California Community Clinics EHR Assessment and Readiness Starter Assessment

How do you know if your clinic is ready for an electronic health record?
Successful transition from paper-based charts to an electronic health record (EHR) requires organization-wide
commitment, significant process change and ample human and financial resources. As with implementation of any
information technology that automates a workflow process, readiness for EHR adoption is extremely important. Lack
of organization-wide readiness has been a major contributor to the overwhelmingly high failure rate of EHR adoptions
throughout the health care industry.

The first question for any clinic to ask itself is “why do we need an EHR?” The answer will probably be somewhere
between “to go paperless” and “to improve quality of care” or “obtain operational efficiencies”. Although no
answer is wrong, we believe that the right the answer is to improve the health of patients. Your answer will determine
whether or not an EHR is the right decision and drive key aspects of the entire adoption process. If your clinic is
considering EHR adoption, your management team should discuss this question thoroughly and document specific,
measurable EHR-related goals that will drive the EHR adoption process.

The question then becomes, “what does readiness really mean?” This is a complex but relatively simple question to
answer. To determine what readiness means, consider the various steps in the EHR adoption process (not an all-
inclusive list): determine clinic needs, select a product, contract with a vendor, configure the product to meet
needs, implement the product, evaluate and expand usage of the product, and, last but most important, use the
product effectively to achieve efficiency and effectiveness goals. To be ready to use an EHR product to achieve
EHR-related goals, your clinic needs to be ready to do everything to support these steps including understanding the
clinic’s needs and defining quality improvement and efficiency metrics to determine success. This requires readiness
in three major areas: Selection and Contracting, Implementation and Effective Use.

To evaluate your clinic’s readiness for EHR, it is very important to take all three categories into consideration from the
beginning to ensure you select the product and develop processes that are appropriate for your clinic. If your clinic
is not sufficiently ready in any one of the above categories, management should not begin analyzing EHR products.
They should, instead, determine priorities and criteria from each of the three major areas for incorporation into the
planning and selection process.

This assessment is the first of two self-assessments intended to help clinics prepare for making a more informed
decision about when and how to adopt EHR. The two assessments are designed as follows:
• Starter Assessment: This is the Starter Assessment and contains a brief set of questions about organizational
alignment and capacity to determine whether or not your clinic is prepared to begin the long, intensive process
of EHR adoption. If you think your clinic is serious about EHRs and is ready to begin evaluating products, take this
assessment to determine potential areas for additional focus. Depending upon your score on this assessment, we
may recommend that you take some preliminary steps before moving forward or that you move on directly to
the Readiness Assessment.
• Readiness Assessment: The Readiness Assessment is designed to help clinics move toward adoption of electronic
health records (EHR) to improve quality of care and gain workflow efficiencies. It is intended to provide
education about success factors for adoption as well as provide your clinic with insight about your degree of
readiness for EHR adoption in order to reduce the risk of failure of your EHR adoption project. This assessment will
be available for download from the library on the Community Clinic website.
It is critical that any clinic considering EHR adoption assemble a representative team to complete both assessments.
Only after completing both assessments and determining a strong level of readiness should your clinic consider
evaluating EHR technology products to fulfill your goals.

Instructions for Completing the Starter Assessment

Answer each question from the perspective of one physical site (i.e. one clinic) or a group of clinics that have agreed
to adopt the same product. Each readiness area is divided into levels showing various stages of readiness. The
stages are represented by points that range from 0 to 5. The higher point values indicate a higher level of readiness.
For each element, identify the description that best describes your clinic’s current status and note the point value
that best describes that level. You are likely to discover that, with some elements, your organization will not fully
match any of the descriptions; in these instances, simply identify the description that is most suitable for your
organization. Your honesty is essential. It is better to underestimate than overestimate your organization’s capacity.
Sum the points in each section (e.g. total Organizational Alignment score, total Organizational Capacity score and
total Overall score) and see the scoring interpretation section at the bottom for feedback on your level of readiness.
With an accurate portrait of your readiness, your clinic will be better prepared to design a plan that meets your
specific needs.

