The EMR installation disconnect

Feb. 1, 2011

When it comes to connectivity issues, you can't be too prepared.

George Gides

With the impending implementation of the federal meaningful-use (MU) standards, healthcare organizations are rushing to fully implement EMR systems. This includes managing the requirements for interoperability. As a consultant who has specialized in making disparate systems “talk” to each other for the past 20-plus years, I'm seeing an interesting trend during EMR implementations: There is a complete lack of planning when it comes to connectivity, yet MU connectivity requirements are one of the major reasons EMRs are being implemented in the first place — to connect all systems for universal patient record access.

In one recent (and increasingly common) example, the EMR vendor's resource was not experienced with large integrated healthcare networks. The person knew the vendor software very well, but was not familiar with the client organization's other systems, business or culture. During the testing phase of the EMR implementation, it was “discovered” that multiple medical record numbers were being created for each patient. The problem could have been solved up front by answering simple questions, such as: What is the main patient identifier (if one exists)? How is it assigned? Does it change? What does the interface code need to do to account for this information? Since the interface connectivity plan did not account for this sort of “global” research and analysis and since the resource was inexperienced, interface installation fell sorrowfully behind.

EMRs must be connected completely across the entire healthcare enterprise. Why, then, is interoperability planning left on the sidelines or given to an inexperienced vendor or internal resources? There are three reasons: 1) There is a mistaken perception that the connectivity solutions that come with the EMR will easily connect to other systems in the enterprise; 2) Healthcare organizations assume that the vendor will provide the expertise and services; and 3) If there are no connectivity experts on the day-to-day implementation team, connectivity project planning gets overlooked or short-shifted due to mere ignorance of the steps that need to be taken.

When an organization implementing an EMR does not have a good connectivity plan in place and a good connectivity project manager, you can bet that there will be delays in the implementation of the EMR itself.

Ok, let's assume you're on board with the need to have a connectivity plan in place and the right resources to execute it. How do you know the plan is a good one? Here are some pillars of a good connectivity project plan:

• A clear statement of what the overall goal is and why it is important to achieve it;

• A clear textual and graphical explanation of the overall connectivity plan;

• A clear definition of the detailed installation steps, when they will be done and by whom;

• A clear statement of the intermediate steps and expectations of the results; and

• A clear contingency process to follow when dates are missed.

Clearly, clarity is crucial. The timing and the process of creating a connectivity plan is as important as the plan itself. Here are some suggestions:

• The client-side connectivity team should be established before the project kickoff.

• This team, in conjunction with the vendor-assigned resources, should build the project plan together.

• The connectivity resources should be available to begin the process within the first two weeks of the overall project, because the connectivity project plan is simply a subset of the major EMR implementation project plan and should be included in the larger document at the beginning of the project.

The connectivity project team members will invariably have responsibilities in addition to the EMR implementation project. That is why it is so critical to plan for their time. It is also critical that the team members have the correct qualifications. Many organizations “take what they get” from their vendors in terms of personnel. This should NEVER be the case. The client should review the “resumes” of the vendor-assigned project resources to ensure that they have the level of experience to complete the project successfully.

When reviewing the connectivity resource plan, here are a few questions to ask:

• What is the personnel-to-interface ratio? Is the load too much for the number of resources assigned?

• Has the connectivity project leader led an assignment like yours before? How many times? What were the outcomes?

• How many other obligations do the resources currently have or do they expect to have during the timeline of your installation?

All healthcare organizations are working on tight budgets. Resources are scarce. However, the investment in developing a solid connectivity plan with a qualified resource to execute it will save time and money in the long run. You will be more likely to make the go-live deadline and have a successful installation of your new EMR.

George Gides is a senior consultant at Hayes Management Consulting.
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