Tip:
Highlight text to annotate it
X
female narrator: Thank you for joining our session
"Key Roles in Implementing
"a Certified Complete Electronic Health Record,"
or EHR.
This is part of a series of education modules
that provide information and guidance
around health information technology,
or health IT.
The other session titles are:
"What is Health Information Technology and Meaningful Use?"
and "Maintenance and Optimization
of a Certified Complete Electronic Health Record."
This module has been developed
as an orientation for health IT staff
working in safety-net health care settings,
such as community health centers,
federally qualified health centers,
and freestanding clinics.
These modules are designed
for use in a variety of settings.
In an organization that is already live on an EHR,
these modules can enhance
the new employee orientation process.
Alternately, this session could serve
as an orientation module
for a team that is embarking on their EHR implementation.
Finally, health centers
focusing on the CMS meaningful use incentive program
would also benefit from this module.
These questions were created
to test your knowledge of the concepts
before they're presented.
The screen will flash first with questions,
and we'll give you a couple of moments
to jot your answers down.
You'll be able to check if your answers are correct.
Thank you for taking the time
to answer these pre-module questions.
Question 1:
Which of the following
are reasons why we should implement
the certified Complete Electronic Health Record?
A: Improving quality,
B: Ensuring safety,
C: Improving efficiency,
or D: All of the above.
Question 2:
An implementation specialist is a health care professional
that processes insurance claims.
A: True
or B: False.
Question 3:
Implementation
of a certified Complete Electronic Health Record
can be done quickly
with a few steps in the process,
and one person is needed for this initiative.
A: True
or B: False.
Question 4:
If you use a "stoplight" approach
for managing a task plan,
what do the following mean?
Green, yellow, and red.
Question 5:
Talking about "change" and "change management"
are important during
a certified Complete Electronic Health Record implementation.
True or false?
Question 6:
The term "future shock"
refers to the psychiatric treatment
known as "electroshock therapy."
True or false?
Question 7:
The term "preloading" means
taking certain elements from the paper chart
and manually keying them
into the certified Complete Electronic Health Record
so the information is readily available.
True or false?
Question 8:
Health centers may experience resistance
to implementing
the certified Complete Electronic Health Record.
Which of the following are types of resistance?
Select all that apply.
A: Individual,
B: Cultural,
and C: Community.
Question 9:
"Re-engineering" workflows
means reviewing the current "paper" processes
and designing them
for the certified Complete Electronic Health Record.
A: True
or B: False.
And question 10:
Match the key words to their definition.
1: Sponsor,
2: Target,
and 3: Advocate.
And the definitions are:
A: An individual or group being impacted by the change,
B: Individual or group who wants the change to occur
and does not have the organizational power
to legitimize it,
and C: The individual or group
who has the organizational power to legitimize the change.
Now let's review the answers to the pre-module questions.
Question 1:
Which of the following
are reasons why we should implement
the certified Complete Electronic Health Record?
The answer is D: All of the above.
Question 2:
An implementation specialist is a health care professional
that processes insurance claims.
That answer is B: False.
An implementation specialist is a professional
that assists you on major tasks
as you near your go-live date as a health center.
This person may be from
a Health Center Controlled Network,
work for an HIT vendor,
or even be a consultant.
Question 3:
Implementation
of a certified Complete Electronic Health Record
can be done quickly
with just a few steps in the process,
and one person is needed for this initiative.
That answer is B: False.
The implementation process may take several months,
has many steps in the process,
and should be done with the work of a team.
Question 4:
If you use a "stoplight" approach
for managing the task plan,
what do the following mean?
Green means a task has been completed on time,
yellow means a task is close to being overdue,
and red: a task is delayed.
Question 5:
Talking about "change" and "change management"
are important during
a certified Complete Electronic Health Record implementation.
And that answer is A: True.
Question 6: The term "future shock"
refers to the psychiatric treatment
known as "electroshock therapy."
That answer is False.
"Future shock" is a condition
in which an individual can no longer cope with changes,
and they fail to incorporate new changes in a functional way.
Question 7:
The term "preloading" means
taking certain elements from the paper chart
and manually keying them
into the certified Complete Electronic Health Record
so the information is readily available.
That answer is A: True.
