1

Project Management Plan

Waverly Family Health EHR Implementation

Madsion Pridemore
University of San Diego
HCIN – 542
Dr. Charisse TaboTabo
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Table of Contents
1 Project Charter and Scope 3
2 Project Plan 6
2.1 Work Breakdown Structure 6

2.2 Gnatt Chart 12

3 Failure Mode Effects Analysis (FMEA) 13

3.1 Testing Plan Summary 13

3.2 FMEA Summary 13

3.3 FMEA Chart 13

4 Stakeholder Analysis 14
4.1 Stakeholder Interview 14

4.2 Influence/Interest Grid 17

4.3 Guidance Notes 18

5 EHR “Go-Live” Checklist 20

6 Post-Implementation Review Report 22
7 Interview Questions 28
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1. Project Charter & Scope

A. General Information
Project Sponsor: Charisse Tabotabo
Project Manager: Madison Pridemore
Prepared by: Madison Pridemore
Date: 5/20/2022

B. Purpose
Waverly Family Health is looking to transition their current health record system to an electronic health
record system. The purpose of this project is to successfully transition all patient records and
supplement documentation into the Practice Fusion EHR system within a specified length of time and to
remain in budget. The Practice Fusion EHR system is a cloud-based EHR system that focuses on allowing
the user to streamline charting, connect efficiently for information exchange, seamlessly manage
subscriptions, and offer means of flexible billing options. Within a six month timeframe, all paper charts
will need to be converted to digital content using the already provided hardware and maintain a
$40,000 budget for the entirety of the project, including start-up costs, labor, training, and any
unforeseen costs. The first month of this implementation will include all planning and budgeting, the
next two will be dedicated to acquiring all necessary equipment/hardware and training staff on EHR
usage, the following two month will focus on transitioning all patient health records into the EHR
system. This timeframe leaves a month to use as necessary is some parts of the transition process
require more time than originally expected.

C. Constraints and Assumptions

CONSTRAINTS


The workstation configurations only meet the minimum standards for utilizing the web-based
EHR
 The project team has limited EHR installation experience
 There may be compatibility issues between certain patent information and the Practice Fusion
system
ASSUMPTIONS

 There will be enough time to transfer all patient information into Practice Fusion during normal
business hours
 The current Wi-Fi plan will be sufficient for implementing Practice Fusion
 Two months is a sufficient amount of time for staff EHR training

D. Project Scope Statement

SCOPE: Waverly Family Health is implementing the Practice Fusion EHR system at their clinic.
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TIMELINE: The entirety of the project has a time limit of six months, resulting in 180 days. This should be
a sufficient amount of time the three main components of the project: planning, training, and
implementation. The first month or 30 days of the six month timeframe will be spend planning and
scheduling. This time can be spent finding personnel to train staff on EHR use and sectioning patient
information to transition into the EHR system. The following two months or 60 days will be spent
training all staff on EHR use and prepare them for the transition. The next two months or 60 days will be
spent transitioning all patient information into the Practice Fusion system. This plan allows everything to
be completed within five months. The final month will be utilized in the case of a holiday taking place on
training days and prepare for any setbacks that may occur.

BUDGET: The clinic has acquired a small business development loan via American Express on their
business card for $40,000. The intention, obviously, is not to spend all the money, however it does leave
enough cushion in case of any unexpected circumstances and expenses. Each Practice Fusion provider
license costs $149 per provider per month. This license includes an unlimited number of users and three
signing permits. For full implementation, two provider licenses are required with a minimum one year
contract. In total, EHR implementation should cost $3,576, not including tax.

E. Resource Requirements
FINANCES: Overall expected minimum cost of the implementation will be under $4,000 with a total
budget of $40,000. $3,576 is expected to cover the EHR system cost for the entirety of a year.
STAFF: The entire clinic staff need to undergo EHR training, while four staff members are involved as
project team members.
TECHNOLOGY: Fully functioning and secure internet connection and cloud system. Additional internet
security to avoid breeches of PHI. Workstation configurations that meet minimum web-based EHR
utilizing standards.

F. Risks
POSITIVE RISKS
 The free training offered by Practice Fusion upon implementation will be adequate to train the
entire staff clinic.
 The Practice Fusion system is a more user-friendly system which allows patients to gain a better
understanding of their own health and promotes a patient-centered environment.
 The new EHR implementation will make accessing patient information quicker, resulting in a
faster-paced working environment without the additional stress.
NEGATIVE RISKS
 The clinic’s cloud system doesn’t get fully secured before transitioning patient information to
Practice Fusion, resulting in a breech in PHI.
 The minimum meeting web-based EHR utilizing standards for the workstation configurations
won’t be sufficient for future Practice Fusion upgrades.
 Staff will have to be paid in over-time to transfer patient information into Practice Fusion if it
cannot fully be done during normal working hours.
 Technical issues may occur during implementation that requires a third-party computer
technology manager which would result in a delay in progress and a rise in costs.
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G. Success Metrics: Criteria for Evaluating Project Success and Milestones

METRICS OF SUCCESS
 Complete plan for EHR implementation is approved by all project team members and key
stakeholders.
 After training is complete, staff will take an EHR comprehension test, and all require a score
higher or equal to 80%. Staff will receive additional training as necessary until goal percentage is
reached.
 The clinic has 60 days to transfer patient information into the Practice Fusion system. All patient
information will be split into four evenly-sized sections with the goal of transferring roughly 25%
every two weeks until the end of the implementation period.
 Decrease in patient wait times by 10% two months after EHR transition.
 20% Improvement in quality of care determined by patient satisfaction via survey before and
after EHR implementation.
MILESTONES
 Have complete plan for training and implementation ready one month into the project.
 Have staff completely trained in EHR use and all licensed providers informed of their
responsibilities three months into the project.
 Have all patient information transferred and secured in the Practice Fusion system five months
into the project.
 Have entire clinic running on Practice Fusion EHR system and any potential concerns or
unforeseen challenges addressed and fixed six months into the project.

