CHAPTER 9student.allied.edu/uploadedfiles/Docs/9f08deef-29ae-490c-bef3-2bf... · Collaboration...

Copyright © 2012, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1

Managing Electronic Health Record Systems:

Collaboration & Implementation

CHAPTER 9


Develop a strong working relationship with information systems staff.

Recognize the strengths of the health information management professional and the information systems professional in developing, selecting, implementing, and modifying health care information systems.

Chapter Objectives


Understand the difference between project activities and operational activities.

Identify the necessary skills to bring an information systems project to completion.

Describe the principles of collaboration between health information management and information systems that help projects be successful.

Chapter Objectives


Recognize the areas where health information management and information systems do not automatically share the same views or information or approaches to a project.

Recognize the value of training in project success.

Differentiate between a training manual and a user manual.

Chapter Objectives


Evaluate the success of systems projects. Identify both measurable metrics and

organizational values addressed by a system. Recognize that systems projects move into

an improvement phase after implementation.

Chapter Objectives


VALUE OF USER PERSPECTIVE


User prespective can help business communities

identify and initiate high level system project sponsors and stakeholders.

They can address fundamental roles for users at multiple levels:

It enables institutional sponsors to: • Understand system implementation dependencies and work

effort • Have realistic expectations of process and outcome • Become sophisticated partner in systems development

and implementation

Value of User Perspective


Collaboration Principle Natural dependence between users and

information systems in the pursuit of definition, design, development, purchase, implementation, and usage of any EHR system

A Natural Dependence


Embrace business community–computer division dependence

Environmental basics – defines the “human elements” that are natural part of work teams accomplishing specific tasks



Eight environmental basics: Personal commitment Trust Respect Policy setting Expectations Vocabulary Understanding Knowledge



Stakeholder is any individual who has a stake or real interest in the computerization project and implemented EHR regardless of department or position.

Both computer and health information departments manage information for the health care industry.



Collaboration means to labor, especially in literary or scientific pursuits, as the associate of another or others.”

A project is a unit of work to acquire or build and implement a computer system with a definitive start date, targeted stop date, steps, milestones, and outcome.



(Required for True Collaboration) ENVIRONMENTAL BASICS


System “life cycle” – can be expressed in simple verbs: Define, design, develop or buy, do (or implement),

and support Life cycle continually recycles until system is

no longer used or another takes its place. Group oriented environmental basics must be

in place before starting an EHR project.

Environmental Basics


Collaboration Principle: Personal commitment, trust, respect, policy setting

are four mandatory environmental basics Personal Commitment

Collaboration Principle – personal commitment builds computer system champions

Produces the political will to make the system happen.

Use focus groups, surveys, and interviews to assess the level of commitment.

Four Shared Environmental Basics


User leaders and managers make the best system and project managers.

Usually underestimate human and financial resources necessary to complete project.

Test their commitment before beginning. I/S leaders declaring the project a priority

is key.

Grounded Champions


Collaboration Principle means: the worst of projects can succeed within a basis of trust, and the best of projects will likely fail without it.

A baseline level of trust must be in place as a project begins.

Use focus groups, interviews, and surveys to identify and resolve areas of distrust.

Trust


Collaboration Principle: Mutual respect breeds collaboration. Disrespect destroys it.

Individuals need to feel respect, regardless of what role they play in the organization or in an automation project.

Project teams and managers must be sensitive to user frustration resulting resource shuffling and timeline movement.

Respect


User community must be sensitive to limitations of project manager and teams.

Gauge mutual respect existing between business units, staff, and project team members.

Respect


Collaboration Principle: In the absence of clear policies and principles of information management, there will be internal conflict and civil war.

Policies and principles manage human behavior.

Policy Setting


As rate of technology advancement intensifies, policies and principles quickly become outdated and ineffective.

Organization must create the appropriate behavioral framework so collaboration is not hindered by lack of organizational directives.

Policy Setting


Collaboration Principle: Expectations, vocabulary, understanding, and knowledge are four environmental basics not common between the user community and I/S.

Can make or break a project.

Four Unshared Environmental Basics


Collaboration Principle: Perception is an individual’s reality built on expectations. Individuals in the user community and individuals in I/S will not share initial project expectations.

Users expect a system to perform a certain way.

I/S expects users to use a system a certain way.

Expectations


Positive expectations can be powerfully motivating.

Shared expectations lead to common goals and objectives.

Unshared expectations need work to achieve consensus on goals and objectives.

All expectations must be “held in common.”

Expectations


Collaboration Principle: It is likely that no common language exists between the user community and the I/S staff.

I/S staff needs to be consciously aware of terminology when communicating with users.

User member must be conscious of business jargon unfamiliar to I/S staff.

When in doubt, ask.

Vocabulary


Be proactive about clarifying confusing terminology.

