by Darcey Trescone, RN
Over the years, I have observed that leaders of successful home healthcare agencies embrace the concept of team structure. Never is this more important than during high-level planning of the phases of a software implementation project.
Since an Electronic Medical Record system in the home care and hospice space is not "shrink wrapped" software bought off the shelf at your local Best Buy, it is critical that its deployment be done well, that it be configured to each customer's business needs. In part two of my series on software implementation, I offer a broad stroke outline for team structure, with a list of specific roles and responsibilities, that has been the foundation of successful software selections and implementations for many organizations I have worked with over the years.
Basic Team Titles and Responsibilities
Described below are roles you need to assign. This plan is based on experience with medium- to large-sized agencies so you will want to adapt it depending on the size of your organization and how complex a system you are deploying. At a minimum, you must have an internal champion, ideally a trained project manager, to oversee and coordinate activities of the team. You will also find it critical that at least one C-level executive sponsor accepts the responsibility to both oversee and encourage the team as well as support appropriate decision-making regarding how the system should flow to best fit your organization.
- Executive Sponsor – leadership role, decision support, contract signature
- Works directly with internal project manager
- Typically a “C” level executive or “VP” level
- Accountable for overall organizational success including deployment of your new “EMR” system.
- Internal Project Manager – a managerial role
- coordination of teams, guide/drive implementation phases internally, communication of implementation phases
- Works directly with vendor project manager and trainers
- Coordinates internal teams and all meetings/trainings with vendor
- Accountable to Executive Sponsor
- Accountable for success of all implementation phases
- System Administrator – a managerial role with focus on IT, security, and system setup/configuration
- In smaller organizations the system administrator may also be the internal project manager
- Ensures the organization technology infrastructure is ready for the new system (works with an outside IT resource for guidance if needed)
- Learns system configuration
- Process definition for maintenance of system configuration
- Accountable directly to Internal Project Manager
- Subject Matter Experts (Operational, Clinical and Financial) – business requirements, work flow, reports/BI/forms requirements
- Defines/documents workflow and reports/BI/forms requirements
- Accountable direct to Internal Project Manager and System Administrator role
Basic Implementation Phases with Roles and Responsibilities Defined
Every vendor will have its own implementation phases for system deployment. Having your own internal phases that your structured team pursues alongside the vendor will better prepare your organization for conversion to your new system. Below is a recommended plan with roles and responsibilities in each that have been found helpful for organizations selecting and implementing new EMR systems.
- Ground Zero – Business Needs/Requirements
- Phase 1 – Functional Workflows and Detail Reports/BI/Forms Specifications
- Phase 2 – System Configuration
- Phase 3 – System Implementation
- Phase 4 – On-going System Maintenance
Ground Zero Phase…..Business Needs/Requirements - What does your business require from a new software system?
Roles and Responsibilities:
- Executive Sponsor – leadership role, decision support and contract signature
- Internal Project Manager – managerial role to ensure teams are coordinated and accountable that activities in the Ground Zero phase get defined/documented
- System Administrator – Defines technology and security requirements
- Subject Matter Experts - Define/document business needs and high-level workflow streams that are required for your organization
Business Need/Requirement Activities
- User and business needs should be defined (workflow high level, payer requirements, patient population requirements, efficiencies you want to gain)
- System environment and security that is important to your organization (Are you a Windows shop? What types of devices do you need in the field? Password authentication? Device security? etc.)
- Interfaces you will require (What other software applications do you need your EMR to communicate with? What info needs to flow back and forth?)
- Conversion to the new system (Will you move data from your existing system or will you start with new admits and new episodes in the system?)
If you complete this prior to system selection than you have a high-level plan for your implementation and you are on your way. If this is not done prior to system selection than there is a risk that your recent purchase will not support your organization resulting in:
- work-arounds within and outside of your newly purchased system to meet your needs;
- custom work the vendor will need to do within your new system to meet the needs, which could delay the actual system implementation;
- cancellation of your new system contract to allow you to find a different system to meet the needs (most vendors offer a warranty period so pay attention to this clause in any new contracts you sign)
System Implementation Phase 1 – Functional Workflow and Detail Reports/BI/Forms Specifications
Hopefully, you have purchased your new EMR system and your team is excited to get it in place. The focus of Phase 1 is to ensure that the requirements for your workflow from patient entry thru billing are defined and documented, along with any key performance indicators you need to manage your day to day operations. Phase 1 is focused on turning your high-level plan into a more detailed outline of your organization's needs.
Basic Roles and Responsibilities
- Executive Sponsor – Leadership role, decision support and contract modification/addendums as needed
- Internal Project Manager – Managerial role to ensure teams are coordinated and accountable that activities in Phase 1 get defined/documented; keeps executive sponsor up to date on progress
- System Administrator – define/document technology and security requirements; work with vendor and internal project manager to ensure your organization meets the “System Requirements” needed for the new system to work i.e. devices, PC’s, operating systems, etc.
