Mastering IT matters, part 2
Get it running: EMR adoption and your IT managers
By Peter J. Polack, MD, FACS
Getting Your IT House in Order Part 2
In Part 2 of “Mastering IT matters,” we discuss how hiring our IT manager and IT project manager in tandem with the installation of our EMR system set up our first milestone (the ownership of an EMR that had to be managed), took us to the next level of our IT evolution, and set the direction for future advances in our IT journey. This article, which also introduces a framework called the “7D Method,” a universal process for adopting software, will tell the story of how IT managers and project managers assisted us as we began expanding the technology footprint of our practice.
The year was 2004, long before the term ‘meaningful use’ became a term of contention. But EMR was certainly around, and having medical records online made sense to us.
With our four offices, 10 physicians, and numerous support staff, we saw EMR adoption as a better financial investment than wasting money to store paper records.
With this large a practice, we knew it wouldn’t be a small job.
Stepping up to the plate
Before EMR adoption, we only had a practice management application and no IT manager — the software vendor managed it.
With this huge project, we realized that it wasn’t just about the software being installed. This commitment entailed IT management practices that the vendor would not or could not provide. We needed to:
• Ensure business continuity. This required IT management of:
❍ Backup and restoration services
❍ Disaster recovery services
❍ Information security best practices
❍ Selection and deployment of appropriate IT security tools
• Optimize IT resources and assets after the EMR goes live. This included:
❍ Basic managed services
❍ Chief information officer oversight and strategy to ensure quality of IT services
❍ Proactive services
• Strategize operational planning. Because the scope of this technology would be extensive, we would need to perform:
❍ IT strategy annual planning
❍ IT operational planning, including developing processes, policies and procedures
❍ IT oversight to monitor robust strategy-to-execution accountability
❍ Performance metrics and IT performance management best practices, as these became a necessity
❍ IT reporting, audit and accountability documentation
❍ Internal service level agreement management
❍ Third-party solution provider and/or vendor management
❍ Selection of appropriate IT management tools
• Make sure that our envisioned cost savings occurred. In Part 1 (http://tinyurl.com/zhytacc), I discussed our move from paper to avoid the cost of physical storage and records room real estate. This required us to focus also on optimizing all costs across our IT ecosystem, including IT budget management and IT procurement management.
• Define the levels of IT expertise required in the new hire. We needed the following:
1. Technology:
• medical practice (health-care) IT security
• disaster recovery planning and testing
• technology road maps (includes managing the life cycle of all technology assets, software and/or hardware refresh)
• end-user productivity
• IT infrastructure management
• service quality management
2. IT management
• strategy and concept planning
• operational planning
• strategy execution and development
• management framework
• procurement and budgeting
• performance management
• vendor management
• compliance and audit
Did we do all this thinking, strategizing, deciding on our own? Of course not. After we chose this path, we: assessed our infrastructure and the skill sets of our staff; and formed an EMR committee to make the decisions that would allow it all to happen. The committee then promoted our IT network employee to IT manager.
Through the Lens of EMR Adoption: 7D Method meets our EMR 10-step project plan
The IT manager must possess seven basic competencies to oversee the successful EMR installation. These will allow him to progress through a complicated EMR evaluation, selection, implementation and continuous management (post “go-live” daily operations) process.
Our EMR adoption project comprised 10 steps. The resources link in the box below will take you to a PDF that describes each step. However, a 10-step project plan still needs a way for all the stakeholders to understand the big picture. They are not familiar with project management issues or processes. We found that describing the process in simple-to-understand terms helped everyone as the project commenced.
During our EMR project, the IT manager followed the easy-to-understand playbook developed by Mount Vernon Data Systems called the “7D Method.”
Our IT manager used this as the key alignment tool and management guidepost so that every stakeholder understood where the project was and where it was going. It simplified our understanding of what our IT manager needed us to decide. It also revealed challenges ahead and gave us time to address them with a minimum of show-stopping surprises.
Resources
Healthcare IT Manager Job Description
Here is a downloadable example from Stratis Health:
Also, all the online resources for this series can be found here:
DISCOVER
To align stakeholders and confirm the point of the project, your IT manager should start every project with the Discover phase. You want to ensure a successful deployment so that you and your partners are satisfied that it works as needed to manage your practice’s medical records.
