EHR Deployment Team Please fill out the table as best as possible. For each item, enter in person (or persons) responsible Facility Preparation Tracking Record (please include specific names when known). Enter any applicable actions or decisions. Finally, if (version 03/14/06) item has been completed, enter the completed date (enter in only month and year if date is not know This table can be useful to facilities to document your or the projected completed date if known. An example has been filled in on the first line. Please no activities toward EHR implementation. From time to that you may not be far enough in your planning to have considered or even understand some of th time the EHR Deployment Team will request an updated items, so you may just leave those blank. In addition, as every site is unique, these items may not b copy in order to track progress and coordinate in chronological order for your site. Do not feel that you must complete one item before going on to deployment activites with other facilities. Until further the next. Significant tracking milestones are highlighted. notice, please email this updated document once a Please email Megan Powers at email@example.com with any questions or for further clarificatio month to Megan Powers, Deployment Coordinator at of any items. firstname.lastname@example.org. Please update the following information regularly as needed: Site Name: Name of Lead EHR Site Contact: Contact information: Telephone E-Mail Address The EHR Program is required to report to the Office of Management and Budget on EHR-associated costs. PLEASE CLICK HERE to go to the cost reporting section of this worksheet. Item Responsible Action/Decision Completed Date (Example) EHR team Decided to start using EHR in all Identification of go-live clinic / location areas (OP, ER, FCU) for ordering labs 12/15/2004 Decision to participate as an EHR site Assign EHR Coordinator or Project Manager Complete EHR site survey (http://www.ihs.gov/cio/ehr/documents/EHR%20Program %20Site%20Survey%20(form).doc) Review EHR web site, sign key staff up for EHR WebBoard (http://www.ihs.gov/CIO/EHR/index.cfm?module=listserv ) Attend EHR Lessons Learned seminar at Warm Springs, Cherokee or Fort Defiance Facility leadership commitment Medical staff buy-in Convey new vision, core values, increase visibility Develop plan to demonstrate commitment to staff Perform "Force Field Analysis" to identify both "driving forces" and "restraining forces" for EHR implementation. Hire and/or appoint Clinical Application Coordinator (CAC) Develop training plan for CAC. Consider (a) CAC & Implementation Team, (b) Basic Site Manager, (c) Fileman, (d) PCC Outputs, (e) Lab Package, (f) Radiology Package, (g) Preparing Pharmacy for EHR (h) Advanced EHR trainings, (i) Site Visit to EHR site Establish EHR Implementation Team to include (a) CAC, (b) Pharmacy Package Administrator, (c) Lab Package Administrator, (d) Radiology Package Administrator, (e) Nursing, (f) Medical Records, (g) Coding, (h) Data Entry, (i) Business Office, (j) Medical Staff, (k) Nursing Services, (l) Other Clinical Departments/Services as necessary, and (m) Information Technology. Identify clinical champions / super users from each clinical service Evaluate current hardware/network Begin procurement process for hardware Hire additional IT staff if necessary Install new equipment Assess utilization of RPMS "Point-of-Service" packages to include (a) Immunization 8.0, (b) Women's Health, (c) Diabetes Management, (d) Behavioral Health System v3.0, (e) Behavioral Health GUI, (f) Dental, and (g) Case Management. Implement "Point-of-Service" utilization of Immunization Package if not already in place Implement utilization of Women's Health Package for PAPs, Mammograms, Breast Exams, and Biopsies if system is not already in place. Develop staff incentives Identification of go-live clinic / location Ensure that all EHR Implementation Team members and key clinical staff have explored the EHR Demo Disk Determine staff concerns and follow up Identify a subgroup of the EHR committee to ensure regular communication with employees and community on project endeavors Publicly promote the EHR initiative, e.g. newsletters, community meetings, local newspaper, fliers on bulletin boards Communication with Labor Union (if applicable) Set implementation plan/timeline Develop training plan for new software packages (PIMS, Radiology, Pharmacy, etc.) Design implementation plan (For example by provider, by clinic, by function, or a combination) Productivity risk assessment and mitigation plan Contingency planning for system down time, etc. Provide Area Office with copy of implementation plan Review "CAC User Guide" and "Clinicians Guide" User Manuals (available from OIT website) Run XBEHRCK: identify and install required upgrades to existing RPMS software PIMS installation, training, and go-live (discontinue use of appointment books in all locations) Identification of baseline measures and metrics Pharmacy consultation -- OIT Pharmacy consultants Pharmacist training for Pharmacy 5/7 Pharmacy file cleanup / preparation for Pharm 5/7 Implement Adverse Reaction Tracking (ART) package. Assign "GMRA" Keys to Data Entry Staff and turn on "ALG Mnemonic". Perform "work flow analysis" and "business process review" for EHR Determine consults that will need to be set up in EHR Begin