The Timeline What type of implementation is planned? –Big Bang approach –Staged implementation approach What type of solution is preferable? –Single vendor solution –Best of breed solution What hardware and software prerequisites must be met? What people need to be hired/ trained? 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

13. Develop Functional Requirements Functional requirements may include: –EHR is Certification Commission for Health Information Technology (CCHIT) certified –Infrastructure has an application service provider (ASP) model –EHR features integrated practice management functionality –EHR is HIPAA compliant –EHR meets meaningful use criteria and is eligible for incentives –Organization owns and controls EHR data –Product integrates with ancillary modules –Vendor has proven track record –Vendor offers EHR upgrades and support –PHR functionality support 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

14. Workflow Analysis Allows examination of how work is being done in an organization Clinical vs. non-clinical workflows Workflows can be mapped and analyzed Allows organizations to optimize workflows Organizations can modify workflows to be more efficient with new EHR Workflow analysis can be used to design a comprehensive training plan (Dykes, 2005) 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

15. Gap Analysis Compares “what exists” with “what will be” Technique for determining the steps needed to transition from the current state to the future state List current characteristics, future objectives, and map factors required to make transition Allows organizations to understand and define what is need to make the change 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

16. When To Ask For Help Internal Expertise –Subject Matter Experts –Technical Experts External Expertise –Hire consultants appropriately based on organizational needs and internal expertise levels (Drazen, 2008) –Learning from other organizations that have gone through selection/ implementation process 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

17. Additional Critical Steps Manage expectations Solicit opinions Elicit buy-in 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

18. Migration to an Electronic Health Record System Summary – Lecture a –Developing a strategic plan –Identifying stakeholders –Building a team –Forming a steering committee –Conducting different types assessments –Determining the level of EHR functionality needed for implementation 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a

19. Migration to an Electronic Health Record System References – Lecture a References Adler, Kenneth. How to successfully navigate your EHR implementation. Family Practice Management, 2007 Feb; 14 (2): 33-39. American College of Cardiology – EHR Optimal Functional Requirements, authored by ACCs Health IT Committee. Accessed at http://www.cardiosource.org/Advocacy/Issues/Health-Information-Technology/ACC-Policies-and- Activities/EHR-Optimal-Functional-Requirements.aspx.http://www.cardiosource.org/Advocacy/Issues/Health-Information-Technology/ACC-Policies-and- Activities/EHR-Optimal-Functional-Requirements.aspx Drazen EL. How To Use Consultants Effectively. Chapter in Carter JH. Electronic Health Records, American College of Physicians; 2nd edition (2008). Dykes P, McGibbon M, Judge D, Poon E. Workflow Analysis in Primary Care: Implications for EHR Adoption. AMIA Annu Symp Proc. 2005; 2005: 944. Example of a workflow assessment checklist from the Arkansas Foundation for Medical Care at http://jeny.ipro.org/attachment.php?s=b0aa327b810e776f0e42cfc3cf7ff797&attachmentid=1336&d=1146666624 accessed on 12/10/2011. http://jeny.ipro.org/attachment.php?s=b0aa327b810e776f0e42cfc3cf7ff797&attachmentid=1336&d=1146666624 HRSA- Developing EHRs: How can stakeholder involvement be encouraged, and what can motivate pediatricians to adopt and use EHRs? Accessed at http://www.hrsa.gov/healthit/toolbox/Childrenstoolbox/DevelopingPediatricEHRs/whatcanmotivitatepedittoadoptehr s.html on 12/10/2011. http://www.hrsa.gov/healthit/toolbox/Childrenstoolbox/DevelopingPediatricEHRs/whatcanmotivitatepedittoadoptehr s.html McClendon, Kelly. “Purchasing Strategies for EHR Systems.” Journal of AHIMA 77, no. 5 (May 2006): 64A–D McGowan J, Cusack CM, Poon EG. Formative Evaluation: A Critical Component in EHR Implementation. J Am Med Inform Assoc2008;15:297-301. 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture a