Summary of a project to develop a home health solution using EHR. Dr Samir Sawli CPHIMS, RN, PhD

1. Samir Sawli, CPHIMS,RN

2.  Designing and building a Home Health Care
solution using EHR is a unique project which
will entail the following phases
Planning Execution Closure

3.  Main modules to be developed
 Actionable Dash Board to enable quick access
and actions on the go
 The dashboard must be mobile view compatible
 Orders & Results to support automated Computer
Physician Order Entry for all care related orders
 Pre-completed notes to facilitate more time
efficient documentation
 Electronic Immunizations record
 Additional modules to support electronic
prescription, standardized coding and referalls.

4. Strategic
Objective
Incidence and
Stats
International
Standards
Business
Requirements
Planning phase starts with a full review of the need of the project
taking into consideration the following factors:
 Strategic importance of this service for your organization, and
how it fits within the strategy of health care plans of your
country.
 Incidence and statistics of home health patients identified by
existing health care providers governmental and private.
 Identifying and review of international standards of Home Health
care example Joint Commission International (JCI).
 Understand and review your local business requirements which
includes the unit structure and operation needs( how many beds,
clinics, appointment slots, slot duration for new case and follow
up, staff requirements, management of information, access
security and reports, staffing model

5. Write Project Charter which includes
 Project Plan
 Identify stake holders including physicians, nurses, IT analysts and
training support staff.
 Identify councils needed to provide input to the project including
clinical user council, electronic documentation council, orders and
clinical decision support councils.
 Identify design and implementation team writing terms of
reference, meeting frequency, quorum and decision making
mechanism.
 Communication and status report plan
 Risks
 Issues
 Cost
 Deliverables
 Interfaces
 Requirements capturing through interviews and literature, then
analyzing the requirements, identify gaps, system analysis,
architecture deign, workflow diagrams, interface requirements,
interoperability, device connectivity,

6. Execution
Design
Build
Test
Train
Go live
1. Design This stage involves the documentation of the
development of a solution to the new system. A prototype
may be used to help clarify the solution to the participant.
System design tools can also be used to explain the solution,
for example; context diagrams, data flow diagrams, decision
trees, decision tables, data dictionaries, storyboards.
2. Build: This stage involves the acquisition of information
technology and making it operational. Additionally, decisions
are made on how the new system will be implemented. An
implementation plan is developed setting out clearly: support
for the participants of the new system through training,
3. Test, include unit testing, integration testing for 2 cycles
using test scripts to capture faults, issues and flow. HP ALM
tools can be used to facilitate this process
4. Training involves, curriculum design, e-learning content,
classroom plan and user manuals. This phase must enhance
user adoption and change management
5. Go live includes: conversion, user support, issue logging and
fix mechanism as well as maintenance and updates

7.  Setup design workshops with the design teams
 Setup Health care providers access roles and policies taking into
consideration who can view and do what within the CIS system
 Review EHR security access policies as such patients must have
strict EHR access
 Design charting forms to be used by providers and referral
specialists
 Design and plan decision support into CPOE module as such
patients may be put on Psychotropic medications. The objective
of decision support is to promote patient safety using rules and
alerts.
 Design advanced directives and consents taking into
consideration that such patients might be unable to make care
related decisions.
 Design care giver forms taking into consideration that such
patients have a family care provider partnering with Sidra care
teams
 Design order care sets to ease placement of orders based on
evidence based practice and clinical pathways

8.  User interface, must be user friendly
 Rules enabled decision support orders must be
employed to maintain patient safety against “e-
Iatrogenesis” refer to harm introduced as a result
of conversion to electronic records.
 interoperability, we refer to the ability to
communicate and exchange data among different
systems with precision and accuracy.
Interoperability includes referrals, continuity of
care documentation, e-prescription, and PACS
 Build Interface using interoperability
methodologies

9.  E-learning curriculum development
 Classroom with at the elbow roamers curriculum
 Computer Based Training
 Development of train domain and training scenarios
along with associated data and results
 Simulation of integrated care approach role based
training
 Provision of manuals and on page help files
 Training of instructors
 Super user training
 User adoption workshops
 Apply Change management strategies
 Plan for on the unit support and through IT support

10.  Access to the system from remote location and on the go using mobile
and static devices
 Privacy and Security of information, using security token or vpn is
common for portal access from outside
 Development of Prototype, then trialing it for 6 month
 Partnering with patient and family care provider is a must
 Tele Communication using electronic and mobile devices
 Collaboration with local authorities to streamline communication,
connectivity, safety and continuity of care
 Telecommunication
 Local health care centers
 Paramedics
 Equipment tracking: equipment may be used on patients at home
example IV pump, how to connect and track the equipment?.
 Close the loop of referral specifically notification of the consultant.

11.  Complete closure documentation
 Measure ROI in terms of process
improvement, patient and user satisfaction
 Measure Quality of solution provided,
incidence reports, medical errors avoided