1. Migration to an Electronic Health Record System
Component 11/Unit 1-1
Migration to an Electronic Health Record System

2. Migration to an Electronic Health Record System
Electronic Health Record Life Cycle:
User Needs Assessment*
Proto type Development*
System selection*
System implementation
Maintenance
* Covered in this unit
This is the first part of unit 1 Migration to an Electronic Health Record System.
We will be discussing the Electronic Health Record Life Cycle:
User Needs Assessment*
Proto type Development*
System selection*
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

3. How To Begin Migration to an EHR
Develop a Strategic Plan Including the Migration to an EHR
Review the Mission and Vision of the Organization
Make modifications if necessary that will move the organization towards a quality EHR to improve patient care
Develop goals that are reasonable, measurable and tactical
Describing the planned migration to the electronic health record including
An effective needs assessment phase,
A strong migration steering committee that is inclusive of user needs
An understanding that this is an ongoing process
Developing a timeline for choosing and implementing an electronic health record
Assuring the financial and human resources to plan, select, implement , and maintain an EHR
How to begin migration to an EHR
Develop a Strategic Plan Including the Migration to an EHR
Review the Mission and Vision of the Organization
Make modifications if necessary that will move the organization towards a quality EHR to improve patient care
Develop goals that are reasonable, measurable and tactical which are
Describing the planned migration to the electronic health record including
An effective needs assessment phase,
A strong migration steering committee that is inclusive of user needs
An understanding that this is an ongoing process
and
Developing a timeline for choosing and implementing an electronic health record
As well as
Assuring the organization has the financial and human resources to plan, select, implement , and maintain an EHR
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

4. Health IT Workforce Curriculum Version 1.0/Fall 2010
User Needs Assessment
Each organization will need to determine what the needs are for an EHR
Some organizations will have components of an EHR while others will be starting at ground zero
To receive federal funding, though, certain components will be mandatory to each system (see meaningful use unit)
In this unit, we will focus on the basic principles guiding migration to an electronic health record
User Needs Assessment
This refers to the process of identifying the system technology and software that is needed to advance to an EHR
Each organization will need to determine what the needs are for an EHR
Some organizations will have components of an EHR while others will be starting at ground zero
To receive federal funding, though, certain components will be mandatory to each system (see meaningful use unit for more information on this)
In this unit, we will focus on the basic principles guiding migration to an electronic health record
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

5. User Needs Assessment Tools
A needs assessment is part of a basic management tool set which will be effective in the decision-making process of migration to an EHR
Many tools are available from the state quality improvement organizations, regional extension centers, consultants, and vendors. An example of a toolkit which includes needs assessment is from Stratis Health the QIO for Minnesota.
User Needs Assessment Tools
A needs assessment is part of a basic management tool set which will be effective in the decision-making process of migration to an EHR
Many tools are available from the state quality improvement organizations, regional extension centers, consultants, and vendors. An example of a toolkit which includes needs assessment is from Stratis Health the QIO for Minnesota.
It is the intention of this unit to acknowledge that there are assessment tools available from many sources. An individual organization will need to find a tool that best suits their facility.
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

6. Proto-type development
Each organization will need to evaluate their specific needs to migrate to an EHR.
Remember, each organization is unique.
Some organizations have basic electronic functions such as billing and coding, scheduling and no clinical documentation ( patient progress notes, lab results) In other words it is a “paper medical record.”
Some organizations will have hybrid EHRs with some scanned documents and some electronic systems, e.g. pharmacy, lab results, radiology results
Some organizations will be completing electronic with online documentation systems for all providers, online order entry systems, and integrated lab, radiology, etc, systems. These are referred to as “paperless.”
Proto-type development
Each organization will need to evaluate their specific needs to migrate to an EHR.
Remember, each organization is unique.
Some organizations have basic electronic functions such as billing and coding, scheduling and no clinical documentation ( patient progress notes, lab results) In other words it is a “paper medical record.”
Some organizations will have hybrid EHRs with some scanned documents and some electronic systems, e.g. pharmacy, lab results, radiology results
Some organizations will be completing electronic with online documentation systems for all providers, online order entry systems, and integrated lab, radiology, etc, systems. These are referred to as “paperless.”
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

