By Jami Woebkenberg, MHIM, RHIA, CPHI, FAHIMA; Sandra Hernandez, MSMIS, RHIA, CPHI, CCS, CHC; and A. Andrews Dean, CPHIMS, CHDA, CPHI, CPPM, CPC
Technology is a major part of our lives and healthcare is certainly not exempt from its influence. Under the 2009 HITECH Act, eligible hospitals and providers are required to implement and adopt an electronic health record system (EHR) that meets certain criteria and is meaningful to its users. Although health information management (HIM) professionals all know how important it is to have a project plan for the implementation, it is easy to forget the human element that is also involved with such a big change. This article will review the basic steps of project planning, including change management techniques, to assist in a successful transition.
The success or failure of any project can be directly tied back to how the project is managed, both how the implementation of the technology is managed as well as how people are managed. Every project has four basic phases in its lifecycle:
The following is a high-level explanation of each phase of the project lifecycle. The initiation phase of the project generally includes development of the business need and creation and approval of a charter for the project. In the planning phase, the project manager is assigned and the project team is created. In addition, the project plan is developed and approved. The execution phase is normally the longest phase of the project since it is where the majority of the actual project work takes place. During this phase, the team will build the deliverables of the project. This may include review of existing processes, workflows, and policies and procedures, as well as the creation of new ones. The execution phase includes testing and training on any new technology, enlisting support of stakeholders and champions, engaging individuals in the changes taking place, communicating the changes, and actual implementation. Depending on the scope of the project, the execution phase may include additional steps. The final phase of the project life cycle is closure. During this phase, the project team discusses lessons learned, wraps up any final details of the project, and, most importantly, celebrates or possibly mourns that the project is complete.
Managing Change Through People
Project managers and members of a project team have a mutual end goal in the implementation lifecycle, sharing a focus and understanding of the technical components for successful completion. Within the span of any implementation are the people who will be using the new technology and the processes they manage. Oftentimes, these are considered operational users across different functional departments.
Engagement of operational departments is critical to the overall success and sustainability of any implementation. Involving people from cross-functional areas during all stages, from product selection to optimization and support, gets not only buy-in but an educated workforce who understands their role and responsibilities along the way.
Operational leaders can be included in:
- Early discussions of technology needs within the organization
- Vendor product presentation sessions
- One idea is to have vendors come to the facility and set up presentation tables or booths and invite operational leaders to see them all side-by-side on the same day. Leaders can complete surveys providing feedback on likes and dislikes for each vendor.
- Ongoing technical project meetings that impact functional areas
- Use-case review meetings
- Go-live readiness checkpoint discussions
- Change control meetings
- Live-day technical meetings
- Post-live and support meetings
Designated departmental super-users can be included in:
- Use case review meetings during the project lifecycle
- Test script creation discussions
- End user testing activities
- Data cleanup activities
- Post-live and support meetings
Including operational staff at different levels allows them to become change agents in support of the end goal. Adopting a people-centered or user-centered approach influences the perception and acceptance of the technology and the changes that come with it.
Monitoring Readiness and Effective Pre- and Post- Go-Live Practices
Assessing readiness is one of the most critical factors to consider during planning. To provide adequate end user and provider support, there are essential factors to consider. For example, organizations must identify, train, and select operational leaders, super users, and trainers and then relieve them from their normal responsibilities during go-live—as well as commit to providing support as needed. Organizations must establish adequate support for every department and unit when creating its support schedule. Run through checklists and utilize consultants who have experience going through implementations to learn what problems to anticipate and address beforehand.
Broadly, go-live readiness can be categorized into three areas:
- Technical readiness
- Effective training
- Post-go-live support and planning
The following content contains summarized excerpts and highlights from the National Learning Consortium’s EHR Implementation Go-Live Planning Checklist, as well as best practices and helpful hints from resources available through the AHIMA HIM Body of Knowledge. Full checklist details are available from healthit.gov.
