Implementation of an EHR involves much more than software installation. While the vendor usually handles installation- setting up hardware and providing and loading the application software- much of the implementation responsibilities are those of the medical practice. MetaStar, Inc. and DOQ-IT have produced a myriad of resources to assist physicians and hospitals in EHR adoption. Below is an adaptation of an article they produced, which brings up some important points about responsibilities of the medical office during the process of implementing an EHR.
The first step medical practices should take in preparing for implementation is to set up their own issues log. This will help document, manage, and resolve inevitable problems throughout the entire implementation process. The issues resolution log will help you keep track of how long an issue has been outstanding, which may allow you to justify whether or not you make a specific payment to the vendor.
It might be a good idea to include a detailed, or at least basic, implementation plan in your contract with the vendor. This can help assure a complete understanding of the vendor’s proposed implementation strategy and set milestones. Some vendors are reluctant to provide such an implementation plan as part of the contract, but at a minimum you should have an opportunity to review a generic implementation plan from the vendor. Since a generic implementation plan or strategy will not include specific dates, vendor personnel, or the specific details relating to every step in the services provided by the vendor, you should come up with your own detailed plan that contains this information.
First, make a list of all the generic steps that are involved in implementation; then, define your responsibilities and those of your vendor’s based on your contract. With the generic plan, you can meet with your vendor and develop more details. Another element of preparation is collaboration between your vendor’s implementation team and your I.T. staff, operations team, and clinical domain team(s).
To make a detailed project plan you can use a table, spreadsheet, or special project planning software. Project planning software is the most advanced, and incorporates task delineation, task dependency checking, task scheduling and progress, and resource allocation. This software might be helpful because tasks for EHR implementation are rarely linear and frequently modular. Sometimes several tasks will be performed simultaneously on different components.
Your turnover strategy will determine how the EHR functionality will be deployed throughout your organization. You will have to decide on how you will shift from paper to paperless, and if you will implement your EHR completely together, or phased out with certain segments. The vendor might have specific recommendations based on the software you choose.
EHR vendors usually train a core group of your staff and/or super users on the specifics of the product early in the implementation. However, a training plan for the all of the rest of the staff and users is necessary. You will also have to consider how staff will be trained for system/software updates, and how new staff members will be trained. Your training plan must consider how much training the vendor is offering with the standard product and how much more training you may have purchased.
Before going live, you want to test functionalities of the system. You can include this in your master implementation plan, but also develop a separate checklist of every component that needs to be tested, when it was tested, and the results. If the results are not satisfactory, this information is recorded on your issues log and you do not indicate completion of the test on your master implementation plan until the issue is resolved. Your vendor contract should specify the extent to which the vendor is responsible for each type of testing.
You must identify the ways you expect to make improvements with your EHR and share this information with your vendor. The product should accommodate desired changes. The vendor usually has insight into the software capabilities, and may be able to suggest improvements that you didn’t even consider.
These are just the beginning steps in the implementation process. As mentioned earlier, installation, system building, and going live are other major steps of implementation. While the vendor may play the major role in carrying out these duties, the medical office will need to plan for each phase and be involved every step of the way for a successful EHR implementation.