1 WHITEPAPER EMR IMPLEMENTATION: SUCCESS DEMANDS A CLINICAL APPROACH
2 The Best Healthcare Providers Begin with the End in Mind. Clinical experts look at a patient and see the whole person, not simply the current illness. This patient-centric treatment view declares, Discharge Begins at Admission. It s imperative we use this same holistic view when implementing, stabilizing or upgrading electronic medical records (EMR). Focusing first on provider buy-in and safe patient care creates an environment that fosters a smooth EMR transition one that delivers safe patient practices and security while ensuring successful end-user adoption. What does the finish line look like? Once EMR implementation is complete, the following should be in place: A sustainable training program that effectively supports staff and their commitment to providing the highest levels of patient care possible. A proficient workforce that demonstrates safe patient care practices through technology adoption that supports department-specific workflows and minimizes workarounds. A roadmap for meeting current and futurestate meaningful use guidelines as well as a strategy for maintaining and tracking meaningful use data for internal employees. EMR Implementation: Success Demands a Clinical Approach 2
3 Keep People in the Equation Achieving the above is accomplished when clinicians are kept in the equation. People drive the success of technology. It s not the other way around. Technology-based solutions should model real world unit- and area-specific workflows for all healthcare providers and work areas, including ancillary departments. The focus should be on patient needs with an eye toward giving providers back their time to perform patient care rather than chart patient care. User reticence can lead to delayed deployments that can jeopardize patient safety. Simply put, system failure (whether human error or technological shortfall) leads to partial adoption and ultimately a loss in confidence of hospital leadership. End-user Adoption and EMR Success Adoption mandates alone are not effective; physicians can refuse to use the system, threaten to take business elsewhere, and in extreme instances can voice their displeasure on social media outlets. Hospital executives can avoid these complications by utilizing strategic change management plans that empower physicians to take ownership of the new technology changes. among staff throughout EMR implementation. Managing perceptions and expectations will ensure that providers understand the overall impact of the EMR implementation as well as the efficiencies and timesaving mechanisms that are built in to decrease their time charting. This whitepaper outlines best practice guidelines with proven results to ensure end-user adoption and EMR success. It is necessary to create and sustain enthusiasm EMR Implementation: Success Demands a Clinical Approach 3
4 I. Creating a Healthy Change Management Culture The Right Outlook: End-user adoption begins day one. Creating and maintaining enthusiasm for change can be difficult. However, the importance of end-user investment in the healthcare setting is paramount. Soliciting feedback from the clinicians and providers involved and providing a steady stream of communication throughout the implementation process is the best way to ensure their involvement. End-user adoption begins the day the EMR solution is selected. EMR system and the implementation process are going to be relevant to their day-to-day patient care beginning the moment the vendor decision is made and the contract is signed. But, a late change management plan is still better than no change management plan. Regardless of where the organization is in the EMR process, a solid change management plan will improve the outcome. Don t wait until a month from implementation to communicate to the staff that EMR is coming. Make sure they understand how the EMR Implementation: Success Demands a Clinical Approach 4
5 The Right People: Choose the team carefully. Put the right people out in front to champion the cause: Executive Sponsorship: This is a requirement for any healthcare IT implementation. If executives are not positively engaged, lack of enthusiasm trickles down, inhibits time to implementation and ultimately jeopardizes patient safety. Physician Champion: A physician champion is not necessarily the chief of staff. It s someone who is highly regarded. It s a physician everyone comes to because they always have that million-dollar answer. The best physician champions are nonconfrontational and comfortable using new technology. Nursing Champion: A nursing champion is not necessarily a chief nursing officer. It s a nurse who is positive and encouraging and has the right personality to not only adapt to change, but to own it. The best nurse champions are experienced in multiple clinical areas with advanced competencies in specific areas. There should be a nursing champion for every department. The Right Timing: Employee change management takes time. The platform of an effective change management plan is a realistic time schedule. The schedule and process documentation should include room for delays. Technology implementations are complex. Hospital workflows are complex. Some implementations take months, not weeks. Plan and budget accordingly. Failure to allow sufficient time for delays can result in staffing challenges, pushed dates and anxiety amongst the clinical staff. EMR Implementation: Success Demands a Clinical Approach 5