planning for EHR Quick Orders Implement "Ward Order Entry" for radiology if not utilizing already Implement Radiology Reports within Radiology Package if not utilizing already Radiology file setup and training for Radiology 5.0 Radiology 5.0 installation and go-live. Implement "Ward Order Entry" for laboratory exams if not utilizing already Develop system for getting microbiology into the RPMS lab package if not already in place Develop system for getting reference labs into the laboratory package (File 60) if not already in place Develop system for getting Point-of-Care (POC) labs into laboratory package (File 60) if not already in place (interface with POC machines or "Fast Bypass" Option) Laboratory file cleanup for Lab 5.2 (if not already running) Laboratory 5.2 training, installation and go-live (including installation of most recent Lab patch-- currently 1018) Obtain and review VueCentric Installation guides Set up a share drive prior to implementing EHR Run XBEHRCK again to ensure system is ready for Pharmacy/EHR installation Pharmacy 5/7 training, installation and go-live Installation of remaining EHR components (includes GUI files) Implement "Paperless Refill" option. Attend EHR CAC/Implementation Team training in Albuquerque Define protocol ("standing") orders for nursing staff Design Order Menus Develop Quick Orders for medications, lab, radiology, and nursing Establish medical records subcommittee for approval of TIU templates Preparation and approval of general, clinic-specific, and provider-specific TIU templates Determine the effect of EHR on departmental policies and procedures, rewriting as needed Review medical records policy and begin to define the legal medical record and its primary source Notifications - define which ones will be used Set up ICD-9 pick lists (by clinic and/or by provider) Set up CPT superbill pick lists (usually by clinic or specialty) Consider implementing the unit dose package and IV package Plan staff scheduling for go-live National team visit to complete EHR setup Prepare training database Demonstrate EHR to staff using local setup on training database Set up EHR client on user computers -- provide access to training database for exploration Site visit for EHR super-user training Complete final preparation activities Let community and staff know go-live date and what they can expect Go-live with EHR Phase I (according to implementation plan) Follow-up metrics (1, 3, 6 months, 1 year) Stepwise, scheduled rollout of EHR to remainder of facility or persons) responsible or decisions. Finally, if the year if date is not known) the first line. Please note understand some of the , these items may not be item before going on to or for further clarification Projected Completed Date Notes The most important step is the first one – deciding to transition to the electronic health record. This is not a decision that may be taken lightly, because of the implications for and impact upon the entire facility. For most locations the decision will not be whether to move to EHR, but when. EHR is expected to become the standard for IHS facilities, and the current plan is to have all federal sites using the application by the end of 2008. This is the person with overall responsibility for the successful implementation of EHR at the facility, and is the main contact person for the EHR Program. This site survey provides the EHR Program with basic information about your facility and its readiness for EHR, and also serves as a starting point for your internal discussions about planning for EHR implementation. Submission of this survey to Howard Hays is required to be put in the EHR implementation queue. The EHR website is located at http://www.ihs.gov/cio/ehr and contains valuable information for the successful implementation of EHR at a facility. It is important for the EHR implementation team to thoroughly look over this website at the beginning of their EHR implementation. In addition, this website should be periodically reviewed during EHR implementation for any new information. The EHR WebBoard is the principal forum for discussion of EHR related issues and has proven to be a valuable support and networking tool for EHR sites. In It is highly recommended that facilities send staff to one of the EHR: Overview, Implementation and Lessons Learned courses. This is a one day course that will show the EHR in action and will discuss the steps in the EHR implementation process. Participants are provided with a number of helpful documents as well as an EHR Demo Disk, which should be explored by all members of the local EHR Implementation Team. More can be read about this course at this website: http://www.ihs.gov/CIO/EHR/index.cfm?module=rpms_ehr_training_overview. Neither the decision to use EHR, nor the activities required to implement it, can take place without the full knowledge, consent, and support of an organization’s administration and governing body (including Area Office officials), as well as local tribal leadership. The steps required are complex, difficult, and potentially costly and controversial. Unless leadership is exerted to both support and enforce the transition, it will not succeed. EHR is above all a clinical application, and its greatest impact will be on providers. While the medical staff does not need to be unanimous in its support for EHR, the transition will