Question 8:
Health centers may experience resistance
to implementing
the certified Complete Electronic Health Record.
Which of the following are types of resistance?
Select all that apply.
It is A: Individual
and B: Cultural.
And Question 9:
"Re-engineering" workflows
means reviewing the current "paper" processes
and designing them
for the certified Complete Electronic Health Record.
And that answer is A: True.
And now let's move
to "match the key words to their definition."
A sponsor is C: An individual or group
who has the organizational power to legitimize the change.
A target is A:
An individual or group being impacted by the change.
And an advocate is B:
An individual or group who wants the change to occur
and does not have the organizational power
to legitimize it.
Putting in place or implementing
a certified Complete Electronic Health Record
at your health center--
or "going live," as it's called--
is one of the biggest initiatives
your organization will undergo.
It is important that you,
as an implementation team member,
have a good understanding of the following:
the role of team members and what to expect,
major tasks team members must complete
during the implementation,
the concept of change management and its importance,
and the impact of implementation on quality improvement.
Everyone in the health center has a role
in helping us make this a successful go-live.
We want to do it for our patients.
We want to show them
that we believe in quality, security, and efficiency.
Determining who will join your implementation team
can be a challenging task.
It is essential to involve the staff
who are delivering patient care today
in the design of these new systems.
Your success will be greater
if a clinical champion and administrative champion
are identified early on.
When implementing a certified Complete EHR,
health centers have used different team models
and different approaches for project management
based on available resources and in-house skills.
Regional Extension Centers,
primary care associations,
and Health Center Controlled Networks
are all readily available to support you
on your journey through EHR implementation.
For this session, let's meet some of the key players
that are a vital part of the implementation process.
There are many ways
to have a successful EHR implementation experience.
This is one example of how staffing could occur.
With us today is Clauderia, the implementation specialist
from your Health Center Controlled Network.
She'll be working very closely with your team
on major tasks as you near your go-live date.
In other support models,
the implementation specialist might work for an HIT vendor
or even as a consultant.
We have a number of staff
from your community health center as well.
Sandra, who has worked in the QI department until now,
has been named your EHR project manager.
She's in constant contact
with your implementation specialist
and the rest of the team
to make sure all tasks are being completed on time.
Dr. Harper is your provider champion.
She has an interest in helping
bring the voice of the clinical users to the table
when making decisions that impact them directly,
which makes her a really good fit
as a provider champion.
And Elizabeth, your health center CEO,
has also joined us today.
She knows it's her job
to provide sponsorship and vision
throughout this major implementation.
It's important to have a member of the executive leadership team
understand the tasks at a high level,
know what's on target,
and know what the barriers are
to getting delayed tasks done.
- Hi, everybody, I'm Clauderia,
and I am your implementation specialist
for this project.
Since you are a member
of our Health Center Controlled Network,
I was assigned to help you implement
the certified Complete EHR,
and I am ready for the task.
I work with the health center
to pull a capable and effective team together
to help us make this project successful.
One of the first things we decide
is who will be a part of the team.
Oftentimes one person can play multiple roles on the team,
so I am here to lend an extra hand.
The EHR manager,
who we will meet in a little while,
works with representatives from the following departments.
Clinical team members--
such as providers, nurses, and medical assistants--
tell us how they currently chart on the paper.
This will help our team make decisions
on how the EHR will be used to document patient care
once it is implemented.
IT personnel will help the organization
identify connectivity issues,
review the internal network,
and purchase and install the necessary equipment,
such as laptops or desktop computers,
scanners, and printers.
The billing and front desk staff
will keep us informed of what CPT codes to use.
They'll learn how to retrieve charges electronically
once we've gone live on the certified Complete EHR.
No more paper superbills.
The quality improvement department
should be on the team to make sure that data
for quality and utilization measures, grants,
health care plans, and current QI initiatives
can be extracted from the certified Complete EHR.
Medical record employees
are an important part of the team.
They will learn how to manage the chart electronically
and how to scan external documents,
like radiology results,
into the system.
Mental health staff and case management
should also be represented
if the health center plans on taking them up
on the electronic health record.
For many organizations,
this may be the first time that their charts
are integrated with the primary care chart as well.