Object Health 1
California Community Clinics EHR Assessment and Readiness Starter Assessment

Section 1 – Organizational Alignment for EHR

Readiness Area Readiness Not Yet Prepared Moderately Prepared Highly Prepared Score
Component 0 1 2 3 4 5
Culture EHR is viewed… as an IT project to “go as a clinical primarily as a
paperless” only. technology to achieve technology to enable
workflow efficiencies. quality care
improvement goals.
The EHR-related top management key planers or all departments and is
planning and/or designated departments and is team-oriented.
process investigator only. participatory.
includes…
Physician limited to a physician primarily occurs for key is active in both
involvement in advocate to represent decisions; clinical planning and
the EHR clinical interests. interested are valued. decision-making;
process… clinical and
managerial interests
are aligned.
Organization Board includes discussion of includes approval of includes creation of
involvement in the need for EHR the need for EHR an EHR subcommittee
the EHR technology. technology to support to manage with
process… clinical quality goals. management and
approval of the EHR
strategy and plan for
accomplishing clinical
quality goals.
Framework for not been thoroughly been discussed but been documented
outlining top discussed. not documented prior before initiating
EHR priorities to initiating vendor vendor evaluation
has… evaluation. and is being used to
facilitate the decision-
making process.
Leadership Leadership… believes EHRs are has studied the pros understands the
necessary, but is and cons of benefits of the EHR
divided as to how to implementing an EHR and sets a clear and
communicate why and can make an consistent vision for
and when to pursue. argument for why how EHR supports
benefits outweigh efficiency and quality
costs. improvement goals.
The Executive relies on vendor to delegates EHR devotes substantial
team… provide EHR planning planning to managers time to planning for
guidance. or a specific team. quality improvement
with EHR technology.
Strategy IT strategic not considered part of been carved out as a been an integral part
planning has… the strategic planning separate part of the of the organizational
process or Strategic organizational strategic planning
Plan, but operational strategic planning process, resulting in a
and addressed process and resulted 3-year Strategic Plan
through special in an IT Strategic Plan. that guides EHR
projects. procurement.
Quality and discussed, but not objectives, but not documented as key
efficiency are… clear objectives of the clearly defined in a objectives in the
organization nor measurable way nor Strategic Plan with
connected with EHR connected with EHR measurable objectives
technology. technology. and corresponding
time horizon and are
clearly connected
with EHR technology.
TOTAL Organizational Alignment Score

Object Health 2
California Community Clinics EHR Assessment and Readiness Starter Assessment

Section 2 – Organizational Capacity for EHR

Readiness Area Readiness Not Yet Prepared Moderately Prepared Highly Prepared Score
Component 0 1 2 3 4 5
Information The Practice has not been has been mostly has been optimized
Management Management optimized or utilized utilized, including a and modules that
system… for patient number of features support patient
management. that facilitate patient management fully
management. utilized.
Standard EHR- have not been have been partially have been defined,
generated defined or defined but have not documented and
reports for documented. been documented. requirements
management, included in the
population product evaluation
health and process.
quality
improvement...
Clinical and Staff and other are involved in has a general are experienced in IT
Administrative human specific aspects the understanding of the vendor contracting,
Staff resource(s) EHR decision-making trade-offs between driving analyses of
dedicated to process but does not products but may not products’ ability to
EHR vendor have vendor selection have vendor selection meet clinic’s needs
contracting… or negotiation or negotiation and capabilities and
experience; publicly experience; publicly determine optimal
available RFP is used available RFP has contract approach
“out of the box” for been used as a and terms; clinic’s
system selection. guideline to requirements have
determine high been documented in
priority requirements. a detailed RFP that
will become an
addendum to the
contract.
Staffing needs have not been are generally have been
for EHR analyzed. understood, but a documented in a
implementation staffing plan has not staffing model,
and use… been developed. detailing current
staffing and proposed
needs; requirements
have been included
in the planning
process.
Staff dedicated have not been have a basic are experienced,
to project specifically identified. understanding of EHR have been educated
management, functionality and are about EHR
change participating in the functionality and
management EHR decision-making workflow impacts and
and quality process. are authorized to lead
improvement for the decision-making
EHR… process.
Training A formal training is not part of the including EHR including EHR
plan… planning process; implementation and implementation,
clinical and skill-set gaps for workflow redesign
administrative staff will necessary physicians and skill-set gaps for
receive training from and key staff is part of management,
the vendor and on- the planning process. physicians and staff is
the-job. part of the planning
process.

