Scrib'd Test Emr

WHITE PAPER MEDICAL GROUP MANAGEMENT ASSOCIATION August 2008

INSTALLATION OF AN ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM

Tom Ealey Associate Professor ALMA COLLEGE Alma Michigan

PROLOGUE

Excerpt from www.johnmccain.com INFORMATION TECHNOLOGY: Greater Use Of Information Technology To Reduce Costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines. TRANSPARENCY: Bringing Transparency To Health Care Costs. We must make public more information on treatment options and doctor records, and require transparency regarding medical outcomes, quality of care, costs and prices. We must also facilitate the development of national standards for measuring and recording treatments and outcomes.

Excerpt from www.barackobama.com Lowering Costs Through Investment in Electronic Health Information Technology Systems: Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT. Obama will ensure that patients' privacy is protected.

CONTENTS PROLOGUE

i

ABSTRACT

1

INTRODUCTION

2

1. INSTALLING AN ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p. q.

needs assessment develop vendor list billing integration decisions hardware capability assessment vendor interviews site visits, evaluation sessions selection and contracting (board action) first planning meeting with vendor planning meeting with staff final planning meeting with vendor install and test hardware install and test software training and additional testing GO LIVE data auditing compliance auditing cut off parallel systems

2. USING THE CRITICAL PATH METHOD (CPM) TO FACILITATE INSTALLATION

3. EVALUATING THE RESULTS OF AN EMR INSTALLATION

APPENDICES: HIPAA SECURITY TRANSITION OF ARCHIVED RECORDS DATA BACKUP DISASTER PLANNING TROUBLE SHOOTING AND SYSTEM COLLAPSES

USING THE CRITICAL PATH METHOD (CPM) TO FACILITATE SELECTION AND INSTALLATION The “Critical Path Method” (referred to here as CPM) was developed to enhance the management of complex defense and aerospace projects, these projects having thousands of activities, thousands of people, hundreds of contractors, and many of the key activities could only be performed in sequence. Example: astronauts could not begin simulator training on time if the simulator was not completed on time. The simulator could not be built until the space capsule was designed. For most of us CPM starts as simple intuition; the house cannot be framed until the foundation is built, if the foundation construction is late, the framing must be rescheduled. We are not in the difficult position of preparing a moon launch, our task is much simpler but still with many activities and more importantly, some critical activities. Major engineering and construction projects use very complex CPM models, the selection and installation can use CPM with a much simpler model, a model usable by most managers. A critical activity is one that must be completed before others are begun, as the home starts with a foundation. Not all activities are critical, some are on non-critical paths, but many can be critical. CPM helps us with two key ingredients of a successful project; 1.identifying the activities, and highlighting the critical activities, and 2. setting a time schedule with the activities in sequence

Project Management: Within the discipline of management an important subtopic is “project management,” being focused on large complex tasks taking an extended period of time and considerable resources. The selection and installation of an EMR qualifies as a “project,” so we use project management methods, guided by CPM, to lower the risk of failure and the fruits of success. Project planning has been charted as [

]:

1. 2. 3. 4. 5. 6. 7.

identify objective/s determined required tasks determine the resources necessary coordinate the work in process, focused on efficiency assign tasks, monitor inform participants of progress track delays, analyze delays, determine fixes

The planning approach should prevent ad hoc actions, failure to provide adequate resources, inefficient use of resources, poor sequencing and missed timing. CPM uses the information developed in the planning process and provides graphic and mathematical pathways for the project managers. Developing the Path: Simple projects may use a single pathway, more complex projects may have multiple subpaths or parallel paths. Selecting and installing an EMR should be a single path unless a hardware installation or update is required, in which case there are parallel paths.

Activities (tasks): Tasks must be sequenced, and then each step is assigned a duration. The accuracy of the duration is critical, as scheduling is dependent on a realistic sequence of tasks. As the plan comes together a key calculation takes place: Total Time Available

minus

Total Duration of All Activities

equals Path Reserve Time

A project with eight months available and 220 days of activities would have 20 days of path reserve, also known as float.

A project with eight months available and 280 days of activities is in deficit, and must have an amended plan or the total time will have to be expanded. In our example we have allowed nine months (use 270 days) with 40 days of float. We will begin our work on January 2nd and go live with a new EMR on October 1st. Adjusting the Project: Step 7 (track delays, analyze delays, determine fixes) moves us toward completion of the project and is the place where we determine the quality of our planning, the quality of our vendor, the mistakes we have made to date and the flaws in our duration judgements. Tracking and analyzing delays is critical (it is a critical path of course) and sooner is always better than later. You need to be on top of delays and be willing to move quickly to realign the path, either by using reserve, shortening duration, or moving back the go-live date.

Gantt Charts: The Gantt chart was developed by Henry Gantt, an engineer and consultant, as an easy-toread graphical illustration of the path and the time duration of each task Other engineers had proceeded Gantt, but had not published and popularized the technique. (see Exhibit #____) The advent of personal computers made the charts much more useful and much easier to prepare and amend. Gantt charts do have limits, projects with too many tasks or several parallel paths need different and more sophisticated modeling. The charts are easily prepared using either specialized software or standard spreadsheet software. For the type of path we use for an EMR project your spreadsheet software should work well. We use standard spreadsheet software here for the exhibits here.