Go-Live Checklist, Pages 230–231

Purpose: Go-live is the date and time you start having at least one individual use the EHR system in
production mode. Because you usually have a number of users going live at once, go-live is usually a highly
stressful time. Having a checklist of everything you need to do to ensure you are ready for go-live can reduce
some of this stress.

Directions for Use: At least a few weeks prior to go-live, review the Go-Live Checklist tool and make sure
everything on the list pertains to you. Whatever does not, delete. Then add any elements you believe may be
missing, especially if you have any special modules being implemented or other unique circumstances. Decide
when you will run through the Checklist. This review will may occur over several days. Literally check
everything on the list and check the tasks off as you go.
Go-Live Checklist

Transition Planning
 Set date for go-live that is during a period of time that is as light as possible.
 Inform vendor of this go-live date and use it to plan all aspects of implementation schedule backwards from that. Allow for
contingencies.
 Determine rollout strategy. Some offices go live with a portion of physicians at a time, or all physicians using limited
functionality. For a small office, this has been found not to be as effective as once considered, often resulting in duplicate
effort and patient safety risks. However, on the go-live day and for a period of time thereafter, schedules should be
lightened.
 Plan to notify third parties and other vendors (e.g., labs, transcriptionists, billers, pharmacies) of go-live date when it
appears certain and request their additional support.
 For e-prescribing, check with the most frequently used pharmacies that they are prepared to receive electronic
transmission of prescriptions; if not, request that they seek assistance from their corporate headquarters (95 percent
of all retail pharmacy chains are certified for e-prescribing but not all local pharmacies have made the transition).

Several Days Prior to Go-Live

 Review evidence of testing:
 Network: devices, connectivity, security
 Hardware: computers, monitors, navigational devices, cables, printers, scanners, servers, universal power supply
(UPS), storage, back-up server
 Interfaces: lab, radiology, billing/clearinghouse, practice management as applicable, other
 Software:
− Unit testing to ensure all build is complete for:
• Screens
• Templates
• Reports
− System testing to ensure data pass from one function to another:
• Tasking
• Ordering
• E-prescribing
• Backup
 Check process redesign:
 Ensure that changes to workflows and processes are documented and practiced.
 Ensure that chart conversion process has begun.
 Review physical layout to ensure that changes to workflows and processes can be accomplished without
bottlenecks or traffic jams.
 Obtain sign-off from each user (physicians, physician assistants, nurses, other clinicians, administrative/operational
support staff) for each process for which they are responsible.
 Review policy for use and achievement of goals with key stakeholders and reaffirm; make any necessary changes if
software precludes goal accomplishment; however, also set appropriate expectations that not everything will go perfectly
on go-live day but that the office will be fully staffed with the vendor standing by to do everything possible to provide
assistance.
 Review appointment times/schedules to allow for EHR learning curve. Make any adjustments in patient schedules or
staffing as necessary immediately:
 All staff must be present.
 Support staff should arrive at least one-half hour early. For a large office, support staff may be instructed to wear a
distinguishing color shirt, cap, or other to stand out as go-to people.
 Mid-morning and mid-afternoon buffers for physicians to catch up have been planned.
 Mid-day huddle is planned to evaluate progress.
 End-of-day debriefing is planned to identify and address issues and celebrate success.
 Training:
 Check that every user has completed basic computer navigation, keyboarding, and other applicable training;
provide refresher if necessary.
 Check that every user has completed EHR training; remediate immediately if not.
 Check that every user has a user ID and password, and that they remember them.
 Role-play with every user who will be using EHR at point of care to ensure process is comfortable, and simulate use
of EHR for a staff member playing role of patient.
 Plan with support staff what to do if things go really wrong.
− Have paper process backup ready in the event of downtime or significant system issues.
− Identify situations or points where go-live needs to be stopped.
Day Prior to Go-Live
 Post signs that office is “under construction” with a new computer system and request patience for any delays.
 Update telephone message that office is implementing a new computer system and request patience for any delays.
 Verify schedule for go-live day.
 Verify readiness:
 Computers, including tablets, PDAs, etc. are plugged in or charging.
 Computers have connectivity to network:
− All user IDs and passwords have been tested by each individual assigned a user ID and password (this verifies
the user has access to this information and that the connection works).
− Any wireless dead spots have been identified with appropriate signage.
− Secondary Internet Service Provider has been tested.
− All computers, including those on wireless, can connect to applicable printers.
• Including printer designated to print prescriptions for Medicaid and Schedule II drugs on tamper-proof paper.
− Printers have appropriate paper.
− E-fax capability works.
− Charts for next day have been pulled and prepped, including applicable data abstracted to EHR as chart
conversion procedure dictates.
 Review escalation procedures to follow in the event there is a problem.
 First-level support staff
 Second-level vendor staff onsite
 Third-level vendor help desk
 Fourth-level vendor management
 Review who within office has authority to make/approve critical system changes on the fly.
 Plan to bring snacks and (nonalcoholic) beverages.

Day of Go-Live
 All staff members arrive early—and with a sense of humor!
 Support staff double-check all readiness.
 Support staff members prepare to respond to any contingency as planned. This will mean that certain staff will not perform
routine, non-patient care duties that day, but dedicate the entire day to being in a state of readiness (including being
prepared to “do nothing” if all goes well).
 Whether or not there appears to be a need, conduct all planned buffer breaks, huddles, and debriefing—if only to
celebrate success. This reduces stress and relieves pressure to do more than what was planned.
 Determine staff schedule for Day 2 and adjust as necessary. Go-live may require several days of similar
scheduling.

Used with permission, © Margret\A Consulting, LLC