Replacing an EHR System-Valley Practice provides patient care services at three locations, all within a fifteen-mile radius, and serves nearly one hundred thousand patients

Valley Practice provides patient care services at three locations, all within a fifteen-mile radius, and serves nearly one hundred thousand patients. Valley Practice is owned and operated by seven physicians; each physi­cian has an equal partnership. In addition to the physicians, the practice employs nine nurses, fifteen support staff members, a business officer manager, an accountant, and a chief executive officer (CEO).

During a two-day strategic planning session, the physicians and man­agement team created a mission, vision, and set of strategic goals for Valley Practice. The mission of the facility is to serve as the primary care “medical home” of individuals within the community, regardless of the patients’ ability to pay. Valley Practice wishes to be recognized as a “high-tech, high-touch” practice that provides high-quality, cost- effective patient care using evidence-based standards of care. Consistent with its mission, one of the practice’s strategic goals is to replace its legacy EHR with an EHR system that adheres to industry standards for security and interoperability and that fosters patient engagement, with the long-term goal of supporting health fitness applications.

Dr. John Marcus, the lead physician at Valley Practice, asked Dr. Julie Brown, the newest partner in the group, to lead the EHR project initiative. Dr. Brown joined the practice two years ago after completing an internal medicine residency at an academic medical center that had a fully inte­grated EHR system available in the hospital and its ambulatory care clinics. Of all the physicians at Valley Practice, Dr. Brown has had the most expe­rience using EHR applications via portable devices. She has been a vocal advocate for migrating to a new EHR and believes it is essential to enabling the facility to achieve its strategic goals.

Dr. Brown agreed to chair the project steering committee. She invited other key individuals to serve on the committee, including Dr. Renee Ward, a senior physician in the practice; Mr. James Rowls, the CEO; Ms. Mary Matthews, RN, a nurse; and Ms. Sandy Raymond, the business officer manager.

After the project steering committee was formed, Dr. Marcus met with the committee to outline its charge and deliverables. Dr. Marcus expressed his appreciation to Dr. Brown and all of the members of the committee for their willingness to participate in this important initiative. He assured them that they had his full support and the support of the entire physician team.

 

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Dr. Marcus reviewed with the committee the mission, vision, and stra­tegic goals of the practice as well as the committee’s charge. The committee was asked to fully investigate and recommend the top three EHR products available in the vendor community. He stressed his desire that the com­mittee members would focus on EHR vendors that have experience and a solid track record in implementing systems in physician practices similar to theirs and that have Office of the National Coordinator for Health Informa­tion Technology (ONC)–certified EHR products. He is intrigued with the idea of cloud-based EHR systems provided they can ensure safety, security, and confidentiality of data; are reliable and scalable; and have the capacity to convert data easily from the current system into the new system. The vendor must also be willing to sign a business associates’ agreement ensuring com­pliance with HIPAA security and privacy regulations.

Dr. Marcus is also interested in exploring what opportunities are available for health information exchange within the region. He envi­sions that the practice will likely partner with specialists, hospitals, and other key stakeholders in the community to provide coordinated care across the continuum under value-based reimbursement models. Under the leadership of Dr. Brown, the members of the project steering com­mittee established five project goals and the methods they would use to guide their activities. Ms. Moore, the consultant, assisted them in clearly defining these goals and discussing the various options for moving forward. They agreed to consider EHR products only from those vendors that had five or more years of experience in the industry and had a solid track record of implementations (which they defined as having done twenty-five or more). Dr. Ward, Mr. Rowls, and Ms. Matthews assumed leadership roles in verifying and prioritizing the requirements expressed by the various user groups.

The five project goals were based on Valley Practice’s strategic goals. These project goals were circulated for discussion and approved by the CEO and the physician partners. Once the goals were agreed on, the project steering committee appointed a small task group of committee members to carry out the process of defining system functionality and requirements. Because staff time was limited, the task group conducted three separate focus groups during the lunch period—one with the nurses, one with the support staff members, and a third with the physicians. Ms. Moore, the

 

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consultant, conducted the focus groups, using a semi-structured nominal group technique.

