How to Use the Toolkit

Section1.1Adopt - Assess

Section 1. 1 Adopt – Assess – How to Use the Toolkit - 1

How to Use the Toolkit

(See accompanyingPowerPoint handouts)

Many health care organizations have used health information technology (HIT) for some time to support administrative and financial processes, to communicate across disparate providers, and to manage quality of care. Telehealth, clinical messaging, and disease registries are also quite common. Momentum is growing to use HIT to:

Improve direct clinical care processes for patient safety and quality
Integrate systems for greater efficiency and to improve use of resources
Communicate across the continuum of care
Accelerate diffusion of knowledge and reduce variability in access to care
Strengthen privacy and data protection
Promote public health and preparedness
Engage individuals in their health maintenance and wellness efforts
Take advantage of increasingly available incentives

The federal is aligning incentives with quality measure reporting. It is encouraging clinics to adopt and optimize electronic health records (EHR)use, with incentives for meaningful use of certified EHR products starting in 2011, and sanctions for not adopting such technology start in 2015.An EHR is a computer system that should capture data from multiple sources and provide clinical decision support through access to knowledge bases at the point of care. EHRs should also facilitate health information exchange across the continuum of care and support personal health record keeping as well as public and population health.

For most clinicians, optimal EHR use resultsin clinical transformational change in the way they do their work. EHR systems can have significant benefits in productivity (e.g., improved coding and resultant reimbursement, reduced clerical and transcription costs) and better patient outcomes. EHR is not software acquired off-the-shelf and implemented over a long weekend. Assessing one’s readiness, planning for, selecting, implementing, maintaining, and using such systems for various improvements are not simple steps.

Importance of Planning

The goals for HITare challenging in any setting. Laying a solid foundation is a critical first step when building anything.For HIT, the foundation must address:

Hardware
Software
People
Policy
Process

While hardware and software are the essential elements of HIT, people, policy, and process are the elements that make the hardware and software work. Everyone must be engaged, starting from the board of directors, administrator, project manager, and IT support, to every end user. The leadership team must believe in the value of HIT in general, assure that a strategic planning process is applied, and be committed to supporting HIT through financial and staff resources. The leadership team members also must establish expectations and policy for achieving results, as they are ultimately accountable for the investment in HIT.

Patients should be the primary beneficiaries of HIT andthey are playing an increasingly important role in their personal health information management. But, physicians, nurses, therapists, social workers, aides, and other clinicians are the primary users. These individuals must participate in the planning, selection, design, and adoption of improved processes brought about by HIT for the benefits to be fully realized.

People, policy, and process are often described as contributing 80 percent to the success of HIT, even though they are the elements most often overlooked as health care delivery organizations approach HIT. The industry is beginning to recognize that lack of thorough planning has resulted in a hit-or-miss approach to HIT, with a high cost-to-value ratio. Understand yourorganization’s readiness and carefully develop a strategy addressing a logical sequence of applications, optimal technology needs, and—most importantly—operational support.

Overcoming the Challenges of Time and Talent

For the physician office, a carefully constructed foundation and the right tools to plan and implement HIT can mean the difference between systems that are not well-used or add administrative burden, and those that achieve value. The purpose of this HIT Toolkit for Physician Offices is to supply tools, tested in this environment, that will help you plan and make the right choices, as well as to avoid having to re-invent the wheel. (See also the Stratis Health Website, at for toolkits that address HIT in hospitals, nursing homes, and home health agencies.)

Using the Toolkit

Much like a carpenter’s toolbox, the HIT Toolkit supplies a variety of tools for use at different points in your HIT adoption. Some tools will be used frequently for many different tasks. Much like using a hammer and a set of nails—the same hammer will help you build a doll house, a shed, or a mansion. Similarly, system flowcharts will help you improve workflow whether for a new laboratory information system or for automating nursing documentation. Some of the tools will be developed once and referred to many times. A blueprint for a building project helps you from the point of selecting the proper building site, to making sure you have all the doors you need. Likewise, a set of HIT goals will help you: 1) define functional requirements for a new application, 2) select the product that supplies those functions, 3) contract for the functionality you expect you are buying, 4) complete the implementation elements for the application, and 5) celebrate that you are using the functionality to achieve success or correct course where you may not be fully achieving the value expected.

Also like the carpenter’s tools, the HIT Toolkit is a set of tools you must learn when and how to apply. Each tool includes:

Brief statement of purpose – informing you when to use the tool and what it should help you accomplish.
Instructions for use of the tool – guiding you in effective use of the tool.
Tool structure – depending on the tool itself, you may find you can customize the tool to help you perform a task or use it as a model to modify for your own needs.

