Rounding, July/August 2017

QUESTION: What are some key tactics c-suite leadership need to take to ensure a stable EMR rollout?

UMC Health System
Bill Eubanks
Bill Eubanks
chief information officer and senior vice president

Full executive support: It’s imperative that the decision to implement an EMR is fully supported by the entire executive team. This implementation impacts all workflows throughout the organization, disrupting established processes. It is critically important that the EMR implemented is supported and viewed as an organizational initiative, not an IT project. Expectations for EMR adoption, and change management communication should come from the top of the organization.

Expect a temporary reduction in capacity: Where possible, schedules should be reduced during go-live to allow time for users to adjust to the new system and associated workflows. In other areas, consider additional staffing levels to reduce the burden of learning a new system and taking care of patients simultaneously. Best practice would be to implement these capacity measures for a minimum of two weeks.

Provide at the elbow support / training – It is important to provide as much “at the elbow” support as possible to the clinicians. Training is also important, but often only provides some basic understanding of the EMR. Real world scenarios encountered during go-live require experts embedded with clinicians to answer questions real-time.

Choose a solid Vendor/Partner – Choose your EMR vendor carefully, and look for a partner who has a long-term vision and is actively engaged with regulatory bodies and is well prepared to adapt to regulatory requirements, such as meaningful use, MACRA/MIPS, and Quality reporting. Technology changes over time, so focus internally on the intellectual capital and knowledge within the company, to ensure you’re choosing a company with a future in Health IT.

Methodist Health System

Brian Kenjarski, M.D.
chief medical informatics officer

First, I highly recommend that operational vice presidents be involved in EMR implementation throughout the build and maintenance phase (CMIO, CIO, CNO, VP Revenue Cycle, VP Ambulatory Practices, etc…). Vice president-level leadership involvement in build decisions throughout the implementation phase helps decisions to be made efficiently.

Medical staff leadership and participation in build decisions is essential. Use existing governance structures (department meetings, medical executive committee meetings) to approve new EMR content that includes physician documentation tools and order sets.

A big opportunity – and one missed by me – is to develop a comprehensive communication strategy to physicians, nurses, and staff well in advance of golive day and perfect it during your build implementation phase. By doing so, at go-live people know where to go for information and how to ask questions. Training your physicians, nurses, and staff cannot occur early enough, and resist any temptation to reduce the training and your go-live elbow-support budget. This is costly and part of training will need to be outsourced. Not a place to skimp.

Consider implementing a physician-led EMR training program for physicians. At MHS, we implemented Epic’s Specialists Training Specialists Program where physicians were trained early on Epic and helped to facilitate physician training sessions (we had about a 70-75% rate of physicians leading training sessions at MHS). I believe it helps with buy-in.

Consider physician and staff time required to participate in build and content review and the approval process. An informal (that is, no compensation) model to engage physicians in the clinical content build out was effective at MHS, but facilities need to be comfortable with compensating physicians for their time when they are asked to have a high level of engagement in the implementation.

Resist the temptation to use third-party consultants in the role of an implementation project manager. Consultants are valuable to augment existing resources in the build phase. However, in a PM role, once the consultant leaves, it can lead to a leadership gap as the implementation team transitions to either leaders who did not serve as PMs or the implementation staff goes back to their home department. You risk leaving a knowledge and build decision gap. Bottom line – consider post-implementation leadership and staffing well in advance of go-live and try to use existing resources to serve as implementation PMs.

Baylor Scott & White

Matt Chambers
chief information officer

For a successful rollout of the electronic medical record, health system leadership must be committed to making implementation a priority. The process can be time intensive and costly, even when things go as planned. Sometimes hard decisions need to be made, and support from top-level leaders will help move the process along.Be sure to plan your work, and to work your plan. These projects exceed budget when they go long, so it’s important to stick to milestone dates. Adhere to the three point triangle: scope, schedule and budget. If one of the three points starts sliding, you’ll have to make changes in the others to compensate. You’ve got to maintain scope in order to maintain budget and timeline.

Electronic health record implementation is ultimately about providing patient-centered care. You should leverage it to drive clinical and operational standardization across the enterprise and to implement best practices across every registration desk, clinic and hospital throughout the health system to offer a consistent, reliable experience to the patient at every access point. Consumers access health care with the expectation of a modernized, convenient and consistent experience, and the electronic health record helps us deliver that. Our goal should be to connect as much of the care process, the financial responsibility process, and the registration and scheduling processes, as can be connected through a common or easily navigable platform.

Hill Country Memorial

John T. Mason
chief information officer

Rolling out a new EMR is a daunting task for IT and the business, and the benefits that were sold early on to the organization, can quickly lose their luster unless the entire leadership of the organization is engaged and involved. Unfortunately, too many leaders believe that anything related to the EHR is completely technical in nature, and doesn’t require them to stay connected. But, if you want to be successful, you have to view this to be just as important as you do all other major capital projects. Here are a few things to consider before you undertake that new EMR implementation.

First, don’t believe that this is simply a ‘technical’ implementation. While implementing an EMR does involve some technical components, the majority of the project will be clinical and revenue cycle in nature. From changes to workflow, to key billing connections, an EMR project is doomed to failure if these items are left to the technical team. Remember, your EMR is the most crucial, and core component of your business, and a poorly designed and implemented one will impact morale and revenue quicker than just about anything. Embrace this opportunity like you were redesigning your business from the ground up and take the opportunity to optimize your business. You don’t get this to do this often!

Second, stay engaged throughout the entire lifecycle of the project. Many times, Executives see their role as cheerleader during the initial phase of the project. They happily attend a kickoff meeting to show their support and make sure the rest of the organization knows they support it. But, it doesn’t take long before other business starts to creep into their busy day, and the Executives find themselves skipping status meetings, sending delegates to ‘sit in’ on vendor meetings, and generally being unavailable during crucial milestones. But, without ongoing, visible support of the project, the team can quickly get tired and start to believe other things should take priority. It’s critical that you keep everyone on their toes, or the project will end up late, over budget and underutilized after go live. You have to be visible and engaged.

Finally, remember that technology is expensive, but the most expensive part is people and the cost of implementing, customizing and maintaining it. EMRs today are designed based on best practices of years of experience in the industry. However, the natural tendency is to believe the old adage that technology should mimic the business process, and not the other way around. Twenty years ago, that was true. But today, EMRs are optimized based on regulatory requirements and best practices in the industry. As a leader, you should be focused on making sure the organization utilizes the tool to its fullest ability, and does this in a way that doesn’t require customization and modification. You should question anything that requires the organization to customize the EMR beyond its built in options. To do this, use your existing governance processes to scrutinize any changes that are outside existing capabilities, and ask the team ‘what makes us different?’. It’s cheaper and easier to modify your human process than it is to change a complex and sometimes delicate technical system. The organizations that don’t do this find costs go up and timelines delayed as the application is customized.

An EMR is singly one of the most expensive things that any health organization will undertake, perhaps only once or twice in your career. Implementing it correctly can make or break an organization operationally and financially. To make sure your organization gets the most from this significant expense, stay engaged and informed and lead the team to success.