EMR Implementation Planning Guide V 1.0

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AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideEMR ImplementationPlanning GuideA Ten-Step Guide to Planningfor Successful Implementation of anElectronic Medical Record (EMR) SystemAOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.01

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideContentsPurpose of this guide . 3Step 1: Establishing the project team . 4Step 2: Project activities and phases . 5Step 3: Planning for change . 9Step 4: Communication planning. 10Step 5: Data migration and data retention from legacy systems . 11Step 6: Training . 12Step 7: Identifying EMR reporting requirements . 13Step 8: Executing and validating deployment . 14Step 9: Executive approval to go live . 15Step 10: Post-Go Live activities and support . 16For questions or comments, please contact:AOHC EMR ProjectAssociation of Ontario Health Centresemr@aohc.orgAOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.02

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuidePurpose of this guideThe EMR Implementation Planning Guide is a ten-step framework to helpyou understand activities necessary for successful implementation of thenew Electronic Medical Record (EMR) system at your health centre. It’sdesigned to provide opportunities for advance planning and resourceallocation, and timelines for deployment activities.EMR implementation will be a collaborative effort involving teams fromyour centre, the EMR vendor, and AOHC staff working on the EMRproject. Depending on the size of your centre and resource availability,the number of project team members will vary. At a minimum, however,all executive directors or a designated senior manager will need toreview the Guide to understand funding and resource commitments andassign staff to the EMR project as appropriate.When and how to use the GuideIntended as a step-by-step planning tool, the Guide provides valuableinformation to help you make decisions regarding the timing of the EMRGo Live date, and resource commitments necessary for successfuladoption of the new EMR. Regardless of when your centre is scheduledfor EMR implementation, this document will help you start thinkingabout what’s needed for smooth implementation. As the system isdeployed across the sector, the Guide will be updated with lessonslearned to ensure information remains current.On-site implementationThis guide is a pre-implementation planning tool. Once your EMR GoLive date has been confirmed, a comprehensive EMR implementationapproach will be available to support project teams in systemimplementation at your centre. Encompassing processes, guides, toolsand activities, the EMR implementation approach will support EMRadoption and use, and help determine your centre’s needs at a detailedlevel, including budget and resource requirements.AOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.03

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideStep 1: Establishing the project teamKey Points While the AOHC and the EMR vendor will play key roles and act inpartnership with the centre, each centre is responsible for its ownEMR implementation project.Centres will be required to assign a dedicated project manager, whowill be responsible for project deliverables and keeping the projecton track.The centre's project teamThe centre's project team is pivotal to the overall success of EMR systemimplementation. Although the full project team may be assigned later inthe project lifecycle, the executive sponsor and project manager shouldbe assigned prior to the start of the project.ROLERESPONSIBILITIESEXECUTIVE PROJECTSPONSORAccountable for the overall success ofthe project, the executive sponsorassigns the project manager. Prosci, aninternationally-recognized changemanagement firm, has identified activeand visible executive sponsorship as themost important factor in project success.PROJECT MANAGERTypically a senior manager experiencedin leading multi-faceted implementationteams, the project manager makes EMRimplementation decisions on behalf ofthe centre, and is responsible for day-today management of EMRimplementation for the duration of theproject.PROJECT TEAMThe project team works on all aspects of EMR implementation witha focus on the following: Budget/agreementmanagementBusiness changeInformation technologymanagement Together, theexecutive sponsorand project manageridentify members ofthe centre's projectteam. They leadchange and manageresistance to change.Privacy and securityCommunicationsData migrationTrainingReportingDepending on resource availability and EMR implementationcomplexity, one person may fulfill multiple roles. The keyconsideration is the time and effort each role requires to ensureoverall project success. It’s important to include clinicalrepresentation on the project team.AOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.04

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideStep 2: Project activities and phasesKey Point This guide is a pre-implementation planning tool. Once your EMRGo Live date is confirmed, a comprehensive EMR implementationapproach will be available to support system implementation atyour centre. Encompassing processes, tools and activities, theapproach will be updated regularly to leverage lessons learned fromearlier EMR system implementation at other centres.Project PhasesReadinessENGAGEMENTASSESSMENT Initial projectplanningdiscussionswith centre AOHC/centrepreliminarymeeting tokick offproject Detailedneedsanalysis toassesscentre'sbusinessandtechnicalreadiness1 monthapproximatelyDeploymentPREPARATION& PLANNING Projectplanning ProjectScope ofWork,FundingAgreement,budgetpreparation Businessprocessredesignpreparation Datamigrationpreparation1 monthapproximatelyDEPLOYMENTGO LIVEWEEKENDAdoption &MaintenancePOSTIMPLEMENTATION Pre-productionenvironmentsallocated Data migrationtrial runs tocreate a cleanextract file Businessprocessredesign User training,EMR demos Identification/developmentof ad hocreports1 Peer leadergroup support Dataconversion,validation Finalreadinesschecklistcompletion Go/No-GoLive meeting Data validationby end users Addressingissues End usersupport Peer leadergroup support Transition toadoption/operationsphase3 monthsapproximately3 daysOngoing6 - 12 monthsapproximately1Peer leaders are health centre staff who will champion the use of the EMR tosector colleagues through best practices and lessons learned. Peer leaders willlikely be drawn from centres that adopted the EMR system early in the sectorwide implementation schedule.AOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.05