F. Key Stake Holders

 Dr. Waverly - clinic owner and medical director
 Dr. Jones - physician and clinic partner
 Mrs. Jones - clinic director

F. Executive Summary
The overall level of user satisfaction is positive. Some of the strengths and areas of success that
attribute to the positive outcome is the system’s ability to give healthcare providers a larger
understanding of a patient’s history and health, as well as the system’s ability to provide flexible
billing options. Some of the problems that the system has produced is an interruption of
workflow. Until all users are completely comfortable with the new system and its attributes,
disruptions in workflow will be produced by the learning curve. So far, there are not any features
not in use, but a suggested improvement would be to provide roleplaying scenarios for the users
so that they can become acquainted with attributes of the system that they are less acquainted
with.

2. Project Plan
2.1 Work Break Down Structure
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1.1 Milestones

Milestone Description Delivery Date

Outlined Project Goals Project begins by outlining goals, risks, and cost- 05/10/22
benefit analysis

Project Charter and Project sponsors approve the project charter, and 05/17/22
Scope Approval all team members have a firm grasp on the
project’s broader details

Work Break Down Project sponsors approve work breakdown 05/21/22

Structure (WBS) structure (WBS) and all team members have a
Approval copy of important project dates

Training Plan Approval Project sponsors approve staff EHR training plan 05/26/22
and resources are acquired
Completed EHR Training EHR staff training is accomplished within a two- 07/31/22
month period

Completed EHR EHR implementation is accomplished within a 09/30/22

Implementation two-month period

Project Success Project Sponsors and project team members 10/30/22

Determination determine the success of the project, post EHR
implementation

1.2 Phases

Phase Description © Sequence

Project Planning Completion and approval of project charter, Phase # 1
scope, WBS, and implementation plans take place,
and all project team members are informed of the
project steps and phases

Project Training Over a two-month period, the entire clinic staff Phase # 2
will be trained in EHR use and tested on their
comprehension of the topic

Project Implementation Over a two-month period, project team members Phase # 3

and other select staff will implement the new EHR
system and transfer all patient heath information
into the electronic system

Project Completion Following the EHR implementation, a month will Phase # 4

be spent determining the effectiveness of the new
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system and ironing any potential issues that have

popped up afterward

1.3 Activities

Phase Activity Description © Sequence

Project Determine All goals of the project and First major step of the
Planning Project risks/benefits are assessed project, happens after
Goals/Outcomes all project team
members, manager, and
sponsors are
determined

Project Develop Work Complete a structure for the project After all goals and risk
Planning Plan and approval that includes all plans and processes are outlined, actual
involved in the project in documents project planning can
that are easy to understand and ready take place
for project sponsor approval

Project Training Training All preparation for EHR training will be First part of the project
Preparation passed to the individual overseeing the post planning, takes
training place before actual
training

Project Training EHR Training Implementation of EHR training plan Final part of the project
takes place and the staff’s training phase and takes
comprehension of the training is place before patient
assessed EHR transfer

Project EHR Preparation before the implementation Before transferring

Implementation Implementation of the new EHR system ensures health records into
Preparation everyone is on the same page before Practice Fusion and after
actual implementation staff training

Project EHR System The transfer of all patient heath The last and largest part
Implementation Transfer records, information, and other of the project
documents should be completed over a implementation phase,
two-month period it takes place before
project completion

Project Implementation Any issues that occurred during the Post-implementation

Completion Issue Assessment implementation phase and after are and done before success
addressed and a plan for fixing them is determination, as
created information from this
activity is vital for the
next

Project Project Success The success of the entirety of the Final part of the project
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Completion Determination project is determined through the completion phase as

implications of assessed issues and well as the project in its
completion of intended goals and entirety
outcomes

1.4 Tasks

Phase Activity Task Sequence

Project Determine - Identify Project Goals 1st
Structure Project - Identify Desired Project 2nd
Planning Goals/Outcomes Outcomes
- Risk Assessment 3rd
4th
- Cost Benefit Analysis

Project Develop Work - Develop Project Charter and 1st

Structure Plan and approval Scope
Planning - Gain Project Charter and Scope 2nd
Approval
- Develop WBS 3rd
- WBS Approval 4th
- Develop Training Plan 5th
- Training Plan Approval 6th

Project Training Training - Individual overseeing training 1st

Preparation obtains approved training plan
- Training resources obtained
- Training rooms booked for
2nd
duration of training
3rd
Project Training EHR Training - All clinicians receive training 1st
- All clinicians take 2nd
comprehension assessment
- Remaining staff receives 3rd
training
- Remaining staff takes 4th
comprehension assessment

Project EHR - Ensure that Practice Fusion is 1st

Implementation Implementation running on and compatible with
Preparation all devices
2nd
- Make sure the project team is
informed on how to input
patient information
- Divide information in need of 3rd
transferring into four sections
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Project EHR System - Transfer Section 1 into Practice 1st

Implementation Transfer Fusion EHR system
- Transfer Section 2 into Practice
2nd
Fusion EHR system
- Transfer Section 3 into Practice
Fusion EHR system 3rd
- Transfer Section 4 into Practice
Fusion EHR system 4th

Project Implementation - Compile all issues/problems 1st

Completion Issue Assessment that developed during and after
implementation
- Create a plan for fixing
discovered issues if issues were 2nd
not fixed immediately after
discovered

Project Project Success - Determine if project stayed 1st

Completion Determination within designated budget after
issues were addressed
- Determine if project
accomplished desired goals and 2nd
outcomes
- Determine ultimate success of 3rd
project

1.5 Effort

Phase Task © Effort

Project - Identify Project Goals 2 days
Structure - Identify Desired Project Outcomes 2 days
Planning - Risk Assessment 3 days
3 days
- Cost Benefit Analysis

