Case Study: Developing an EMR Implementation Schedule at UVA Health System Paul Dreyer VA HIMSS Student Liaison

An Implementation Plan Must Include: 1) Technology Sequencing (Focus) 2) Workflow Impact/Re-design 3) New/Updated Policies and Procedures 4) Go-Live Support 5) Post-Go-Live Support and Trouble Reporting

Sequencing Options 1) Big Bang = All systems / all users live at the same time Used Primarily for: Replacements of legacy systems OR Systems that primarily impact a single departmentUsed Primarily for: Replacements of legacy systems OR Systems that primarily impact a single department RISKS -RISKS - Extensive simultaneous effort and more user support neededExtensive simultaneous effort and more user support needed Training (large number at once)Training (large number at once) Delays effect a larger number of users and areasDelays effect a larger number of users and areas BENEFITS -BENEFITS - Speed (completed at once)Speed (completed at once) Less complexity in most casesLess complexity in most cases

Sequencing Options 2) Phased In Approach = One or two systems / users live at different times Used Primarily for: A health system/facility- wide systemUsed Primarily for: A health system/facility- wide system RISKS -RISKS - Increased complexityIncreased complexity Longer implementation timeframeLonger implementation timeframe Multiple departments with different workflowsMultiple departments with different workflows BENEFITS -BENEFITS - More controlled and better ability to focus support and sequence trainingMore controlled and better ability to focus support and sequence training Able to work out problems arising in the first departments/units before implementing the restAble to work out problems arising in the first departments/units before implementing the rest

Sequencing Options 3) Combination = Pilot a few units/ departments and then roll out (big-bang) Used Primarily for: New technology with a complicated implementation that needs to be first tested in a controlled environmentUsed Primarily for: New technology with a complicated implementation that needs to be first tested in a controlled environment RISKS -RISKS - Testing may not be adequately completed in the pilot units/departmentsTesting may not be adequately completed in the pilot units/departments Movement between pilot/non-pilot unit can be difficult for staff and patientsMovement between pilot/non-pilot unit can be difficult for staff and patients BENEFITS -BENEFITS - Issues with training, workflow, and hardware can be resolved and changed prior to full roll outIssues with training, workflow, and hardware can be resolved and changed prior to full roll out

Categories of Implementation Issues 1) Organizational Attributes of the organization or staff that will affect the implementation Attributes of the organization or staff that will affect the implementation 2) Technical IT implementation/connectivity/hardware issues that will affect the implementation IT implementation/connectivity/hardware issues that will affect the implementation 3) Financial The incremental financial costs/benefits that will be realized during and after implementation The incremental financial costs/benefits that will be realized during and after implementation

Development of an Implementation Sequence 1) Interviews with necessary managers and site visits - Interviewed 25 managers and the CFO (Yield = 60 Potential Criteria / Issues / Factors) 2) Identification of implications (impact on resources) for each criteria: - Selected criteria with the greatest implications that differentiate the clinics (Yield = 11 final non-financial criteria and appropriate financial criteria) 3) Interviews with members of management to confirm findings - General consensus on the final non-financial criteria 4) A survey was developed to calculate weights for each of the criteria, which was completed by 80% of the managers - Yield = a relative weighting scheme for all of the criteria

Development of an Implementation Sequence 5) Development of an evaluation methodology 6) An evaluation survey was developed for each manager to apply the criteria to their specific clinic, which provides a rating for each clinic on the final non-financial criteria - The rating combined with the afore mentioned weights are combined to determine an overall ranking for each clinic (Sum of the products of each criterias weight and rating)

Methodology 1) Clinic Criteria identify factors with the greatest implication on implementation, yielding differentiation among the clinics 2) Each Criteria includes: - A relative weight ( ) pertaining to the importance on implementation - A rating (0-100) of how pertinent the criteria is to an individual clinic Organizational Criteria completed by department/clinic manager Organizational Criteria completed by department/clinic manager Technical Criteria completed by IT managers and staff Technical Criteria completed by IT managers and staff Financial Criteria completed by IT department per Finance guideline Financial Criteria completed by IT department per Finance guideline 3) A final overall ranking will be determined for each clinic 4) Comparison of overall rankings to develop an implementation schedule

Non-Financial Criteria: 5 Organizational Criteria For UVAHS: 1: Clinic Size – Patient Volume: Patient safety benefits driven by visit volume 2: Opinion Leader: Internal sponsorship by a member of the clinical leadership 3: Patient Linked – Clinic: High referral volume with another clinic 4: Separate Chart: The amount of documentation in the clinic sent to HIS 5: Technology Acceptance: The ability of staff to accept and use technology

Non-Financial Criteria: 6 Technical Criteria For UVAHS: 1: Alternate Systems: Non-standard systems needing assimilation prior to implementation 2: Distance to Main Grounds: Distance in miles from the main hospital 3: Equivalent Clinic: The presence of clinics with the same medical specialty 4: Location Linked – Ancillary: Physical proximity / connection to an ancillary 5: Location Linked – Clinic: Physical proximity to another clinic 6: Unique Information: Unique data collection / documentation needs in a clinic

Financial Criteria: Simplified Cost-Benefit analysis for the duration of one year: Simplified Cost-Benefit analysis for the duration of one year: Costs = Hardware, training, tailoring, and support expensesCosts = Hardware, training, tailoring, and support expenses Benefits = $6 per patient visit (Source = 2003 ROI)Benefits = $6 per patient visit (Source = 2003 ROI) The financial benefits were analyzed and it was determined that the best representation of financial benefits would be visit volume and not revenue or profitability The financial benefits were analyzed and it was determined that the best representation of financial benefits would be visit volume and not revenue or profitability

What Would A Final Sequence Look Like?

Overall Process Step 1 = Step 1 = Interview end users and managers (organizational), IT staff (technical), and CFO (financial)Interview end users and managers (organizational), IT staff (technical), and CFO (financial) Step 2 = Step 2 = Develop criteria based on these interviews that will differentiate the different departments/unitsDevelop criteria based on these interviews that will differentiate the different departments/units Step 3 = Step 3 = Develop a weighting and ranking scheme for each final criteriaDevelop a weighting and ranking scheme for each final criteria Step 4 = Step 4 = Determine overall ranking for each department/unit and sequence the implementationDetermine overall ranking for each department/unit and sequence the implementation

Takeaways Provides an objective and thorough approach to sequencing the implementation of an IT project Provides an objective and thorough approach to sequencing the implementation of an IT project UVA and its clinics are different from other organizations: UVA and its clinics are different from other organizations: 1.Provider Based Clinics vs. Physician Based Clinics – Reimbursement 2.UVA already has a well developed IT infrastructure so these issues were not included 3.The UVA clinics are very diverse and geographically dispersed

Any Questions? Thank you - Barbara Baldwin: Chief Information Officer (UVAHS) Barry Wagner: Management Engineer (UVAHS)