6 II. Taking A Clinical Approach to Project Management Clinical Expertise and Workflows: It takes one to know the other. Appoint a clinical expert to lead the project management team. This is the rare individual who understands the technology capability but also the clinical workflow for the system as a whole the overall practices and behaviors that drive patient care. The best way to prevent provider inefficiency is to allow the clinical project manager to guide and direct the team to ensure that the system build reflects department-specific workflows for all end users. It s not enough to have a computer system that is brand new, works appropriately and looks great. Every process for providers must be efficient and prevent lost time. Every minute spent charting is one less minute spent assessing the patient. The Human Touch: Get a relationship guru to lead the charge. The project manager should be a relationship guru. He or she should be directly involved with the change management process throughout the facility. The project manager should be open, direct and encourage feedback, while also being able to remain accountable for the rollout schedule. This typically ends up being an outside consultant who has a complete understanding of the systems capabilities paired with knowledge of common misconceptions, which will prevent costly pitfalls during the full life cycle of the implementation. Excellent project managers understand the need to manage the information exchange between vendor and client. The right clinical understanding and system expertise can validate vendor suggestions and prevent costly adjustments during the build phase of EMR implementation. EMR Implementation: Success Demands a Clinical Approach 6
7 III. Developing an Accurate Workflow Analysis The Written Analysis: Get it down in black and white. Going into an EMR implementation, hospitals often begin with how the system can work, rather than how the system can work within the current workflow. Implementation teams have the capabilities to customize EMR solutions to accurately reflect their hospital s unique patient care processes. Every hospital is different. Yet one thing most have in common is that few have written workflows at the beginning of EMR conversion. Successful EMR requires capturing every workflow scenario: for instance, how a blood transfusion is done or how send-out labs are performed. And since every user can impact billing and charge capture, it s important to align on workflow up front to prevent delays in the revenue cycle. Avoid The Workarounds: Don t teach to technology. Too often hospital teams teach to technology. Getting the staff to follow the system rather than building the system to support the staff is never an effective choice. IT professionals may deem it easier to alter departmental workflow rather than invest time to customize the system to reflect real-life workflow scenarios. Instead, ensure time is taken to collaborate and consult clinicians on accurate workflow analysis. Each decision along the way no matter how insignificant can lead to increased patient safety and more accurate charge capture. The right clinical expertise leading the way in workflow analysis prevents costly errors before they happen. Avoid post implementation workarounds and failed enduser adoption to ensure patient safety and protect the revenue cycle. EMR Implementation: Success Demands a Clinical Approach 7
8 Know What To Change When: Replicate real-life workflows but stay flexible. Workarounds happen when the system build does not accurately reflect the workflow. The key is in knowing what to change and when to roll out those changes. There is always a deployment timeline for successful change. There is room to make changes. Just make sure to have someone at the helm who understands the significance of the change management process and how important the perception of change will be to the end users. Consider hiring clinical consultants from external sources not influenced by vendor relationships and biases. Choose support from experts who have a wealth of experience with a range of EMR solutions and builds and with clinical workflow design. IV. Creating a Clinical Build Doctors And Nurses Need A Voice: Keep a change management outlook in mind. In today s implementations the majority of builders do not have clinical backgrounds. They are IT professionals. Take a different approach and look for system architects who are also clinicians. While the build relies on tech-savvy people, it s also important to ensure the doctors and nurses have a platform. As the implementation team actively engages with each department, the department champions become more than cheerleaders. They are the clinicians who work directly with workflow analysts and design what their department needs will be inside of the new system. Work with the project manager to develop a plan for physicians, nurses and staff to provide feedback throughout the process. Questions should be frequently asked of the staff to engage them in the change. This will fall under the change management plan. Ensure the division heads have strong relationships in their departments. Like the other appointed champions (executives, physicians, nurses), ensure the departmentspecific champions are respected as well as effective in communicating the benefits of EMR. EMR Implementation: Success Demands a Clinical Approach 8
