2. Patricia Alafaireet

3. Patricia E. Alafaireet, PhD Director of Applied Health Informatics University of Missouri-School of Medicine Department of Health Management and Informatics Columbia, Missouri 2

4.  Lecture1 - Concepts of implementation pre-planning Concepts of implementation preplanning and strategies for implementation Basics workflow analysis Basics of installation preparation

5.  Upon completion of this lecture, students will be able to:  Understand that implementation pre-planning is a necessity if adverse events are to be prevented and resources used most effectively.  Apply at least one workflow analysis tool and understand why the use of such a tool in imperative in successful technology implementation.  Discuss some of the many pre-installation issues involved in the use of technology and how the application of specialized tools can assist with addressing these issues.

6.  An implementation plan is almost always required, especially when the organization: Is installing new information technology Is not experienced in the use of technology Lacks experienced project management staff Needs to reduce the complexity of its planning efforts

7.  A blueprint of the organization  Implementation stages  Planning of interim solutions

8.  Selecting the team, the tactics and the technology  Risk evaluation (locating show stoppers)  Workflow analysis  Other preparation needed such as training 7

9.  Total failure= de-installation  Partial failure= installed but not all providers are users  Sustainability failure= EHR is implemented, but is never embraced and is later replaced  Replication failure= successful EHR implementation in one practice fails in similar practice [1] 8

10.  Executive Team  Clinical Team  Administrative Team  Technology Team[1] 9

11.  Roles is to guide organization through change  Key members of upper level administration  Daily involvement  Responsibilities include budgeting, hiring, conflict resolution, policies and procedures and organizational restructuring[1] 10

12.  Oversees standardization of clinical process  Carries out clinical workflow redesign  Addresses clinical polices and procedures  Includes open membership from nursing and medical staff [1] 11

13.  Addresses administrate policies and procedures  Responsible for leading change in charge capture, billing, job descriptions, and adding new staff 12

14.  Responsibility is to ensure technical infrastructure is sound[1] 13

15.  Have as many decisions to make as large practices and provider organizations  May lack critical expertise[1] 14

16.  Employ project management  Carry out extensive workflow redesign  Develop a realistic budget  Beware of gadgetry  Avoid serious mistakes Ensure teams have authority to act Hold vendors accountable [1] 15

17.  Get and keep motivated teams of 4-9 members  Appoint a project manager  Schedule regular meetings  Review budget  Review staffing needs  Set a timeline  Create a chart migration plan  Review security [1] 16

18.  Identify one or more champions  Ensure senior administration support  Use an experienced project manager  Utilize change management principles  Have clear measurable goals  Make sure users support these goals  Establish reasonable expectations  Make sure organization is functional [2] 17

19.  Redesign workflow  Improve processes rather than simply automate  Identify key data elements that must be consistently entered and enforce the entry  Utilize a phased implementation  Train everyone and then train more  Allow for flexibility is style  Avoid a Monday go-live  Lighten the load during go-live  Pick a vendor with an excellent reputation for user support  Develop and use “power users” [2]

20.  Don’t scrimp on IT infrastructure  Consider an application service provider (ASP)  Make sure to do adequate testing  Utilize expert IT advice  Maintain servers, interfaces, etc. on a daily basis  Back up your data daily at least  Have a disaster recovery plan and test it [2]

22.  A representation of the sequence of work steps  Visual diagram of a process or set of processes  An enabler of communications  A common view of the activities of the organization

23.  Tend to be rather simple, linear maps very similar to flowcharts  Show a series of steps, tasks or activities that have a distinct beginning or end

24.  Messaging and information sharing  Task Completion  Scheduling and resource management  Documentation support [5]

25.  Task redefinition  Adding tasks  Re-sequencing tasks  Reassigning tasks [5]

26.  Direct observation  The right level of detail [5]

27.  Context review  Identification of specific processes to be re-designed  Outlining of new processes and changes needed [5]

28.  One example: “Workflow Assessment for Health IT Toolkit” Agency for Healthcare Research and Quality Provides in-depth information about Workflow Educational presentations, Research materials Specific tools Examples of workflow analysis

30.  Communicating with stakeholders  Redesigning workflow  Creating a project plan  Developing a contingency plan  Conducting training [8]

31.  Tailoring software to meet needs  A way of ensuring system quality  A very detailed process

32.  Iowa Foundation for Medical Care “System Build Tool”  http://www.internetifmc.com/ http://www.internetifmc.com/

33.  Implementation pre-planning is a necessity if adverse events are to be prevented and resources used most effectively.  Workflow analysis is imperative in successful technology implementation.  There are many pre-installation issues involved in the use of technology and the application of specialized tools can assist with addressing these issues.

34.  Complete reference list is available at the end of the slide set for Lecture #3