Avoiding EHR Disasters

1. Leadership and support from the top – Successful EHR implementation requires absolute support from upper management within an organization. Support needs to be unwavering throughout the inevitable “ups” and “downs” of project implementation.
2. Physician Champions and EHR advocates – In order to ensure success, physician and other clinician EHR champions should be identified and recruited. Physician champions serve as the positive driving force for EHR implementation.
3. Set unified goals and realistic expectations for change management – Define objectives up front, and stick to those goals. Workflow changes using an EHR are inevitable and people need to be patient and realize that the transition to an EHR may not be smooth, but in the long run will pay off. Strive for compromise among clinicians in defining common goals.
4. Avoid “vapor ware” – If choosing a vendor system, make sure that the selected vendor system can deliver what it promises by talking to other clients. You do not want to be the beta test site for promised functionality that does not really exist. Be wary of functionality that exists in the “next release of code” or the “next system upgrade” that is not due for several months. Do not believe it unless you can see it.
5. Project management – Effective implementation is dependent upon utilizing a project manager who can coordinate all aspects of the implementation, from hardware to software to testing and training, across clinicians, administrative staff, IT staff and the vendor/s. This individual needs to be an effective communicator dedicated to all aspects of the EHR project.
6. Map out an implementation timeline with flexibility expected – Choose a timeline for implementation milestones with the realization that dates can change. It is important to focus on specific deliverables due by specific dates. If deadlines are offset in an egregious manner, then the project should be reassessed for any serious problems that would prevent success.
7. Involve clinicians and staff in the decision-making process – Involve front line physicians, nurses, and other support staff in the EHR implementation, including the system selection process, workflow definition and process redesign. Engage physician staff in the design of EHR components such as order sets, flow sheet views and documentation templates. Keep people up to date with implementation tasks and progress.
8. Avoid “Scope creep” – Do not be thrown off by requests for added features or functionality that were not part of the original change management goals. Table or “park” those items for post implementation prioritization and review. Freely adding on to the scope of the originally defined work plan creates extra tasks and confusion that may not be attainable within the defined timeframe for implementation. Scope creep throws people off from their goals.
9. Test, Test, Test – The value of testing cannot be underestimated when implementing an EHR. Hardware setup needs to be tested. It is absolutely essential to test new workflows within the context of the new EHR software. Engage front line staff in the testing process well in advance of the EHR go-live date.
10. Train, Train, Train – Successful EHR implementation requires thorough staff training. Tailor training to meet the needs of office staff based on their experience with computers and their role within the organization. Training does not end with the first day of system go-live. Create a group of staff who are system “superusers” that others can go to for immediate assistance, and who can serve as point people for system and process issues that develop post go-live.

This article is available as a pdf handout. Click here to download.

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Attention DOQ-IT Participants Office Systems Survey (OSS) Available Online

If you are a participant in the Doctor’s Office Quality – Information Technology (DOQ-IT) initiative, this is your chance to share your experiences with the Centers for Medicare & Medicaid Services (CMS). The purpose of the survey is to ascertain the progress in implementation and optimization of an Electronic Health Record (EHR) in practices throughout the nation. It is imperative to the DOQ-IT program that no matter what stage the practice is at – from still investigating to providing care management – that your responses are included in this survey.

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Practices Encouraged To Promote The Welcome To Medicare Visit

The Welcome to Medicare Physical, also know as the Initial Preventive Physical Examination (IPPE), is a one-time physical examination that is covered during the initial six-month period following enrollment in Medicare Part B. This Medicare Physical is used to screen for a variety of diseases, including hypertension, diabetes, and heart disease. The goals of the physical exam are health promotion and disease detection.

The comprehensive examination consists of:

• A review of an individual’s medical and social history with attention to modifiable risk factors
• A review of an individual’s potential risk factors for depression
• A review of the individual’s functional ability and level of safety
• An examination to include an individual’s height, weight, blood pressure measurement, and visual acuity
• Performance of an electrocardiogram (EKG) and interpretation of the EKG
• Education, counseling, and referral based on the results of the review and evaluation services described in the previous five components
• Education, counseling, and referral. Including a brief written plan such as a checklist for obtaining the appropriate screening and/or other Medicare Part B preventive services

Support the Welcome to Medicare Visit as another tool to assist you in enhancing the quality of patient care. For additional information and resources visit: www.cms.hhs.gov/WelcometoMedicareExam

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This material was prepared by the Illinois Foundation for Quality Health Care, the Medicare Quality Improvement Organization for Illinois, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. IL-8SOW-PO-207-08/07