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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Information Technology and Quality

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What is involved in planning?

Now that the system has been selected, what happens next?  To properly implement an e-prescribing system, it will take a commitment of time and effort from everyone in the organization.  Loading software is the "easy" part of the process, but before that happens, sufficient effort in the planning and early deployment stages will help to reduce aggravation and minimize productivity losses.  The following areas need consideration before starting implementation:

"Big Bang" or Incremental Rollout.  One of the first decisions needed in outlining the implementation process is how fast is this going to happen.  For example, if this is a multi-office practice will all the offices convert at the same time (i.e. "big bang") or begin implementation at just one site?  Will all the physicians within one site switch over at the same time?  There are pros and cons associated with either approach, depending upon things such as how many physicians and offices are being implemented, how fast it needs to occur, or whether it is a full EMR or a stand along e-prescribing system.  This is something that will be discussed with the vendor since it has a significant impact on how the system is implemented.  Practices may consider using a combination of the two approaches depending upon the stage of implementation.  For example, some practices will download health plan eligibility, formulary and medication history all at once (Big Bang), while other practices will only download the same information once the patient has made an appointment after the implementation occurs (Incremental).  Because of the time needed to reconcile medication lists, a key issue in making this decision is prescriber readiness to undertake this activity.

Timeline.  The planning of an implementation is almost as important as selecting the software system for the organization.  Developing timelines and plans in advance can save time and problems during the actual implementation process.  A few things to consider in designing a time line are the school year schedule, holiday/vacation schedules, staff readiness and availability, and any specific activities throughout the year (such as screening drives).

Do not rush the process. Going too quickly can cause unexpected delays that can potentially disrupt the entire project.  Some of the questions in the previous section are related to the implementation process, but one essential is that the vendor provides a consultant to work specifically with the practice to design the timeline and implementation process.

Training.  For many organizations and practices, the assumption is made that individuals can pick up the computer program "on the fly", i.e. while using it without training.  There may be computer savants, who can do this without training, but most people need training and everyone needs continual training.  First consider the familiarity the staff has with computers, such as basic computer skills (such as keyboarding), Word, or Excel.  Next consider training staff grouped together based on their function and potential use of the system.  This helps people learn with their peers and can create an environment that encourages people to ask each other questions after the training is completed.  By creating scenarios that are common in the office it allows staff to ask questions about their daily activities.  These can include situations such as:

  • How are prescriptions for medical supplies or durable medical equipment written?
  • How are pediatric dosages calculated?
  • How are tapering dose directions written?
  • How are compounded prescriptions written?
  • How will e-prescribing affect the prescription renewal/refill process?  Who is responsible for what specific activity?
  • How does the system create provider-specific commonly ordered medications lists?
  • How does the provider take care of alerts and reminders from the system?

Not all the details of a system can be taught in a day.  By scheduling training over several days, it allows staff to think about the training and ask additional questions.  For example, when Kaiser Health Systems implemented an EMR go to exit disclaimer, they found that in an evaluation of clinicians more than 50 percent of clinicians remembered less than 50 percent of essential material taught during the initial process.  If possible try to schedule additional training sessions, such as webinars or online tutorials, over the first few months to assist with staff questions.  Work with the vendor to "train-the-trainer" in some of the staff and providers.  This can provide peer-to-peer training once the standard training is completed and it also develops the ability to provide answers quickly as staff become more familiar with the system.

Deciding what resources are available to people once the system goes live is an essential part of the training process.  By conducting training in peer groups and train-the-trainer, the practice is creating a support network for when the system is up.  As part of this, the practice may want to consider the creation of a group of super users, that is staff who have received extra training and are available for immediate help for other staff.  The practice should think about what post-implementation resources are required for each type of user, for example prescribers will require different support resources than front office staff.

Finally, talk with the vendor concerning the availability of additional help in implementation beyond the standard level.  Communicating with other practices that have specific lessons learned can be a key resource for any practice during implementation of an e-prescribing system. Many states, such as Florida go to exit disclaimer, and professional associations, like the Texas Medical Association go to exit disclaimer and the Health Information Management Systems Society go to exit disclaimer (HIMSS), are encouraging the implementation of e-prescribing, so listservs and other online communities have been created to facilitate learning and discussion between providers.

Staffing.  As with the implementation of any change in a practice, there is an impact on staffing and productivity.  Practices may find it beneficial to bring in temporary nursing and office staff to relieve regular staff while they attend training sessions.  There is also likely to be a drop in productivity while providers and staff become familiarized with the new systems.  During Kaiser's EMR rollout go to exit disclaimer, training and related productivity losses accounted for more than 50 percent of the total cost.

The implementation of an e-prescribing system is an ongoing process that will require staff feedback, organizational workflow flexibility, and ongoing training relative to software and hardware upgrades and staff turnover.

The following resources provide additional information on the implementation of e-prescribing:

Developed by the Health Resources and Services Administration as a resource for health centers and other safety net and ambulatory care providers who are seeking to implement health IT.
Health Information Technology Toolboxes help health centers, safety net providers, and ambulatory care providers with electronic and online resources and technical assistance to improve patient care.  More>
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