It’s All in Your Head


“We have some custom workflows and configurations but, it’s not documented anywhere.” These are challenging words for a consultant to hear. It should not be “All in Your Head”. Without documentation, resources must sometimes rely on several unfamiliar sources to gather pivotal information. This could unknowingly lead to time and effort spent on a futile process. With larger organizations, many departments function with complete autonomy and that can sometimes lead to fragmentation within an organization.  Consultants focus not only on the individual user role, but on the entire patient care process as is flows through the organization and each user role involved.

Having an accurate EHR Configuration Workbook (CW) to offer consultants, or even new vendor resources coming on board, may not only save all parties from performing redundant work, but also the some billable hours. When a client contracts a consultant to assists them with a project, one of the first things they are asked for is their EHR System “Configuration Workbook (CW)”. Unless the project is very refined or specific to one function, this is an invaluable tool to give to a new resource at the project kick off. As consultants, we are hired by clients to not only consult, but more often than not implement system changes that touch many aspects of the organization. One small change to a client’s current system configuration can affect groups of users, entire departments, and sometimes even teams that function outside of the CEHRT.  Because of the intricacies of each client’s organizational set up, it is important for onboarding resources to have a clear understanding of how all the pieces work together.

Examples of items that organizations could include in their CW in addition to the standard:

  • List of all moving pieces – The PM that is used, the various environments being maintained, server diagrams and lists, Patient Portal, HIE, etc.
  • A grid w/ Products version and status – Upgrades, Installs Patches or hot fixes, dates etc.
  • Organizational Hierarchy with high level process – Does your Org have a separate support team for the EHR, a Network team, an MU Team, a compliance department, or a separate training team?
  • List of ‘Go-to’ people for information – Who should be contacted and how for questions.
  • MU Status – What stage, which CQMs are being reported, are there any EPs that are exempt, etc.
  • Custom workflows or processes – Is there a call processing or triage team, do certain sites have POC lab testing, does the org use and follow the standard work/task lists?
  • Up to date user list – The list of users should be current with a process in place for on-boarding new users or inactivating user profiles and assuring that user EHR assignments are captured and reassigned as needed.
  • List all interfaces – What interfaces are in place and what department monitors these.  Does your org primarily use Quest, LabCorp, or a local hospital?

The scramble to meet imposed deadlines is a common denominator amongst clients and documentation that is not an obvious and immediate requirement may not seem like a priority. However, organization should maintain a current CW with managers and/or departments leads doing their part in keeping the information captured up to date. All organizations no matter what product they are running would find this a tool that could be used for many purposes as a whole and information extracted from for many reasons.

Lastly, it is important to have a department or team take ownership of this documentation and commit to maintaining its accuracy. Evolving governmental requirements have pushed the industry of EHR technology to develop and roll out new functionality at a rate most organizations struggle to comply with. Having an accurate Configuration Workbook for the organization both now and going forward will become an invaluable tool of reference not only for hired resources or consultant but most importantly, for the client’s organization.

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