Summary
Technological advancement is one of the phenomena taking shape globally. It is considered the best mechanism for speeding up Workflow in an organization. Healthcare systems worldwide have been criticized for failing to meet community needs, especially during the pandemic, as was witnessed recently.
Health practitioners spend too much time on paperwork as patients wait in long queues. These and other challenges necessitated the innovation of Electronic Medical Records (EMR). The system can integrate paperwork containing patient information into software-based services or components and share data through the individual end-user’s organizational structure.
Leo Pediatric Center (LPC) is one of the facilities, which have recently approved the implementation of EMR to help fast-track its operations. The project is in line with its short-term and long-term strategy to minimize carbon footprint and promote the ongoing green initiative. It can give patients the ability to self-service and ensure their information is secure. Once the EMR project goes live, all the center teams, including clients, will extract data, visualize care, and prevent time wastage by avoiding unnecessary visits.
Introduction
To compete successfully in modern markets, organizations should embrace and explore opportunities resulting from new technologies. Care delivery, patient safety, and health providers are vital in ensuring sustainable health facilities. As such, improvement at the LPC will ensure challenges associated with documentation, communication, and evaluation are mitigated to pave the way for effective operations.
Ambulatory care will be cost-effective, enabling more patients to access the service. Assessment and research will tremendously improve, enhancing the adoption of better methods and innovations. Quality of health care is assured, making life expectancy possible to increase (Scott et al., 2018).
Therefore, to ensure these objects are successful, the adoption of EMR should be based on continuous quality improvement. In this paper, the implementation of EMR at LPC is discussed in detail by highlighting the project design from planning and analysis, implementation and testing, and staff and customers’ preparation to “go live.”
Planning and Analysis
The scope of this project includes:
- Designing schedule and budget
- Coding and configuration of data
- Assessment of the project to ascertain its viability
- Migration of health records to the new system
- Training stakeholders
- Development of test plan
- Selection of suitable project management tools
- Go live
- Licensing
- Hosting of new electronic medical record
This stage should begin earlier before the commencement of EMR implementation. Since LPC has decided to engage Banks Resource Data (BRD) to offer project management services, they should delineate their goals and objectives and identify success and evaluation metrics. Putting all these aspects in place will ensure the effective accomplishment of purposes throughout the implementation process. LPC will have to choose the vendors, type of EMR, and project team composition (Lambley & Kuziemsky, 2019).
Designing a schedule and budget is critical at this stage by allowing both the appointed vendor and BRD to gather enough information as possible and deliver. Assessment of the project to ascertain its viability based on the goals and objectives set is essential. All resources needed and the number of personnel who will facilitate the implementation plan is determined. BRD will design the scope of the project and requirements to avoid deviating from the activities. Lastly, the agency will choose project management tools to aid in proper supervision of the plan.
Strategic Project Assessment
The viability of the project is vital in ensuring goals and objectives are successful. Through online research, LPC can make the right choices of the vendor and type of EMR after reviewing other users’ feedback. Views of agencies, which have implemented the plan, can assist in making suitable decisions and choices. Through their independent assessments, PLC can evaluate its choice of EMR to ascertain if it will easily integrate with already existing software solutions at the facility. Responsivity of the system selected can also be assessed against clinicians needs. Requirements, rules and laws are aspects, which must be put into consideration while implementing the plan.
As such, choices made should adhere to regulatory requirements such as HIS and PDGM (Paré et al., 2020). Interoperability, which is the transfer of data from one clinician to another, should be given a lot of emphasis to ensure the best healthcare software solution is established. It also helps practitioners to get a clear picture of patients’ health in real-time. The system is integral in improving home care services as it can quickly transfer data from one care provider to another.
BRD will have to assess workflow and procedures to avoid any inefficiency or infectiveness. Any issues with the sequence of tasks can easily intensify during implementation; therefore, optimization and redesigning will be essential. Similarly, each event is assessed to ascertain if it is beneficial to the agency and patients. BRD should evaluate steps, and in case of any issues, reordering should take effect. The organization should establish mitigation plans and troubleshooting times to moderate any potential concerns or glitches during implementation (Sutton et al., 2020).
The facility should update policies and procedures to accommodate the new system. LPC online solution, just like any other technological initiative relying on websites, can face security breaches, which can be harmful to the agency and patients. The protection of personal data from third parties is essential at all costs to minimize cyberattacks.
Set up Goals and Define Project Success
The main objective of this project is to implement an EMR plan that will ensure end-user acceptance. Throughout the process, communication is maintained to gather enough feedback from clinicians and patients, improving the new system. Adopting backup plans to help facilitate the transition from one stage to another and enable the project’s full potential will be equally important. Additionally, the system usability scale (SUS) should test implementation processes at each interval to improve baseline EMR usability scores (Lyerla et al., 2018).
Some staff may take longer to adapt to the changes brought about by the new system. The EMR development team must identify areas that require improvements. The development’s success is crucial and possible by creating a project management plan (PMP), which involves identification, definition, unification, combination, and coordination of all the activities. Achieving objectives will enhance documentation, communication, and the safety of patients.