Project - Develop Project Charter and Scope 3 days

Structure - Gain Project Charter and Scope Approval 4 days
Planning - Develop WBS 3 days (can be done while
waiting for Charter and Scope
Approval)
- WBS Approval 4 days
- Develop Training Plan 3 days (can be done while
waiting for WBS Approval)
- Training Plan Approval 4 days

*Approval may take a longer

or shorter time depending on
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sponsor availability*

Project Training - Individual overseeing training obtains approved 2 days

training plan
- Training resources obtained 4 days
- Training rooms booked for duration of training 1 day

Project Training - All clinicians receive training 3 weeks

- All clinicians take comprehension assessment 1 week
- Remaining staff receives training 3 weeks
- Remaining staff takes comprehension 1 week
assessment

Project - Ensure that Practice Fusion is running on and 2 days

Implementation compatible with all devices
- Make sure the project team is informed on how 1 day
to input patient information
- Divide information/records/documents in need
2 days
of transferring into four sections

Project - Transfer Section 1 into Practice Fusion EHR 2 weeks

Implementation system
- Transfer Section 2 into Practice Fusion EHR 2 weeks
system
- Transfer Section 3 into Practice Fusion EHR
2 weeks
system
- Transfer Section 4 into Practice Fusion EHR
system 2 weeks

Project - Compile all issues/problems that developed 1 week

Completion during and after implementation
- Create a plan for fixing discovered issues if issues
1 week
were not fixed immediately after discovered

Project - Determine if project stayed within designated 2 days

Completion budget after issues were addressed
- Determine if project accomplished desired goals
2 days
and outcomes
- Determine ultimate success of project 3 days

1.6 Resources

Phase Task © Resource

Project - Identify Project Goals All the tasks in this activity
Structure - Identify Desired Project Outcomes require the involvement of the
Planning project team members as well
- Risk Assessment
as information on the Practice
- Cost Benefit Analysis Fusion EHR System.
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Project - Develop Project Charter and Scope All the tasks in this activity
Structure - Gain Project Charter and Scope Approval require the involvement of the
Planning - Develop WBS project team members, the
- WBS Approval project sponsors, as well as
- Develop Training Plan information on the Practice
- Training Plan Approval Fusion EHR System.

Project - Individual overseeing training obtains approved - Approved training plan

Training training plan
- Training resources obtained - Practice Fusion EHR training
videos, required devices
- Room reservation request
- Training rooms booked for duration of training form

Project - All clinicians receive training - Practice Fusion EHR training

Training videos, required devices
- Pre-made HER comprehension
- All clinicians take comprehension assessment assessments, required devices
- Practice Fusion EHR training
videos, required devices
- Pre-made HER comprehension
- Remaining staff receives training assessments, required devices

- Remaining staff takes comprehension assessment

Project - Ensure that Practice Fusion is running on and - Access to all required devices
Implementati compatible with all devices - Meeting room for project
on - Make sure the project team is informed on how to team members
input patient information - A scheduling platform to input
- Divide information/records/documents in need of the transfer schedule
transferring into four sections
Project - Transfer Section 1 into Practice Fusion EHR system All the tasks in this activity
Implementati - Transfer Section 2 into Practice Fusion EHR system require the involvement of the
on - Transfer Section 3 into Practice Fusion EHR system project team members, all
- Transfer Section 4 into Practice Fusion EHR system patient health
records/information/document
s, and the Practice Fusion EHR
System.
Project - Compile all issues/problems that developed during Resources for these tasks
Completion and after implementation depend on the severity of the
- Create a plan for fixing discovered issues if issues issues and if contact with
were not fixed immediately after discovered Practice Fusion IT, an outside
contractor, or new devices will
be necessary

Project - Determine if project stayed within designated - Original Budget

Completion budget after issues were addressed
- Determine if project accomplished desired goals - Original Charter and Scope
and outcomes
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- Determine ultimate success of project - Meeting room for project

team and sponsors
2.2 Work Break Down Structure – Gantt Chart

Work Breakdown Structure -

Waverly Family Health EHR Implementation
HCIN-542

Project Manager Madison Pridemore

Today's Date: 5/29/2022

[42] Start Date: 5/1/2022 (Sun) 0

Days Remaining
Duration (Days)

Days Complete
Working Days
% Complete

10 / 10 / 22
10 / 17 / 22
10 / 24 / 22
5 / 23 / 22
5 / 30 / 22

6 / 13 / 22

6 / 27 / 22

7 / 11 / 22

8 / 15 / 22

8 / 29 / 22

9 / 12 / 22
9 / 19 / 22

10 / 3 / 22
5 / 16 / 22

6 / 20 / 22

7 / 18 / 22
7 / 25 / 22

8 / 22 / 22

9 / 26 / 22
5 / 9 / 22

8 / 1 / 22
1 / 0 / 00

6 / 6 / 22

7 / 4 / 22

8 / 8 / 22

9 / 5 / 22
WBS Tasks Task Lead Start End

1 Project Planning Project Manager 5/01/22 5/31/22 31 100% 22 31 0

Determine
1.1 Goals/Outcomes 5/01/22 5/10/22 10 100% 7 10 0

1.2 Charter and Scope 5/11/22 5/17/22 7 100% 5 7 0

Work Breakdow n
1.3 Structure 5/14/22 5/20/22 7 100% 5 7 0
1.4 Training Plan 5/17/22 5/23/22 7 100% 5 7 0
2 Project Training EHR Instructor 5/24/22 7/25/22 63 30% 45 18 45

2.1 Training Preperation 5/24/22 5/30/22 7 90% 5 6 1

2.2 Clinician Training 6/01/22 6/28/22 28 0% 20 0 28
2.3 Staff Training 6/29/22 7/26/22 28 0% 20 0 28
Project
3 Implementation Project Manager 7/30/22 9/30/22 63 0% 45 0 63
Implementation
3.1 Preperation 7/30/22 8/05/22 7 0% 5 0 7
3.2 Section 1 8/06/22 8/19/22 14 0% 10 0 14
3.3 Section 2 8/20/22 9/02/22 14 0% 10 0 14
3.4 Section 3 9/03/22 9/16/22 14 0% 10 0 14
3.5 Section 4 9/17/22 9/30/22 14 0% 10 0 14