9 V. Ensuring Effective Testing Superior Testing For A Seamless Go Live: Stay clinically focused and incorporate workflows. The value of superior testing is proven in a seamless go-live. Ensure the testers are adept at documentation during the testing phase and in follow-through with the build and operational teams to ensure that workflows can be met. documenting answers surrounding workflow, charge capture, and legal documentation requirements as they explore the pathway for every scenario. At the end of each scenario, the revenue cycle should be evaluated. The combined clinical experience and IT expertise of testers provides additional scrutiny beyond a typical scenario-based testing phase. They are asking questions and EMR Implementation: Success Demands a Clinical Approach 9
10 VI. Developing a Training-Needs Assessment, Instructional Design and Delivery Training-Needs Assessment: Invest time and money up front. Staffing is money. Spend money up front on the training assessment to produce a schedule that matches departmental needs and minimizes staffing shortfalls during the training phase itself. A great training schedule should avoid including travel or agency nurses. Save any travel or agency nursing budgets for the go-live period. Typically, hospitals tend to skip or misfire on the training-needs assessment. They frequently rely on their own understandings of how training typically works in their facilities. The risk is revealed when at the last minute departments have staffing shortages. The extra dollars often come out of department budgets. Managers get dinged for going over budget. This puts a dent in enthusiasm for change management going forward and is an unnecessary cost that could be deferred by performing a training-needs assessment up front. Instructional Design and Training Delivery: Mirror the workflow and inspire confidence. When the right investment has been made, nothing compares to a clinician instructor-led, classroom learning environment. Maintain enthusiasm for change management by inspiring confidence in training delivery. This is crucial to keep the anxiety level low among the end users. The instructional design should always reference the workflow analysis. No trainer should ever say, Well, this is just training. In the real world Invest in quality clinicians who can communicate the EMR benefits in real-world scenarios and avoid hiring larger numbers of less-qualified personnel just to get the job done quickly. Training is a decisive factor in EMR success. Health systems struggling with adoption are losing money. An inadequate training program is not good for the facility, the providers or patient care. EMR Implementation: Success Demands a Clinical Approach 10
11 VII. Conducting Pre-Go-Live Assessment and Planning Team Readiness: Get up close and personal. Adoption is most successful when the physicians and nurses are as efficient as possible from day one of go-live. But they have to get familiar with the system first. There are hundreds of customizable options and personal preferences in each EMR system. Find the right people to coach the staff ahead of time on the personalization aspect. Sell them on the flexibility of the system and empower them to get personal with it. Customization labs are the way to achieve this. helps illustrate to users how the EMR system will ultimately support and streamline the documentation aspect of patient care. By setting up provider-focused lab environments (accessible to but separate from patient care areas), hospitals demonstrate investment in their people. Make the lab about them, accessible to them and let it demonstrate that leadership understands that their time is valuable. A clinical trainer should host each lab. Customization labs enable physicians to set system personal preferences prior to go-live. This makes for a more efficient go-live and Sufficient Support: Finding the right balance. Pre-go-live assessment is also about getting the right balance of go-live support. Ensure there are enough people available to help, but not so many that patient safety is jeopardized. A thorough pre-go-live assessment uses predictive analytics and site visits including feedback from the clinical units and managers to determine appropriate support levels. Some of the factors considered include department turnover rates, identification of revenue markers, and accounting for repetitive workflows. Pinpoint areas where support can quickly be reduced post go-live and understand which areas may require additional resources. If the number of end user interactions that exist in each department is documented, the right resources can be sent to the right areas and scale back can occur sooner without decreasing end-user confidence. EMR Implementation: Success Demands a Clinical Approach 11
