Care Coordination and Interoperable Health IT Systems Unit 6: Implementing Health Interoperability Lecture e – Implementation: “Go – Live” Phase Welcome to Care Coordination and Interoperable Health IT Systems, Implementing Health Interoperability, Lecture e. This material (Comp 22 Unit 6) 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 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

Implementing Health Interoperability Learning Objectives Objective 1: Identify major tasks required to implement interoperability (Lecture a) Objective 2: Explain why interoperability implementation projects are needed. (Lecture a) Objective 3: Define and discuss each phase of the interoperability implementation lifecycle (Lecture a-e) Objective 4: Describe how to apply each phase of the interoperability implementation lifecycle to simple interoperability implementation problems. (Lecture a-e) Objective 5: List types of production issues with interoperability and identify and describe support strategies (Lecture f) This unit will cover the following learning objectives: 1) Identify major tasks required to implement interoperability; 2) Explain why interoperability implementation projects are needed; 3) Define and discuss each phase of the interoperability implementation lifecycle; Objective 4: Describe how to apply each phase of the Healthcare Interoperability Implementation Lifecycle to simple interoperability implementation problems; and 5) List types of production issues with interoperability and identify and describe support strategies. In this lecture, you will be able to identify and describe the “go-live” phase of interoperability implementation.

Go – Live Phase for which you prepare and then execute the production move of your interoperability project Schedule the production move Finalize your build Write a go – live plan Plan for after go – live Execute the production move Support the new interoperability function The “go-live” phase is when the system is ready to move over into production following the successful completion of all of the other tasks. It is the phase for which you prepare and then execute the production move of your interoperability project. It consists of scheduling the move, finalizing the build to be moved, writing a go-live plan, planning for after go-live, executing the production move, and initiating support for the new interoperability implementation. INSTRUCTOR GUIDE - contains STUDENT WORKBOOK - contains

Announce the date Plan for change through formal change control procedures Pick a quiet date / time Make sure that it is properly communicated Downtime might be involved Whenever a change is made in an IT environment, it is important that the change is coordinated with all other changes and with business operations. That is why formal change control procedures need to be followed. Change management is described in detail as part of a set of processes known as Information Technology Services Management or ITSM. Basically, it is important to pick a time that works with everyone involved, to communicate widely about the change, and to plan for any expected downtime. Interfaces are very important so downtime of interfaces can be very disruptive to operations. Plan carefully.

Finalize the build Prior to go – live, you should freeze all configurations and save files to source code control You might also want to do a practice go –live Before going live, make sure you know all the configuration items that are part of the change and save copies of what you plan to change. You might even want to do a practice go-live in which you turn on the feeds from a production system, but point them to a test system, and then analyze the results.

Write a detailed go – live plan List every detail Automate when you can Include: Communication Imports Resynchronization of data Checks (Is it really running? Did anything else break?) Watch closely for awhile Again, planning is crucial and go-live is a team effort. Write a detailed, ordered checklist with each step. When possible, automate the steps using scripting languages. Include imports, re-synchronization of data, communication steps, and checks to ensure that the information is really flowing everywhere it needs to go and that the information is correct. When it comes to downtime, scheduled downtime may be inconvenient, but unscheduled downtime can lead to serious operational and safety issues. Allocate enough time to implement the change and check it and include a buffer. You want to be extra observant when you first move to production. Sometimes a new change will break something unexpected so watch closely for awhile. Health IT Workforce Curriculum Version 4.0

Sample go – live plan section Move patient medication query app into app store Download apps and run final testing with production system Send out communications that the app is available Monitory app downloads and audit logs for the resulting queries for problems; turn on alerts of any errors or problems This sample go-live plan is for a patient facing medication query application. Note that it includes technical steps as well as communication steps. Health IT Workforce Curriculum Version 4.0

Include a back – out plan Good change management process dictates that you should always be prepared to back out a change if it is found to cause problems or if it takes too long, leading to unscheduled downtime Good change management process dictates that you should always be prepared to back out a change if it is found to cause problems or if it takes too long, leading to unscheduled downtime. Health IT Workforce Curriculum Version 4.0

Immediate go – live support Staff for new production installations (critical) Have people on the floor and behind the scenes Have a coverage schedule Expect the worst Inexperienced users need help Process change is hard Problems will be found in production Weekends, weekdays, nights and holidays all offer different challenges The time right after go-live is a time for extra vigilance in support. Expect the worst as inexperienced users need help, process change is hard for users, and problems not detected during the testing phase will be found in production. Make sure to staff appropriately with people on the floor and behinds the scenes. Have a coverage schedule because if serious problems arise, people will need relief. Weekends, weekdays, and nights all offer different challenges. For example, weekends are often quieter so the data flow is different and there are different users during those times. In the middle of the night, some systems have background batch processes that run that could slow down other processes. Some areas might have higher volume such as the emergency department. Mornings on weekdays might have high volume. The point is, when your new implementation successfully survives the challenges of the first day in production, it may not still be fully proven until it has run through nights, weekends, holidays, staff changes, and has a run for a period of time that allows the users to become accustomed and reliant on its availability.

Before you go – live, plan for life after go – live Plan for support for technology and surrounding processes Set up monitoring for the interface Set up an incident resolution process Provide detailed support documentation including diagrams of data flows between systems Anticipate a need to change the interfaces soon after go – live Plan for enhancements, fixes, rollouts, and upgrades Maintain a test environment Determine what staff will do the changes Schedule changes as formal change requests Successful production life of an interoperability implementation needs to be planned for. Plan to assure that your implementation will be well supported. Make sure the technology and the surrounding processes will be supported. Make sure there is support technology and staff in place to ensure that the interoperability will continue to work and that service disruptions will be quickly detected and restored. Provide detailed support documentation including dataflow diagrams and make sure there is monitoring configured and an incident resolution process in place. Also, it is quite common that production will need to be changed. Also, it is quite common that production will need to be changed. Plan for the ability to continually upgrade production. Make sure you have change control processes in place and test systems available separate from production. We will discuss supporting production in more depth in the next lecture.

Unit 6: Implementing Health Interoperability, Summary – Lecture e, Implementation: “Go – Live” Phase Go – Live is the phase for which you prepare and then execute the production move of your interoperability project As with the other phases, it is important to plan by keeping a detailed go – live plan, providing support for the go – live, and planning for after the go – live This concludes Lecture e of Implementing Health Interoperability. To summarize, the “go-live” phase is the phase for which you prepare and then execute the production move of your interoperability project. As with the other phases, it is important to plan by keeping a detailed go-live plan, providing support for the go-live, and planning for after the go-live.

Implementing Health Interoperability References – Lecture e Information Technology Infrastructure Library (ITIL) Glossary of Terms. English v.1.0 ©AXELOS Limited 2011. Royce, W. (1970). Managing the Development of Large Software Systems. Proceedings of IEEE WESCON 26: 1–9. No audio.

Unit 6: Implementing Health Interoperability, Lecture e – Implementation: “Go-Live” Phase This material 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 90WT0004. No audio. End.