Following is a summary checklist we use at the beginning stage of implementation planning. We ask all process designs to be completed about 5 months before the go live to test and minimize the variability during the actual implementation.
· Project Team/s formed
· Readiness assessment conducted (we use CCI's summary assessment as the tool)
· Provider Champion identified
· Super User/s identified
· Pilot location identified
· Facility assessment and corrected for workflow, wiring and other requirements
· Staffing / After Hours / Per Diem / Float processes defined
· Workflow / Business Process / P & P / Job Description at the clinic and support functions
· IT help desk process readied for go live and on-going operations
· Technology, Storage and Network (log-in, scanning, tablet, carts, wireless, printers …) changes
· Medical Equipment identified for usage w/ EMR
· Interfaces (lab, medical equipment, others apps, other devices) determined
· Downtime Procedures & Forms updated/created & tested
· Disaster Recovery / Business Continuity impact assessed and addressed
· Electronic / Paper across locations process if not doing a big bang (for multi-location organizations)
· Training Room & Training strategy defined
· Abstraction & on-going scanning policies determined
· Paper based Referral / Follow-up systems are accommodated
· Electronic processes replacing any manual logs
· Audit / Compliance related areas are assessed
At the end of this planning process, we firm up the project plan, the team and go live strategy to be executed.
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4 comments:
Bobby -
Thanks for this list - it is a very comprehensive planning document! I'm wondering if it's possible to identify categories of decisions within each of these domains. For example, are there decisions that are made at a network level (i.e., standardized, non negotiable for all organizations, all regions), an organizational level (to allow for state or regional variations) and possibly at a site level? If so, can you give some examples of this? The reason I ask is because this addresses the issue of speed/acceleration of implementation by limiting the decisions and prework that an organization needs to undertake in advance of the imlementation.
SA,
It's a great question. In NGHN model, the standardization takes in few different forms;
- Mandatory (we call this NGHN Frameworks)
- Best Practices
- Guidelines
Mandatory is exactly that - you must do as agreed (sounds worse that it really is). For us, this means how certain things are configured in practice management system (i.e. drop down list value of Race in demographics screen) and usage of all custom developed EMR templates without modifications. This is 100% defined for each implementation.
Best Practices are not mandatory but should be adopted for each organization either as is or with some customization. To be fair, anything to be at best practice level, it has to be proven and well documented. This area continues to grow as more sites and organizations go live and really experience what works and what doesn't. Downtime process & forms is a good example of this as well as Go Live sequence we follow for each go live. This is 80% pre-defined with additional 20% work required to localize/customize.
Lastly, Guidelines are optional good "thoughts" or "practices" that should be considered. These can turn into best practices at some point if enough outcomes are measured. You can look at this being 20% pre-defined with bulk of work necessary for localize/customize.
In terms of speed/acceleration, beside standardized process or configuration, I think the following helps;
- Moving the starting point of any decision points based on past discussions & decisions - everyone decides on whether/how to use tablets
- Interactive and timely access to each other – we have weekly call of currently implementing members and those in various planning stages to provide updates and ask questions of each other
So, another way to look at the speed question is not only limiting the decision points but really quickening the decision making process while sustaining or improving the quality of the decision.
Bobby.
Bobby - that is a great point about not only limiting the number of decisions but paying attention to the process of decision-making itself. Thanks for elaborating on your process for achieving standardization. For some EHR implementations in which I've been involved, it seems that standardization is a four-letter word! But with broad participation in defining those standards, coupled with an expeditious process, it really forms the bedrock of the network services.
Great List Bobby!
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