12 VIII. Providing Effective Go-Live Support Hands-on Support: You don t know what you don t know. The change management approach and its effectiveness are put to the test at system go-live. Motivation and communication matter. Rarely do hospitals achieve a seamless go-live without calling in outside support. All consultants are not the same; the combination of clinical experience and software expertise is the defining difference between value added and wasted funding. Set up an onsite command center and continued elbow support for departments. Resources are allocated based on the results of the pre-go-live assessment. Support is best provided by clinicians with firsthand knowledge of the units workflows and extensive expertise with the software being implemented. Get involved in the hiring process. Know that the personnel being brought in will be the right fit for the organization. Ensure they are experienced clinicians with excellent communication skills. Ask to see a sampling of resumes. Be involved in some of the consultant interviews. Ensure they are knowledgeable clinicians who are also personable and professional. The consultants should deliver feedback in a timely manner from lists of staff members who may need additional training to input on insufficient workflow processes. Determining mission critical fixes and compiling lists of requested enhancements is essential to ensure that the command center resources are deployed appropriately during go-live. Analysis continues through go-live to provide the opportunity to make adjustments in real time. EMR Implementation: Success Demands a Clinical Approach 12
13 IX. Delivering Post-Go-Live Support Keep the experts on hand and within reach. Implementation could span months. Once the implementation command center closes and the core team has departed, maintaining post-go-live support ensures a smooth transition into ongoing successful end-user adoption. Onsite support gives way to a remote help desk, a small contingent of elbow support, or a combination of both. The help desk should remain open until the workforce is proficient until they deeply understand the software, the workflows and how they work together. Then they will be meaningful users. There is great importance in having a dedicated team of software and workflow experts that can be available 24/7 whether that s an internal team or an experienced staff of clinical implementation consultants. Keep the confidence and positive attitude of the staff; prevent burnout and increase retention by ensuring that they have help when they need it. EMR Implementation: Success Demands a Clinical Approach 13
14 Conclusion The first priority of every EMR system implementation, optimization and upgrade is patient safety. When hospitals begin with the end in mind, foster a healthy change management culture, and lead with a clinical approach, the road to successful EMR implementation is less rocky. Once again, successful EMR is marked by the following attributes in place: A proficient workforce that demonstrates safe patient care practices through technology adoption that supports department-specific workflows and minimizes workarounds. A roadmap for meeting current and futurestate meaningful use guidelines as well as strategy for maintaining and tracking meaningful use data for internal employees. A sustainable training program that effectively supports staff and their commitment to providing the highest levels of patient care possible. Want to learn more about how our clinical approach to EMR implementation can preserve safety and security while delivering successful end-user adoption? Call Judge Learning Solutions at or visit Judge.com. EMR Implementation: Success Demands a Clinical Approach 14
15 About Judge Learning Solutions Judge Learning Solutions provides qualified clinicians as well as certified IT professionals to hospitals in order to create effective change management, ease transition to EMR adoption and ensure clinicians understand the connection between use of the electronic medical record and safe patient care. Dedicated to consistency and quality, Judge consultants provide a vast array of clinical skills matched to client s needs, ensuring the right balance of technical skill and clinical workflow knowledge at every implementation site. At the completion of every engagement Judge Learning Solutions clients have adopted EMR systems which incorporate clinical workflows, created training programs which are sustained by their internal training teams, developed a workforce that is proficient with the software and workflows, and are working toward meeting the meaning use guidelines. About The Judge Group The Judge Group is a leading professional services firm specializing in technology, talent and learning solutions. Our services are successfully delivered through a network of more than 30 offices in the United States, Canada and China. Privately owned and headquartered outside of Philadelphia, The Judge Group serves more than 30 Fortune 100 companies. It is responsible for the placement of more than 4,500 professionals annually across a wide range of industries. Working at the crossroads of people and transformative technologies, The Judge Group delivers innovative business solutions powered by top talent to help organizations reach their strategic goals and realize opportunities now and in the future. Copyright 2014 The Judge Group, INC. All Rights Reserved. EMR Implementation: Success Demands a Clinical Approach 15
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