Anticlue

An EHR in the practice

Lessons Learned are one of the key drivers to new projects. If you have to learn something, its best to learn it from someone without pounding thy head against the wall. Unless you really like an infinite loop.

The AAFP has a study on what it takes to pilot and implement an electronic health care record in a family medicine practice setting.

What have they found?
Well one of the first steps what to track workflow. Very good, workflow tracking and determining what someone does is creating the as usecases and actor scenarios.

The next key finding, there are some bells and whistles we want. This is normally true of all projects implementations. There are key needs and then there are key desires, and there are also the pie in the sky desires. The trick of scope management is to deliver the needs and a couple of key desires, while avoiding the dreams.

Another finding, built-in templates would save them time. Great thought, clear repeatable processes save anyone time.

It was also discovered that the physicians needed a playground to learn the new system. Here the playground was offered fully throughout the implementation.

There was a frustration with the staged reiterative rollout quoting a key physician, "My only frustration is I want the project to move even faster". The truth be told a big bang initiative is always painful, rather staging pieces helps because clinicians have a lower learning curve for the new items. No one has to learn how to do their whole job function all at once on a new system.

Finally on the job learning is costly to productivity, this loss of productivity needs to be clearly defined in the pilot. Might I also suggest piloting in a different manner at different sites. See what items might make more sense to stage concurrently, and what items it makes sense to stage in sequence. Also have one site with more user training right before the live, and the other with the playground. These different approaches may yeild different losses in productivity. Obviously the approach with the least impact is the one you go with.