Object Health 3
California Community Clinics EHR Assessment and Readiness Starter Assessment

Training have not been will be identified as have been identified

programs for included as part of necessary by to ensure these staff
project the EHR initiative. management. possess appropriate
managers and IT skill sets.
staff involved in
EHR adoption…
Workflow Current and not developed. generally understood documented in a
Process proposed EHR- and incorporated into process map and
enabled product evaluation, requirements are
administrative but workflow redesign included in product
and clinical and change evaluation process;
processes, management planning process is in
including approaches are not place for workflow
estimated documented. redesign and change
patient volumes management
and staffing approaches.
are…
Policies, have been have been analyzed have been analyzed
procedures and considered but not and a plan for and developed
protocols analyzed. development in including information
necessary for place. access rights, medical
EHR-enabled record correction,
processes… system downtime,
data storage
requirements and
record printing.
Accountability Roles and have not been have been have been assigned
responsibilities for established or developed; and are clear;
analyzing assigned or may exist requirements are requirements and
product options, in a functioning group generally understood expectations have
contract terms (i.e. Management and prioritized been captured and
and negotiating Team). accordingly. vendor response
with the EHR documented.
vendor…
Finance and EHR technology more of an expense an investment an investment rather
Budget is considered… than an investment requiring less than 2- than an expense;
requiring a return-on- year timeframe for business case is
investment based on return-on-investment. analyzed over a
traditional IT or office longer time horizon
automation models. and incorporates non-
quantifiable returns.
EHR acquisition funds have not been will be funded with will be funded with
and on-going identified. one-time discretionary capital earmarked for
maintenance funds. such.
Patient Patient has not been considered, but no determined with
Involvement interaction with evaluated. requirements have patient input and
EHR has been… been documented. requirements have
been included in the
planning process.
Policies and have not been have been discussed have been analyzed
procedures for evaluated. but not documented; and requirements
patient a plan is in place to included in the
corrections or develop policies and planning process; a
amendments to procedures. plan is in place to
electronic develop
medical records communications for
and release of patients and external
patient organizations.
information…

Object Health 4
California Community Clinics EHR Assessment and Readiness Starter Assessment

EHR-enabled have not been have been discussed have been designed
referral evaluated. but no specific plan and requirements
processes, e- exists. included in the
prescribing and planning process.
other patient-
specific hand-
offs…
IT Management IT Management limited experience experience with strong experience
and Support has… with system system integration or with system
integration or data data conversion but integration, data
conversion, and relies tends to rely on the conversion and
heavily on external vendor to detail the managing expert
resources for IT tasks and activities. resources to fill
planning and internal skill or
decision-making. knowledge gaps.
IT staffing for EHR has not been is generally has been
implementation, analyzed. understood but is not documented in a
maintenance, documented in the Staffing Plan and
infrastructure planning process. requirements have
and users… been included in the
planning process.
IT staff… are determining IT are involved in have been educated
infrastructure decision-making about EHR objectives
requirements without process to determine in order to actively
involvement in IT infrastructure engage in the EHR
process. requirements. decision-making
process and
determine necessary
IT infrastructure
requirements.
IT Infrastructure A needs is generally has been performed has been performed
assessment of understood but has but not documented and requirements
hardware, not been evaluated. in the planning included in the
desktop process. planning process.
terminals and
other devices
necessary to
support EHR
use…
A plan for a is not in place; is being developed is in place and will be
technical infrastructure will be and will be standards- standards-compliant
infrastructure upgraded according compliant with HL7 with HIPAA, HL7 and
using a high- to projected needs as being considered. other clinical and
availability standards-compliant administrative
platform, as possible as new transaction standards.
upgraded to be systems are
standardized, purchased.
scalable, and
easily
maintained….
TOTAL Organizational Capacity Score

TOTAL Overall Score

Object Health 5
California Community Clinics EHR Assessment and Readiness Starter Assessment

Score Interpretation
The Starter Assessment is one of the first steps in the evolutionary learning process of EHR adoption. Thus, it should be
used as a tool to educate this process along with continual clinic exploration and use of more in-depth tools like the
Readiness Assessment. Score interpretation is designed to help you understand how to move forward in the process
by learning from expertise embedded in these tools as well as learning what is important from your clinic. Although
strong technology and industry research are very important, successful EHR adoption will require teamwork,
collaboration and readiness.