Review Resources Needed and Align the Project Team
The cost of implementing a clinical system is always high, especially that of EMR. According to Scott et al. (2018), “there exists hundreds of EMR systems and vendors to choose from, hence regular clinical system concerns” (p. 1552). Therefore, a lot of care is imperative to avoid investing in deficient or obsolete systems, which will not serve their purpose. Clinicians should be involved during the selection of the EMR system to enable them to give their perspectives. Training and supporting vendors are vital in ensuring successful implementation (Sutton et al., 2020). Therefore, effective communication among the project team is essential in obtaining desired results.
Three leading roles are critical to the implementation of an EMR plan. The first one is the lead physician, who acts as the front-line user and is responsible for guiding and imparting technical knowledge to the organization staff. The project manager ensures timeliness, quality, and cost of the project is fast-track. They work closely with vendors and teams to manage issues and establish suitable solutions to ensure a smooth implementation process. Lastly, as an expert, the lead super user configures the EMR software, revises workflows, policies, and procedures to address lead physicians’ concerns.
Review Project Scope and Requirements
High-level requirements include:
- New system should provide aesthetically agreeable and user-friendly environment
- Licensing is mandatory
- New must be compatible will all current terminologies, classifications, and coding system
- Testing to ensure functionality
- System must provide easy access and familiar navigation capabilities
- Upon completion of testing, system should run smoothly without hitches
- EMR system capable of running various reports
Adherence to the implementation roadmap is critical in maintaining the project scope to the latter. Four project phases, including Planning and Analysis, Implementation and Testing, Staff and Customer Readiness, and Go Live Event, should be emphasized. However, in case of concerns from the front-liners, further evaluations must be carried out, readjustments made to ensure set goals and objectives at the end of implementation. Stakeholders are informed of changes made in the project scope to bridge the gaps. Center reporting is developed to enable changes and to address core business needs.
Project Management Tools
As the provider of project management services, BRD should adopt suitable tools that will aid in tracking progress. Gantt chart breaks a large project into small tasks indicating the dates of commencement and completion of each. Critical events are marked as “milestones” and can be emphasized by the project team (Desmond, 2017). It enhances visualization of activities at each stage, hence easy progress tracking.
PERT Chart software can generate diagram displays showing starting and ending dates of each task. It is more applicable in tracking the implementation phase and makes relationships between activities easier to identify than the Gantt chart. Work Breakdown Structure (WBS) software is another tool used in monitoring progress. It is a tree-style diagram and helps visualize the scope of work from the overall task to smaller events (Desmond, 2017).
Trello is a management software enabling users to collaborate through sharing files and comments on the progress. Zoho project is a tool offering Gantt chart features, real-time chat, and forum pages. It is suitable in implementing EMR as team members can easily share their experiences while tracking progress.
Implementation and Testing
Complete the System Setup and Product Implementation
Launching the new EMR system can be done in two approaches: big bang or incremental roll-out. Cost and time are always a factor whenever either of the two methods is adopted. The big bang is when all the stakeholders, including patients, clinicians, and other staff, are allowed to go live simultaneously. It requires dedicated agency and saves time if successfully adopted since learning curves for users are shorter (Lambley & Kuziemsky, 2019).
On the other hand, incremental roll-out engages one patient, department, or product line at a given time as the implementation process is observed and analyzed at a small scale to identify any issues that may arise. It takes longer as compared to the big bang approach but enhances higher accuracy. Duration for each activity is as shown in the table1 below.
Activity Duration
Table 1
After deciding on the launch strategy, BRD should identify and install hardware. The selection should be based on the vendor’s requirements and recommendations but must be subject to quality and costs evaluations. LPC should provide each employee with a laptop and IT personnel hired to help with system hardware needs. Software configuration is essential in ascertaining if it meets appropriate security measures, and this possible by conducting an HSPAA risk assessment (Paré et al., 2020).
The vendor should develop schedules for hardware and software installation, highlighting each team member’s roles and expectations. The generated implementation roadmap should underline the lead superuser, lead physician, project manager, and IT staff responsibilities to avoid confusion.
Identify and Validate Conversion Data
Before data migration, the destination system, which is the EMR, is prepared to avoid hitches. Data is then extracted from the source system and transferred, analyzed, and modeled. This is to achieve accuracy by identifying potential issues, variations, or duplications. By investigating the source data, the project team can understand its relationships, usage, and structure before feeding it into the destination database (Sutton et al., 2020). In case of any pitfalls, it is cleansed and modeled to fit in the EMR.
Further testing is done to identify, which data can or cannot be migrated and its duration to accomplish the task. Validation involves comparing and mapping the source to the destination system to ensure the data’s accuracy and integrity. Transfer or migration is carried out by classifying patients’ records and making sure their critical information is accessible in the new system. Statistics such as medical history, allergies, medications, hospital visits, and test results are transmitted starting with the most recent ones.
