Once you have made the decision to implement health information technology (IT) into your practice and have undergone extensive assessment as well as detailed evaluations of health IT providers, you are ready to create a work plan to guide your practice through the implementation of the selected technology/ies.
Conduct as much front-end analysis as possible—especially for hardware (it can be difficult to reconfigure network arrangements after the fact) and staff preparation (you will need all hands on deck for this transition). Transition planning should be detailed, but flexible, too. Prepare for decreased productivity, workflow disruption, errors and roadblocks, initially.
Planning workflow processes
You already have detailed information about your practice’s workflow and the way information moves throughout your office, etc. (1) Use your workflow to help plan the location of PCs, assign tasks and train your staff. (2) Make a diagram and change or accommodate the flow of information from task-base to task-base, accordingly. (3) Make a contingency plan for clinical documentation and information retention in case you run into significant problems. A backup plan should already be a part of your system. (4) Develop a plan for handling paper charts and a system for archiving records.
In allowing and promoting culture change, remember that people adjust at their own pace. Be sure to plan how you will work through this process with your staff and your patients. To help the transition, make sure each member of your staff is comfortable with the tasks they will be performing and that they have practiced them in advance. Inform patients long before you actually “go live” that you are planning to move to a digital format. Send letters to patients and prepare your staff to answer questions and communicate the change.
To prepare for implementation you will need to allocate staff resources. There are four primary roles that you will need to fill immediately:
- Lead physician
- Project manager
- Analyst (note: for a very small practice the analyst role may be assigned to the project manager; for larger practices you may need to assign additional people to assist the analyst)
- Super-users (one physician and one staff member with advanced EHR skills and the ability to help others)
Implementing a complete electronic health record (EHR) system or key EHR modules forces significant changes in the way a practice does business. The lead physician, in consultation with the project manager and vendor, must decide if the software will be implemented in stages or all at one time (“big bang”). Here are some pros and cons for a staged approach:
- Builds momentum in practices where there is no pro-EHR consensus
- May prevent productivity losses
- Limits implementation pains to one function at a time
- Allows for time to fix kinks in workflow and process changes
- Increases potential for getting stuck partway through implementation
- Can be exhausting
- Hybrid paper/EHR system is confusing
There are many ways to phase in the use of your EHR (see grid below). Consult with your vendor and similar practices that have already gone through the process for tips and best practices. Ultimately, the key is to think it through thoroughly and have a written plan.
Start with one patient on the first day and document the entire visit. Add a few more patients per day until all patients are on.
Start with your most enthusiastic provider. Add one provider per week until all are using the system(s). This enables you to work out the kinks for the less enthusiastic providers.
Start with certain functions in the EHR such as patient scheduling, registration, ePrescribing, order entry, visit documentation, etc.
Start with phone calls, prescriptions, billing, injections, labs, visit documentation, etc. Isolating individual processes can make the transitions seem less daunting.
If your practice generally has a full schedule, you will need to accommodate some type of schedule reduction. How much of a reduction will depend on several things, such as the complexity and amount of health IT you are implementing, how well you are trained, how much you’ve practiced before your go-live date, and how well your system is configured to help you be both good and fast using the EHR during a patient visit.
Estimate of productivity reduction during go-live
50% reduction—weeks 1 and 2
30% reduction—weeks 3 and 4
15% reduction—weeks 5 and 6
Think about how long you want to have vendor-provided tech support and trainers on-site after implementation. Plan financially to use them longer if needed. Make sure your practice’s “super users” are ready to help nervous staff through their first weeks.