the path to paperless
Developing Our Training Plan
We design a "Work Breakdown Structure."
By Peter J. Polack, M.D., F.A.C.S.

Until now, we have looked at various parts of our EMR implementation project, from installing infrastructure to choosing hardware and software. In part 12 of this series, we begin to bring the parts together to make our paperless office a reality.

Although our IT personnel had begun to plan some critical tasks such as the wiring of satellite offices, we needed an integrated plan that would tie in the technical aspects of the project with the training aspects to maximize efficiency, making the best time-use of our personnel.

Developing the Plan

Key personnel from different departments including administration, clinical, IT and clerical met with Frank Polack of Eviton Consulting, a facilitator in project management, to create a WBS (Work Breakdown Structure) for the EMR implementation project.

We first identified the major processes that needed to be addressed and placed them under 10 overall headings: Software, Hardware, Infrastructure, Resources, EMR Configuration, Testing, Training, Support, Process Review and Rollout Phasing. [see diagram]

Each process was then further broken down into smaller steps, which could be delegated to staff who would "own" that particular subprocess. For example, configuring the EMR program was divided into specific issues (such as configuration of templates) and further subdivided into specific tasks (which standard templates to use, which templates to create, who creates them, who will review them and how will they be tested).

For EMR configuration, a workgroup comprised of physicians and IT personnel is now analyzing the existing clinical templates in the EMR program. This workgroup will then make modifications based on the workflow currently used in the practice, in order to have
the most transparent effect on the task of patient examinations.

Making the System Work

Particularly for physicians who are less "tech-savvy," it is critical to have a system which is as efficient, if not more so, than the current one they are used to using.

Some changes in the current workflow will probably be required given the hierarchical design of the EMR system. For example, while we currently dictate to a scribe something such as "2+ NS (nuclear sclerosis) and PSC" we may need to say "lens, NS 2+ PSC 2+". While this may seem like a minor difference in the way physicians have been doing things, it can have an impact on workflow efficiency when multiplied by hundreds of patient examinations per day.

The onus is then on the configuration workgroup to come up with a method to marry the way the physicians and staff have previously been working with the way the EMR software works most efficiently.

A separate "test" database of the EMR system can be accessed from home via remote desktop services by any member of the workgroup to make changes to templates and test them. The workgroup can then do a final review before the changes are made to the "working" database.

Next: The training process

Peter J. Polack, M.D., F.A.C.S., is co-managing partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology practice located in Ocala, Fla. The practice, which has five locations including an ASC and laser center, has 140 employees. He can be reached by e-mail at ppolack@ocalaeye.com.