4 Project Completion Project Manager 10/01/22 10/21/22 21 0% 15 0 21

3.1 Issue Assessment 10/01/22 10/14/22 14 0% 10 0 14

Success
3.2 Determination 10/15/22 10/21/22 7 0% 5 0 7
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3. Failure Mode Effect Analysis (FMEA)

3.1 FMEA Testing Plan Summary

In total, the testing plan contains four different testing sections with their own components. The four
sections include General Hardware/Software Testing, Training Specific Testing, Integrated Testing finally
Performance/Stress Testing. All four testing sections include vital components to ensure the success of
the project and EHR implementation. For example, the General Hardware/Software Testing is vital in
ensuring that project can be done regardless s of potential issues, laying the foundation for the rest of
the testing sections.

3.2 FMEA Summary

The Failure Mode Effects Analysis (FMEA) for the hardware being used by the Waverly Family Clinic is an
important process in determining the potential issues that could be faced when implementing the new
EHR system. The FMEA focuses on five potential hardware issues, reasons why the issues may take place
and the means to address them appropriately. This FMEA addresses the overall severity, occurrence,
and likelihood of detection using RPN evaluation technique. This allows for a broader understanding of
how the potential failure modes take place and how to properly handle them.

3.3 FMEA Chart

Failure Modes and Effects Analysis
FMEA Process Action Results
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Hardware Hardware is Have budget Budget created in

cannot Disruption of Project
EHR System insufficient for System update ready in case of case new
sustain an EHR 6 4 5 120 Manager 3 2 1 6
Updates EHR system Implmentation potential notifications needed hardware harrdware is
07/25/2022
update updates updates needed
Invest in a higher Internet plan
Disruption of Low
Transfer from paper Internet Lose of quality internet IT Specialist chosen better
5 connection to 6 connection 10 300 5 1 10 50
to electronic records crash progress plan during 05/24/2022 suited for EHR
server warnings
implementation use
Purchase/create Emegancy
EHR System Power Lose of Storms/Normal IT Specialist
4 2 None 10 80 back-up generater generator system 1 2 10 20
Implementation Outage progress outages 05/24/2022
system installed
Create priority
Transfer from Delays in Only current patient
Insufficient system for Project information and other
paper to patient Insufficient Low storage
hardware 5 5 5 125 needed EHR Manager priority information is 5 1 2 10
electronic information data storage alerts transferred to reduce
storage transfer to stay 07/25/2022
records retriaval low storage risk
within storage limit
New schedule is
Transfer from Congestio Internet connection Create schedule
Low Project implemented
paper to n on Delay in isn't sufficient for for EHR trnasfer
2 7 connection 10 140 Manager during EHR 2 2 5 20
electronic internet progess normal clinic tasks during low internet
and implementation warnings 05/24//2022 record/information
records server usage times
transfer
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4. Stakeholder Analysis

4.1 Stakeholder Interview

Category Name Objectives/Questions

(Bold – Key Topics to Cover (adjust as necessary):

Stakeholder)
 Special Interests

 Influence

 Dependencies

 Critical Timelines / Risks

 Actions required

Non-clinical Staff Mrs. Jones: Clinic  Discuss interests of non-clinical staff/stakeholder

(could be listed by Director in EHR Implementation
department or OTHER STAFF: - How do their areas of work benefit from
agency) implementation?
Ms. Felps: Office Clerk - How do we keep this area running
smoothly during implementation?
Mr. Lawrence: Accounts
 Medical Director, Mrs. Jones, will have most
& Billing
influence in external in communicating with non-
clinical staff and representing non-clinical needs.

 This category depends heavily on the

communication between all clinical personnel. It’s
incredibly important that the implementation
process does not negatively affect patient care.

 How can non-clinical staff/stakeholder

communication be prioritized to further encourage
quality patient care?

Clinical staff (could Dr. Waverly: Clinic  Discuss interests of clinical staff/stakeholders in
be listed by Owner EHR Implementation
department or Dr. Jones: Physician - How do their areas of work benefit from
agency) implementation?
OTHER STAFF - How do we keep this area running
smoothly during implementation?
Mrs. Johnson: Physician’s
 Because both Dr. Waverly and Dr. Jones have
Assistant
clinical responsibilities, both have some influence
Mrs. Wright MSN, NP: on the clinical aspects of the project. However, for
nurse practitioner the sake of efficiency, Dr. Waverly will have the
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most influence in case of contradicting opinions

between stakeholders.

 This category depends heavily on the

communication between all clinical personnel. It’s
incredibly important that the implementation
process does not negatively affect patient care.

 How can clinician/stakeholder communication be

prioritized to further encourage quality patient
care?

Admin staff (this Dr. Waverly: Medical  Discuss interests of Admin staff/stakeholders in
might include your Director EHR Implementation
practice manager and Dr. Jones: Clinic Partner - How do their areas of work benefit from
medical director) implementation?
Mrs. Jones: Clinic - How do we keep this area running
Director smoothly during implementation?
 Because all three stakeholders have
OTHER STAFF:
administration responsibilities, all have some
Ms. Felps: Office Clerk influence on the admin aspects of the project.
However, for the sake of efficiency, Dr. Waverly will
Ms. Smith MA: Medical have the most influence in case of contradicting
Assistant opinions between stakeholders.

 High priority in maintaining admin responsibilities

while implementing the new HER system.

