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1 Working with Health IT Systems is available under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported license. Johns Hopkins University.

2 This is Component 14 Unit 8: EHR go-live strategies. 1

3 At the end of this lecture, you will be able to evaluate training and go-live strategies in terms of impact on cost and workflow. More specifically, by the end of this unit, you will be able to Describe characteristics of training and go-live strategies that would facilitate implementation of a new Electronic Health Record (EHR) system. Compare the advantages and disadvantages of a big-bang roll-out versus a phased roll-out and vice-versa. Identify staffing, command center and consultant considerations Compare strategies for monitoring systems and change management during the immediate post go-live period. 2

4 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. 3

5 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. 4

6 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 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. 5

7 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. 6

8 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. 7

9 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. 8

10 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. 9

11 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. 10

12 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. 11

13 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. 12

14 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. 13

15 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. 14

16 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. 15

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