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideEngagement MeetingDesigned to kick off the project, the engagement meeting brings togethersenior centre executive and project team members and the AOHC EMRProject Team, who will work in partnership to implement the EMRsystem. The centre's executive sponsor should assign a project managerprior to the meeting. Meeting activities include reviewing projectmilestones, resource assignment, roles and responsibilities, andestablishing a high-level approach to project communications and issuesmanagement. The funding agreement and budget templates will also bereviewed at this session.ACTIVITY START Four months prior to your EMR Go Live dateDURATION Half-day sessionAssessment PhaseThe centre's technical and business leads are assigned during this phase.Working with leads, the AOHC EMR Project Team will conduct a detailedbusiness and technical needs analysis including network requirementsof the centre. Information gathered at this stage will be used to evaluategaps in business processes or technology, inform the EMRimplementation budget and support development of the Project Scope ofWork (SOW) and funding agreement between the AOHC and your centre.PHASE START Four months prior to your EMR Go Live dateDURATION One month approximatelyPreparation and Planning PhaseYour centre's full project team should be assigned prior to the start ofthis phase. Activities include: Development of the project work plan using an AOHC EMRProject templateReview of results from the business and technical needs analysisProject Scope of Work (SOW) preparation by the centre and theAOHC, and signature by the centre, AOHC, and vendorPreparation of the EMR implementation budgetFunding agreement preparation, and signature by centre andAOHC executive directorsData migration and transfer activitiesDocumenting current workflowsEnabling deployment portal accessOrdering network services, infrastructures upgrades, equipment,etc.AOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.06

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuidePHASE START Four months prior to your EMR Go Live dateDURATION One month approximatelyDeployment PhaseThe deployment phase involves all activities required to advance theproject from planning and preparation to the day the EMR goes live atyour centre. Activities in this phase include: Meetings to coordinate EMR implementation activitiesVendor team engagement with centre/AOHC project teamsAllocation of data migration, training, demonstration and preproduction environmentsData migration trialsIdentification of additional local reporting requirementsPreparing staff for the new EMRIdentifying and implementing local EMR configurations (i.e.,setting up authorized users, assigning role-based access, etc.)PHASE START Three months prior to your EMR Go Live dateDURATION Three months approximatelyGo Live WeekendOccurring from Friday to Monday, Go Live weekend is the most criticalpart of EMR implementation. A time of intense activity for centre, AOHC,and vendor project teams, activities include: Data migration and IS/IT teams copying the database(s) andsending files to a centralized migration environmentData conversion using data migration toolsExporting data to the new EMR, and data validationExecutive approval to go live.For more information on this activity, see Step 8: Executing andvalidating deployment, and Step 9: Executive approval to go live.ACTIVITY START Three days before your EMR Go Live dateDURATION Three daysAOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.07

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuidePost-Implementation PhaseEven after your new EMR is up and running and in active use, there arestill a series of activities to undertake, including: Data validation by end usersSuper user2 support of end usersAOHC and vendor team support for a specified periodPeer leader supportOngoing practices to support full EMR adoptionFor more information on the Post-Implementation Phase, see Step 10:Post-Go Live support and EMR adoption.PHASE START As soon as your new EMR is liveDURATION Ongoing2EMR users at your centre who receive additional training on the new systemso they may share knowledge and assist other staff. See Step 6 - Training.AOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.08

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideStep 3: Planning for changeThe new EMR will bring significant change to your centre. To help youplan for change, the AOHC Transition Management Team will work withyou to develop a strategy to support the transition of people, processesand technology.Three key activities are required to develop a change strategy andprepare providers and staff for EMR implementation from a businessprocess perspective:1. Set the strategic direction by defining goals around the use ofthe new EMR to support and improve client-centered care.2. Map current processes to identify the people, processes andtools currently used to provide client care. Likely led by yourcentre's change manager with assistance from the AOHCTransition Management Team, this is an opportunity to identifywhat works well at your centre, and more importantly, whatdoesn’t, and to identify processes or workflows that needimprovement.3. Define to-be processes by re-thinking and re-designingprocesses to ensure a client-centered practice. This activityprovides opportunities to plan organizational changes in yourdaily workflow based on the improved features and functionalityof the new EMR. This exercise should be a centre–wide initiativewith representation from all areas of care and operationalsupport.Change management helps organizations and individuals affected bynew processes and technology understand the need for changing currentbehaviour, and provides practical approaches and tools to helporganizations and individuals implement and adopt new skills andbehaviours. To support you in these activities, the AOHC EMR ProjectTeam will provide guides, tools and expert assistance.ACTIVITY START Four months prior to your EMR Go Live dateDURATION Four monthsAOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.09

