Preparing for Implementing an Electronic Medical Record - Technology Alone is Not the Answer
By Cynthia A. Ethier
Engagement Manager
Beacon Partners, Inc.

While the health care industry is eager to reap the benefits of Electronic Medical Record (“EMR”) implementations, many organizations need to realize that the systems alone will not provide the solution to all of their issues. The implementation of an EMR provides the opportunity to take a look at your organization’s operational processes, clinical workflows, forms and documents, organizational structure, policies and procedures and training programs. A successful EMR implementation provides a chance to identify opportunities for improving operational efficiency, improving patient care and overall effectiveness.

Are we ready to implement an Electronic Medical Record?
The place to start is to assess your organization’s readiness to engage in the overall process. How you plan and prepare will determine success or failure of the implementation. By using the following checklist you can gauge your organization’s readiness to begin tactical planning:

• Are goals and objectives defined?
• Is executive sponsorship in place?
• Do we have the appropriate resources to allocate to the project?
• What operational and clinical processes do we need to improve?
• Are change management and communication plans established?

Goals and Objectives
Defining goals and objectives for an EMR implementation is vital. A sample of goals may include:

• Providing real-time access to patient health record information during the point of patient care (eliminate paper).
• Improved accuracy and compliance with the entry of orders and clinical documentation (decrease medical errors and enhance patient safety).
• Improved efficiency and operation of the organization (eliminate redundancy).

Goals lay the groundwork that drives the implementation process. Goals should have quantifiable milestones that can be monitored. Meeting the goals will be the measurement of success for your EMR implementation. The goals and objectives should be published and communicated to all staff.

Executive Sponsorship
Securing executive sponsorship is imperative to the success of the project. Executive sponsorship should endorse the scope and vision of the project, include an understanding of what it takes to make the implementation succeed, and drive the process, championing the project with a commitment to its cultural and process changes. Executive sponsorship should include the commitment of physician champions and ensure that funding and resources are in place. Staff is the key to a successful implementation, and the commitment to dedicate personnel to an implementation project is necessary to build a strong cohesive project team that allows the organization to achieve its goals.

Resource Allocation
A critical step in the process is building an implementation team. The team should include representation from all pertinent departments. Individual skills may be different but should complement each other. It is also essential that, when taking employees who have never worked together from different areas, they are taught to work as a team. Team building can consist of a simple exercise, such as working on a problem together to strengthen the team and build trust among each member.

The team should be sponsored and empowered by executive leadership and be led by a project manager who is high energy, detail-oriented and well organized. The project manager should have outstanding leadership and communication skills to motivate the team and take your organization from its current state to where it wants to go. In addition, the project manager should handle the day-to-day operations to maintain the project timeline and lead the efforts of the team.

Current State Review
One of the first tasks of the team is completing the assessment phase of the project.

The timeline should begin with an assessment phase, which can provide a comprehensive gap analysis that includes review of the following.

• Current operational workflow processes
• Existing information systems, functionality and use
• Existing interfaces
• Reporting tools
• Manual processes
• Forms and documents
• Organizational structure
• Policies and procedures
• Training and support

Results of a gap analysis will help determine where you are now and what you need to do to accomplish your goals and objectives. By analyzing your current operational and clinical processes and comparing them against your goals and objectives, you can identify areas requiring process improvement to ensure you are complying with Best Practices as appropriate to your organization. Examples of gaps you may identify during your analysis may be redundant data entry, which decreases the efficiency and operation of the organization, or missing patient charts, which prevent access to patient health record information during the point of patient care.

Change Management & Communication
Implementing an EMR also means a change in culture and employee attitude and behavior. It is essential to have a change management process in place to ensure that staff is cooperative and embraces the changes that must take place to ensure a successful implementation. A change management plan for an EMR implementation should include a methodology incorporating the following.

• Communication
• Explanation of the business reasons for change
• The cost and risks of not implementing an EMR
• The positive impact the EMR will have on the organization
• Goals and Objectives
• Involvement of staff
  • people must be involved in the implementation process.
  • people of all levels need to feel a part of the process
• Measurement
  • development of measurement tools
  • beginning measurements
  • ending measurements
• Training
  • workflow
  • system
  • policies and procedures
• Celebrate and recognize the success of the implementation
  • recognize accomplishments
  • reward employees

How do we get from here to there?
We know that change is going to take place and that we must manage this change in a positive way. It is imperative that a change management process is put in place to reduce and manage resistance to the operational and system changes that must take place to improve efficiency and patient care as you implement an EMR. It is important to communicate to all levels of staff why the change is necessary, the business reasons for change and the costs and risks of not changing. People need to understand why activities need to be done differently and the positive impact change will have on the organization. Communication is the thread for maintaining a cohesive environment and preventing employee resistance. Involving staff in the process makes them feel that they are included. Training is the foundation for building knowledge about the change. Awareness training should be conducted for all staff and defined for each audience. People are the key contributors to identifying your current workflow.

Instead of just automating what you are doing, good process redesign should include evaluating your current work flows and needs. Future workflows should be designed to enhance efficiency, reduce redundancy and streamline processes. It is important to understand how the system can assist you to accomplish the improvement in processes. If there is not an efficient workflow, time and money are lost and productivity decreases.

Now we are ready to implement an EMR
By securing executive sponsorship, defining your goals and objectives and conducting a gap analysis, you will be able to identify process improvements. Implementing process improvements and a change management plan must occur in tandem with an EMR implementation to obtain the benefits of success and ensure that you are meeting the goals and objectives of your organization.

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About the Author
Cynthia Ethier is an Engagement Manager with Beacon Partners.

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