be more likely to succeed if influential clinicians are enthusiastic and energetic about EHR, and are given the opportunity and time to take leadership in the effort. The experience and example of these clinicians will be invaluable as use of the application penetrates to the remaining staff. By whatever means are most appropriate for the culture of the facility, leadership needs to begin early on to promote the EHR effort among the staff. EHR implementation is not just installation of new software. It requires comprehensive process changes throughout the organization in order to realize the potential for improvements in patient safety and quality of care that EHR offers. Success will depend upon all staff understanding the new vision and how it relates to the work in their own departments. With the implementation of EHR comes many changes in a facility. Many of the facility's business processes need to be reviewed and possibly changed to better fit an electronic health record. Such large changes can make staff wary about the project and less willing to participate in the EHR. Therefore, the facility must develop a plan for change management to assist staff with the change. In doing so, the facility will demonstrate its commitment to its staff. The EHR Implementation Team should put together a list of forces that are driving the implementation of EHR at their facility (e.g. striving toward better documentation, federal mandate) and those forces that might hinder a successful implementation of EHR (e.g. need funding, lack of provider support). Using this "Force Field Analysis", the Implementation Team can discuss ways to mitigate the restraining forces and use the driving forces to their benefit. The EHR Program strongly urges and expects that all facilities will have a Clinical Application Coordinator (CAC). For most facilities this will be a full time new hire position, and larger facilities will require more than one, as EHR use moves into all clinical departments. The typical CAC is a nurse or midlevel provider with strong computer skills who understands all aspects of the EHR GUI. The CAC provides training for clinical users on an ongoing basis as new staff enters the organization or as enhancements to EHR are developed. The CAC also is a day-to-day troubleshooter, available to assist users with the application at any time during the clinical workday in order to facilitate patient care. Finally, the CAC works closely with clinicians and other staff to customize screen views, TIU templates, order sets, and POV, CPT, and be thepick lists for the facilityperson(s) about EHR at each facility, and will require the most training. The Program The Clinical Application Coordinator(s) will other most knowledgeable and its providers. Sample position descriptions for the CAC have been provided to each recommends at least two weeks of training at a collaborating Veterans Health Administration (VHA) facility, in addition to at least one week at a federal or tribal site running the IHS Electronic Health Record (see below). VPN access to VHA-sponsored Web based training will also be arranged. EHR is not an application whose implementation can be effected by one person. An implementation team consisting of representatives of major affected departments must be formed, and must meet regularly both during preparation and perpetually after implementation. Recommended composition of the EHR team includes representatives from the following departments: administration, medical staff, nursing staff, pharmacy, medical records, business office, laboratory, radiology, information systems and other support departments depending on local implementation plans. Specific team members should include: o Local EHR coordinator o Clinical champion / super user o Clinical Application Coordinator o Administration member These are influential medical staff members with enthusiasm for EHR and a measure of technical skill, who will likely be the first EHR users and will take the lead in bringing the rest of the medical staff on board. It is the role of the EHR Program Technical Lead to provide consultative support to EHR sites on the hardware and network infrastructure at each facility. This support will include both evaluation of the existing infrastructure and recommendations for new equipment that will be required to support EHR. o Evaluation of RPMS hardware / server / capacity o Evaluation of facility network infrastructure o Evaluation of end-user hardware needs Following the technical consultation described above, the procurement process for identified hardware needs to begin, as this may be a time-limiting factor in the transition to EHR. Although the EHR implementation is a largely clinical project, it cannot be completed successfully without the proper IT personnel. Some of the duties of IT in this project include networking, installing new computers, and assisting in software installation and upgrades/patches. Many facilities will be able to utilize their current IT staff for this project, though others may wish to consider hiring additional staff. Once new equipment has arrived at the facility, it should be installed in its appropriate locations and checked for functionality. Several RPMS applications allow clinical users to directly enter data into the system at the point of care. Full use of these applications increases