Develop and Complete Test Plan
Since this is an innovation, glitches sometimes are bound to occur. Testing the accuracy of the system is integral to the success of an online solution such as EMR. On some occasions, significant issues can occur requiring a longer time to fix, warranting budget and schedule adjustments. There are several steps to follow to build a testing plan. Firstly, strategy and timeline establishment is done during the planning stage. It is completed by allocating time for the testing script to ensure user acceptance is achieved. Validation of workflows is conducted by investigating how applications integrate across the agency using multiple patient scenarios (Lyerla et al., 2018).
Allocation of resources in terms of personnel to carry out the test is planned earlier enough. Integrated test scripts are developed from the collaborated groups to ascertain both clinical and financial inputs are incorporated. An automated testing solution is initiated to create the final product. Lastly, the testing process is tracked at each phase to ensure adherence and desired outcome.
Staff and Customer Readiness
Personnel and customers understanding of the new system is critical in ensuring acceptance and maximum productivity before “go-live”. To boost stakeholders’ experience, BRD must conduct training by educating its teams on the policies, procedures, and usage of the PLC online solution. The strategy for directing these teachings must be adequate to shorten the learning curve and make the new system more comfortable for the end-users (Scott et al., 2018).
However, inadequate training may result in dissatisfaction among stakeholders, hence minimizing productivity. Consequently, preparation is made based on team members’ roles and responsibilities to equip them with the knowledge and expertise required to deliver their duties.
The EMR vendor will provide training to staff and the superuser, who will provide on-site expertise to new staff. Online teaching modules are done to supplement staff with new responsibilities. According to Scott et al. (2018), “on-site training is critical and should be done in two weeks before the Go Live date to ensure new workflow and process will be fresh in the minds of the staff” (p. 1554).
Through notices and tutorials, customers are enlightened on the new system’s procedures and general operations to enhance quick adoption of the innovation. Effective training process mitigates staff resistance, minimizes misuse, and maximizes compliance, productivity, and understanding of the system and its functionality. To meet new agency regulations and familiarize new hires and patients with the requirements, post-live training is established.
Go Live Plan
Upon completion of on-site training, the project team can decide to go live. This stage is critical and enables identification of errors, which can harm the system. The plan is best scheduled for three days over the weekend after the project manager has obtained consensus from all parties and everything is ready (Lambley & Kuziemsky, 2019). Specific messages are sent to all stakeholders, informing them about the launch of the new EMR system.
Additionally, a roadmap for the activity, including pre-and post-go-live system testing, rescheduling shifts to accommodate overtime, temporary workers’ appointment, communications, network speed, reliability checks, and data backup procedures are established.
After implementation processes are complete and the system has gone live, continual checks and evaluations are carried to maximize return on investments and mitigate risks. Feedbacks from end-users are vital for the success of this process. Staff and customers’ experiences and views are reviewed to make necessary adjustments to fine-tune and optimize system operations.
Workflow efficiency and effectiveness are given more priority by establishing a long-term plan to evaluate potential risks. Third-party vendors and executive project sponsors are engaged to assist in the assessment of the responses. More resources in terms of personnel are allocated to every branch to work during critical hours.
Conclusion
Both LPC and BRD teams need to develop a suitable schedule and budget for the EMR implementation. The planning phase is critical and should be accorded more emphasis to ensure subsequent steps are efficient. Scope of the project and its success are evaluated to ascertain viability. All resources required, including the hardware, software, and project team members, are the assigned duties based on their expertise to maximize productivity. Team members, including third parties, are trained on the system’s policies, procedures, and usage. To effectively track progress,
BRD must choose suitable project management tools such as Gantt chart, PERT Chart, and Zoho. System setup is vital since it ensures efficient product implementation. Data stored in the old system is identified, audited, and validated for successful conversion and integration into the new EMR system. The plan is then tested in preparation for the launch to avoid any issues, which may arise.
After the system has gone live, further checks and evaluations are conducted, and appropriate resources are allocated in case of glitches. Therefore, by adopting an effective plan, the organization can efficiently realize their goals by having all the necessary resources at each phase of their projects.
References
Desmond, C. (2017). Project management tools-software tools. IEEE Engineering Management Review, 45(4), 24-25. Web.
Lambley, J., & Kuziemsky, C. (2019). A tactical framework for EMR adoption. Healthcare Management Forum 32(3), 148-152. Web.
Lyerla, F., Durbin, C. R., & Henderson, R. (2018). Development of a nursing electronic medical record usability protocol. CIN: Computers, Informatics, Nursing, 36(8), 393-397. Web.
Paré, G., Marsan, J., Jaana, M., Tamim, H., & Lukyanenko, R. (2020). IT vendors’ legitimation strategies and market share: The case of EMR systems. Information & Management, 57(5), 103291. Web.
Scott, D. J., Labro, E., Penrose, C. T., Bolognesi, M. P., Wellman, S. S., & Mather III, R. C. (2018). The impact of electronic medical record implementation on labor cost and productivity at an outpatient orthopaedic clinic. Journal of Bone and Joint Surgery, 100(18), 1549-1556. Web.
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3(1), 1-10. Web.