Keep it simple. Ask, listen, repeat to help facilitate clear

communication.

Vocabulary


Collaboration Principle: Much of understanding revolves around how people think. I/S people think in systems; users think in business tasks.

Understanding is dramatically affected by how we think.

Different ways of processing information allows varying views of the same material.

Understanding


Vagueness blocks understanding. Vague language is open to

(mis)interpretation, which hinders collaboration.

Vagueness is the lack of enough fact to clearly communicate.

Feedback and clarification exercises can help facilitate understanding.

Understanding


Collaboration Principle: Team members must understand not only the content of the project and product but also, equally important, the process by which the team is obtaining the outcome.

Often project team members clearly understand what they are working toward; but not how they’re getting there.

Understanding Process


Many aspects of a project can be “unknown.” Project leaders must share with all members

of the team what are the “unknowns.” This identifies vulnerabilities that the whole

team must work together to resolve.

Understanding Process


Collaboration Principle: I/S and the user community each initially have a knowledge base NOT well known to the other.

Never assume. Know. Learning from other members is part

of natural communication process.

Knowledge


Users gain knowledge advantage as system is implemented and used over time.

Environmental basics for successfully moving ahead with collaborating EHR projects: shared and well-defined proposal relevant policies and principles personal commitment from users and I/S staff solid trust and respect common vocabulary and understanding shared expectations

The Tide Turns


PROCESS MODELING


Four components must be integrated into system design: Technology People Data Business process

Process Modeling


Process hierarchy: Function Process Subprocess Procedure

Process Modeling


Several challenges need attention in current modeling process. Workflow inconsistencies are result of two or more

people performing same subprocess. Are multiple versions of same subprocess within

business unit or organization. Documentation of variances is important.

Process Modeling


Documenting current work activity is critical step in new system design.

Provides “baseline data:” “What if” analysis of new system’s impact Powerful aid in discussions with vendors,

especially for “retrofitting” True measuring stick of new system’s benefits

Process Modeling


Next step is designing workflow. A conceptual model of process that changes

as system designs takes shape. User members need to obtain user

community acceptance of new workflow. Be honest about the “unknowns.”

Process Modeling


DATABASE DESIGN


Often first of development activities Conceptual model of data turned into logical

model Database plan used as foundation for system

feature and functionality

Database Design


IMPLEMENTATION READINESSS


Time to review plan for operational workflow changes.

User or group of users take on sole responsibility of “process owner.”

User members should understand system may not be totally functional at first.

User Processes and Procedures


Conversion from one system to another should be planned for a time least disruptive to the business operations.

User members need to work closely with planning staff and user managers to smooth the conversion path.

Users drive implementation process to ensure workflow continuity.

Plan Transition


Training is critical task. It is usually underfunded, understaffed,

underscheduled, and forgets process. In combination approach – new system

supported by new processes. Training materials sold by vendors must be

applied to each client’s environment.

Training


Questions to be answered when planning training: How much is enough? Who needs training and when? Who will cover for employees in training? If system purchased, does vendor supply any

training or training materials? If new system, who will prepare training materials

and manuals?

Training


Training manual Teaches concepts Provides hands-on exercises for practicing use of

system features and functionality Users manual

Complete documentation of system Includes all system features and rationales Overall picture of system’s use in organization Source of help for troubleshooting and resolving

problems

Training


Built systems require development of user manuals.

Serves as reference to system functionality, navigation, and workflow.

Becomes “bible” for system. Needs updating as changes occur Systems purchased.

New processes and workflow information need to be added to vendor documentation

Prepare User Manual(s)


Programs must be written to migrate data from old system to new system.

Need to test for data availability and integrity. Data mapping forces users to assess value

of data.

Data Migration


System testing is a BIG DEAL. It is often called “user acceptance test.” Uses test database of dummy records and

information to test system features and functionality.

Users should actively participate in testing process.

System Testing


Implementation is a time to be highly organized.

Identify roles of team members. Clearly and completely communicate to

the user community the planned steps for implementation

Everyone is learning.

“Go Live”


Implementation time when “unknowns” become apparent.

Draw heavily on environmental basics to support and sustain teams.

Use formal log to keep track of problems and issues.

Implementation will not be perfect – be prepared to document and problem solve for first several months.

“Go Live”


SYSTEM AND PROJECT EVALUATION


Use accumulated information as baseline to determine system implementation success or failure.

Measures changes to baseline to review implementation.

Value-based approach helps assess financial and intangible benefits.

Value benchmarks help measure achievement of objectives and expectations.

System and Project Evaluation

CHAPTER 9student.allied.edu/uploadedfiles/Docs/9f08deef-29ae-490c-bef3-2bf... · Collaboration...

Documents

Transcript of CHAPTER 9student.allied.edu/uploadedfiles/Docs/9f08deef-29ae-490c-bef3-2bf... · Collaboration...