familiarity with RPMS capabilities and comfort with using computers. Sites should review how well their staff is already using point of service applications, and encourage their use as part of the preparation process for EHR. See #32 above. The Immunization package is one of the more important point of service applications, and nursing staff should be using it exclusively for entry of immunizations and management of the immunization registry. Dependence upon immunization "blue sheets" needs to be eliminated. See #32 above. The Women's Health Package is another very important point of service case management application. At present, there is no EHR component for direct entry into Women's Health, so staff need to be familiar with using the application in RPMS. Several EHR reminders depend upon accurate data in Women's Health, making it even more important to keep this data up to date. Although exciting as well, EHR implementation can be challenging, difficult, and even discouraging. Designing incentives to encourage committed and enthusiastic participation in the initiative can go a long way toward preserving staff morale throughout the transition. The decision of where to start with EHR is a purely local one, and may be influenced by such disparate factors as hours of operation, patient volume, physical layout, the presence of computers and network connections, and the specific clinical and nursing staff who work in the area. Once this decision is made, the implementation team will need to decide what technology to use for EHR in this area. Typically the decision will be between hard-wired personal computers and wireless-enabled tablet computers, and will influence the technical consultation described below. It has been our experience that many facility staff members, including those on the EHR Implementation Team, have not viewed and/or explored the EHR software prior to key EHR trainings, leaving them at a disadvantage during these trainings. Therefore, it is important that facility staff be given access to the EHR Demo Disk obtained at the EHR Lessons Learned course (see #18 above) in order to become familiar with the EHR software. In addition, the National EHR Team hopes to have a recorded training session available via the Internet in the future. On a regular basis, the EHR Implementation Team should discuss the upcoming changes related to EHR with its staff, and talk about any concerns that may arise. These concerns should be addressed in a timely manner. A few members of the EHR Implementation Team should form a subcommittee that is focused on communicating with employees and the community regarding changes that will occur due to the implementation of the EHR. This committee might consider creating a pamphlet for its patients that explains what the EHR is and how it might affect them. The community should be aware of the upcoming changes in business process and clinic flow. The facility can take the opportunity to promote EHR as a modernizing initiative intended to improve patient safety and quality of care. At the same time, advising patients of the possibility of delays or other inconveniences during the transition may reduce the likelihood of confusion and complaints. If any employees at the facility are members of a Labor Union then the EHR Implementation Team will need to make sure it discusses with the Union any potential changes in the scope of work for these employees. The EHR Implementation Team should consider major milestones in the EHR implementation process (many are highlighted in blue in this document). The team should create an estimated timeline for these milestones and create a plan for how they are going to reach these goals. This Site Tracking Document can be a helpful tool in this process. If the facility is not currently using EHR required software such as PIMS, Radiology and Pharmacy, then the facility may want to send staff to trainings to learn how to use these new software packages. Current trainings offered can be found on the RPMS training website: http://www.ihs.gov/Cio/RPMS/index.cfm?module=home&option=OITTrainingLinks. The facility should consider the strengths and weaknesses of its departments and determine where and when it will first begin to use EHR. Most facilities will use a stepwise rollout of the EHR, beginning in one department and later moving to other departments. Each facility must determine if it would like to begin using the EHR "tab by tab" (e.g. begin with the Wellness Tab to document immunizations and patient education and then move to the Lab Tab, etc.) or "provider by provider" (e.g. begin with one provider using all tabs of the EHR, then bring on other providers one by one). All sites implementing EHR can expect to see a decline in provider productivity (number of patients seen per day) for the first several weeks and lasting up to 2-3 months. Each facility will need to consider how it will address this issue, such as through a staggered rollout strategy or by hiring temporary providers. Through the EHR WebBoard and other means, sites can learn about the experience of other sites in the management of provider productivity during implementation and develop a strategy that is most appropriate for the local situation. All systems fail from time to time. Effective planning for system failure can reduce the risks and chaos that result when