Change Management Strategies

While the EHR will impact departments outside of HIM, it will also impact staffing in the HIM department.    From your reading about EHR implementation, you realize that the EHR will drastically change tasks in the HIM department.  Your department’s clerical area is most affected; paper sorting and chart assembly will be almost eliminated by the EHR, and chart analysis, which used to be done with paper records, will be done on the computer.    Currently, 10 full time employees (FTEs) handle these tasks; not everyone is computer-savvy.  The Director wants you to prepare the department for changes ahead.  She asks you to report to her next week about how you will present this at the next HIM staff meeting.  Change is difficult, especially when someone’s job may change or be eliminated.  Research change management strategies and in a two-page paper, using APA format, discuss: •        How a manager can present change, when change is not necessarily positive. •        What new skills must be learned with the new EHR system (EPIC)? •        Who should be trained in the new tasks?  •        Who should train them? In-house Super User trainer or vendor trainer?  Is there a cost? •        If the FTE load must be reduced to 8 FTEs with the new system, how do you recommend going about making this change? What should you consider for reducing staff?  What criteria will you use to recommend which staff should in the reduction of staff? Case Scenario (FYI) Rasmussen Medical Center is a 250 bed acute care rural critical care medical facility with the following centers:  general medical services, surgical care services, emergency department, cardiac intensive care, general intensive care, laboratory, radiology, physical therapy, respiratory therapy, nutritional services and nursing services.  The administrative departments are HIM, Claims and Billing Management, Quality Management, Patient Access and Risk Management.  The Medical consists of 25 physicians and surgeons, 5 Physician Assistants, and 5 general medical Hospitalist.  The Emergency Department is operated by an outside emergency medical physician services and radiology services send radiology to an outside service to read the x-rays.  The outside service has a routine turn-around of 5 hours.   The facility also includes a 20 bed SNF and an Ambulatory Center for day surgery and diagnostic services.   The HIM Department has kept transcription and coding in-house along with records review, compliance, CDI but release of information has been out-sourced to a ROI company who placed a ROI clerk on site.  The hospital has an outdated electronic health records system which needs to be replaced.    The old legacy system has the following issues:   ·       Poor mobile access and communication – there is no patient portal system available and physicians cannot access their incomplete records outside of the hospital ·       Lack of built in tracking of suggested screenings, test and medication interaction to improve patient care. – No effective physician reminder or clinical alert system ·       No monitoring or alerts for incorrect or coding errors ·       Poor integration with other systems or portals – unable to complete required exchange of health information.  (System is unable to communicate effectively with E-prescribing, billing, data sharing other clinical facilities and reporting to CMS). ·       Time consuming documentation workflow – documenting and updating patient information is difficult and time consuming.  Clinicians are complaining that it takes too long to input patient data.   The new system should be able to do all of these functions for the facility.   EHR Implementation: Gathering Information   This is your first day on the job as Assistant Director in the HIM department at Rasmussen Medical Center (RMC).  You meet with the HIM Director and she explains that RMC has given her the go-ahead to begin the process of implementing a new electronic medical record.  As Assistant Director, you will have responsibility for several phases of this important project.  Your Director knows that while you have earned an RHIT certification, you still need to learn some background before you begin.  You have one week to learn as much as you can about EHR implementation.   You know that you may have more questions as the process goes along, think about collecting additional resources as you do your initial research.   The HIM Director has given you some things to think about while you’re researching the implementation process.  Those items are:   ·       What steps are needed to transition from a legacy EHR to a new EHR system? ·       What’s involved in a data migration from the legacy system to a new EHR? ·       Who would be the best members of an EHR Task Force and Work Team? ·       How can you verify that an EHR system is ONC certified? ·       What type of issues can we expect to have during this transitioning process?

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