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Implementation Planning for SOAPware
Table of contents
As soon as we receive your SOAPware order, you will be able to access all of our implementation materials, to help guide you throughout your implementation process. Not only will we provide you with the training guides and installation instructions needed for physically setting up your system and getting started, but we will
Path (Advanced) - 2. Preparing for Implementation
++++++++++++++++++++++ Temporary Notes Below ++++++++++++++++++++++++++++++++++
This Booklet will be each clinic's Bible for implementation and organizing all of the associated tasks. It's purpose will be inspirational, educational and functional.
If the client wishes, they can go through the Implementation booklet themselves, have a SOAPware trainer assist them in their planning efforts or have a certified SOAPware Reseller assist them, whichever works best for them.
The format in which this package will be delivered will be in written format (a physical booklet), on CD possibly (videos and a PDF for written content?), or via the web on SOAPedia...or a combination of them all.
The 6-S solution to implementation!
Seemingly insurmountable tasks melt away if they are broken down into easily achievable, small steps. Most failed implementations of mainstream EHR systems are not due to the hardware, software and training, but are primarily due to lack of planning. Start Simple with SOAPware then Sequential Simple Steps
1 – SMARTstart - Address the leadership and change management issues that fundamentally determine the degree of success that is possible.
2 - SOAPware.- Learn basics.
3 – Study/Define Current Situation – Describe and define current workflows in the practice. To get where you really need to be, it is necessary to figure out where you are.
4 - Schedule and Plan Implementation Activities - Develop an implementation plan regarding the tentative timing of implementations of new workflows. Communicate the plans and schedule meetings with all involved in the implementation to get feedback and to revise plans based on the feedback.
5 – Series of Pilots - limited implementations to prove concepts, develop site-specific customizations and ensure that hardware, software and workflows are appropriate for more general adoption.
6- Sequential Progress - advance to high performance practice that wisely uses the most advanced information technologies available in order to achieve quality results in all areas. This is the path to best serve the well-being of all involved.
We call the approach that a majority of practices (not using SOAPware) take as bleeding-edge for many reasons but primarily because the most common end result is to bleed the practice of its financial life-blood by costing from twice to ten times as much in lost revenue and other miscellaneous expenses. Sadly, the end results are typically inferior to SOAPware implementations. Indeed, it can be expensive to preserve the egos of decision-makers who don't really understand leadership, change management and how to achieve quality results. Equally sad, this industry has largely evolved to be in a position to serve in the role of preserving egos of misguided decision-makers rather than being focused on best serving patients by empowering the clinicians deserving of their patient's trust. It is SOAPware's intent to disrupt this industry by returning the focus to where it needs to be, and we are dong well with this mission.
In addition to the software costs, it is a good idea to add an amount to cover the costs of implementation in both dollars and hours. Purchasing implementation services early usually results in far fewer hours having to be spent by the practice to implement the functionality. In order to avoid a failed implementation later, budget for this.
The more users there are at your site, the more likely you could benefit from implementation and customization services.
SOAPware Implementation services are often accomplished via presentations on your computer which is being controlled by the SOAPware trainers. The presentations combined with the implementation guides, and with a speaker phone for your staff, is an ideal and cost-effective means to address your specific implementation and training needs. Purchasing implementation services early usually results in far fewer hours having to be spent by the practice to implement the functionality.
The traditional implementations of SOAPware assumed that the staff at the sites did their own project management totally on their own. SOAPware, Inc. offers implementation coaching as to how sites can best perform the customizations and follow the guides. SOAPware, Inc. also has relationships with several specialized resellers and some other entities offering additional services designed to maximize the effectiveness of the install. Most implementation obstacles can either be prevented or quickly resolved via consultation with experienced implementation specialists.
The good news is this implementation guide offers cutting-edge insights into the simple, convenient, and reliable steps that have proved to be useful in thousands of implementations at a fraction of the cost average for this industry. The insights and approaches are divided into these broad categories:
A: Change Readiness
C: Clinical
P: Project Planning
T: Technical
Cautions:
- The planning process for a 10 physician practice is about 10 times more challenging than for a solo practice. For 50 physicians, it is about 50 times more challenging. Economies of scale are not to be expected in the implementation process.
- No single project plan works for a majority of practices. Each is unique! This shared knowledge and experience is only a starting point for what is best for any particular site. These guides are generally a middle of the road approach and are most consistent with a 5-10 physician group. Smaller practices can be less diligent and larger practices should consider the steps in this guide may be minimalistic.
Fact - Obtaining the hardware, software and training is about 30% of the necessary preparation for an EHR.
Fact -20 to 40% of EHR implementations going from paper fail to the point that the systems are actually un-installed with a return to paper. SOAPware has enjoyed a much lower failure rate by focusing on simple, reliable, affordable and convenient in a step-wise fashion.
