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Using A Standard EHR Approach
July 1, 2008
Because Oregon Health and Science University has 59 clinics, two hospitals and 800 salaried faculty physicians, implementing an enterprisewide electronic health records system was a daunting task. To greatly simplify implementation at the clinics, the academic medical center developed a standardized, 10-week approach, using a team of clinical experts to guide each implementation.
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.
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