- How can the project team avoid infringing

on administration during implementation
and transition?
 High priority in updating all admin on scheduling
updates

Outside personal or Mrs. Jones: Clinic  High priority in maintaining clear and quick
agencies Director communications with any necessary outside
agencies in case of emergency situations
OTHER STAFF:
 Project Manager will determine the need of an
Project Manager
outside agency in case of a need for any
emergencies and maintain direct contact and
approval through clinic director, Mrs. Jones

- In case Mrs. Jones cannot be contacted,

does project manager have authority to
make emergency decisions as necessary?
Vendors Dr. Jones: Clinic Partner  High priority in maintaining clear
communications with any necessary Practice Fusion
OTHER STAFF:
staff
Mrs. Wright MSN, NP:
 Dr. Jones, the clinic partner, will have most
nurse practitioner
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Possible Practice Fusion influence over the vendor communication

Staff: Training Specialist,
 Communication with Mrs. Wright will be high
IT Personnel
priority. She can help make help answer question
about HER implementation before the need to
contact Practice Fusion

- What is the extent of Mrs. Wright’s EHR

implementation experience?
 Project Manager must inform Dr. Joes anytime
the vendor is contacted and keep him up to date on
any correspondence outside anything scheduled in
the project schedule

Patients Dr. Waverly: Medical  High priority in maintaining clear

Director communications with any necessary patients during
EHR implementation so as no information is lost
Dr. Jones: Physician
during normal clinic business/tasks
OTHER STAFF:
 Dr. Waverly & Dr. Jones have highest influence in
Mrs. Johnson: Physician’s maintaining normal patient care and clinic
Assistant healthcare responsibilities during implementation

Mrs. Wright MSN, NP:  This category relies heavily on all staff
nurse practitioner maintaining normal business practices during
implementation

 If patient care is being negatively affected by the

implementation process, implementation will be
put on hold until continuation is approved by both
Dr. Waverly and Dr. Jones.

- How can this be avoided?

External to Clinic (this Mrs. Jones: Clinic  High priority in maintaining clear and quick
could be outside Director communications with any organizations that may be
organizations like affected by EHR implementation
practices that have a  Medical Director, Mrs. Jones, will have most
contract for referring influence in external to clinic communication
patients)
 Ensure any outside communications are updated
accordingly if schedule is being affected by delays

Do the external to clinic organizations have

compatible means of information sharing post-
implementation that maintain necessary security?

Finance Dr. Waverly: Clinic owner  The clinic owner, Dr. Waverly, will have highest
influence in the budget/financial structure of the
Other Staff:
project with the assistance of Mr. Lawrence
Project Manager
- Can expenses be approved by Mr.
Lawrence and the project manager in
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Mr. Lawrence: Accounts extreme circumstances if Dr. Waverly is

and Billing unavailable?
 Any updates to budget/emergency expenses
must be approved by Dr. Waverly before putting
into action

-  Finance depends heavily on the

communication of all other categories. All
financial needs of other categories must be
streamlined through finance before
approved.
Misc. Mrs. Jones: Clinic  If in need of an emergency update to schedule
Director the project manager will address needs as
necessary, while keeping key stakeholder, Mrs.
Other Staff:
Jones in the loop
Project Manager
 Do any stakeholders have any additional
questions/input at this point?

4.2 Influence/Interest Grid

High KEEP SATISFIED MANAGE CLOSELY

Dr. Jones Dr. Waverly

INFLUENCE

MONITOR KEEP INFORMED

Low
(MINIMUM EFFORT) Mrs. Jones

Low INTEREST High

4.3 Guidance Notes

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 What financial or emotional interest do they have in the outcome of your work – is it positive or
negative?
o Dr. Waverly: Wants to expand the clinic and grow his family business
o Dr. Jones: Wants what’s best for the patients in a way that is most convenient
o Mrs. Jones: Wants the clinic to operate more smoothly and become more organized
 What motivates them most of all?
o Dr. Waverly: Expansion
o Dr. Jones: Convenience
o Mrs. Jones: Organization
 What support do you want from them?
o Dr. Waverly: Overall approval of the project and opinions in major decision making
o Dr. Jones: Positive influence on the rest of the clinical staff to embrace the new EHR
system
o Mrs. Jones: Positive influence on the rest of the non-clinical staff to embrace the new
EHR system as well as assistance in non-clinical project needs
 What information do they want from you?
o All key stakeholders expect biweekly updates on project progress and notification on
any changes to schedule, budget, or basic project structure
 How do they want to receive information from you – what is the best way of communicating
your message to them? (This will input into your communications plan)
o All key stakeholders prefer to receive information via biweekly meetings on project
progress. However, in the case of more emergent cases, they prefer to receive
information via the following.
o Dr. Waverly: Phone
o Dr. Jones: Email
o Mrs. Jones: Email
 What is their current opinion of your work and is it based on good information?
o Dr. Waverly: Positive opinion on work and was highly influential in the beginning stages
of the project. Dr. Waverly is the induvial who originally requested the switch from
paper records to the EHR system.
o Dr. Jones: Negative opinion on work. Dr. Jones is worried that the learning curve from
paper records to the EHR system will negatively affect patient flow and will ultimately
bring in fewer patients.
o Mrs. Jones: Positive Opinion. As the clinic director, Mrs. Jones is always open to the
possibility of creating a more organized and efficient clinic.
 Who influences their opinions generally and who influences their opinion of you?
o All stakeholders are often influenced by each other. Dr. Wavery tend to be influenced by
finances so Mr. Lawrence has some influence on his opinion. Dr. Jones highly values the
opinions of the people he works closely with, so Mrs. Wright and Mrs. Johnson have
some influence on his opinion.
 Do some of these influencers therefore become important stakeholders in their own right?
o In some ways, yes, it is highly important to make informed decisions that take the
influence of both the stakeholder and these additional influencers into account when
the opportunity provides it.
 If they are not likely to be positive what will win them round to give their support?
o Dr. Waverly is typically happy with aspects of the project as long as enough information
is provided. Creating information packets on areas he is less positive about may help.
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o Because Dr. Jones highly values the opinions of the people he works closely with, it
would be important in this case to gain the support of both the nurse practitioner and
the physician’s assistant.
o Mrs. Jones appreciates structure. If she feels uncertain about an aspect of a project, it is
important to offer all details to her in an organized manner (ex. PowerPoint
presentation, more detailed work breakdown structure)
 If you are unlikely to win around, then how will you manage their opposition?
o In the case of opposition, it is imperative to clearly understand the hesitations of the
stake holder. In this scenario, I would plan a meeting where the stakeholder outlines all
the aspects of their opposition. Then you would be able to take that information and
provide the stakeholder with action plans on how address their concerns.
 Who else might be influenced by their opinions and decide if they need to become stakeholders
in their own right?
o Everyone at this moment understands their roles, responsibilities, and extent of
influence, so it is unlikely that anyone would decide they need to become a stakeholder.

