Lecture 10 System Implementation and Maintenance (Chapter 10)

Learning Objectives 1.Cultural change in System Implementation 2.Implementation committee 3.Issues in test, training, and production environments. 4.The “go-live” process 5.Implementation pitfalls. 6.Maintenance and System Life Cycle IS 531 : Lecture 102

System Implementation Third phase of the life cycle Begins with purchase of the system Planning before purchase Selection of the implementation committee to oversee the process IS 531 : Lecture 103

Implementation Committee Project leader—needs to be involved in the entire process Technical staff Informatics representatives Clinical representatives Managers who understand day-to-day operations and how those processes might be improved IS 531 : Lecture 104

Implementation Committee Steering Committee membership and organizational issues are as important as the technology when implementing a new system. The project leader must have strong leadership and communication skills. IS 531 : Lecture 105

Committee Tasks Develop plan /work breakdown structure (who is responsible of what, timeframe). Schedule tasks for implementation. Define the scope of each task. Identify timelines and “go-live” date. Identify resources and constraints. Get to know the system. Research what data is needed and how it is used. IS 531 : Lecture 106

Getting to Know the System “Base” system—supplied by vendor without any changes Training for committee – On-site training by the vendor – Vendor training at corporate headquarters – Consultants may provide training Should revisit issues examined during selection IS 531 : Lecture 107

Issues to Revisit Is technology current? Upgradable? Financial stability of vendor Vendor compliance with regulations Integration with other systems Support different types of patient accounts Clinical support (client care) EMR support IS 531 : Lecture 108

Cultural Changes in System Implementation IS 531 : Lecture 109 “If change does not produce a notable resistance, then the change is probably not big [significant] enough” New IT always change life (at home/at work) People should embrace (buy-in) the reason for change Any change should make people feel differently (more important/valuable/ effective/efficient …)

Base System vs. Custom System as-is vs. customized Workflow Optimization: Gap Analysis to identify required changes in workflows and prototype Customization requires time and resources. Customization may have ripple effects on other systems and interoperability. IS 531 : Lecture 1010

System Function A task performed manually or automated Must identify information pertinent to completion of each function Examples – Order entry – Results reporting – Documentation IS 531 : Lecture 1011

System Output Material generated by the system Examples – Requisitions produced in other departments – Reports – Diagnostic results – Work lists – Charges IS 531 : Lecture 1012

Required Output for New System Analyses of the current and desired workflows provide this information. Specifications must be agreed to, or “signed off” by, managers in the areas that will be impacted. Constant changes to specifications delay the project and increase costs. IS 531 : Lecture 1013

Test Environment System testing vs. integrated testing Use a copy of the information system software to make changes from the off- the-shelf version Programmed changes are tested to ensure that they work as designed IS 531 : Lecture 1014

Test Plan Long-range goals (what for) and test items (what) Test Script provides a series of transactions from beginning to end for all associated functions Requires input and participation from users from all areas of the facility Evaluate actual vs. desired output IS 531 : Lecture 1015

Hardware Requirements Analysis of needs must be done early in the implementation phase Considerations – Network infrastructure – Types of workstations and mobile devices – Workstation locations – Hardware locations – Printer needs IS 531 : Lecture 1016

Network Infrastructure Should be determined early—later changes will increase costs – Network configuration requirements – Server specifications—memory, processing power, consider future needs – Technical standards – Cabling and power – Wireless access IS 531 : Lecture 1017

Workstations and Mobile Devices Advantages and disadvantages of each type of device. The number of devices needed. Technology and support for access by PDAs and handheld devices. Where devices will be located. IS 531 : Lecture 1018

Procedures and Documentation Determine how the system will be used before end user training starts. Evaluate/revise policies and procedures for system use and include in training. Develop user guides. What to do in the case of planned and unplanned system downtime IS 531 : Lecture 1019

System Documentation Develop a “dictionary of terms” and map terms from one system to another. Mapping terms across systems help to ensure high-quality data. Finalize pathways and screens before the test plan is written and training starts. IS 531 : Lecture 1020

User System Training Do not start until changes are complete Training environment—separate copy of the information system software that works the same way as the actual system and is populated by fictitious clients IS 531 : Lecture 1021

Go-Live Planning Go-live—system running and used to collect and process actual client data Implementation strategies / rollout — staggered/modular/all at once Conversion—bring in old data (backloaded) Develop the support schedule Develop evaluation procedures Develop a procedure to request post go- live changes IS 531 : Lecture 1022

Implementation Pitfalls Underestimation of time and resources needed Ongoing addition of changes and more features (“scope creep” and “feature creep”) Failure to consider costs for annual maintenance and other expenses Problems with testing or training Lack of system “ownership” by users IS 531 : Lecture 1023

Maintenance User support—resource staff available during go-live on units and via help desk at all times User feedback / requests for changes analyzed and appropriate changes made to identify problems Must apply updates to all three environments—testing, training, and production/live IS 531 : Lecture 1024

Technical Maintenance Problem solving and debugging Backup supply of hardware File backup procedures Storage space Interfaces with other current/new systems System upgrade Disaster recovery plan IS 531 : Lecture 1025

Return on Investment (ROI) A system having poor performance, dated, outgrown should be replaced Financial justification for changes – Decrease in costs/expenses – Increase in profits/benefits (tangible vs. intangibles) Payback /break-even IS 531 : Lecture 1026

The Role of Nursing All users should have input into the systems that they use. Nurse informaticists provide “credibility” for information system projects. IS 531 : Lecture 1027

Nurse Informaticist Responsibilities The Chief Nursing Officer (CNO) must work with key figures to develop strategies to transform care, prioritize system design to maximize the value and benefits of a clinical information system, and reallocate time saved in documentation and other efficiencies to improve client care services. IS 531 : Lecture 1028