Fact - of the 60 to 80% of EHR implementations that remain, only around 20% are using more than 20% of the EHR functionality available!
Opinion - In the past, lack of full use of available functionality did not cause obvious, significant harm to the well-being of most practices. This will not likely be the case in the future. For example, increases in fee schedules are going to be tied to "quality performance." SOAPware v4 and other, popular EHR's that are based on free text will not be able to meet these challenges.
Most of the current generation of EHR products able to deliver the needed functions are difficult to use and have high rates of failed implementation. Even when successful, the associated costs have often proven to be crippling to practices. Vendor salespersons are often masterful in the use of invalid ROI analyses to justify overpriced products.
A planned, incremental implementation of a more proven, more capable, more affordable and easier to use tool such as the current generation of SOAPware is likely to be an option with the fewest risks and the greatest potential benefits.
Here are a few articles that provide some good outlines and points of interest:
Eight Mantras to a Successful Software Implementation
Implementing New Business Systems Successfully
Implementing Accounting Software On Time, On Task, and On Budget
Review Key Business Objects & Long-term Goals
Establish a Team & Define a Leader
Prepare a Project Plan, Meet, & Reevaluate Frequently
Research & Prepare a Budget
Define Clear Requirements & Project Goals
Select the Right Package
Testing, Testing, and More Testing
Data Migration
Training the End Users & Technical Staff
Seek Outside Assistance if Needed
Take Control & Take Away Failure
- Define requirements and research options - Start by defining what you want to do.
- An active implementation leader - A user at the site who has the knowledge and vision to direct their implementation and act as a cheerleader and evangelist when needed. The primary reason is practical: when one person is in charge of a project, even if all they do is coordinate input and delegate duties, the chances of success increase dramatically. We've seen this consistently in sites implementing SOAPware. Implementing an EHR isn't like choosing a new word processor, however much we wish it were so.
- A core implementation team - A small group of users (probably one from each department) who are selected to receive more extensive initial training and assistance. Just as the leader provides guidance for the entire office, these core users provide expertise for their departments. At first pass, we would suggest a breakdown of front-office, physician, nurse, and IT, with coaching by us (or someone endorsed by us) possibly providing specialized support and training for each category. Most of our sites won't have dedicated IT staff, but we work with preferred, local consultants, who could later use that knowledge to help other sites in the same area.
- A planned implementation roadmap with tangible milestones - Big Bang implementations are notoriously doomed. It's up to offices to decide what order and milestones are right for them, but we and our preferred consultants can assist in providing some recommended roadmaps as starting points. Ideas such as implementing front-office usage first, followed by nursing staff, then physicians, but that's just an example.
- Intense intervention around the go-live date - Training and help that intensifies approaching the any launch dates of upgrades, new functions, etc. This can gradually beginning to taper off as things stabilize and needs diminish. Plan sort of an EHR Office Surge, if you will.
3 – Study/Define Current Situation
Describe and define current workflows and tasks performed in the practice. To get where you want to be, it is extremely wise to understand the specifics of where you are, and what you do now. This creates the necessary framework to consider more efficient ways of doing things in the future.
Action List:
- List all the staff in your clinic. Beside each name, itemize their responsible tasks.
- Have each clinician make a list of the 20 most common prescriptions, then add these to be available as local SMARText items.
- Have each clinician make a list of the 20 most common plan items, then confirm they are available as local SMARText items.
- Have each clinician make a list of the 20 most common follow up items, then confirm they are available as local SMARText items.
- Collect the 20 most common type of documents or forms the clinic creates and create document designs for these in Document Designer.
- List the 20 most common reasons for patient encounters and create docuplates(protocols) for each.
- List the handouts that the practice wants to use and make these available in SOAPware.
DATA FLOW
Develop specific flow charts as to how informational tasks are performed now and how they will be performed in the future. Consider the following tasks.
PATIENT ENCOUNTER NOTE OR RECORD OF VISIT
Which of the following method(s) best describes how you presently create clinical documentation and how you would like to create clinical documentation in the future?
Paper record, little or very little documentation
Paper record, physician writes or types documentation
Paper record, assistant writes documentation
Paper record, unstructured dictation
Paper record, structured dictation
Paper record, Encounter form as the final document
Paper record, Encounter form used to collect information which is then typed
Computerized record, Doctor typing into EHR
Computerized record, Assistant typing into EHR
Computerized record, Unstructured dictation and data entry
Computerized record, Structured dictation and data entry
Computerized record, Pen-based computerized encounter form
Computerized, Speech recognition software used for data entry
Computerized, Patient interactive questionnaire used for data entry.
