Section 1.1 Adopt - Assess
How to Use the Toolkit
(See accompanying PowerPoint handouts)
Many health care organizations have used health information technology (HIT) for some time to
support administrative and financial processes, to communicate across disparate providers, and to
manage quality of care. Telehealth, clinical messaging, and disease registries are also quite common.
Momentum is growing to use HIT to:
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Improve direct clinical care processes for patient safety and quality
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Integrate systems for greater efficiency and to improve use of resources
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Communicate across the continuum of care
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Accelerate diffusion of knowledge and reduce variability in access to care
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Strengthen privacy and data protection
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Promote public health and preparedness
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Engage individuals in their health maintenance and wellness efforts
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Take advantage of increasingly available incentives
The federal is aligning incentives with quality measure reporting. It is encouraging clinics to adopt
and optimize electronic health records (EHR) use, with incentives for meaningful use of certified
EHR products starting in 2011, and sanctions for not adopting such technology start in 2015. An
EHR is a computer system that should capture data from multiple sources and provide clinical
decision support through access to knowledge bases at the point of care. EHRs should also facilitate
health information exchange across the continuum of care and support personal health record keeping
as well as public and population health.
For most clinicians, optimal EHR use results in clinical transformational change in the way they do
their work. EHR systems can have significant benefits in productivity (e.g., improved coding and
resultant reimbursement, reduced clerical and transcription costs) and better patient outcomes. EHR
is not software acquired off-the-shelf and implemented over a long weekend. Assessing one’s
readiness, planning for, selecting, implementing, maintaining, and using such systems for various
improvements are not simple steps.
Importance of Planning
The goals for HIT are challenging in any setting. Laying a solid foundation is a critical first step
when building anything. For HIT, the foundation must address:

Hardware

Software

People

Policy

Process
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While hardware and software are the essential elements of HIT, people, policy, and process are the
elements that make the hardware and software work. Everyone must be engaged, starting from the
board of directors, administrator, project manager, and IT support, to every end user. The leadership
team must believe in the value of HIT in general, assure that a strategic planning process is applied,
and be committed to supporting HIT through financial and staff resources. The leadership team
members also must establish expectations and policy for achieving results, as they are ultimately
accountable for the investment in HIT.
Patients should be the primary beneficiaries of HIT and they are playing an increasingly important
role in their personal health information management. But, physicians, nurses, therapists, social
workers, aides, and other clinicians are the primary users. These individuals must participate in the
planning, selection, design, and adoption of improved processes brought about by HIT for the
benefits to be fully realized.
People, policy, and process are often described as contributing 80 percent to the success of HIT, even
though they are the elements most often overlooked as health care delivery organizations approach
HIT. The industry is beginning to recognize that lack of thorough planning has resulted in a hit-ormiss approach to HIT, with a high cost-to-value ratio. Understand your organization’s readiness and
carefully develop a strategy addressing a logical sequence of applications, optimal technology needs,
and—most importantly—operational support.
Overcoming the Challenges of Time and Talent
For the physician office, a carefully constructed foundation and the right tools to plan and implement
HIT can mean the difference between systems that are not well-used or add administrative burden,
and those that achieve value. The purpose of this HIT Toolkit for Physician Offices is to supply tools,
tested in this environment, that will help you plan and make the right choices, as well as to avoid
having to re-invent the wheel. (See also the Stratis Health Web site, at www.stratishealth.org, for
toolkits that address HIT in hospitals, nursing homes, and home health agencies.)
Using the Toolkit
Much like a carpenter’s toolbox, the HIT Toolkit supplies a variety of tools for use at different points
in your HIT adoption. Some tools will be used frequently for many different tasks. Much like using a
hammer and a set of nails—the same hammer will help you build a doll house, a shed, or a mansion.
Similarly, system flowcharts will help you improve workflow whether for a new laboratory
information system or for automating nursing documentation. Some of the tools will be developed
once and referred to many times. A blueprint for a building project helps you from the point of
selecting the proper building site, to making sure you have all the doors you need. Likewise, a set of
HIT goals will help you: 1) define functional requirements for a new application, 2) select the
product that supplies those functions, 3) contract for the functionality you expect you are buying, 4)
complete the implementation elements for the application, and 5) celebrate that you are using the
functionality to achieve success or correct course where you may not be fully achieving the value
expected.
Also like the carpenter’s tools, the HIT Toolkit is a set of tools you must learn when and how to
apply. Each tool includes:

Brief statement of purpose – informing you when to use the tool and what it should help you
accomplish.
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Instructions for use of the tool – guiding you in effective use of the tool.

