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The Importance of EHR Design Documentation
By Sondra Bruderer

In an industry where documentation is critical to executing safe and efficient patient care, it is surprising how little effort is invested in documenting healthcare technology. The increased pace of EHR implementation and the push toward meaningful use makes documentation even more critical.

Organizations rely heavily on their management and IT staff to be “repositories” of design decisions, customizations, and specifications. However, we should no longer depend on individuals for this information. Hours of healthcare system implementation planning can be wasted trying to figure out why systems were configured the way that they were. These decisions were most often made for a good reason. But what is that reason? Does it still apply today? What will its impact be on a new or optimized system and workflows? Creating design specification documentation will reduce the cost and improve the success of future system changes.

A design document serves a multitude of purposes. It becomes the tool or method of “knowledge transfer” for new analysts, vendor representatives, and integration partners. It serves as the baseline for unit and integrated testing. It also provides a reference point for future customizations or other system changes.

A good design document should contain the following pieces of information:

• an overview of the system and project;

• concepts and terminology;

• system components (profiles, system options, etc);

• screens, baseline and customized;

• dictionaries;

• reports, baseline and customized;

• customizations;

• integration points;

• interfaces;

• workflows; and

• issue management.

Hayes Management Consulting worked with one client that had more than 50 customizations in one system. Staff members had to spend several hours explaining the customizations so that an impact analysis could be performed. If design documents had been available, a considerable amount of time could have been saved. What if the staff hadn’t been at the organization anymore?

A design document should always be created when a new system is introduced in an organization. However, the document can be created for existing systems. The investment of time and resources will pay off during future system changes. It will be only a matter of time before you will need to answer questions such as “Why did we do that?” and “How did we do that?” Therefore, document your design decisions and be better prepared for the future.

— Sondra Bruderer is a principal consultant at Hayes Management Consulting, where she specializes in healthcare system optimization and revenue cycle improvement.