Computerized, Patient entering history into computer
Documentation and Clinical Information Tasks
Because this is the main task of most physicians (i.e. 20 to 40 times daily as patients are seen). Other physician uses of the information system tend to be of much less importance than this daily, time-consuming and often repetitive task. Many EHR’s that have a lot of bells and whistles, fail in this basic, essential task.
Ideally the doctor is not forced into structured entry initially. Over time, however, structuring the information will bring great rewards! Allow for both free text entry and offer structured entry of information while facilitating a migration to the latter.
Physicians often still think of their records as only important to themselves as memory prompters. This is fraught with problems. As a rule, the greater the amount of documentation, the less the risk for problems with third parties.
Medical Records and Clinical Tasks
Chief Complaint and History of Present Illness (SOAPware Subjective)
Patient Examination (SOAPware Objective, Vital Signs)
Impression of Patient’s Problems or Diagnoses (SOAPware Assessment)
Treatment Plan (SOAPware Plan)
Education: Routine set of basic instructions for aftercare
Activities: Such as bed rest, return to work or school, etc.)
Restrictions: Things to avoid, which developments should be reported to physician)
Diet: Low calorie, low cholesterol, etc.
Interventions: OTC meds, Treatments administered in the clinic, injections, etc.)
Referrals: Cardiology, Urology, etc.
Other Goals: Items not included in any of the above categories
PRESCRIPTIONS (SOAPware Medications)
Doctor writes them out
Assistant writes them out
Doctor calls them in
Assistant calls them in
Pre-Printed Scripts
Computer prints out Scripts
Fax to Pharmacy
Electronic transfer (PC to PC)
TIMING:
At time of Encounter
After the Encounter
Other
REFILLS:
Doctor writes them out
Assistant writes them out
Doctor calls them in
Assistant calls them in
Pre-Printed Scripts
Computer prints out Scripts
Fax to Pharmacy
Electronic transfer (PC to PC)
RETURN APPOINTMENT (SOAPware Follow-Up)
LETTERS:
Letters are usually a repeat of what the doctor placed in the clinic note. SOAPware allows the doctor to automatically generate letters using the same information contained in the clinic note.
•Referral letters to other doctors
•Letters to patients
•Letters to third parties
Templates to implement practice guidelines, standardize.
Manage results (e.g. lab, x-ray).
Health Maintenance Recalls
Flow Charts.
Lab Management.
Order entry-tracking, Order sets.
e.g. Hospital admission orders.
Consultations: (When, who, what, date, recommendations)
Record allergies and type of reaction.
Interaction checking (drug-drug, drug-allergy, drug-diagnosis).
Message Management - Internal and external.
e.g. Information transfer between doctors; Telephone call management
Images-Photos, EKGs, etc.
Patient Education – print as needed. Web links.
Interfaces.
Super Bill (ICD and CPT codes for proper billing) .
Generate the information for ICD9 and CPT codes for billing.
Patient Notes for Work or School.
Loose Reports (from outside sources such as hospital, laboratory, consultation reports) .
Nursing TASKS: RN, LPN, Physician Assistant, Registered Nurse Practitioner
Data Entry Specialist (Transcriptionist?)
Initially, re-train to use SOAPware instead of word processor. As need for transcription wanes, consider re-training them in managing the storage of outside reports, etc..
Front Office Clerical
demographics
Sign in (patient registration)
sign out
Release of Information
No Shows; Cancellations
Consent for Treatment
Release of Information.
4 - Schedule and Plan Implementation Activities
Develop an implementation plan regarding the tentative timing of implementations of new workflows. Communicate the plans and schedule meetings with all involved in the implementation to get feedback and to revise plans based on the feedback.
Example of a General Task List of major Items:
- From the list of all the staff in your clinic. Security Administrator is to enter everyone into the security system and notify that access is available.
- From the list of all the staff in your clinic. Each is to be added to the Task Manager List.
- Confirm the necessary diagnoses each clinician are available as local SMARText items.
- Confirm the necessary procedures and CPT codes for each clinician are available as local SMARText items.
- Confirm the 20 most common prescriptions each clinician in the practice are available as local SMARText items.
- Confirm the 20 most common plan items for each clinician are available as local SMARText items.
- Confirm the 20 most common follow up items for each clinician are available as local SMARText items.
- Confirm the 20 most common type of documents or forms the clinic uses have been converted to document designs for in Document Designer.
- Confirm the 20 most common reasons for patient encounters have been developed into docuplates(protocols or templates).
- Confirm the handouts that the practice wants to use are available in SOAPware.
5 – Series of Pilots
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Plan and implement a series of limited "pilots" to prove concepts, develop site-specific customizations and ensure that hardware, software and workflows are appropriate for more general adoption.
6- Sequential Progress
Advance to a cutting-edge, high-performance practice that wisely uses the most advanced information technologies available in order to achieve quality results in all areas. This is the path to best serve the well-being of all involved.