7. Proto-types: Start Where You Are
No electronic systems: at ground zero
Legacy Systems: computerized systems that were developed by the organization’s staff
Legacy Systems with some vendor solutions: systems that have added on components with the legacy systems with no/some interoperability
Vendor systems: vendors systems used to develop computerized and/or electronic systems
Start where you are: Organizations will vary with the type of technology/software.
There are organizations with No electronic systems and they will be starting at ground zero in migration to an EHR.
Others may have Legacy Systems: computerized systems that were developed by the organization’s staff over a period of years
Then, there are organizations that have Legacy Systems with some vendor solutions: systems that have added on components with the legacy systems with no/some interoperability
Other organizations have one Vendor with many integrated systems: vendors systems used to develop computerized and/or electronic systems
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

8. Health IT Workforce Curriculum Version 1.0/Fall 2010
System Selection
The development of ongoing systems towards the migration to an EHR includes decision making about potential new systems
Developing a project team to make decisions for the organization
Critical to success
Involves careful selection of team members
Needs leadership
System Selection
The development of ogoing systems towards the migration to an EHR includes decsion making about potential new sytems
Developing a project team to make decisions for the organization is critical to success, involved careful selection of team members, and needs leadership.
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

9. Migration Project Team
Migrating to an EHR needs leadership
“Study after study on EHR implementation reports the same thing: People are key, and leadership is one of the biggest issues. An EHR project needs three kinds of leaders: a physician champion (or two or three), a CEO and a skilled project manager.” (Adler)
The project needs someone with information management skills. This may be the champion of the project, and information technology professional in the organization, a vendor or consultant or a combination of team members who are interested in migration.
Migration Project Team
Migrating to an EHR needs leadership.
Adler said "Study after stufy on EHR implementation reports the same thing: People are key, and leadership is one of the biggest issues. An EHR prject needs three kinds of leaders: a physician champion (or two or three), a CEO and a skilled project manager."
The project needs someone with information management skills. This may be the champion of the project, an information technology professional in the organization, a vendor or consultant or a combination of team members who are interested in migration.
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

10. Choosing the Migration Team
Champions
All clinical areas affected
All ancillary areas affected
Non-clinical areas that use data collected
Change agents
Technology specialist
Work flow analysts
Developing a team for the migration project includes finding
Clinical and non-clinical champions– those that will encourage others in the organization to move towards an electronic environment.
Included all clinical and ancillary areas affected by the change is essential to understanding everyone’s needs. The medical record has always been communication tool for the health care team, but not all practitioners understand one another’s data needs or roles.
Many end-users of the documentation collected need to be a part of the project team as well.
The team should be made up of change agents, those that see the need to move forward and are willing to deliver on the goals and objectives of the strategic plan for an EHR. This may include those that will be developing the organizations change management program as well.
Initially, in house information technology specialists should be involved in the team’s work. After a vendor is selected, it is common to include a vendor consultant to the team as well.
Including work flow analysts on the team will provide the team with insightful information about the processes for changing work environments. Planning for an EHR is not just about the software/hardware. It is about the flow of information, and those using the systems.
When we refer to “users” of the system this includes clinicians and non clinicians, and everyone work flow.
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

11. Responsibilities of the Team
Conduct needs assessment
Develop/ support efforts for the Request for Information/Request for Proposals
Develop criteria for selection of system
Only include vendors that meet ONC criteria for a certified EHR
Develop additional criteria that will support the needs of your organization
Recommend through discussion/decision-making (or delegation)
Big bang or not (with work-flow analysis)
Vendor selection (seeing presentations of systems, making visits to other facilities that have them)
Ongoing training prior to, during, and after implementation (this includes addressing change management concerns as well as system training)
Here are some common responsibilities of the team. These responsibilities may be delegated to other’s in the organization, but the project team orchestrates the process:
Responsibiities of the Team
Next, develop and/or support efforts for the Request for Information/Request for Proposals
First, the team should conduct a needs assessment that will determine what type of system is needed to fulfill the needs of the users of the EHR
Remember to only include vendors that meet ONC criteria for a certified EHR
When writing the RFP, develop criteria for selection of a system.
The project team must spend enough time reviewing the needs analysis, dicussing the pros and cons of doing a "Big Bang" approach or a more system by system implementation. Doing some preliminary work flow analyis of a few areas, may help to determine the readiness of the users and the environment. Before making a decision about a particular vendor, it is important to have adequate demonstrations of the system with all stakeholders. It is best to visit other sites that have used the system to see it in action.
Rember to develop additional criteria that will support the needs of the organization
Ongoing training prior to, during, and after implementation is very important to the success of an implementation.
Although the project team may delegate some of the work that needs to be done, the team needs to keep very involved in the process so that when a decision needs to be made about the system selection, they will be able to do so with confidence.
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

