No matter the size or scope, thorough electronic health record (EHR) implementation planning should begin with determining your desired end-state, what is needed to reach it, and the potential hurdles you may encounter along the way. Identifying potential activation risks before implementation allows for time to proactively and appropriately plan, budget, and communicate resource needs and expectations. You can alleviate surprises that may negatively affect clinician satisfaction and limit the full benefit of your new EHR.
What follows are several common activation risks and how you can address them upfront.
- Ambulatory Acquisition Scope Creep
Risk: As more physician groups are added to the potential user base through acquisition, affiliation agreements or EHR extension initiatives, the temptation is often to accommodate these additional providers in the original activation timeline. This increases resource needs for build, testing, and go-live support and introduces additional risk to the timeline.
Solution: Develop an implementation strategy for ongoing acquisitions, affiliations and private practices to minimize the impact on activation budget and plans. This will also set expectations with the newly acquired and affiliated groups as to how they fit into the implementation strategy. For example, create a schedule to add new providers to the beginning of the last clinic group’s testing cycle. Determine how many clinics the implementation team can handle to determine when to create the next grouping – whether the current strategy is “big bang” or phased. This requires reviewing the existing team resources to ensure the right number of resources are available to support ongoing implementations and clinics that are live on the system.
- Scheduling Reduction Trickledown
Risk: To provide physicians with time to adapt to a new system and workflows as they gain expertise with the new EHR, many organizations allow for a scheduling reduction in operating cases, office visits or scheduled procedures. Physicians who receive RVU-based compensation could see a reduction in their compensation. Scheduling reductions may also trigger revenue loss for ancillary departments such as radiology, laboratory and surgical services due to fewer referrals – a common trickledown effect from schedule reductions.
Solution: If you choose to reduce scheduling, you need to determine how or if you will bridge the gap in compensation or bring in external clinical staff with EHR experience to maintain existing schedule loads. It is also a good idea to provide insight about potential budget impacts (e.g., up staffing, vacation planning and schedule reduction) to the finance department as soon as they are identified to help them plan for the impact. By proactively communicating the trickledown impact of revenue loss for ancillary departments to executive leadership and governance bodies, the reduction in revenue will be anticipated and planned for accordingly.
Risk: Clinicians and staff will be required to participate in manual conversion activities before activation for inpatient chart conversion, scheduling and registration of appointments, schedule template build, surgical case block and case creation, pre-op order entry, etc. Manual conversions will result in overtime due to after hours and weekend work, as well as hospitality costs, which are often overlooked.
Solution: A hybrid approach to converting appointments is possible by using an electronic format for simple appointments and manual conversion for more complex appointments to save time. Staff will be needed to validate electronic conversion results as well as participate in backfilling for those participating in manual conversion activities – either with internal or external resources. Early communication with clinical and business departments about the need to participate in these activities will help them better manage their staff scheduling. Prepare for additional staffing and their needs in the budget.
- Command Center Planning
Risk: Allocating adequate space for command centers can be challenging, especially for large scope activations. Dedicated space is necessary to accommodate large groups of people (120+ for a “big bang”) before and after activation. It may be necessary to reserve space well ahead of time to ensure it will be available. For ambulatory activations, there are challenges with where to locate the command center to best meet the needs of the end users. Command center space must be equipped with network access, telephony and hardware. Additionally, there are physical security considerations, increased parking needs and workspace considerations, such as tables and chairs, and hospitality costs for the command center which are typically an afterthought and under-budgeted.
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