I make sure to tell all members of the group
that they must attend all meetings
when we discuss their roles and responsibilities,
ask questions should they not understand something,
represent their departments
by bringing their colleagues' questions and concerns
to the group,
and finally, complete their homework on time.
Once our team has been formed, we have a kickoff meeting
to discuss the project in general,
as I know this is new information for everyone.
We talk about how to manage
this big change at the health center;
revisit our vision for quality improvement
and how the EHR will help us meet it;
and demonstrate the features of the EHR,
as many team members may not have seen it before.
As the project progresses,
the team and I will review current workflows
in the organization
and determine how their paper processes
will happen electronically.
This is known as workflows re-engineering.
Training is another big topic of discussion
amongst the team.
We work out a plan
where clinical staff will first take advantage
of computer-based learning modules
to learn the basics of how to document patient care
using their new certified EHR technology.
Next there will be
a classroom-style learning session
for team members to practice their new skills
and workflows.
And finally, we will provide support on the team
in scheduled practice sessions before the big go-live.
We plan training right before go-live
so users can remember what they just learned.
There are some teams who request
that I come on-site to the health center
to help support users
as they document in the system for the first time,
whereas other teams develop in-house super users
to provide on-the-job assistance.
One thing is certain:
an investment in training your staff up front
will pay off in terms of productivity
and quality outcomes
once they are using
the certified Electronic Health Record.
Implementation is the first step.
Ongoing maintenance
and enhancing or optimizing the use of the system
becomes an activity woven into the daily work
of individuals at the health center.
In the days following the kickoff meeting,
implementation team members review a task plan.
One of the tools I like to use
is a "stoplight" status approach.
Green means completed on time,
yellow means the task is in jeopardy for delay,
and red means that the task is delayed
and we need a plan to get it back on track.
I will show the EHR manager how to monitor and track
the team's progress on their task.
Part of my work as an implementation specialist
is to help the team learn about change management.
Because implementation of an EHR
is such a big transition,
we have to keep change management
in the front of our minds.
I am an advocate for change,
meaning I want the change to occur
but I don't have the organizational power
to legitimize it.
I rely on my health center sponsors,
like the CEO or medical director,
who can make it happen.
Change agents are the implementation team members
who help bring change along to all staff.
The employees impacted by the change
are called targets.
It is certain that many employees
will play several roles in the change process.
If you think about it,
the implementation team members are not only change agents
but are often targets of the change,
and they can serve as sponsors
to an employee who they supervise.
It can get a bit overwhelming,
which is why having a trusted team
and solid executive-level sponsorship
is so important.
As an implementation specialist,
you can expect that I will do the best I can
to meet your needs,
commit to doing what it takes to get the job done,
respond in a timely manner,
respect the perspective of others
and support the team's choices,
be professional and trustworthy,
and share experiences and best practices
to help the health center succeed.
Implementation specialists have many responsibilities.
We must be able
to help organizations manage this large project,
effectively train users of the system,
engage with clients
to help answer their questions and concerns,
and, finally, support the health centers remotely
when needed.
The HITECH Act that was passed
has helped fund a health IT education and training program
at a nearby community college
for me to enhance my skill sets,
as I hope to become an implementation manager soon.
This is an extensive program that lasts about six months.
I'll get a certificate at the end.
The program is looking to train over 10,000 people.
I encourage everyone to check it out.
- Hello there, everyone, I'm Sandra,
and I am the new EHR manager at the health center.
I was promoted
from the quality improvement department,
and I am so excited about this new opportunity.
My organization created this role
because we have a vested interest
in health information technology.
My responsibilities include
managing the implementation project
locally at the health center;
bridging communication
between our Health Center Controlled Network,
our implementation team,
and sometimes various HIT vendors;
keeping track of the budget
to ensure we are appropriately using our funds
for the EHR and other technologies;
helping the organization address any change management issues;
giving status updates to all stakeholders;
and carefully monitoring the implementation plan
and making sure tasks get completed on time.
I have come to understand
the major milestones for the EHR project.
This is a projected timeline
of some of the more complex steps
in the plan.
They include kicking off the project,
evaluating clinical workflows
and designing them for the certified Complete EHR,
preloading vital clinical information
from the paper records to the electronic chart,
setting up the application and interfaces,
training users,
and preparing for go-live.
