Transcript What you don’t know about upgrading an EHR.

What you don’t know about
upgrading an EHR.
Steven M Adkins MD FAAFP
Chair EHR Committee HMG
Chip Childress
Director Information Systems HMG
Holston Medical Group
• Multi-specialty Physician Owned Group Practice Based in
North-East Tennessee
• EMR Project dates back to mid-1990s
• Numerous previous upgrades since 1997
• Upgrade to V11.1.4 in November 2008
~140 Providers, >100 Physicians,
– >800 Users to train
– 16 Locations
Project Leadership
• Physician Champion – Chair EHR Committee, Physician Liaison to
IT, Ex-officio on Board of Directors (2d/week)
• EHR Committee
– 11 members (6 MD, 5 IT/Med Rec)
• Upgrade Core Team
– 5 members (1 MD, 4 IT)
• V11 Upgrade Team
– 75 members (½ Volunteers, ½ Draftees) – All groups represented,
MD/NP, Nursing, Management, Clerical, Med Records, QA
The Role of Physician Champion
• Leader of all teams, Core and V11 Upgrade
• Attended Upgrade Training Class – Certified in Upgrade
Process – should have some IT knowledge of process
• Chief Communicator – Authored weekly e-mails, liaison to
board and IT staff
• Trained 2/3 of Providers, assisted by physician volunteer
• Functioned as Clinical Project Manager
• Involved in all phases of design and build – Built Clinical
Desktop Views, etc.
V11 Upgrade Team
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Initial development began in 2007
Team formed in 2008 – Cast a big net, 75 members!
Solicited Volunteers from all departments and offices
Key members drafted to create large team
No large group or evening meetings, all e-mail and small
groups, “lunch and learns”
Given advanced training materials, printed & DVDs
Weekly e-mails for 13 weeks prior to Go-live
First line of support, extended testing team
Incentives – Logo shirt and gift cards
Training
• Over 800 users trained in 3 weeks – Mandatory
• Role-based training – Train with like users, train by like
users
• 6 trainers
– 3 Nurses, 1 Front Office Trainer, 2 MDs (3 IT staff, 3
volunteers)
• Focus on core components to get job done , minimize time
spent on gee-wiz components
• Could have used 2 more hours, allow sufficient time
Training Challenges & Successes
• Provider time – Offered early AM and late PM
sessions, asked for preferences and tried to honor
those times
• Role-based training – Train with like users, train
by like users, consider a physician trainer
• Training Staff – Used Volunteers, Train the
Trainers early and give them access to TEST
• Focus on core components to get job done -minimize time spent on “gee-wiz” components
• No Surprises – Show bugs and problems but also
train solutions and suggested workflow changes
Testing
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Core Team, EHR Committee,V11 Upgrade Team
Test, test, test and then test some more
Focused testing, instruct team in areas to test
Testing questions sent to V11 Upgrade Team prior
to access to TEST
• As many different types of users as possible on
testing group but the most effective testing still
comes from the core team
• Attempt to simulate load-testing
Take Away Lessons
• Start Early – There is never enough time or too much
preparation for a major upgrade
• Clinical Leadership Critical – Strongly recommend
Physician Champion understand the IT side of EHR
• Cast a big net – if only ½ are active can still succeed
• Get all user groups involved – Nurses some of the best
team members
• Mandatory Training backed up by Executive
Leadership
• Communicate, communicate, communicate
• Test, Test, Test
All Upgrades are Not the Same
• Minor Upgrade
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Example version 10.1  10.2
Typically contains bug fixes and small enhancements
Workflow changes are minimal
Test carefully to avoid “gotchas”
• Major Upgrade
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Example version 11.5  12.1
May contain user interface design changes
May contain database architecture changes
May require redesign of multiple office workflows
Review server and workstation requirements
Approach to a Minor Upgrade
• Identify areas of change
– Determines areas of focused testing
– Helps identify other areas that should be tested
(underlying code may be used in more than one
place)
– Understand how changes impact workflow,
stability, and performance
– Small changes sometimes have major
implications
Approach to a Minor Upgrade
• Communicate those changes
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Simple e-mail
An e-mail with a detailed instruction sheet
Lunch and learn
Formal training
What about a Major Upgrade?
• Identify areas of change
– Significant user interface change
• Treat as a reimplementation
• Create a multi-disciplinary team for project
• Generate training materials for classes
– Significant software architecture change
• Review current system baseline performance and
compare to test system
• Test for stability issues
What about a Major Upgrade?
• Redesign of office workflow
– The more offices/persons involved, the more
possible permutations there are of a “standard”
workflow
– Look for opportunities for additional
optimization
– Change is painful
– Adjust schedules based on significance of
workflow changes
What about a Major Upgrade?
• Review hardware requirements
– Minimum specifications SHOULD NOT be the target
– Core servers are typically replaced every three years
• Increasing sophistication of EMR products continue to increase the
load on database servers
• Storage requirements have increased and will continue to increase
significantly
– Workstation CPU and display specifications
• Maximize CPU spec to provide longer service life
• Review display specs to optimize user experience
– Highest resolution may not be best; minimum resolution spec may
frustrate users
– Use different displays for specific end users (widescreen, portrait, etc.)
What you don’t know, can hurt you!
• Understand the dangers of each type of
upgrade
• Remain vigilant even with what appear to
be minor upgrades
• Where affordable, over spec hardware;
never just meet the minimum
• Communications is key with users and
vendors