Configuring Electronic Health Records

1. Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b This material (Comp11_unit1b) 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) Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

3. Migration to an EHR • Develop and applying criteria for selecting an appropriate vendor for the electronic health record including: • Generate an RFI/RFP • Select an appropriate system • Generate interface requirements • Compare and contrast EHR solutions • Negotiate a contract • Develop a training plan Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

4. Identify The Leaders • Who will make the decisions regarding system purchasing and implementation? • Who are the champions? • Who will manage the process? Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

5. Select Requirements Specifications • This stage asks “what elements of the EHR are needed?” • Essential in the vendor selection process • Helps to determine what is essential • An RFI (Request For Information) can be issued if more information needed • a tool to ask vendors about their products Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

6. Write the Request For Proposal (RFP) • A request for proposal (RFP) is an open request to vendors • Tells vendors what they need to know about an organization • Allows vendors to respond with information about their product • Criteria should include questions regarding: • Specification of vendor system • Meeting meaningful use criteria and federal certification processes • Cost for implementation • Interoperability, especially with a legacy EHR system • Vendor support in planning, implementation and post-implementation phases Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

7. The RFP (continued) • An RFP answers the questions of how a vendor will meet individual organization needs • It should include a summary of • Costs • For new/upgraded hardware • For software, including interface and system software • Training • Support of project from beginning to post implementation • Implementation methodology • Post implementation assessment tools Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

8. System Selection • Selection process based on responses from RFP • Need to narrow the field of contenders before demonstrations • Does product meet requirements? • Does product have favorable ratings? • Is product suitable for size and operations of organization? • Schedule vendor demonstrations • Prepare a selection tool (ratings form) • Have vendors demonstrate scenarios in addition to features • Check references, discuss with other organizations that have used the vendor’s product • Rank vendors • Conduct site visits – if site visit is not possible, talk with other organizations remotely (Lorenzi, 2009) • Select the final vendor/product Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

9. Interface Requirements • An interface integrates an EHR with other software or software module • Need to specify interface requirements • Specify interaction with disease registries or health information exchanges • Interface with laboratory or practice management modules Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

10. Comparing EHR Features • Every EHR has a feature set • Identify essential feature sets • Specify the desirable characteristics of the feature • Contrast comparable feature sets between EHRs Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

11. Negotiating A Contract • Define terms • Negotiate product features • Have a Best Alternative to a Negotiated Agreement (BATNA) • Obtain legal assistance! Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

12. Developing A Training Plan • Analyze workflows • Different types of training • Live (in person) • Online (distance) • Different learning groups • Large groups • Small groups • One-on-one Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

13. Developing A Training Plan (continued) • Different Types of Sessions • In a classroom • At-the-elbow • Different timings for sessions • During work hours • During evenings, nights and weekends • Different models of compensation • CME for providers • RVUs for providers Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

14. The Culture Of Change • Develop an organization development (OD) plan • Manage people and technology • Ensure cooperation and “buy-in” of all users • Identify champions and super users • Develop a training plan Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

15. Change Management • Who will lead the process of change management? • What will be the components of the change management program? • When will the program be implemented? • Where and in what ways will the discussion about change take place? • How will the program be operationalized? Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

16. Leading The Process Of Change • Change occurs at the very beginning of the process • Include all employees in the changes that are anticipated • Change continues after EHR implementation • Focus on communication • Listen to employees • Encourage respect between people • Operationalize the change process using teams and tools • Manage expectations Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

17. Migration to an Electronic Health Record SystemSummary – Lecture b • Vendor selection • RFI and RFP generation • System selection • EHR solutions – compare and contrast • Contract negotiations • Training plan Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

18. Migration to an Electronic Health Record SystemSummary The process required to move an organization from a paper-based health record to an electronic health record system or from one electronic health records to another: • Aspects of initial planning • How to determine a timeline for system selection and implementation  • How to develop a set of functional requirements, a workflow analysis, a gap analysis, and recognize when to bring in expertise. • The process of vendor selection, and identified criteria to be used to generate a request for information (RFI) and request for proposal (RFP). • Developing interface requirements and selecting an EHR • The basics of contract negotiation, training plan development, and change management • Change management strategies Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b

19. Migration to an Electronic Health Record System References – Lecture b References Abdelhak, A, Grostick, S, Hanken, M, Jacobs, E. Health Information: Management of a Strategic Resource, 4th Edition: Saunders. Adler KG. How to select an electronic health record system. Fam Pract Manag. 2005 Feb;12(2):55-62. Amatayakul, Margret K. Electronic Health Records: A Practical Guide for Professionals and Organizations. 4th Edition. AHIMA. Johns, M. PhD, RHIA. Health Information Management Technology: An Applied Approach 2nd edition AHIMA Press 2007. Lorenzi, N, Kouroubali, A, Detmer, D, Bloomrosen, M. How to successfully select and implement electronic health records (EHR) in small ambulatory settings. BMC Medical Informatics and Decision Making, published on line 2009, v 9, 15. Lowes R. EMR Success: Training is the Key. Med Econ 2004 May 7Z;81(9):TCP11-4. The RFP Process for EHR Systems. Journal of AHIMA 78, no. 6 (June 2007): 73-76. Updated version at http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961 accessed on 12/11/2011. Configuring Electronic Health Records Migration to an Electronic Health Record System Lecture b