Go-lives can either be set up as a big-*** theory,
meaning that all departments
go up on the EHR at the same time,
or some sites choose a staged approach,
meaning different departments or users
start using the EHR at different times.
Remember, there is no one approach
to managing this initiative.
In addition to managing the task plan,
I also create agendas
and take notes at the team meetings
to document next steps and discussion points.
Highlights from these meetings
keep the senior leadership team and staff
updated on our progress.
I know that I can rely on my Regional Extension Center
or other health centers in the network
for best practices
and tips on how to manage this large initiative.
This isn't all on my shoulders.
A certified Complete EHR
will have a significant impact on how the clinic functions.
The workflows assessment and re-engineering tasks
will help us determine
how our current processes will change.
Our health center has been asked
to document all of our processes
on how the patient and their chart
move through the health center,
including how we communicate
when the patient is ready for the next care team member,
how we handle prescription refill requests and phone calls,
and how we track down paper records.
This is our chance to look at what is working right
and what needs to be improved.
To begin the workflows task,
our implementation specialist
has asked us to define all the steps
to register, schedule, and perform an office visit.
Other areas we needed to cover
were management of walk-in patients,
prescription refills,
phone call triage,
abnormal lab follow-up,
referral management,
medical records processes,
and our billing steps.
On the workflows,
we have to identify who performs each step,
what is being currently documented,
and how members of the team communicate.
This is a huge undertaking,
and it's a good opportunity
to get input from our colleagues
who are doing the work every day.
During the implementation, we want to focus
on our opportunities for improvement,
as well as preserving those workflows
that serve us well.
Now that we are electronic,
I can easily pull data out of the system in real time.
I can produce dashboards
for the meaningful use initiative
that we submit to the government
as proof we are using certified Complete EHR
in a meaningful way.
For example, recording vital signs
is one core measure of the meaningful use program.
I can pull reports such as blood pressure
to make sure we are meeting this measure.
And it looks like we're doing a really good job.
I know that this is a big period of transition
for my fellow colleagues.
Recently I learned about the future shock concept,
which is the point in time
when people can no longer assimilate change
without displaying dysfunctional behavior.
For example, some staff members may cling on to the paper chart
and not want to move on to using the EHR
due to future shock.
Other staff members may become concerned
that the EHR will replace their jobs.
As a change agent for my organization,
I want individuals to feel comfortable coming to me
should they have these kinds of concerns.
There are many expectations of an EHR project manager.
I must be able to support
the implementation team and fellow colleagues,
work with quick learners of the system
to help them grow into super users,
and troubleshoot issues in a constructive way.
As an EHR project manager,
I have to possess several critical skills.
I act as a liaison
between our Health Center Controlled Network,
our vendor, and our users.
I help to maintain
an up-to-date implementation plan.
I provide basic and advanced training
to all employees.
And I need to be able to run reports
for important initiatives such as meaningful use.
The data pulled from the certified Complete EHR
determines the amount of incentive payments we receive.
While talking with our implementation specialist,
I heard about the six-month training program
that the Office of the National Coordinator
is providing.
Since documenting workflows
and transforming them over to the certified Complete EHR
is so important,
I am looking into the practice workflow track.
- Hi, I'm Dr. Rita Harper,
and I'm a physician on the EHR implementation team.
I am the head
of the internal medicine department,
and I like working with computers,
so when I was asked by my CEO to join the team,
I thought it was a good fit.
As a provider,
I bring the voice of the clinical user to the table,
making sure our perspective is being heard.
I review the current-state workflows with our team
and help design them for the electronic system.
I help train my fellow providers
so they understand what and how to document electronically.
I ensure our QI vision is being met.
And I set up important medication,
problem lists, and orders in our EHR.
I also rely on our implementation specialist
and EHR manager
to assist with many of these functions.
We've grown into a pretty tight team.
One of the first tasks we were given is preloading.
This means taking certain elements
from the paper chart
and manually keying them
into the electronic health record
so we have that information available right on the screen
when we start seeing our patients during go-live.
We had to make decisions
on exactly what would be entered into the system.