- Subject Matter Experts – your internal operational, clinical and financial experts define/document workflow streams and reports/BI/forms detail required; this then gets reviewed with the Executive Sponsor and Internal Project Manager for feedback
Functional Workflow Specifications – how will the system operate daily?
- Functional workflows from referral management, eligibility checking, authorization management, scheduling, patient care delivery/documentation, clinical oversight/quality assurance, data submission to payers/regulatory bodies and revenue cycle management (billing, accounts receivable and posting payments)
- Critical: Business process re-engineering with the new vendor system will be identified, defined and documented with your team and the vendor. It should be expected that some of your internal workflows (aka business processes) will need to change with a new system.
Detail Reports/BI/Forms Specifications – what deliverables do we need such as reports/BI and forms to manage our organization and present functional workflow?
- Reports/BI and Forms you presently use or will need for each functional workflow point to ensure your operations are flowing accurately and your team is managing your business the right way.
- Critical: Reports/BI and Forms within the vendor system should be defined and documented with your team and the vendor. This ensures you know how to get your top key performance indicators that you use daily from your new system.
You may find after Phase 1 is defined you could still end up with work arounds and/or custom work from the vendor but if Ground Zero was done well your present software selected should still be a good fit.
System Implementation Phase 2 – System Configuration
Phase 1 defines your business process workflow within the system which is required by your vendor to ensure the system is configured appropriately for your organization in Phase 2.
Basic Roles and Responsibilities:
- Executive Sponsor – Leadership role, decision support, escalation resource if issues are identified
- Internal Project Manager– Managerial role to ensure teams are coordinated and accountable that activities in Phase 2 get defined/documented; keeps executive sponsor up to date on progress
- System Administrator – Define hardware, security and user access requirements in line with Phase 1 to support the system configuration. Inventory/guide purchase of any internal hardware or software required to support the new system.
- Subject Matter Experts - Define/document workflow streams and reports/BI/forms detail specifications in Phase 1; Participates as testing team once system configuration in phase 2 is setup to ensure accuracy.
- Vendor guides and your team learns basic system setup and maintenance
- System testing to ensure configuration supports functional and detailed requirements
- Interface setup and testing
- Conversion setup and testing (where applicable)
System Implementation Phase 3 – operations are converted to the new system
Phase 3 is the actual system implementation within your organization. This is what you have been preparing for until now and the below is only broad strokes of what is required. Your team will need to work closely with your new vendor in this phase.
Basic Roles and Responsibilities:
- Executive Sponsor – Leadership role, decision support, escalation resource if issues arise
- Internal Project Manager – Managerial role to ensure teams and vendor are coordinated and accountable that activities in Phase 3 get defined/documented; keeps executive sponsor up to date on progress
- System Administrator – Ensures hardware, security and user access requirements are in place to support the system implementation in Phase 3; assists with decisions about modification to this configuration as needed during the project
- Subject Matter Experts – Train and support workflow streams and reports/BI/forms detail specifications in Phase 3 to end users in conjunction with Internal Project Manager and Vendor team members
Operational conversion to new system
- End users are trained on new business processes and devices
- End users are trained on forms and reports/BI needed to do their roles
- New system is rolled out across your organization
Phase 4: ongoing system maintenance
Many leaders do not consider Phase 4 as part of software implementation, but this is a mistake. This phase includes ongoing system support, maintenance and continual training after initial implementation. This is clearly your organization's responsibility but too many organizations treat it as an after-thought. These agencies will fall behind, resulting in poor future processes and inadequately trained staff to keep the system working properly.
Basic Roles and Responsibilities
- Executive Sponsor – Leadership role, decision support, escalation resource if issues arise with current system
- System Administrator – Managerial role to ensure teams and vendor are coordinated and accountable that activities in Phase 4 get defined/documented; keeps executive sponsor up to date on progress; receives software updates and plans end user device updates; works with subject matter experts to review new software updates and plan workflow changes and trainings
- Subject Matter Experts – Operational, clinical and financial resources that train and support workflow streams and reports/BI/forms detail specifications in Phase 4 to end users in conjunction with System Administrator
On-going System Maintenance
- Software updates and upgrades are directed to the System Administrator who works with Subject Matter experts to determine impact, changes in workflow that need to occur, trainings and roll-out of the system changes across your organization
- Management of support tickets and enhancement requests submitted to vendor for resolution; tracking to ensure compliance with the vendors service level agreement (most vendors the service level agreement or SLA is part of your original contract)
- Quarterly and annual software trainings for new employees and refresher courses for existing employees coordinated between the System Administrator and Subject Matter Experts
- Documentation maintenance of workflow process changes to ensure future trainings are in line with existing practices within your system
As an industry, we spend a significant amount of our revenue and human resources on our EMR systems. By embracing some internal project management principles and adopting appropriate team structure, you can help to ensure your organization's success with your most mission critical software system, now and in the future.