Special Topics in Vendor-Specific Systems: EHR Go-Live

Strategies

Audio Transcript

Slide 1: Vendor-specific Go-Live Strategies

This is Component 14 Unit 8: Vendor-specific go-live strategies.

Slide 2: Outline
In today's class, we will be discussing two approaches to rollout: big bang and
phased. In addition we will talk about project staffing, how to set-up a command
center, and the use of onsite consultants. Lastly, we will cover monitoring system
usage during go-live and change management with its effects on the
organization.

Slide 3: Big-Bang vs. Phased Roll-Out

One of the first project decisions that have to be made is whether to rollout the
system in a big bang or a phased approach. When referring to big bang or
phased, we are mostly referring to the software modules or main application
functions. However, with the big bang approach, you still have implementation
choices. You could rollout all modules in selected locations or all modules in all
locations. This big bang approach is usually used when replacing a legacy
system. It would be difficult to have two systems running at the same time. In the
phased or incremental rollout, selected modules are implemented. Again, you
have the choice of selected modules in all locations, selected modules in some
locations or a combination of both.

Slide 4: Big Bang

There are pros and cons to both the big bang and the phased rollout approaches.
Let's talk about big bang. The pros for doing the big bang rollout are a short-term
disruption and there will be no need to link the old and the new system. Since the
old legacy system will not be running during the go-live, it will not require support.
On the other hand, the rollout will demand much more organization. It absolutely
requires comprehensive planning and all the users will need to be trained and
ready to go at the same time. This can be a massive undertaking.

Slide 5: Phased Roll-Out

So, what are the pros and cons of the phased or incremental rollout? The benefit
of this approach is that it allows you to progressively adjust your strategy during
implementation. Your planning can be more focused. Any disruptions will be
isolated to only those locations and those modules involved. As a result, smaller
groups of users are affected during the rollout. Against this approach is the need
to maintain two systems: both the new and the old or legacy systems. There is a
danger that the project will stall or stagnate. In addition, obstacles will be found
Health IT Workforce Curriculum Special Topics in Vendor-Specific Systems
Version 3.0 / Spring 2012 EHR Go-Live Strategies

This material (Comp14_Unit8) was developed by Columbia University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.
which may cause groups to think about not continuing with the implementation. It
will be necessary to correlate information from both systems for management
reporting. Furthermore, detailed business operations will have to be extracted
from both systems simultaneously.

Slide 6: Staffing
The staffing required for implementing and maintaining an EHR depend on many
factors. For example, you need to consider the product being implemented, the
location (whether hospital, inpatient or physician office), whether the
implementation will be formed by the vendor or consultants and if it is a big bang
or a phased rollout. All of these factors will greatly determine the required
staffing. From a technical standpoint, if the application is hosted locally, that
would require a much larger team versus hosted remotely by a vendor. In
addition, you will have to determine temporary staffing during implementation,
actual go-live support, and the permanent staffing once the project is fully
functioning.

Slide 7: Staffing: Example EHR Implementation Team

In Unit 3, we reviewed an example EHR implementation cost profile including
staffing requirements. Here, we have the same list of personnel including
physician champion, application coordinators, database designers, third party
reporting, two administrators, programmers, security analysts, work station
management staff, trainers, go-live support, and chief privacy officer, just to name
a few.

Slide 8: Command Center

An important component of an EHR go-live is the command center. This is a
special location set up during implementation. While command centers can exist
in the phased or incremental rollout, they are more typical of big bang rollouts. All
project communications go through the command center. It serves as the
project's help desk and all user calls are routed to the command center. Field
staff meets at the command center usually at the beginning and end of each day
to report and get project updates. Moreover, project executives meet together at
the command center to take the pulse of the project and to make immediate
necessary decisions.

Slide 9: On-site Consultants

Onsite consultants can play many important roles in an EHR project. Staff is
needed during implementation and during the go-live period; but not needed
during the maintenance phase. For example, consultants can assist with EHR
selection; develop processes during implementation, work on meaningful use
criteria, assist in EHR review of existing projects and direct training and
certification processes.

Health IT Workforce Curriculum Special Topics in Vendor-Specific Systems

Version 3.0 / Spring 2012 EHR Go-Live Strategies

This material (Comp14_Unit8) was developed by Columbia University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.
Slide 10: Monitoring System Usage
A very important task to be formed during the rollout is monitoring system usage.
As the system gains users, increases functionality and takes on heavier loads, it
is critically important to watch all system health indicators. The operating system,
disk space and application usage need to be monitored. Each day requires a tally
of the number of documents created, orders written, orders completed and
prescriptions written. It is also important to monitor the count of calls coming into
the help desk. Some concerns could be: Are there system issues? Are there
logon issues? Are there application questions? Monitoring all of this will help
detect early on whether the system has some issues. A lot will be learned from
performing these tasks.

Slide 11: Change Management

A lot goes on during the implementation of an EHR. There is a significant amount
of change that occurs. While organizational change is a fascinating topic, where
organizations evolved to different levels in their lifecycle, here we will be
specifically talking about system change. This typically refers to information
systems or other process changes in an organization.

Slide 12: System Change Management

An important aspect to the system change is the management of changes. If a
formal change management system is typically instituted immediately post go-
live, a structured approach to transition individuals, teams and organizations from
a current state to a desired future state is needed. Changes are implemented in a
controlled manner by following a very well defined framework managing all
modifications.

Slide 13: System Change Management (cont.)

During implementation and go-live, changes are usually made on the fly and that
is okay. However, during post go-live, when the system is stable, it is very
important to follow the formal processes of change control. This ensures that
changes are introduced in a controlled and coordinated manner. This is done to
reduce the possibility that an unnecessary and harmful change is introduced;
thereby, creating defects in the system. The goals are to minimize disruption, to
reduce having to back out changes, and to utilize resources in a very cost
effective manner.

Slide 14: System Change Management: Set of 6 Steps

Change control management consists of the following steps: recording and
classifying each requested change, assessing all aspects of the change,
planning for the change, building and testing every aspect of the system
including the parts that no one thinks will be affected by the change,
implementing the change, closing it out and gaining acceptance from all users.

Health IT Workforce Curriculum Special Topics in Vendor-Specific Systems

Version 3.0 / Spring 2012 EHR Go-Live Strategies

This material (Comp14_Unit8) was developed by Columbia University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.
In this lecture, we have covered just a few of the most important go-live
strategies. We talked about big bang versus phased rollout. We talked about
staffing, command centers, use of consultants and change management. These
are just a few of the very important aspects of go-live strategies that have to be
considered during the implementation of an EHR in both the inpatient and
ambulatory settings.

Slide 15: Summary

In this lecture, we have covered just a few of the most important go-live
strategies. We talked about big bang versus phased rollout. We talked about
staffing, command centers, use of consultants and change management. These
are just a few of the very important aspects of go-live strategies that have to be
considered during the implementation of an EHR in both the inpatient and
ambulatory settings.

Slide 16: References

No Audio.

Health IT Workforce Curriculum Special Topics in Vendor-Specific Systems

Version 3.0 / Spring 2012 EHR Go-Live Strategies

This material (Comp14_Unit8) was developed by Columbia University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.