1 © 2007 Chapter 3 Strategic Planning for the EHR Migration Path

© 2007 EHR Migration Path Because an EHR is a journey toward goals for clinical transformation aided by technology, a high level view of the journey is needed A migration path identifies the applications, technology, and operational elements needed to accomplish an organization’s EHR goals along a specified timeline

© 2007 Gartner Generations One of the most widely recognized descriptions of a pathway to an EHR

© 2007 Generations Collector –Clinical data display/results retrieval Documenter –Data capture at point of care –Simple documentation tools –CPOE with alerts in near-to or real time

© 2007 Generations Helper –More advanced EHR systems –Decision support –Patient care charting –Integration of functions –Knowledge management –Integration with “extranet”

© 2007 Generations Partner –Advanced systems with complex decision support –Links to PHR Mentor –Most complex –Fully integrated across continuum of care –Highly advanced knowledge management, decision support, and predictive modeling

© 2007 Strategic Planning Strategic planning consists of the process of defining goals and developing strategies to reach those goals with specific milestones Determines for an organization: –Where it is going over the next several years –How it is going to get there –How it will know whether it got there

© 2007 The EHR Pathway Strategic plan: establishes the framework within which an EHR will be adopted –Migration path: provides a high level view of the pathway toward putting the components together Implementation plan: identifies timeline and accountability for performing detailed tasks to implement any given component of an EHR –Transition strategy: how each component of an EHR will be rolled out

© 2007 Conducting Strategic Planning Determine approach Conduct every one to three years Conduct in a retreat environment Executive management team and other resources Use facilitator to overcome bias and group process pressures Prepare perspectives or analysis in advance Develop a written plan, with objectives, responsibilities, time line, etc.

© 2007 Traditional Approach to Strategic Planning Preparation Strategic Analysis Strategic Direction Process Who, when, where, why, how Environmental scan SWOT Organizational assessment Mission, vision, values Strategic goals/initiatives Action plans Evaluate planning process Acknowledge completion

© 2007 Strategic Planning for EHR Determine interest in advance –User readiness –Attitudes and beliefs survey Construct a briefing paper –Outline a definition –Illustrate the notion that EHR will be built over time –Fairly outline costs and benefits –Accurately reflect current level of interest, understanding, and readiness

© 2007 Strategic Planning Models Basic –Small organizations Issue-based –For experienced planners Alignment –Organizations with internal inefficiencies Scenario –As part of major change in direction Organic –Self-organized approach

© 2007 EHR Migration Path Models

© 2007 ©2006 All rights reserved. Migration Path Template Time frame Goals Applications Technology Operations

© 2007 Time Frame and Goals Overall period for EHR implementation –Can be broken down into phases initially –Many paths are several years long, Often with phases lasting 1 to 3 years each Goals –Cluster goals according to each phase and provide a summary statement –Attach the complete set of goals to the migration path document

© 2007 Applications Group by: –Financial/administrative –Operational –Clinical List all current applications, then planned applications as they may be related to each other Consider acquisition strategy for applications: –Best of breed –Best fit –Dual-core

© 2007 Acquisition Strategy Best of FitDual CoreBest of Breed One primary vendorTwo primary vendors Financial/Administrative Operational or Clinical Many vendors Small hospitals Standardization Both moving to this strategy Large standalone or academic centers Simpler to implement and maintain Consolidation or way to achieve comprehensive EHR Difficult to implement and maintain Interface requirement

© 2007 Technology Describe current technology: –Database structure –Network and infrastructure –Interoperability strategies –Human-computer interfaces –Storage Identify new and/or upgrades needed

© 2007 Operational Elements Need to support: –Planning –Selection –Implementation –Adoption –Benefits realization Must address: –People –Policies –Procedures

© 2007 Critical Success Factors Create a vision Identify the planning horizon Gain agreement Develop a funding and acquisition strategy Develop functional, data, and technical strategies Carry out a vendor selection process Plan implementation Conduct benefits realization

© 2007 Different Care Settings Acute versus ambulatory Other (e.g., nursing home, home health, dental, mental health) Academic versus community Managed care versus fee for service For-profit versus nonprofit

© 2007 Conclusion Tipping point for EHR is when strategic planning recognizes the supporting role the EHR places in every planning component Strategic planning provides a clearly defined migration path, which is then used to direct more focused planning and detailed tactical plans