The Discover phase includes the first three of the 10 steps:
1. Decide you need to do something.
2. Assess your office needs: infrastructure and staff core competencies.
3. Form an EMR committee.
DESIGN
Once our IT manager helped us understand what we would need we brought all the lists and assessments together and prioritized the findings. This was useful for understanding the scope of our project as he and the IT project manager later articulated the project management plan.
The Design stage covered these next two steps:
4. Get your doctors involved.
5. Create a short list of vendors. Do not start with this step. If you do, you will have issues.
DEVELOP
Our IT manager and IT project manager developed our project plan using models from the Project Management Institute (PMI.org). The project management plan should be under the control of your practice with input from the vendor, not vice versa.
If your vendor controls the project plan without your input, you put the project at risk of being hijacked with very little say as to the work-product deliverables. This sets the stage for many a nasty surprise.
6. Plan your implementation.
7. Organize a training schedule.
DEPLOY
This is the last mile of the project. This is also the first of our technology adoption challenges. When systems are deployed, your assumptions are tested. Deploy is not a ‘big bang’ event. It is an iterative process with feedback and corrections by all stakeholders: the doctors, the staff and the vendors.
The Deploy steps include:
8. Day of simulation
9. Going live
10. Assessing and planning next steps.
Basic IT management needs for adopting an EMR
1. Hiring an IT manager cannot be prescriptive or dependent on a templated checklist, no matter the level of IT adoption in your practice. Every practice is unique.
2. EMR adoption is usually the first signal that an IT manager will be required.
3. At minimum, one should require basic technical and managerial competencies of the IT manager who oversees your EMR adoption.
4. As your practice becomes more IT-dependent, the required management talents will change, and your IT hire must accommodate a more complex operating environment.
5. For the IT manager whose primary responsibility is EMR, you will probably have to engage outside talent for things like compliance and cyber-security. This is very likely the case if you hire for basic IT technical skills without any niche competencies for information security or compliance management.
Case Study: Our first IT manager
An EMR committee member recommended our first IT manager based on technical skills and software project experience (back then, few IT managers possessed EMR experience except those working in hospitals and large clinics).
First, we were happy to discover that he knew he was ignorant of some knowledge and was willing to learn for the EMR project to succeed. He focused on planning and constantly communicated with all stakeholders, two reasons why we quickly trusted his decisions and recommendations. He understood how little we knew and how serious the investment was because he previously implemented software projects with administrative teams as uninformed as ours (although not in medical practices). Knowing where the potholes lie in the road of new technology adoption should be universal to experienced managers. Deep experience with an EMR platform is a bonus but I would err on the side of knowing the impact of technology adoption on a business before deferring to the expertise in one software application or another.
Our manager’s strongest asset was his project communication ability. His technical skills were good enough so that when vendors told half-truths or otherwise sinned by omission, he could cry foul. But, what we truly valued were his abilities to manage expectations; understand the end-to-end process; follow-up on operational accountability; explain status and challenges; and foresee problems in enough time before their fruition to avoid rework and massive waste.
DAY-TO-DAY
This begins the practice’s new way of managing medical records. You have made preparations, and the system is running. Trained users are developing competencies in using the software.
In our practice, staff members designated as “super-users” were stationed in all clinic locations. These staff members continue to be a great resource for other employees and for cutting down on lengthy (and potentially costly) help-desk tickets with the EMR vendor.
DEFEND
Defending your information is critical regardless of which software application it lives in (even if it is digital). EMR defense comes in layers. Your EMR vendor might have very little to contribute in this regard, and you could be on your own except for updates and patches the vendor sends.
DECOMMISSION
Every software application has a life cycle. At the end of the software’s life, you decommission the existing application and replace it with a new version, usually a completely re-written software program.
The three primary reasons for decommissioning are:
1. The EMR vendor no longer certifies your product according to HHS Meaningful Use reimbursement requirements
2. Your vendor no longer supports your EMR because it does not exist/is out of business
3. Your practice requirements have changed substantially, and your understanding of your own EMR requirements dictates a rip-and-replace scenario.
Key takeaways
Now is the time to evaluate your own progress:
1. If you have an EMR and don’t have an IT manager, why not?
2. If you have hired an IT managed services provider as your IT manager, get a third-party evaluation of the individual’s performance, technical ability and IT management ability. Think of it as being just like a second opinion that a patient would get. OM
About the Author | |
| Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multi-subspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice resource for physicians and administrators. His email is ppolack@ocalaeye.com. |
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