Our health center decided
that the problem lists, medication lists, allergies,
and the last visit's vital signs would go into the chart.
For our complex patients,
specialists' reports would be scanned into the system as well.
We were also able to electronically import
our historical lab data,
which allowed us to take advantage
of clinical decisions and support prompts
for diabetes and *** lab tests that were due,
starting right at go-live.
Our EHR manager helped document
how our paper workflows, or processes,
would look in the EHR.
We then walked through
these newly re-engineered workflows
to test them.
This helped us determine
who got what privileges or securities
to view certain information in the chart.
Throughout the training and go-live support period,
I helped the providers use the basics of the charts,
all the different templates we would use,
and where to put the information,
like our chief compliant assessment and plans.
Finally, I helped the users understand
how we would hand off our charts electronically
between providers, nurses, and medical assistants.
Many providers had questions
about why we were doing something a certain way.
I was the voice for the implementation team
to discuss how we reached those decisions.
Two weeks before go-live, we scheduled simulations,
meaning we would have one patient in the morning,
then another in the afternoon,
all on the certified Complete EHR.
This was great learning for us.
During go-live, I was around our main pod.
People would ask me questions about how to document something,
and I would take any concerns back to the implementation team.
I'm an advocate for change.
I can have some influence over the change,
but I rely upon my sponsor, my CEO,
to actually make the change happen.
We learned a lot about change management
from our implementation specialist.
I learned that resistance occurs
when people's expectations are disrupted.
Resistance means opposition to the status quo.
It can be individual or cultural.
Resistance doesn't mean that something is wrong.
It means that people can't operate
as they expected to
or are uncomfortable.
I help the team identify where there's resistance,
and I try to work with those individuals
so they don't feel so uneasy.
Our EHR project manager
is being trained to pull certain reports
for the meaningful use initiative.
Documenting smoking status and smoking cessation
are clinical quality measures in the program.
I take these dashboards back to our provider meetings
to share outcomes data with them.
It's great to see data from a total population
and not just a small sample size
that we used to get out of our paper records.
I pull other members of our care team in
to review these reports as well,
as their work directly impacts
the performance of these measures.
We talk about opportunities for intervention
and ways to proactively reach out to our patients
who need to come back to see us.
The EHR is a tool
for enhancing our ongoing quality improvement efforts.
One of the first tasks we completed during our kickoff
was to review our quality improvement mission and vision.
That serves as our guide
to review the clinical templates available to us
and create reports
that will pull out the information we need.
As a provider champion, I am very interested
in helping to manage and maintain our EHR
in order to meet our QI vision,
maintain provider satisfaction,
and ultimately improve patient satisfaction.
In order to be a provider champion,
I have to be able to effectively communicate
the clinician's need to the implementation team.
I am currently being trained by my IT team
to learn basic troubleshooting techniques,
such as identifying what server a user is on
or what problem the printers are having.
I never thought I would learn this,
but it actually makes sense
to be able to solve some of these problems quickly.
Finally, I train the clinical team
on important workflows, like electronic prescribing
and how to order a test correctly.
I'm thinking about joining
the Community College Consortia Program too,
as I know that provider consultants
are in demand right now.
- Hello, I am Elizabeth,
and I am the CEO at the health center.
Our implementation team has worked very hard
over the last several months.
I was their leadership support throughout this project.
I attended meetings when I could,
and I received regular updates from our EHR project manager
and our provider champion.
Our COO worked with the implementation team
to review all of our current policies and procedures
and made changes as appropriate to support our EHR.
I reviewed and signed off on all of them.
I also approved the certified Complete EHR
awareness planning for our staff and our patients.
At our all-staff meeting,
I shared the goals and the vision
of our certified Complete EHR,
and I provided regular updates to the staff.
We created flyers informing patients about the EHR
and posted them throughout the health center.
We even put together a campaign
that counted down our go-live date.
We had to determine the impact on access
and make plans to accommodate patient volume
as we reduced our schedules
to allow the users time to learn the new system.
During the go-live period,
I routinely made rounds on the floor
to see how our users were coming along.
They did great.
Since this is the post-go-live period,
I'm thinking about forming some focus groups
to discuss what we did well and what we can improve upon
to prepare for other big initiatives
coming our way.