Several Days Prior to Go-Live: Review Technical and Training Readiness
☐ Technical Readiness → Review testing
- Hardware: computers, monitors, cables, printers, scanners, other peripheral devices, servers, uninterruptable power supply (UPS), storage, backup server
- System testing to ensure data pass from one function to another: Interfaces, lab, radiology, billing/clearinghouse, admission/discharge/transfers as applicable, other
- Tasking, ordering, and e-prescribing
☐ Effective Training → Check and re-check training
- Ensure super-users are prepared and well-trained to provide support to all users
- All users have completed the training necessary for their role
- Plan with the support team what to do if go-live goes awry, and identify contingency plans or points where go-live needs to be stopped
- Have proper processes and backups ready in the event of downtime or other major issues
Immediately Prior to Go-Live: Technical Readiness and Effective Training Come Together
After you finish developing, training, testing, and customizing, you are almost ready to go live—but assessing readiness again a few weeks prior to implementation will help avoid costly mistakes such as diverting subject matter experts to deal with workflow issues during go-live. Some essential tips include:
- Verify the schedule for go-live day, including contacting users to check readiness and speaking with the help desk staff, super-users, and operational leaders
- Verify support and system readiness for support tiers and review escalation procedures to follow in the event of a problem
- First level, second level, third level, or others
- Define and reinforce who within the organization has the authority to make/approve critical system changes in the live/production environment
Day of Go-Live: Full Speed Ahead!
- All staff members should plan to arrive early to support the first go-live, and the support team should re-check all readiness procedures
- Determine staff scheduling and resources for subsequent days and adjust as necessary; go-live may require several days of similar scheduling
- Ensure implementation and support teams are ready for post-go-live support
Communicate Before, During, and After Go-Live
While communication is important before and after go-live, it is absolutely vital during go-live. Issues are going to arise, and there will be user frustration and a learning curve for real-time point-of-care EHR use. Making sure all end users understand the issues, reporting problems, and system errors provides valuable feedback to the EHR team. If users do not feel adequately heard, they may mentally abandon the new health technology and go back to old habits, which can be difficult to overcome.
Trust is also necessary at go-live; if end users sense that they are not being supported and that the EHR is not working for them, then a decline of buy-in and use could also hinder the effectiveness of the system. If end users are understood and trust that support is available and ready, buy-in will be stronger, which can be used to further the project and overall team morale.
In almost every implementation, there will be users who are not as prepared or not as engaged and happy with the technology. However, having a well-managed project, involving key players in the various project phases, and providing thorough training will certainly help with the implementation. Communication at all stages is important, especially allowing users to share their concerns and be involved in any remediation and resolution planning. Following these basic steps can provide the tools necessary for a smooth and successful implementation.
AHIMA HIM Practice Transformation Work Group. “Checklist for Assessing HIM Department Readiness and Planning for the EHR.” Journal of AHIMA 76, no. 6 (June 2005): 56E-H. http://library.ahima.org/doc?oid=104177.
Glondys, Barbara and Lesley Kadlec. “EHRs Serving as the Business and Legal Records of Healthcare Organizations (2016 Update).” Journal of AHIMA 87, no. 5 (May 2016): extended online version. http://library.ahima.org/PB/BusinessRecord.
Method 123. “Project Management Life Cycle.” 2018. http://method123.com/project-lifecycle.php.
National Learning Consortium. “Electronic Health Record (EHR) Implementation Go-Live Planning Checklist.” March 31, 2012. www.healthit.gov/sites/default/files/tools/nlc-ehr-implementation-go-live-planning-checklist.docx.
Rizer, Milisa K. et al. “Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center.” Perspectives in Health Information Management (Summer, July 2015). http://library.ahima.org/doc?oid=301175.
Wang, Tiankai and Jackie Moczygemba. “Risk Management in EHR Implementation.” Journal of AHIMA website, May 1, 2015. http://bok.ahima.org/doc?oid=301018.
Jami Woebkenberg (firstname.lastname@example.org) is the senior operations director, HIM services, at Banner Health. Sandra Hernandez (email@example.com) is the director of coding at OrthoAtlanta. A. Andrews Dean (firstname.lastname@example.org) is a health IT consultant.
Woebkenberg, Jami, Sandra Hernandez and A. Andrews Dean. “Remember the Human Element of Change Management.” Journal of AHIMA 90, no. 5 (May 2019): 30-31.