12. What is a Request for Information?
A Request for Information (RFI) is a tool to ask vendors about their products
In an EHR it is important to find vendors who are certified by the Office of the National Coordinator (see meaningful use)
The person(s) that manage the electronic systems at an organization use the RFI to keep abreast of current vendors and their products and how they could meet the organization’s needs
What is a Request for Information?
Later in this unit, we will discuss in more depth the use of request for information and request for proposals.
To begin with though, some basic information may be helpful.
A Request for Information (RFI) is a tool to ask vendors about their products
In an EHR it is important to find vendors who are certified by the Office of the National Coordinator (see meaningful use)
The person(s) that manage the electronic systems at an organization use the RFI to keep abreast of current vendors and their products and how they could meet the organization’s needs
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

13. What is a Request for Proposal?
A request for proposal (RFP) is an open request to vendors for specific answers to the needs of an organization
Remember, each organization is unique.
Some organizations have basic electronic functions such as billing and coding, scheduling
Some organizations will have hybrid EHRs with some scanned documents and some electronic systems, e.g. pharmacy, lab results, radiology results
Some organizations will be completing electronic with online documentation systems for all providers, online order entry systems, and integrated lab, radiology, etc, systems
What is a Request for Proposal?
A request for proposal (RFP) is an open request to vendors for specific answers to the needs of an organization
Remember, each organization is unique.
Some organizations have basic electronic functions such as billing and coding, scheduling
Some organizations will have hybrid EHRs with some scanned documents and some electronic systems, e.g. pharmacy, lab results, radiology results
Some organizations will be completing electronic with online documentation systems for all providers, online order entry systems, and integrated lab, radiology, etc, systems
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

14. Health IT Workforce Curriculum Version 1.0/Fall 2010
Developing the RFP
The team will develop criteria to evaluate an RFP.
Criteria should include questions and a rating system for items such as:
Specification of vendor system
How the vendor meets the meaningful use criteria and federal certification process
Cost for implementation
Interoperability issues with current system
Vendor support in planning, implementation and post-implementation phase
Developing the RFP
Criteria for an RFP will include many different items. The list included in this slide is not inclusive of all criteria. The project team will develop a list of criteria and a rating scale to help with the process of decision-making. An RFP alone is not the decision-making factor. The project team will want to have vendor demonstrations of products, in depth discussions of cost/benefit of the product. But the RFP is an important step in the process.
In your assignment for this unit, you be given several RFP's from health care to review. Or you may seek out an RFP on the internet or within an organization you work with. This will give you an exposure to the depth or the RFP. Later in the unit you will continue your study of the RFP in greater detail.
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

15. RFP’s : Legal Documents towards the Migration Process
An RFP answers the questions of how a vendor, (its system products and services) will meet those individual organization needs
It should include a summary of
costs for new/ upgrading hardware,
Software including interface and system software
Training pre-implementation, during implementation, and post training
Support of project from beginning to post implementation
implementation methodology
Post implementation assessment tools
Since the RFP eventually leads to a legal contract, it is an especially important document to the organization and to the vendor
RFP's" Legal Documents towards the Migration Process
An RFP answers the questions of how a vendor,will meet the individual organization system needs
It should include a summary of costs for new/ upgrading hardware,software including interface and system software, training during pre-implementation, during implementation, and post training
It should also address support of project from beginning to post implementation
It needs to state the implementation methodology and post implementation assessment tools
Since the RFP eventually leads to a legal contract, it is an especially important document to the organization and to the vendor.
This ends the first part of unit 1 Migration to an EHR
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010

16. Health IT Workforce Curriculum Version 1.0/Fall 2010
Resources: Adler, Kenneth. How to successfully navigate your EHR implementation. Family Practice Management, 2007 Feb; 14 (2): Valerius, Joanne. The electronic health record: what every information manager should know. The Information Management Journal January/February, 2007, The RFP Process for EHR Systems. Journal of AHIMA 78, no. 6 (June 2007):
Resources: Adler, K. How to successfully navigate your EHR implementation. Family Practice Management, 2007 Feb; 14 (2): Valerius, J. The electronic health record: what every information manager should know. The Information Management Journal January/February, 2007, The RFP Process for EHR Systems. Journal of AHIMA 78, no. 6 (June 2007):
Component 11/Unit 1-1
Health IT Workforce Curriculum Version 1.0/Fall 2010