As the sponsor of the project, I am the individual
who can approve or legitimize the change.
As the sponsor, I know I have a number of roles.
I have a public role:
showing my support of this initiative
to patients and to the staff;
I also have a private role with my leadership team:
supporting the same message;
the ability to use motivational rewards,
like free lunches,
to minimize logistical hassles,
like removing paper prescription pads,
and establishing consequences,
performance improvement plans for stragglers.
As the sponsor of this project,
I also have the responsibility to monitor actions
to ensure that things are running smoothly.
I also must have the willingness to sustain support
throughout the duration of the change.
I am fully committed to this initiative.
When I need help, I know I have the support of our network,
our Regional Extension Center,
and our primary care association.
I counted on my medical director,
the chief operating officer, and the nursing director
to make decisions
on who would be on the implementation team.
We looked at individual skill sets,
qualities, and attributes.
We needed a group of cross-departmental staff
that were capable of achieving a good team dynamic.
We have to establish an environment
of mutual trust and respect,
because that is the foundation
of building and maintaining an effective team.
Clearly there are times when one individual
might represent multiple roles on the team,
and our Health Center Controlled Network
has really been able to assist us along the way
as we identify gaps.
The team leader must have a good working relationship
with both team members and senior leaders
to keep all stakeholders informed.
He or she must be well organized,
be able to identify resource gaps,
as well as resolve team conflicts when they arise.
The provider champion
is identified to work with the team leader.
This individual should be
a clinical opinion leader in the health center.
A nursing representative
should be able to keep the department up to speed,
understand the capabilities of the system,
and be able to train others
that are new to the health center
or are struggling.
We want our medical assistants to be able to provide
the current state of how things are running
or flowing through the health center.
We look to the MA to tell us what is really going on
in terms of bottlenecks and where we can improve.
Our IT department makes sure
we have good connectivity in place
and helps procure the equipment,
such as workstations and laptops.
Administration helps us understand
the organization's goals
for the certified Complete EHR project
and keeps us up to date
in terms of upcoming initiatives,
such as meaningful use.
Patient Support Services
includes our front desk and our billing department.
What gets entered into a patient's registration
not only impacts meaningful use,
but it helps us correctly collect co-pays
or bill insurance.
Quality improvement and data
are key in reviewing our initiatives
and identifying what we can easily pull from the system
and what fields may need to be created
so a report can be run.
Since we joined our Health Center Controlled Network,
we have benefited
from significant leadership and support in these areas.
Medical records needs to be involved,
as they will learn a new skill of scanning documents
and inputting data into the chart.
The behavioral health and case management department
may also go live
at the same time as the other services.
We have decided to stagger their go-live
eight weeks after primary care goes live.
The primary goal is to integrate these often separate charts
into one shared medical record.
Effective communication among all team members
is the key to success.
There must be an understanding
that everyone's opinions and ideas are valued.
Each team member must own the change
and understand why and how
this new system will be an improvement.
All impacted stakeholders
must feel like part of the project
and agree to the process and goals.
In helping to support the project,
it's essential that I understand
the common characteristics of change.
These characteristics are
low stability;
emotional stress;
high, often undirected energy;
control becoming a major issue;
past patterns of behavior becoming highly valued;
and the rise of conflict.
If users are experiencing these,
I want them to feel comfortable
to discuss what's on their minds.
I've seen all of these potential problems arise
throughout our implementation/adoption
of the certified EHR technology.
And my involvement in mitigating these concerns
is instrumental to getting buy-in.
My ability to review reports with up-to-date data
and to be able to track the high quality of care
we are providing to our patients
is another benefit of this program.
We have listed a number of our providers
as eligible professionals,
meaning that they are incentivized
to meet certain measures
within the meaningful use program.
We are thinking through add-on features,
such as e-prescribing,
and new technologies, like telemedicine,
that we can purchase.
The EHR implementation was a wonderful example
of our hardworking employees centering around a common goal
to make this initiative go smoothly.
I'm so proud of them,
and I know your team will be successful too.
narrator: Thank you for joining us today.
Make sure to check out our other modules
on "What is Health Information Technology and Meaningful Use?"
and maintenance
of the certified Complete Electronic Health Record.