Concurrently with the requirements definition phase of the project, Mr. Rowls and Dr. Brown, with assistance from Ms. Moore, screened the EHR vendor marketplace. They reviewed the literature, consulted with colleagues in the state medical association, and surveyed practices in the state that they knew used state-of-the-art EHR systems. Mr. Rowls made a few phone calls to chief information officers (CIOs) in surround­ing hospitals who had experience with ambulatory care EHR to get their advice. This initial screening resulted in the identification of eight EHR vendors whose products and services seemed to meet Valley Practice’s needs.

Given the fairly manageable number of vendors, Ms. Moore suggested that the project steering committee use a short-form RFP. This form had been developed by her consulting firm and had been used successfully

 

project a clinical perspective as well as an understanding of IT and informa­tion management processes. (The roles of CMIOs and CNIOs are described more fully in Chapter Eight.) Regardless of the discipline or background of the project manager (for example, IT, clinical, or administrative), he or she should bring to the project passion, interest, time, strong interpersonal and communication skills, and project management skills and should be someone who is well respected by the organization’s leadership team and who has the political clout to lead the effort effectively.

Pulling together a strong team of individuals to serve on the project steering committee is also important. These individuals should include rep­resentatives from key constituent groups in the practice. At Valley Practice, a physician partner, a nurse, the business officer manager, and the CEO agreed to serve on the committee. Gaining project buy-in from the various user groups should begin early. This is a key reason for inviting representatives from key constituent groups to serve on the project steering committee. They should be individuals who will use the EHR system directly or whose jobs will be affected by it.

Consideration should also be given to the size of the committee; typically, having five to six members is ideal. In a large facility, however, this may not be possible. The committee for a hospital or health systems might have fifteen to twenty members, with representatives from key clinical areas such as laboratory medicine, pharmacy, and radiology in addition to representatives from the administrative, IT, nursing, and medical staffs.

 

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by other physician practices to identify top contenders. The short-form RFPs were sent to the eight vendors; six responded. Each of these six pre­sented an initial demonstration of its EHR system on site. Following the demonstrations, the practice staff members completed evaluation forms and ranked the various vendors. After reviewing the completed RFPs and getting feedback on the vendor presentations, the committee determined that three vendors had risen to the top of the list.

Dr. Brown and Dr. Ward visited four physician practices that used EHR systems from these three finalists. Mr. Rowls checked references and prepared the final vendor analysis. A detailed cost-benefit analysis was conducted, and the three vendors were ranked. All three vendors, in rank order, were presented in the final report given to Dr. Marcus and the other physician partners. Dr. Marcus, Dr. Brown, and Mr. Rowls spent four weeks negotiating a contract with the top contender. It was finalized and approved after legal review and after all the partners agreed to it.

 

It is important to have someone knowledgeable about IT serving on the project steering committee. This may be a physician, a nurse, the CEO, or an outside consultant. In a physician group practice, having an in-house IT professional is not always possible. The committee chair might look internally to see if someone has the requisite IT knowledge, skills, interests, and also the time to devote to the project, but the chair also might look externally for a health care IT professional who might serve in a consultative role and help the committee direct its activities appropriately.

Define Project Objectives and Scope of Analysis

Once the project steering committee has been established, its first order of business is to clarify the charge to the committee and to define project goals. The charge describes the scope and nature of the committee’s activ­ities. The charge usually comes from senior leadership or a lead physician in the practice. Project goals should also be established and communicated in well-defined, measurable terms. What does the committee expect to achieve? What process will be used to ensure the committee’s success? How will milestones be acknowledged? How will the committee communicate progress and resolve problems? What resources (such as time, personnel, and travel expenses) will the committee need to carry out its charge? What method will be used to evaluate system options? Will the committee con­sider contracting with a system developer to build a system or outsourcing

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