this occurs. Procedures need to be developed for rapidly identifying and correcting the cause of the failure, and for continuing to provide patient care while this is taking place. Additional procedures for populating the database with information gathered on paper during down times would be appropriate as well. Once the EHR Implementation Team has created their implementation plan (which may consist of this Site Tracking Document and possibly other documents), they should submit this plan to their Area Office. Well in advance of attending EHR CAC and Implementation Team training, each member should begin to review these documents to familiarize themselves with what will be covered. All documents can be found here: http://www.ehr.ihs.gov/index.cfm?module=preparing The XBEHRCK routine identifies deficiencies in RPMS application versions and patches. Any upgrades and patches need to be accomplished early in the process before any EHR-specific applications are installed. The Patient Information Management System (PIMS) is the first new RPMS application that is required to be installed and running preparatory to EHR. PIMS incorporates scheduling, admission/discharge/transfer (ADT), and sensitive patient tracking functions. As PIMS is rather different than the previous scheduling and ADT applications, specific staff training is required and will be scheduled for each site by the EHR Program PIMS application team lead. Evaluation is a critical component of the EHR Program, both locally and nationally. The EHR Program will provide a description of the evaluation process, along with recommendations for metrics that should be baselined during the preparation phase. With the exception of clinical providers, the pharmacy staff will see the most significant changes in process and practice as a result of EHR implementation. The new pharmacy applications (Inpatient Pharmacy 5, Outpatient Pharmacy 7) are considerably different than their predecessors, and the changes are made more complex by the introduction of on-line medication ordering by providers. The EHR Program pharmacy consultant will contact each chief pharmacist and develop training and implementation plans for the new pharmacy applications. Pharmacists training for the Pharmacy 5/7 applications is coordinated through OIT offices in Albuquerque. Sites should contact Steve Bowman at email@example.com for further information. Because of the differences introduced by the new pharmacy applications, considerable revision of pharmacy data files is required. This is estimated to require a minimum of 2 weeks of a full-time pharmacist’s time to complete. In addition to cleaning up drug files, orderable items will need to be created and configured for each drug, and nouns and verbs will need to be linked to specific dosage forms before the pharmacy is able to go live with the new versions. The pharmacist may want to consider attending one of the Preparing Pharmacy for EHR training courses. Only allergies and adverse reactions documented in ART will participate in order checks in EHR. Allergies on the Problem List will not be detected by the order checking routines. It is very important that sites take the time to enter allergies into ART, rather than depending on the Problem List for allergy documentation. This process will take time and needs to begin as early as possible. Implementation of an electronic record forces a broad range of business process changes in a variety of departments. A listing of recommended business process changes is provided in a document on the EHR website. This document is based upon the experience at a number of early EHR sites. Although the recommendations may not apply to every site, it is imporatant that they be reviewed and considered as early as possible in the preparation phase, in order to give the facility adequate time to implement necessary changes before going live with EHR. The Business Process Recommendations document is not guaranteed to Consults are referrals of patients by the physician to another hospital service/specialty, to obtain a medical opinion based on patient evaluation and completion of any procedures or treatments the consulting specialist deems necessary to render a medical opinion. The EHR Implementation Team needs to determine which consults are used at their facility and must be set up in EHR. Quick orders are either one order or a set of orders that are predefined in the system so that providers may choose these orders with a minimum amount of clicks. The EHR Implementation Team must determine which orders they would like to include in the Quick Order menus and how they would like the menus to be arranged. See #32 above. This is another opportunity to utilize the point of service options already available in RPMS. Using Ward Order Entry for Radiology orders will get the Radiology staff accustomed to receiving (and trusting) electronically generated orders, as opposed to paper requisitions. Having providers originate these orders from the exam room will help them to become more familiar with RPMS and its capabilities, and facilitate the transition to order entry in EHR. RPMS order entry is somewhat more time-consuming than it is in EHR, and this ensures that providers will welcome and appreciate the advantages offered by the EHR GUI. Facilities should move away from paper Radiology reports as soon as