Tool structure – depending on the tool itself, you may find you can customize the tool to help
you perform a task or use it as a model to modify for your own needs.
Section 1. 1 Adopt – Assess – How to Use the Toolkit - 2
The HIT Toolkit Overview (1.1 Overview of Tools) lists all of the tools and the points at which the
tools may be helpful. You may want to start out using the planning tools to identify your HIT
strategy, and then select from the toolkit those tools needed for each application. Not all tools will
apply to all applications. A variety of types of tools are included:

Short recorded Webinars may be viewed to introduce specific concepts or to reinforce ways
HIT can be used. For example, you may view the Webinar on How to Use the Toolkit during
a planning meeting to help you focus on the size and scope of the HIT project. You may view
the Webinar on Visioning and Strategic Planning for HIT at another steering committee
meeting to help you define your vision of the future. This Webinar, or parts of it, may be
reviewed again when it comes time to specifically plan for vendor selection or to explain to
staff what an EHR is. You may want to post one of the slides in a staff meeting room to
further HIT education.

Survey forms can help you understand current attitudes and beliefs toward HIT and assess
skills that need improvement. Checklists help assure all steps in a process are taken.
Inventories help you describe current status and compare them with requirements for specific
forms of HIT. For example, you may take an inventory of your current applications and their
interfaces (1.1 IT System Inventory) to enable you to identify and sequence acquisition of
missing applications in light of the desire for an EHR. You may also use this inventory to
compare against vendor requirements for new HIT applications so that you can anticipate the
cost and resources necessary to maintain technology additions.

Charts of various kinds aid in evaluating and improving workflows and processes. For
example, several easy ways to perform process mapping are explained in the Workflow and
Process Redesign tools (1.2 Workflow and Process Redesign and 2.1 Workflow and Process
Improvement).

Sample job descriptions, policies, and other documents are included for you to use directly or
modify as needed. Model plans may be adopted to prepare for communications (1.1
Communication Plan), implementation (2.1 Project Planning), training (2.1 Training Plan),
and other elements of preparing for effectively utilizing HIT. Scripts or use cases are
included as a way to help you evaluate products and test systems (1.3 Request for Proposal
and 2.1 Testing Plan).
Toolkit Sections
The following is a brief description of each section of the HIT Toolkit:
1.1 Adopt – Assess provides tools to start using the HIT Toolkit. Many of the tools in this
section are surveys, inventories, or assessments that can help you understand your staff’s current
attitudes towards information technology, their computer skills, and your technical infrastructure.
The tools will help you develop a communication plan so you can convey the right messages to
the right people at the right time. Many of these tools will be added to and used throughout the
remainder of your HIT project.
1.2 Adopt – Plan emphasizes the importance of planning. Investing the time and resources up
front will mean expending less time and resources during implementation, and reaping greater
value. Don’t overlook dependencies or important steps that reduce risk. Unfortunately, many HIT
vendors do not put a lot of emphasis on supporting the planning effort—focusing instead on
selling and installing systems, then moving on to the next customer. Vendors who recognize the
need for more focus on planning have higher customer satisfaction. Still, the onus for the
majority of planning is on the organization. Planning tools include those for goal setting,
Section 1. 1 Adopt – Assess – How to Use the Toolkit - 3
developing a business case, change management, and understanding your current workflows and
processes to identify opportunities for improvement.
1.3 Adopt – Select helps you understand the HIT marketplace and conduct all aspects of vendor
selection, due diligence, and contracting. The extent to which a hospital needs to review the
marketplace depends on its overall IT strategy. If you are part of a corporate structure, the
selection process is performed for you. However, the assessment, planning, implementation,
effective use, and exchange tools will still be very important for you to use.
2.1 Utilize – Implement builds upon the foundation in the Adopt tools to help you address the
specific application, technology, and operational elements that have been acquired and now are to
be implemented. Tools included here help with the tactical issues that need to be addressed in any
implementation—from sample project plans to issues logs, training plans, testing plans, chart
conversion and pre-load techniques, and many others.
2.2 Utilize – Effective Use provides examples of how tools may be used for specific types of
implementations. This set of tools provides tips for workflow and process improvement for
various types of applications, such as for messaging systems, point-of-care charting, and
physician oversight. Resources to support quality measurement reporting are also included.
3.1 Exchange – Readiness provides tools to help evaluate your readiness for participating in
health information exchange (HIE) and to help you understand the goals and governance of
various forms of HIE.
3.2 Exchange – Interoperate provides tools to help you pursue participation in an HIE
organization, including tools to understand interoperability standards and HIE architectures, and
to prepare for clients’ or their families’ use of personal health records.
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
For support using the toolkit
Stratis Health  Health Information Technology Services
952-854-3306  [email protected]
www.stratishealth.org
Section 1. 1 Adopt – Assess – How to Use the Toolkit - 4