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Is Your EMR Project Being Hijacked?

EMR projects get ‘hijacked’ every day.  Some get hijacked by vendors, some get hijacked by consultants and, yes, some even get hijacked by the very doctors who invested in the project in the first place – an investment that was supposed to help them treat their patients, run their offices and collect their money.

While writing “Navigating the EMR Jungle – 10 Steps to Ensure a Proper EMR Rollout” (for a free audiobook version, click on ) and later during the development of a simple-to-follow EMR roll-out strategy map ( ), the issue of hijacking was a sidenote.  However, since the launch of Meaningful Use there have been several studies illustrating the percentage of EMR  I.T. projects that have outright failed or underperformed –  as high as 50%.  And one of the root causes is the inability to recognize EMR project hijacking.

Hijack Exposure #1: EMR Evaluation and Selection  

EMR projects first get hijacked during evaluation and selection.  The risk lies in jumping to Step #5 (Create a Short List of Vendors) without progressing through the previous 4 steps (see below).  EMR vendors and HIT consultants may love it when you start here but this means you are probably underprepared for a robust and thorough evaluation process.

EMR Evaluation requires more reflection than a check list (often vendor supplied) of reports and menus, workflow names and core modules.  Selection requires more than asking for a proposal. Some of the signs of an EMR evaluation in danger of being hijacked are lack of doctor alignment (“Don’t worry, they’ll come around”), low levels of management commitment (“Don’t bother me, that’s an IT project”) and underappreciating change management or the effect on staff (“Don’t worry, they’ll get used to it”).

In order to avoid this, be clear on the initial steps:

Step 1 – Decide You Need to Do Something – Why EMR? Why now? Are you doing if simply for the financial incentives?  For improved productivity?  Regardless of the reason, your entire team should be on the same page before proceeding.

Step 2 – Assess Your Needs – Before you commit to running an EMR on wireless devices, for example, you need to determine whether your office has the necessary infrastructure. And when it comes to your staff, they might not be ready for EMR if they lack basic computer skills.

Step 3 – Form an EMR Committee – Make sure all key areas of your practice are well-represented. The ‘perfect’ EMR may be a no-go if the billing department can’t do its job properly or if the IT people can’t make it function between multiple locations.

Step 4 – Involve the Doctors – This is especially important for those who are less than enthusiastic about EMR.

Once you are ready to start evaluating systems, you are at risk of hijack once again unless you make EMR vendors respond to an RFI (Request for Information) and an RFP (Request For Proposal) that you create based on the needs of your practice.  Simply asking for their proposal means you have to do all the heavy lifting when you try to compare their proposals against one another.  Why make yourself crazy when you can standardize the responses?

For the RFI, make a table of the most important elements you are concerned about (wireless capability, multi-location, security features, ease of use, etc), and give each a rating based on their importance, such as “must have” or “would like to have.” Within the “would like to have” category, you can further ‘weight’ each item to come up with a score. Your RFI will help cull out the systems that you know up front won’t meet your most basic needs.

The RFP is more robust, asking the vendor about their depth of experience in project management, support, training and the system itself. What are their SLA’s (Service Level Agreements)? Do they have references? Are their staff members employees or contractors? Having them all answer in the same way will save you countless hours of review.

Evaluation and Selection Hijack Prevention Takeaways:

Be clear on why you are deciding to take action.  Understand all of the implications of a major IT project before you start building a vendor list.  Check in with all stakeholders and ensure that they are all in alignment with the goal of this project. Standardize your RFP process.

Hijack Exposure #2: EMR Project Management

Project Management hijack prevention requires you to focus on the project management lifecycle, especially the project planning and implementation of your EMR. The best way to do that is to learn the basics of project management so that you understand the implications of any project decisions you will be asked to make.

It begins with a basic mastery of terms and concepts, and a high-level understanding of what goes into a well-managed project. Begin with WHY knowing about project management is important as your project begins, followed by WHAT are the basics elements of project management that your project should include and, ending with a deep understanding of  the two most critical-to-success elements of an EMR project: the Project Charter and Work Breakdown Structure.

It matters that you and your staff understand the basics of project management in order to avoid getting hijacked by a consultant or an EMR vendor’s own Project Manager. If you don’t have a context for some of the essential elements, then the plan that you sign-off on could be missing critical success factors either by design or omission, or by accident or incompetence on the part of your EMR implementation manager.

A second reason why you need to know about project management comes during the negotiation and contracting steps for your practice’s EMR purchase. Going into negotiations with a clear idea of what successful project management includes means you will ensure the “i’s” are dotted and “t’s” are crossed before you sign any contract.

The final reason why you need to know about project management is for long-term productivity and performance after the EMR system is implemented. Medical practices have an unending stream of projects every year, every quarter, every month.  Regardless of why projects become a must-do (compliance, IT refresh, employee staff development, clinical quality, safety, best practices, competitive advantage, etc. ), your ability to better manage projects, your ability to better evaluate project outcomes, and your ability to prevent project disasters begins with having some competencies in basic project management. These competencies apply to executives, staff and contractors.

Occasionally issues arise during a project. These can be addressed individually. But when a number of them appear at once, the project may be in dire need of a project turnaround which necessitates expert guidance to get the project back on track. Knowledge of project management can help you diagnose the condition you’re in ( )

Project Management Hijack Prevention Takeaways:

Understand WHY project management is important to establish early on in your endeavor. Know WHAT the elements are that need to be tracked. Learn HOW to use a Project Charter and Work Breakdown Structure to minimize your risk exposure and to ensure a successful outcome. Keep in mind that if a project turnaround becomes necessary, bringing on a good project manager is advisable.

Hijack Exposure #3: EMR Technology Adoption

Change management and adoption readiness are crucial to the success of your EMR project yet many practices are misled into believing that software mastery equals technology adoption. What does this mean? Software training is not technology adoption. Just because your EMR vendor spends three days in your office training users how to use the software doesn’t mean you will successfully integrate the technology into your practice; if you settle for training as a one-time event, your practice’s post-go live adoption of EMR has been hijacked.  At the very least you should have a series of application adoption milestones.  It might help to seek the advice of other users of the (preferably same) EMR who have been “in the saddle” for 6 months. You might also consider having a series of refresher trainings for staff as their competency with the software moves from novice to capable and capable to expert.

Technology Adoption Hijack Prevention Takeaways:

Don’t let software training be the only arrow in your change management quiver.  EMR adoption requires a strategy far more complete than 3 days of on-site software training.   Work alongside your vendor to review the nuances of software mastery for each job role in your practice.  Identify levels of change readiness and enroll your EMR vendor in helping you engage staff whose adoption is crucial but whose readiness is low.  Negotiate hard for learning and performance support interventions to be scheduled periodically for 6 – 12 months after implementation.


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