possible. The only Radiology reports visible within the EHR are those created within the Radiology package, so in order for providers to be able to call up old reports, these have to be entered into Radiology. The earlier the Radiology reports function is utilized, the more historical reports will be accessible to providers once EHR is implemented. Most sites are presently running Radiology 4.0 (supported by OIT) or Radiology 4.5 (with independently contracted support). Radiology 5.0 represents a modest change from version 4.0, and little change from 4.5. Some file preparation is required, but the amount of end-user preparation is expected to be small; this should be addressable through updated documentation rather than focused training. Install Radiology 5.0 at the facility. See #32 and #59 above. As with Radiology, the use of Laboratory ward order entry will introduce providers and laboratory staff to the benefits of computerized order entry and facilitate the transition to EHR. In order for Microbiology reports to be available to providers using EHR, these results will need to be entered into the Laboratory package. Reference laboratory results also are not available within EHR unless they have been entered into the Laboratory package. The upcoming availability of the bidirectional Reference Lab Interface will facilitate this by having results from Quest and LabCorp reference labs electronically passed to the Lab package. In order for Point of Care lab tests to be visible through the EHR, the results have to be entered into the Laboratory package. This can done by the staff member performing the test by using the Fast Bypass option in the Laboratory package. Although not as extensive as that required for pharmacy, a certain level of file preparation is required for the laboratory order entry component. Most facilities are already running Laboratory 5.2, so the upgrading and training requirements to use this application with EHR are minimal. These documents can be found here: http://www.ihs.gov/Cio/RPMS/PackageDocs/EHR/clientsideDocs.asp The share drive is where the EHR application files reside, and must be shared so that client computers can access the application. Setting up a share drive is a part of the VueCentric Framework Installation Guide. This must be done prior to installing the EHR GUI since creation of a shared folder requires administrative rights to the Windows Server. The technical consultation will include an evaluation of the present state of RPMS and other software installations at a facility. Any upgrades and patches need to be accomplished early in the process before any EHR-specific applications are installed. Once all pharmacy file preparation is complete (see above), training of pharmacy staff on the new applications will be scheduled, and use of the applications will begin. OIT staff and/or contractors will assist local IT personnel to assure successful installation of required applications and the GUI EHR framework on local servers and client computers. Substantial local configuration of the applications is required as well, and will be part of this support activity. Paperless refills are an option in the Pharmacy package that allows pharmacists to refill medications and create a completed visit in the pharmacy package, eventually without pulling the paper chart. The patient encounter is documented in the pharmacy package instead of on a PCC form. This familiarizes the pharmacists with the capabilities of the Pharmacy package. In addition, it changes the work processes for medical records and data entry staff, as data entry will now have to work error reports and coders will see an increase in uncoded diagnoses for pharmacy visits. However, there is no longer any PCC data entry for The National EHR Program will work with the EHR Implementation Team to determine which CAC training they should attend. Most facilities should be using Pharmacy 5/7 for at least one month prior to attending CAC training. EHR requires standing orders (so-called "policy" or "protocol" orders) to be very clearly defined. Ambiguous standing orders that may have been acceptable in the paper environment will not work in EHR. It is important for the organization to take the time to very clearly describe any standing orders they wish to use after implementing EHR. One of the powerful features of EHR is the ability to create an unlimited number of quick orders that greatly simplify the entry of common orders by providers. These orders are arranged in menus and it is important for the provider staff to define how these menus should be laid out so they will be most understandable to all users. This layout should be thought through and documented on paper prior to the National EHR Team's on-site setup visit. The EHR Implementation Team should already be considering which quick orders they would like to have at their facility (see item #58). At this point, the quick orders should be discussed again with the appropriate departments and finalized. Since TIU templates define the format for many clinical notes, it is important to have the templates reviewed and approved by the medical records committee. Having received training, each facility’s CAC(s) will be responsible for the Text Integration Utility (TIU) documentation templates in use there. Many model templates will be available from the VHA and the