Below are ranges of scores for each section and the overall score with some general interpretation and advice.
• Organizational Alignment for EHR Adoption:
o Score = 31 - 45: A score in this range may indicate that leadership understands and communicates the value of
EHR adoption clearly throughout both the documented planning process and the clinic environment. There is
likely an environment for achieving success that comprises team work, flexibility and mechanisms to manage
communication and collaboration. Organizational alignment is strong and, pending the Organizational
Capacity score, consider further assessment with the Readiness Assessment tool that can be found in the library
on the Community Clinic website.
o Score = 16 - 30: A score in this range may indicate that there is an understanding of the value of EHR, but that
detailed exploration of how EHR enables the clinic’s ability to achieve its strategic goals and what impact it will
have on clinic operations and patient management may be less clear. Consider additional management and
cross-departmental planning discussions about the areas of weakness, using this tool and/or the Readiness
Assessment as a guide to understanding where differences in opinions or lack of detailed understanding may be.
o Score = 0 - 15: A score in this range may indicate that there is not a strong enough understanding of the value of
EHR or how it will impact the clinic’s goals or operations to move forward without a process for management and
clinic-wide discussion. Consider adopting a longer-term set of planning discussions and a methodology to
develop a clinic vision and decision-making to support quality improvement before moving forward with other
EHR adoption activities.

• Organizational Capacity for EHR Adoption:

o Score = 67 - 100: A score in this range may indicate that managerial, operational and IT capacity are strong,
although further analysis of scores in individual areas will reveal relative strength in each area. There is likely the
capacity for achieving success including management methodologies, staff resources and IT environmental
strength. Pending the Organizational Alignment score, consider further assessment with the Readiness
Assessment tool that can be found in the library on the Community Clinic website.
o Score = 34 - 66: A score in this range may indicate that there is adequate capacity in some areas, but not
consistently throughout management & staff capacity, operational processes &mechanisms and the IT
environment. Identify the exact categories of weakness and consider further management and cross-
departmental planning discussions about areas of weakness, using this tool and/or the Readiness Assessment as a
guide to understanding how to increase clinic capacity.
o Score = 0 - 33: A score in this range may indicate that there is weak capacity in several areas that are critical to
EHR adoption success. Identify the exact categories of weakness and consider a more comprehensive analysis
of requirements for EHR adoption and develop a plan to improve capacity in those areas before moving forward
with other EHR adoption activities.

• Overall Score:
o Score = 98 - 145: A score in this range may indicate that your clinic both understands the value of EHR and has
the capacity to see a long and potentially challenging adoption through to success. To ensure readiness for
adoption, consider further assessment via the Readiness Assessment tool available through the library on the
Community Clinic website.
o Score = 50 - 97: A score in this range may indicate that your clinic is strong in some areas and weak in others. It is
important to identify strength in each area of the assessment to determine where to focus additional managerial
and planning attention. Consider using this tool and the Readiness Assessment to inform the process and
develop a more targeted plan toward EHR adoption.
o Score = 0 - 48: A score in this range may indicate that your clinic is not currently prepared to move forward with
EHR adoption. Consider developing a more comprehensive plan to facilitate management and cross-
departmental education and planning processes to determine why your clinic is interested in EHR adoption and
how to build the capacity to ensure successful adoption and use.

Object Health 6
California Community Clinics EHR Assessment and Readiness Starter Assessment

Glossary
Organizational Alignment
• Culture: values; environment for achieving excellence; ability to manage change and maintain flexibility; team
approach
• Organization: infrastructure to support information flow, decision making, and problem resolution; role of the
board and leadership team; vision for quality; ability to collaborate with external organizations
• Leadership: the characteristics of leadership team: setting vision, commitment to quality; alignment across
organization
• Strategy: mission and vision and priorities documented in a strategic plan; internal and external communications

Organizational Capacity
• Information Management: quality, accessibility, relevance and communication of data/information
• Clinical and Administrative Staff: staff capacity; staff training and competence; consistent policies and
procedures; methods to motivate and drive individuals/groups to achieve goals
• Training: Infrastructure and resources dedicated to initial and on-going IT training
• Workflow Process: tools and methods for managing change, developing policies, procedures, protocols; Quality
Improvement model; process for monitoring and communicating performance; analysis and actions taken to
improve processes and performance
• Accountability: how results are achieved and mission/vision fulfilled; role and responsibility of patient in care
process
• Finance & Budget: extent of infrastructure and management of IT budget; capital and operational resources
• Patient Involvement: preventative and chronic care processes; patient follow-up and care continuum;
comprehensive care
• IT Management and Support: IT staff skill-set and capacity for IT management and support; consistent policies
and procedures
• IT Infrastructure: information systems environment and infrastructure

Object Health 7