Download the EHR Implementation RoadmapTo help guide physicians through the EHR implementation process and assist in determining which of the many applications is best suited to the needs of their practice, IPRO is providing implementation support, at no cost, to physician practices.
The milestones of IPRO's process are based on important principles of change management, as well as the cumulative experience of hundreds of small- to medium-sized practices around the country that have made the move to an EHR system.
The EHR Roadmap is divided into six stages of implementation:
Each stage is then sub-divided into three sections:
In this stage, the process is to evaluate the practice and create an environment from which successful implementation can emerge. The practice begins to prepare for change and evaluate its existing situation in terms of staff skills, hardware/software inventory, communications and practice procedure workflows. By identifying shortfalls and efficiencies, the practice can determine a focal point on which to target its efforts for change. Shortfalls, i.e., patient check-in/check-out or prescription refill procedures, should be addressed, redefined and improved before implementation begins. (Approximately 60 Days.)
The second stage builds on the workflow efficiency efforts of the previous stage and expands on the idea of lean business processes. Drawing on work from the Dartmouth Clinical Microsystems ideology, among others, the practice will redesign any identified bottlenecks and inefficiencies. In addition, the EHR goals are defined and an introduction of EHR definitions is explored. Practices are also encouraged to examine quality improvements and patient self-management procedures. (Approximately 60 Days.)
The previous two stages help create a strong foundation and business process into which an EHR system can be integrated. An EHR system should fit into and complement an efficient practice; an inefficient practice should not be crammed into an EHR system. This is not a computerized panacea. The selection stage walks the practice through the various steps in evaluating, analyzing and selecting an appropriate EHR system vendor. A short list is determined; from there, more detailed comparisons can be made, with the ultimate goal of selecting the vendor most compatible with the practice. Demonstration and evaluation techniques as well as vendor contract negotiations are also covered. (Approximately 120 Days.)
Stage four is principally between the selected vendor and the practice. The vendor will set the expectation of the implementation project and provide a time frame and plan for each step of the installation. At this point, we introduce more detailed approaches and evaluations of patient self-management and quality improvement, which can be enacted as the EHR system comes online and the practice begins to build a patient database. This is also a very hectic time for the practice, so good communication is strongly encouraged. (Approximately 150 Days.)
Once stage four has been concluded, it is time to review and evaluate the implementation. This stage will provide guidance in evaluating how successful the new EHR system has been at addressing the goals of the practice. Any missed items should be addressed and corrected before continuing. This is also a good starting point for practices that have recently adopted an EHR system into their practice. (Approximately 30 Days.)
The final stage addresses the post-implementation side of DOQ-IT. We will focus on ways to enhance quality improvement by taking advantage of the EHR system capabilities. The roadmap begins to shift emphasis from IT toward quality improvement and patient self-management. With an EHR system in place, and populated with patient data, the practice can begin to build a chronic care management system and patient database. This stage is essentially the beginning of a practice evolution: from passive patient care (seeing patients when they are ill and visiting) to proactive patient and physician engagement (patient self-management and preventative health care). Some practices will prepare data for submission to a Centers for Medicare & Medicaid Services (CMS) data warehouse, as required by the DOQ-IT project. (No timeframe; ongoing process.)
In the early stages of the DOQ-IT project, the emphasis is on preparing, selecting and implementing an EHR system. The IT sub-stage details and guides the user through the various steps that are required to ensure a successful installation and vendor relationship. As the project evolves and the EHR system comes online, the emphasis shifts to making the most of the new technology for practice and health care quality improvement (QI).
Successful projects all have strong leadership. The early stages in this sub-section emphasize the importance of leadership, clear and open communication and system redesign. Building a good foundation allows future improvements to be more successful, as failing systems and inefficiencies are revised and corrected. An EHR system permits the practice to shift its focus from paper chart chasing and other reactionary processes toward value-added and expanded services. The latter stages concentrate on quality improvement and ways to utilize the EHR system to enhance patient care.
Much medical literature and academic thinking has begun to revolve around the idea of building a productive patient and physician relationship or health care partnership. The third sub-section provides guidance on patient communication and education techniques. Empirical research shows that patient engagement, involving the patient in his or her own health care management, results in noticeable improvements in patient health. With the inclusion of an EHR system, data collection, reports and patient instructions can quickly be produced and provided to support patient action plans.
Download and use the complete EHR Roadmap.