The HIT Toolkit Overview (1.1 Overview of Tools)lists all of the tools and the points at whichthe tools may be helpful. You may want to start out using the planning tools to identify your HIT strategy, and then select from the toolkit those tools needed for each application. Not all tools will apply to all applications. A variety of types of tools are included:

Short recorded Webinars may be viewed to introduce specific concepts or to reinforce ways HIT can be used. For example, you may view the Webinar on How to Use the Toolkit during aplanning meeting to help you focus on the size and scope of the HIT project. You may view the Webinar on Visioningand Strategic Planning for HIT at another steering committee meeting to help you define your vision of the future. This Webinar, or parts of it, may be reviewed again when it comes time to specifically plan for vendor selection or to explain to staff what an EHR is. You maywant to post one of the slides in a staff meeting room to further HIT education.
Survey forms can help you understand current attitudes and beliefs toward HIT and assess skills that need improvement. Checklists help assure all steps in a process are taken. Inventories help you describe current status and compare them with requirements for specific forms of HIT. For example, you may take an inventory of your current applications and their interfaces(1.1 IT System Inventory) to enable you to identify and sequence acquisition of missing applications in light of the desire for an EHR. You may also use this inventory to compare against vendor requirements for new HIT applications so that you can anticipate the cost and resources necessary to maintain technology additions.
Charts of various kinds aid in evaluating and improving workflows and processes. For example, several easy ways to perform process mapping are explained inthe Workflow and Process Redesigntools(1.2 Workflow and Process Redesign and 2.1 Workflow and Process Improvement).
Sample job descriptions, policies, and other documents are included for you to use directly or modify as needed. Model plans may be adopted to prepare for communications(1.1 Communication Plan), implementation(2.1 Project Planning), training (2.1 Training Plan), and other elements of preparing for effectively utilizing HIT. Scripts or use cases are included as a way to help you evaluate products and test systems(1.3 Request for Proposal and 2.1 Testing Plan).

Toolkit Sections

The following is a brief description of each sectionof the HIT Toolkit:

1.1 Adopt –Assess provides tools to start using the HIT Toolkit. Many of the tools in this section are surveys, inventories, or assessments that can help you understandyour staff’s current attitudes towards information technology, their computer skills, and your technical infrastructure. The tools will help you develop a communication plan so you can convey the right messages to the right people at the right time. Many of these tools will be added to and used throughout the remainder of your HIT project.

1.2 Adopt – Planemphasizes the importance of planning. Investing the time and resources upfront will mean expending less time and resources during implementation, and reaping greater value. Don’t overlook dependencies or important steps that reduce risk. Unfortunately, many HIT vendors do not put a lot of emphasis on supporting the planning effort—focusing instead on selling and installing systems, thenmoving on to the next customer. Vendors who recognize the need for more focus on planning have higher customer satisfaction. Still, the onus for the majority of planning is on the organization. Planning tools include those for goal setting, developing a business case, change management, and understanding your current workflows and processes to identify opportunities for improvement.

1.3 Adopt – Selecthelps you understand the HIT marketplace and conduct all aspects of vendor selection, due diligence, and contracting. The extent to which a hospitalneeds to review the marketplace depends on its overall IT strategy. If you are part of a corporate structure, the selection process is performed for you. However, the assessment, planning, implementation, effective use, and exchange tools will still be very important for you to use.

2.1 Utilize – Implementbuilds upon the foundation in the Adopt tools to help you address the specific application, technology, and operational elements that have been acquired and now are to be implemented. Tools included here help with the tactical issues that need to be addressed in any implementation—from sample project plans to issues logs, training plans, testing plans, chart conversion and pre-load techniques, and many others.

2.2 Utilize – Effective Useprovides examples of how tools may be used for specific types of implementations. This set of tools provides tips for workflow and process improvement for various types of applications, such as for messaging systems, point-of-care charting, and physician oversight. Resources to support quality measurement reporting are also included.

3.1 Exchange – Readinessprovides tools to help evaluate your readiness for participating in health information exchange (HIE) and to help you understand the goals and governance of various forms ofHIE.

3.2 Exchange – Interoperateprovides tools to help you pursue participation in an HIE organization, including tools to understand interoperability standards and HIE architectures, and to prepare for clients’ or their families’ use of personal health records.

For support using the toolkit

Stratis Health Health Information Technology Services

952-854-3306 

Section 1. 1 Adopt – Assess – How to Use the Toolkit - 1