5. EHR “Go-Live” Checklist

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3 Months Prior to Go-Live

☐ Ensure all project team members and stakeholders have completed EHR training
☐ Ensure all project team members and stakeholders have passed EHR training assessment
☐ Ensure communications with Practice Fusion is established and easy to access
☐ Communicate which EHR plan from Practice Fusion site was selected with project team and
stakeholder.
☐ Obtain verification on EHR plan from stakeholders
☐ Begin constructing down-time plan
☐ Run software sample to ensure hardware is compatible
☐ Verify implementation budget with stakeholders in the case of hardware updates or
maintenance
1 Month Prior to Go-Live
☐ Ensure all clinic staff members have completed EHR training
☐ Ensure all clinic staff members and stakeholders have passed EHR training assessment
☐ Update Project Team and Stakeholders on Go-Live Plan
☐ Determine all necessary hardware for EHR system functioning properly
☐ Determine if any hardware have malfunctions that need addressing
☐ Complete down-time plan
Two Weeks Prior to Go-Live
☐ Update all clinic staff on Go-Live Plan
☐ Update project team and stakeholders on roll-out plan
☐ Schedule hardware maintenance to address previously determined hardware malfunctions
☐ Purchase any necessary hardware whose malfunctions cannot be fixed through
maintenance
☐ Verify budget one more time with stakeholders before purchase
☐ Download EHR system on all clinic computers
☐ Purchase and download notification system that will work during down-time that will
maintain updates for staff
Several Days Before Go-Live
☐ Update all clinic staff on roll-out plan
☐ Adjust staff schedules to properly adhere to the roll-out plan and
☐ Contact entire staff via email requesting they be there thirty minutes early on day of go-live
☐ Ensure EHR system is accurately downloaded on all clinic computers and functioning
properly
☐ Role-play scenarios with each staff member to simulate the use of EHRs with a patient to
ensure all hardware is working correctly
☐ Create an emergency plan in the case of a hardware malfunction during go-live
☐ Alert staff of all scheduled down-times via email and captioned in bold lettering
Day Before Go-Live
☐ Ensure all project team members, stakeholders, and all clinic staff have proper
passwords/identification to access the EHR system
☐ Recap meeting/debriefing/huddle times with clinic staff
☐ Communicate emergency plan in the case of a hardware malfunction during go-live with
entire clinic staff
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☐ Ensure all staff has proper means of communicating with project team and
maintenance
☐ Communicate with staff how patient care flow will continue during down-times
☐ Check-in and check-out processes
☐ Method of scheduling (both new patients and follow-up visits)
☐ Protocol for documenting patient appointments
Day of Go-Live
☐ Ensure all clinic staff has signed documents verifying their understanding of EHR policies
and procedures
☐ Do final check to ensure all staff members have completed training and assessment
☐ Ensure all clinic staff members have received the scheduled down-times
☐ Ensure all clinic staff members have received the alternate protocols in the case of down-
times
☐ Do final read-through of go-live plan with entire staff before the official beginning
of the workday
☐ Make sure staff knows who has the authority to make critical decisions
☐ Open communications with maintenance and Practice Fusion in the case of emergency
☐ Ensure all paper copies of necessary documents are printed in the case of down-time
☐ Verify all hardware is up and running and EHR system is active on all computers

6. Post-Implementation Review Report

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1 Introduction

1.1 Project Identification

Project Title: Waverly Family Health EHR Implementation

Project Control Code: WP001 (Waverly Project 001)

System Acronym: WFHEHR (Waverly Family Health EHR)

1.2 System Proponent

Project Manager: Madison Pridemore

Clinic Owner: Dr. Waverly (Stakeholder)

1.3 History of the System

Practice Fusion EHR System

- Previous paper record system

- The Practice Fusion EHR system is a secure, cloud based system that is HIPAA compliant
and regularly backs up data on a daily basis.
- Data usage can extend as far as the company is willing to extend their cloud’s data
holding abilities.
- New system uses data to streamline charting, manage prescriptions, exchange
information with other healthcare systems, monitor patient progress, and manage billing.

2 Evaluation Summary

2.1 General Satisfaction with the System

The overall level of user satisfaction is positive. Some of the strengths and areas of success that
attribute to the positive outcome is the system’s ability to give healthcare providers a larger
understanding of a patient’s history and health, as well as the system’s ability to provide flexible
billing options. Some of the problems that the system has produced is an interruption of
workflow. Until all users are completely comfortable with the new system and its attributes,
disruptions in workflow will be produced by the learning curve. So far, there are not any features
not in use, but a suggested improvement would be to provide roleplaying scenarios for the users
so that they can become acquainted with attributes of the system that they are less acquainted
with.

2.2 Current Cost-Benefit Justification

One of the major benefits that the EHR system provides is the streamlining of charts and tasks.
Because the system has the ability to save the time of both staff and patients through templates
and a cloud-based data retrieval, it reduces the amount of time spent waiting. This can be seen in
the system’s ability to communicate with pharmacies, imaging centers and other laboratories
without having to wait the extra time is takes to process paper records. Because of this decrease
of waiting times, this gives the clinic the ability to accomplish tasks faster and more efficiently,
overall justifying the cost of the new system. A faster-paced work environment produced by
quality systems allows for more work to be done without rushing and the ability to take on new
 23

patients. This will change over time in a positive way because the staff will become more
acquainted and comfortable with the new system.