EHR Program, but local customization in consultation with users will be required. Each department should review its policies and procedures to determine if any will be affected by the implementation of EHR. Those that are affected should be rewritten to reflect the new policies and procedures that will be enforced. When changing from a paper medical record to an electronic medical record, facilities must delineate the source system in the EHR system of the hybrid electronic health record. The source system is defined as where the information is originally created (such as RPMS or scanned documents). Switching to EHR means that facilities need to update their policies and procedures that outline maintenance, use, disclosure and rentention of the medical record. Notifications are alerts regarding specific patients that appear on the patient chart. These could include critical lab results, patient discharged or deceased, or flagged orderable items. The EHR Implementation Team needs to determine which notifications will be used at the facility. EHR also allows for facility- and provider-specific pick lists for ICD-9 codes, to facilitate entry of POV data. The CAC(s) will develop these as well. EHR allows for entry of procedure and supply data directly into PCC, where it is picked up by the billing application. It will be the responsibility of the CAC(s), in collaboration with nursing staff, coders, or others, to develop facility- and provider-specific pick lists for procedures and other billable items. This is for inpatient facilities only. Facilities should make sure all medications (both inpatient and outpatient) are in the patient's medication profile. This will assist with medication reconciliation. When providers first begin using the EHR, their productivity will drop until they become more familiar with the software. Therefore, it is advised to decrease the patient load of the providers for a period of time following EHR go-live. The National EHR Program will work with the facility to set a date for the onsite EHR setup visit. This visit lasts for one week. The National EHR Team will perform a walk through at the facility and discuss any process issues found. Next, the National Team and the facility's EHR Implementation Team will go through the items discussed at the CAC training and will set up these items in the facility's EHR database to match the facility's business processes. Once the setup of EHR is complete, it is a good idea to copy the database over to a training server for use by staff in the EHR training process. Once the EHR is set up on the training database at the facility, the EHR Implementation Team will be able to demonstrate the EHR to the rest of the staff. This is recommended so that the staff can get an idea of what the EHR looks like. More in-depth training on how to use the EHR will occur at the Super User training. Giving users the opportunity to explore EHR in the training environment on their own time will increase their familiarity and comfort with the application before they need to start using it for clinical care. It is HIGHLY RECOMMENDED that users become familiar with the EHR interface prior to Super-User training. On-site user training for those providers identified as initial EHR users will be offered in the weeks before going live. This training will be conducted by the local CAC(s) in collaboration with trainers provided by the EHR Program. Subsequent user training, during a facility’s phased implementation period, will be provided by the local CAC(s) and EHR Super Users. Some additional limited on-site training and implementation support will be available depending upon facility size. The CAC and EHR Implementation Team should make sure that all users have been assigned the correct keys and that they are able to log in to the EHR. Staff that will be initially using the EHR should spend some time in the GUI with demo patients to become familiar with the software and to bring to light any technical or setup issues that remain. Communication with both facility staff and the community about the EHR transition is important throughout the project. Especially as the go-live date approaches, the organization should identify ways to publicly promote the advent of this new technology and also to advise staff and patients on potential impacts on patient flow and other processes during the transition phase. Many facilities have accomplished this through fliers and articles in local papers. Some examples of fliers can be found on the WebBoard. Only very small facilities will be able to effect full-scale implementation of EHR in a single event. The majority will start with a handful of providers in a single clinic or ward, and will move to other locations and providers according to a predefined schedule. The facility should re-run the reports used to compile baseline metrics and report this information to the National EHR Program. These metrics should be collected 1 month, 3 months, 6 months and 1 year following the facility's go-live date with EHR. Each facility’s implementation plan will be different, but the EHR Program strongly recommends that a specific timeline for moving the application through all clinical departments be adopted in advance and followed, in order to overcome bottlenecks and other impediments.
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