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After launching the EHR at about five clinics late in 2005, the organization used the regimented approach to roll it out to all the other outpatient sites by last March. Now it’s turning its efforts to implementing the software, from Epic Systems Corp., Verona, Wis., at its hospitals.

An Assembly Line

The assembly-line strategy was essential because of the complexity and scope of the project, which got off to a somewhat rocky start, says Thomas Yackel, M.D., associate medical information officer.

OHSU executives spent several months evaluating all of the practice sites to determine which ones would be ready to go live first. Some of the delivery system’s physicians indicated they didn’t want to change the way they practiced outpatient care to use an EHR, Yackel recalls.

The organization also faced a time crunch because some of the practices were planning to move into a new building in 2006, and they didn’t want to bring their paper records with them.

So after deploying the EHR at Yackel’s and about four other OHSU practices in late 2005, he and other clinicians created a toolkit of standard weekly agendas and documents to enable each of the remaining facilities to go live with the application.

“We needed to bring each practice up in 10 weeks because of our deadline and how many practices we had,” Yackel says. “But we also knew making the system simple and consistent would bring a huge number of benefits.”

While many large group practices have used a big bang strategy to implement software at all their locations at the same time, some, like OHSU are now shifting gears, going live one location at a time instead, says Megan Chavez, vice president at Tower Strategies, a Houston-based consulting firm.

“With the big bang approach, there’s no collaboration between the groups, and you end up globalizing the errors,” she says. “But a standard toolset enables you to set and establish standard policies, procedures and expectations regardless of specific location needs. More practices are starting to use this strategy because it creates a lot of transparency with the project.”

Initiating a standardized implementation strategy, however, requires practices to thoroughly evaluate the workflow at each of their locations and carefully assess what their organization is trying to accomplish with the new system before they start rolling it out, Chavez says. This includes establishing best practices for system implementation and use, perhaps collaborating with the vendor or a consulting firm, she adds.

“With a standard toolset, you can put software on top of best practices instead of broken processes,” she says. “It really does help to manage clinician expectations and generate ownership in the implementation if they know the process and can talk to their peers about it.”

Getting Started

Yackel spearheaded the EHR implementation project by hiring about 20 clinicians, including medical assistants, physical therapists and nurses, from the outpatient practices to full-time positions in OHSU’s I.T. department. Once the outpatient system went live at all the clinics, these clinicians remained on the I.T. staff to further support outpatient use and inpatient implementation.

Yackel worked with the new staff to identify core elements that were necessary for the remaining practices to successfully deploy the system, as well as ones they felt could be excluded.

The effort resulted in a toolkit of documents that included eight weekly agendas of information for how the practice should use the EHR for billing, scheduling, orders, standard office visits, phone and refill encounters, practice workflows, and other ancillary applications. Further, each week’s agenda included documents related to its subject, such as registration forms and medication preference lists practices should use for scheduling or billing.

As OHSU was developing its standard EHR implementation toolkit, it found that several of the vendor’s other customers also had used one. So the implementation team borrowed some of the best practices these organizations already had established, Yackel says.

It also created evaluation forms to rank how a practice was doing throughout the eight-week training session so it could target specific elements that needed more work to ensure a successful deployment.

The clinicians then were divided into five teams and fully trained on the EHR. The organization also gave each member of the teams specific duties. A workflow analyst, for example, was project manager for implementation at each practice. A clinical content analyst built and maintained charting tools for the software. A user support analyst coordinated go-live activities. And a training analyst conducted weekly training meetings at each of the practices.

Then each team was assigned to train staff members at each clinic about the core elements of the EHR system for eight weeks and offer support for two weeks after they went live with the system.

With a staggered implementation schedule, the clinicians were able to help one clinic to go live every two weeks. The final clinic went live in March. Then in April, the delivery system began deploying the inpatient version of the Epic EHR in select units of its hospitals. It expects to go live with nursing documentation and other modules later this year.

“Once we engaged this process, some people asked us to delay it. But we didn’t have much of a choice but to finish it because we also had to bring up the inpatient side,” Yackel says. “We’ve laid the foundation now, and people are very quickly getting used to it and appreciate it.”