2.3 Needed Changes or Enhancements

Scenario Roleplaying- This would be to allow staff to become acquainted with attributes of the
system that they are less acquainted with in controlled scenarios before having to manage it in a
real-life setting. Resources would require time outside of accomplishing normal tasks as well as an
individual to run the scenarios.
Refresher Classes- This would allow staff to gain a refreshed understanding of system attributes
that maybe become less used but remain useful. Resources would require time outside of
accomplishing normal tasks as well as an individual to teach the classes.
Satisfaction Surveys- The surveys would be given quarterly to staff and select patients to gain a
deeper understanding of what parts of the system are working and what areas need closer
inspection. Resources would require an easily manageable survey system.

3 Analysis and Implementation

3.1 Purpose and Objectives

Original Objectives

- Complete plan for EHR implementation is approved by all project team members and key
stakeholders.
- After training is complete, staff will take an EHR comprehension test, and all require a
score higher or equal to 80%. Staff will receive additional training as necessary until goal
percentage is reached.
- The clinic has 60 days to transfer patient information into the Practice Fusion system.
- All patient information will be split into four evenly-sized sections with the goal of
transferring roughly 25% every two weeks until the end of the implementation period.
- Decrease in patient wait times by 10% two months after EHR transition.
20% Improvement in quality of care determined by patient satisfaction via survey before
and after EHR implementation.

While all objectives were achieved during implementation, the timeline of a few of the goals were
disrupted. The complete plan for the EHR implementation was approved by all project team
members and stakeholders after revisions were made. All staff completed the EHR training and
scored higher to or equal to 80% apart from the individual teaching the course, the did not need
to test. The clinic was able to transfer all paper records into the system in sixty days, however,
after transferring 50% of the records in four weeks, a holiday occurred, setting transfer back to
71% in the following two weeks. This was fixed in the following two weeks, and the system was
100% transferred by the end of the implementation period.

3.2 Scope
The scope statement for the project was, “Waverly Family Health is implementing the Practice
Fusion EHR system at their clinic.” Overall, this scope was followed in both timeline and budget.
The project was given six months to complete, with the last month being a “catch-up time” in the
case of holidays or set-backs. As seen in the previous section, this time was utilized during a
 24

holiday implementation set-back. The budget consisted of a small business development loan via
American Express maxing out at $40,000. Budget was maintained during the implementation of
the new system. The system ended up costing $3,576 and between hardware upgrades,
unexpected circumstances, and the use of outside sources, expenses stayed under $15,000,
therefor staying under the $40,000 budget. No changes were necessary for this scope.

3.3 Benefits
One of the major benefits that the EHR system provides is the streamlining of charts and tasks.
Because the system has the ability to save the time of both staff and patients through templates
and a cloud-based data retrieval, it reduces the amount of time spent waiting. Waiting times can
be measured by recording the amount of time that it takes to complete tasks before and after
implementation. A faster-paced work environment produced by quality systems allows for more
work to be done without rushing and the ability to take on new patients. This is also quantifiable
by determining the number of a patients the clinic can successfully treat before and after
implementation.

3.3 Costs
The budget consisted of a small business development loan via American Express maxing out at
$40,000. Budget was maintained during the implementation of the new system. The system
ended up costing $3,576.
Additional costs included the following:
- hardware upgrades
o Three PCs needed replacing costing $2,400 ($800 per computer)
- unexpected expenses
o During implementation, an examination room monitor cracked, costing $450 in
repairs
o One of the EHR training rooms needed brief construction, requiring the
organization to rent out an additional space for two weeks, costing $1,225
- the use of outside resources
o Hiring a temporary EHR system instructor for staff training cost $1,290

Total Cost of Project: $8,941

Expenses stayed under $10,000, therefor staying under the $40,000 budget. While the hope was
to pay for only the cost of FMEthe new system and the training instructor, repairs and
emergency expenses are to be expected.

3.4 Training
Two months or 60 days of the project were spent training all staff on EHR use and preparing them
for the transition. All staff completed the EHR training and scored higher to or equal to 80% on
training evaluations apart from the individual teaching the course, the did not need to test.
Although the training was determined to be both adequate and appropriate, refresher classes of
the training are supplied. This allows staff to gain a refreshed understanding of system attributes
that maybe become less used but remain useful.
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4 Outputs

4.1 Usefulness
The users feel that the EHR system meets the intended needs, is important, and highly desirable.
Because the clinic is still on a learning curve in using the EHR system to its full extent, the clinic
doesn’t feel that the system is absolutely essential yet. All information/reports that are needed
are generated by the system. Areas of improvement are now taken from the clinic staff quarterly
in order to ensure the system is demonstrating its abilities in the most productive ways possible.

4.2 Timeliness
So far, there have been no issues when it comes to the output production performance. All
patient clinical records, clinical data, lab reports, imaging data, previous clinical visits and billing
data can be easily access in the patient’s electronic record. Additionally, if any data is missing,
such as a lab result, the EHR system has made it easier to communicate with laboratories to
retrieve those results in a quick and HIPPAA approved manner.

4.3 Data Quality

The Practice Fusion EHR system is a secure, could-based system that is HIPAA compliant and
regularly backs up data on a daily basis. Data usage can extend as far as the company is willing to
extend their cloud’s data holding abilities. This makes sharing data both easy and safe. As long as
the clinic gives access to the appropriate individuals, then the system allows the correct
individuals to access the appropriate data. The data inputted into the system should be both
accurate and reliable if it is being inputted by a reliable and accurate resource. Addititonally,
because it is being backed up daily, there is no need to worry about loss of data.

5 Security

5.1 Data Protection

Part of the Practice Fusion EHR system’s qualities is that as long as the data is maintained in the
cloud-based system, then data and activity meet HIPAA compliance. This makes sharing data both
easy and safe. As long as the clinic gives access to the appropriate individuals, then the system
allows the correct individuals to access the appropriate data. In the case of restarts, the system
goes on lockdown until the system is back in running condition.