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideStep 4: Communications planningCommunications planning focuses on informing and engaging staff fromthroughout your centre, and stakeholders, on changes that will resultfrom implementation of the new EMR. Providing early awareness andkeeping these audiences informed of project progress and the impact thenew system will have on their day-to-day lives is an important part ofoverall project success.A communications plan should at a minimum fulfill the followingobjectives: Provide staff with awareness and understanding of upcomingchanges early onInform any centre partners, such as laboratories, of EMRimplementation, to give them time to make necessary processchangesKeep users and stakeholders informed about project progress, aswell as EMR adoption statusInform and update your board of directors and LHIN about theproject and current status.A comprehensive guide and communications planning template will beprovided by the AOHC EMR Project Team once your EMR Go Live date isconfirmed. Communications planning should start four months beforeyour EMR Go Live date and continue throughout the project, up toapproximately one month after your Go Live date.ACTIVITY START Four months prior to your EMR Go Live dateDURATION Four monthsAOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.010

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideStep 5: Data migration and data retentionfrom legacy systemsData migration and retention of legacy clinical management system(CMS) data to the new EMR is the most critical activity in successfulimplementation of the new system. Without proper migration of existingclient data, the new EMR will fail to support optimal client care. Due todata migration complexity and the variation in levels of electronic recordadoption across the sector, careful and detailed planning is necessary ateach centre to prepare for successful migration of legacy CMS data to thenew EMR.Data migration involves five key activities:1. Data preparation of paper and electronic charts, as perinstructions, guides and tools provided by AOHC EMR ProjectTeam.2. Data mapping of local data values to data fields in the new EMR.3. Data migration using AOHC EMR Project Team migration toolsand data mapping spreadsheets. Data migration will happen in adedicated, centralized environment supporting preimplementation practice runs and final migration and validation.This approach will enable project teams to benefit from iterativedata migration trial runs, so data conversion errors can becorrected, and data can be validated after each trial run.4. Planning and execution of manual entry of relevant data frompaper charts.5. Retention of original historical records to ensure compliancewith medical/legal requirements.Data migration supportAlong with a dedicated data migration environment, an AOHC datamigration coordinator, as well as guides and tools will be available toassist you with data preparation, retention and migration.ACTIVITY START Four months prior to your EMR Go Live dateDURATION Four monthsAOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.011

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideStep 6: TrainingAll staff who will use the new EMR will require training. Specializedtraining will also be necessary for super users, system administrators,data management coordinators and financial staff.The AOHC EMR Project Team will provide you with tools to help youdevelop a training strategy for your centre to meet your short and longterm needs. This includes identifying training roles and responsibilitiesand completing a training and course planning matrix.The EMR vendor will provide onsite training for your staff.3 Each centreshould identify at least one super user4 who can be trained to provideonsite expertise and who can, when required, train new staff.A training environment for staff to practice using the new EMR will alsobe available. Staff will have ongoing access to online training modules torefresh knowledge, and supplement training for new staff or staff withnew responsibilities.EMR training will be supplemented by a peer leader support network.The network will enable clinical staff from other centres experienced inusing the new EMR, like physicians, nurse practitioners, nurses,dietitians, social workers and clinical support staff, to act as mentors tonew users. The program aims to speed adoption of the new system andassist you in achieving meaningful use of your EMR.ACTIVITY START Three months prior to your EMR Go Live dateDURATION Three months3Basic computer skills are a prerequisite to EMR system use. Training tosupport basic computer literacy will not be provided as part of the AOHC EMRProject. If some of your staff lack basic computer skills, it’s important torecognize and address this gap before they receive training on the new EMRsystem.4 For a definition of super user, see Step 2, Post-Implementation Phase.AOHC EMR Implementation Toolkit EMR Implementation Planning Guide – Version 1.012

AOHC EMR IMPLEMENTATION TOOLKITEMR Implementation Planning GuideStep 7: Identifying EMR reportingrequirementsThe new EMR will offer pre-defined reports to address core businessneeds. Additional reports requested on a sector-wide basis and availableto all centres will be added based on an approved change requestprocess.If required, centre-specific local reports will be developed to address thespecific reporting needs of a centre. Driven by the centre's businesschange team, each centre will need to compare their reportingrequirements to standard system reports to verify if additional localreports will be required.The following activities will be required to identify local reportingrequirements at your centre:1. Identify current reporting activities across all offices.2. Assess current reporting activities in terms of relevance andusefulness and identify new reporting requirements.3. Prioritize and develop new, local reports.Identifying EMR reporting requirements should start three months priorto your EMR Go Live date, and take approximately one month. Reportdevelopment should begin two months prior to your Go Live date andcontinue after EMR implementation as an operational activity.ACTIVITY START

Designed to kick off the project, the engagement meeting brings together senior centre executive and project team members and the AOHC EMR Project Team, who will work in partnership to implement the EMR system. The centre's executive sponsor should assign a project manager prior to the meeting. Meeting activities include reviewing project

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