CNEA QUESTION 1: How did you plan for and model the loss of staff and provider productivity during the initial implementation period?

The Children's Clinic planned and modeled for the loss of Provider productivity during the initial period with multiple strategies.

1. TCC Management Staff attended multiple trainings and researched case studies from previous sites who implemented EMR and learned that the average organization took six to eight months to go back to normal productivity after EMR implementation. Due to this research TCC incorporated the loss of productivity and need for additional staff assistance into all of our funding requests.


2. Our Memorial Care consultants (providers of EPIC) who had extensive experience with EMR implementation made recommendations that TCC schedule patients at 50% of our normal patient visits for the first week, 75% the second week and 100% by the third week.


3. Managers and front desk staff met on a Saturday one month before G0-Live and reviewed all schedules and decided to stop scheduling a week before Go-Live and entered a new schedule template into EPIC with the downsized schedule.


4. Per diem providers were hired and trained in EPIC and staff during the implementation period. Two front desk and two back desk staff were hired in our largest clinic for the first year.


5. Managers met frequently to discuss how to lessen the impact of the decreased productivity. For example, for the training all clinic managers met to coordinate staffing so that no site was left too short handed for the patient load scheduled each day and our clinics did not need to close for more than half a day. TCC was able to train all staff for eight hours and only lost one half day at two of our satellite clinics and only lost a total of 15 visits.

A. Did this modeling/planning influence the tactics you employed to rollout the EHR (incremental, big bang or hybrid)?

TCC, using our research and the above plan, was able to go live at all six sites, in all departments simultaneously on December 3, 2008 (Big Bang). Therefore, the above tactics/plan influenced TCC to comfortably implement the practice management, EMR system and the billing module in one day across all sites.

B. How accurate were your predictions?

Our predictions were sufficiently accurate except for one unplanned for variable. While TCC scheduled down to 75% (of normal monthly productivity) for the first month of implementation, walk-in patients continued to seek care in our clinics. Therefore, due to the walk-in patients, TCC we were at 86% of our normal productivity by the end of our first month. On the other hand, TCC did better on productivity than our implementation coordinators had predicted or seen in their prior implementations. By the second month of implementation, TCC was more productive in patient visits than prior to EPIC implementation. TCC was averaging 4500 visits per month prior to EPIC and by our second month post EPIC implementation were 367 visits over that average, 265 visits in our third month and then about 1,000 visits beyond that average by our fourth month. We have now consistently increased our productivity by 800-1,000 visits per month post EPIC implementation. Now, eleven months since EMR implementation, TCC has increased our projected monthly goals from 4,500 (again, prior to EPIC) to 5,300 visits (for FY 2009-10).