EHR Resource Planning (2) – Defining Resources

Defining the resources that are needed for an Electronic Health Record (EHR) implementation can be a challenging task. What types of resources are needed? What are their responsibilities? What are the required skill sets and job descriptions for each resource? Each EHR implementation is unique and therefore the answers to these questions will vary by project. A resource assignment matrix (RAM) is the tool that will assist your organization to assign work (responsibility) to the resources (role) for your project.

This process begins by requesting roles and the responsibilities documents and a project plan from the software vendor. This should be completed in the sales process to understand the operational requirements to implement and maintain the system in the future. The documents and project plans you receive will be in different formats. To organize and clearly define the work and the resource needed to complete the work the RAM is the best tool. Do not assume that the vendor has defined all the work and resources required. The software vendor has expertise implementing the product but not integrating it within your operational infrastructure.

The RAM tool contains tasks down the vertical edge and resources across the horizontal edge (See example below). Start with compiling a list of tasks, from the project plan, and populate the vertical edge of a spreadsheet. Next, along the horizontal edge create a list of resource types. Finally, for each task identify the resource and their role. Keep in mind that one activity may need more than one type of resources.

The next blog will focus on using the RAM to define the work or effort for each task and estimating the project schedule.

Example Resource Assignment Matrix

Task	Clinical		Technical			Clinical W/Technical Skills			Administrative
	Tom	John	Sue	Terry	Bob	Carol	Susie	Nick	George	Brian
Establish VPN connectivity			A	C	R				I
Review EHR vendor statement of work	C		C			C	C	I	A	R
Finalize future state workflows	A	R	C			I
Finalize interface specifications			A	R		C
Test all Interfaces	S		A	R		S

 

Role	Description
Responsible (R)	This role conducts the actual work/owns the problem.
Accountable (A)	This role approves the completed work and is held fully accountable for it. There should be one and only one A.
Supportive (S)	This role provides additional resources to conduct the work or plays a supportive role in implementation. Optional.
Consulted (C)	This role has the information and/or capability to complete the work. Two-way communication (typically between R and C). Optional.
Informed (I)	This role is to be informed of progress and results. One-way communication (typically from R to I). Optional.
Verifies (V)	This role checks the work to ensure that it meets all defined criteria and standards. Optional.
Signs (S)	This role signs off on the completed work. Optional.

EHR Physician Adoption

Physician documentation is a major component of practicing medicine. Complete and appropriate documentation can be time consuming and costly. Traditional dictation incorporating manual transcription remains an option for many practices. A host of alternatives exist in the EHR (Electronic Health Record) world aimed at increasing efficiency and reducing costs. Assessing these alternatives and implementing the best set of solutions is a critical step to help physicians make the transition to an EHR. Successful adoption demands careful consideration of multiple options that can be chosen by the community of physicians in your practice depending on the nature of the visit, physician tolerance for change, and more appropriate technology match for the physician and their personality. Whatever the solution: cost, productivity, reimbursement, patient safety, patient and physician satisfaction should all be considered carefully.

Options for physician documentation include:

1. Leverage telephone or voice recorder devices to dictate the entire note for manual transcription. Solution can be accomplished with or without an interface.
   
2. Leverage telephone or voice recorder devices to dictate while taking advantage of macros on the back end to reduce dictation and transcription effort. Solution can be accomplished with or without an interface.
   
3. Leverage telephone or voice recorder devices to dictate while taking advantage of back end voice to text technology to assist transcriptionists and to reduce transcription effort. Solution typically requires an interface.
   
4. Leverage dictation markers to minimize the portion(s) of the note that need to be dictated and transcribed. Solution typically requires a bi-directional interface.
   
5. Leverage front end voice to text software to remove need for transcriptionists. Solution requires no interface.
   
6. Leverage point and click templates to build the documentation for the visit. Solution requires no interface.
   
7. Leverage text templates or macros to build the documentation for the visit. Solution requires no interface.
   
8. Physician manual typing
   
9. Provide physicians patient worksheets (piece of paper) that can be marked up and handed off to support staff member for entry into the EHR.
   

There are pros and cons to each of the options. Assessing the options for your organization, choosing the best matches and implementing the solutions correctly, is critical to your success. You will need to arrive at a subset of these options that best supports adoption while remaining supportable.

For more details on how to select the best options, best practices for implementation, training and support, contact us for additional information at information@projectnavigation.com.

EHR Resource Planning (1) – Introduction

You just signed a contract to implement an electronic health record (EHR) at your organization. The vendor has been engaged explaining that the implementation is a partnership and they will be there to lead your organization through the process. In order to start the project, the vendor suggests that you staff your team according to their roles and responsibilities (R&R) matrix. Based on the vendor's R&R matrix you feel that you have most of the staff in house and will be able to start the project within the next month. This is a common scenario healthcare organizations encounter in an EHR project. Without even knowing it you just started the implementation with a considerable risk unless you define the staffing requirements for the implementation as well as long term support.

This series of blogs will discuss how to define your resources for implementation, outline the work for each resource, define project schedules, and the operational plan for long term support.

EHR Risk Management

Without evaluating risk, issue management alone is an incomplete strategy for an Electronic Health Record (EHR) project. Do not misunderstand, issue management is very important, but without preventing issues managing them alone will not reduce the number of issues. All resources, for the most part, are familiar with issue management on EHR projects. Issues include software and organizational related items that impact the project. The key difference is in regard to consequences to the project. An issue, such as a software defect, has an immediate effect on the project. On the other hand, a risk has the potential to affect the project but has not yet come to fruition. Issue management is reactive since once it occurs the only option is to react by managing the impact. Risk management techniques will provide a proactive strategy when combined with issue management to provide a comprehensive strategy for an EHR project.

So what level of risk management is appropriate? The Project Management Book of Knowledge (PMBOK®) has a chapter dedicated to risk management. The key is to use tools and techniques that are appropriate for the scope of the project. A small budget three month EHR project does not require a Monte Carlo analysis, so what risk techniques are appropriate? The key is to have a project manager with the education and experience to use the appropriate tools and techniques. An easy step is to add risk review as a standing agenda item for team meetings. Do not underestimate the benefit of challenging each team member to a weekly review of potential risks. Setting the expectation that each member is responsible for identifying risks will leverage the collective experience and will result in more effective planning and decision making. The project manager is responsible for managing the risk management plan, however too often only identifies risks from one perspective. Team members will have various insights and perspectives. Implement this intervention today and you will begin to have less unforeseen issues, better planning and decision making.

In upcoming blogs we will discuss risk tools and techniques for EHR projects. If you would like to synch the blog with Outlook click on “ATOM” on the left to setup an RSS feed.