One of the most overlooked steps when choosing a new EHR is to clearly define the future state. The future state is how you envision a new system will run for the practice. It is the final destination after implementing a new EHR. This is your organization’s wish list to design the most efficient processes and procedures. This step comes after documenting your current state and before performing a gap analysis.
The future state should focus more on the optimal processes and procedure rather than the EHR software. I firmly believe people and process come before the technology pieces in the EHR puzzle.
I know it sounds like a simple step, but I often see this step rushed or skipped as a shortcut in the new EHR process.
One of my favorite stories about final destinations is one about Albert Einstein.
Albert Einstein was once traveling from Princeton on a train when the conductor came down the aisle, punching each passenger’s ticket. When he came to Einstein, the renowned physicist reached into his vest pocket but could not find his ticket. Then he reached into his other pockets but still could not find the ticket, so he looked into his briefcase. Nothing there. He looked at the seat beside him. Nothing.
The conductor said, “Dr. Einstein, I know who you are. We all know who you are. I’m sure you bought a ticket. Don’t worry about it.” Einstein nodded appreciatively, and the conductor continued down the aisle, punching tickets. The conductor looked back at the end of the car and saw Einstein down on his hands and knees, looking under his seat for the ticket. Rushing back up the aisle, the conductor cried, “Dr. Einstein! Dr.Einstein, don’t worry about your ticket! There’s not a problem. You don’t need a ticket. I’m sure Princeton bought you one and I know who you are!”
Einstein looked up and said, “Young man, I too know who I am. What I don’t know is where I’m going!’”
The point of the story is to articulate that you must clearly know the end destination after implementing a new EHR.
One of the challenges in determining the future state is separating your thinking from how you are doing things now. Think outside of the box. I have worked with practices looking for a new EHR and they have been in their current vendor’s box for 15 years. I don’t have to tell you a lot has changed from then to now. Find out from peers, healthcare technology groups, and the web on the latest healthcare IT trends. For example did you know that many payers allow for RTCA (Real Time Claim Adjudication) and many EHR vendors are integrating this into their software? Healthcare IT News and Health Informatics are great places for web research on the latest trends.
Another challenge of defining the future state is to stay focused on the business requirements and not how these requirements will be carried out. In other words think about Hawaii and not the 12 hour flight to get there. The “how” part will come later on in the discussion life cycle.
Some guidelines of the future state analysis are:
- Determine best practices implemented in other organizations
- Focus on the end result and not how to get to the end result
- Determine current states problems last so that you don’t get hinder by the current state when thinking of new ideas.
- Document detail “Use Cases”
“Use cases” are a great way to document the future state for the EHR system users and their optimized steps. “Use cases” describe how users will interact with an EHR in the final state. Activity diagrams and flowcharts are great communication tools for documenting the different use cases. Microsoft Visio and their free counterpart Drawanywhere are excellent tools for creating these diagrams.
An example of a high-level clinical swimlane diagram is included here.
Lastly your future state analysis should be included in your RFP to EHR vendors. This is one of the primary measures to determine which software will be the best fit for the organization. Don’t let the software vendors dictate what your final state should be. Vendors will always pick the items that are nearest to their software.
In closing, future state analysis is one of the most important steps in the EHR process. Keep looking for that train ticket so that final EHR destination is clearly known.
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