5.2 Disaster Recovery

Again, because the data is stored in a cloud-based system, there is no need to worry in the case of
disaster recovery. All data, clinical files, and records are safe and secure in the cloud, even during
unintended down-time. In the case of down time, all staff have pre-determined procedures to
follow until the down-time is over. Any paper records acquired during down-time will be promptly
put into the system after.

5.3 Audit Trails

All clinical documentation and other online processes and transactions through the system can
be accessed and assessed as necessary by Mrs. Jones, the clinic director and Dr. Waverly, the
clinic owner, and the determined security officer. Audit trials that are recorded by the system
may be the access of a patient’s record, input of patient information, requests sent to outside
systems, and changes in patient billing information.
 26

5.4 System Access

All access to any system or patient data will comply with HIPAA standards and be highly
monitored by the assigned security officer. The security officer will make sure the assigned access
is available to the appropriate individuals, document any access breaches, and follow the breech
notification plan by reporting breaches to superiors that follow through with HIPAA policy. All
HIPAA policy will be refreshed to staff during the EHR system training in order to avoid any
incidents or breaches.

6 Computer Operations

6.1 Control of Workflow

After evaluating the EHR user interface for collecting clinical data for given workflows, very few
issues arose. While there weren’t many problems in accomplishing clinical workflow processes, on
more significant problem has occurred. It has become difficult to fully utilize the EHR system’s
ability to communicate with other organizations when they haven’t yet transferred from paper
records to an EHR system. The decided way to remediate this issue is after determining that the
organization doesn’t have an EHR system, to follow to previous systems means of communication
if applicable.

6.2 Scheduling
No issues have been determined in scheduling patient visits, procedures or follow up. While this is
favorable, it is important to recognize that issues may still arise. Any issues can be reported to
superiors or mentioned in the quarterly satisfaction survey.

6.3 EHR User Interface

Since the completed implementation of the EHR system, the following usability of the system has
been analyzed:
- Number of patient visits processed (number of transactions) – 140
- Number of errors made when carrying out clinical documentation – 28
- Frequency of problems with the interface – On average, 1-2 weekly
Because of the newness of the system and staff learning curve, most of these issues should iron
themselves out over time, however the suggested means of reducing errors are scenario
roleplaying to become more acquainted with system attributes, EHR refresher classes, and
satisfaction surveys.

6.4 Computer systems

Some computer issues and problems that have been identified throughout project
implementation are as follows
- Needed replacement of three PCs
- Internet crashes
- Congestion on internet servers
- Need for additional browser security to prevent bugs

6.5 Peak Loads

Since the implementation of the EHR system, there have been moments of high patient volume
and peak loads that have caused a delay in system use. When these peak loads happen, there
have been reported user complaints as well as a longer response time. The suggested changes
 27

would be to create a scheduling system where peak loads are less likely to happen. If
appointment and tasks can be evenly distributed, then overloads are less-prominent. It is
important to note that while there are delays during these times, the overall speed of processing
and response times is faster than what it was when the paper record system in place.

7 Maintenance Activities

7.1 Activity Summary

Hardware Maintenance: Ensuring the PCs are up to date, routine check-up on all clinic hardware,
crack in monitor repaired
Software Maintenance: EHR system updates as necessary, making sure the three new PCs have all
necessary software downloaded, glitch fixed on older PC
All maintenance efforts were adequately done, and all repairs were made successfully. Based off
the systems maintenance that has already occurred, the projected workload will be minimal.

7.2 System Maintenance

While the Waverly Family Clinic does have IT personnel, the Practice Fusion company provides IT
support for the EHR system. Any system maintenance that needs to occur, that is not to the fault
of Waverly Family Clinic staff, will be handled by Practice Fusion IT support. In order to prevent
staff-caused maintenance, it is vital that all staff is constantly refreshed on EHR system rules and
limitations.
 28

7. Interview Questions
What were the projects original goals and vision?

- Asking this question creates a framework for the following questions. It allows a basic
understanding of what the original intentions of the project were and helps the interviewer
determine the overall success of the system change.

How was workflow addressed during the implementation period and how long was it disrupted?

- You never want to implement a project if the overall outcomes negatively affect day-to-day
workflow. On average, it takes roughly four months for productivity levels to return to normal. If
productivity levels return to normal or higher during this timeframe or earlier, the EHR
implementation can be evaluated as successful.

What have been the key challenges and facilitators that you have faced so far?

- Understanding the challenges created by a system change is a significant part in understanding

the success of the project planning and implementation itself. It would be a good idea to cross-
examine which challenges the end-user talks about with the risk assessment to determine how
successful the project team was in identifying potential challenges and create plans to
prevent/fix them.

After getting used to the new EHR system, has the implementation positively or negatively affected your
ability to complete daily tasks/work?

- This is a good question to ask to understand how the system change has affected the daily lives
of staff and their overall feelings towards the new system. If this individual has a typically
positive/negative view on using the EHR system in their daily tasks, it is likely the other staff feel
similar.

What features or functionality do you find in the EHR that are particularly helpful for your practice?

- Similar to the last question, if this individual finds that specific features of functionalities are
helpful, it is likely the other staff feel similar. This question allows you to understand which goals
of the original implementation were successfully established and which positive outcomes came
out of implementation that weren’t necessarily goals but are positive outcomes, nonetheless.

In what ways do you feel the key facilitators of the project could’ve done better throughout
implementation?

- This question doesn’t necessarily benefit this system change, but it provides information that
will seriously aid future company projects and create a more comfortable environment during
upcoming system changes.

Do you feel the project was successful in accomplishing the original goals and vision?

- This question gives the interviewer an idea of how the end-user views the success of the project
as a whole. By asking this question, you gain information like the attitude towards the system
change, the favorable results, and the areas of the project that lacked in vision.