Managing the Medico-Legal Risks of System Migration Liz Price Training and Consultancy Manager

Why problems occur  Implementation poorly planned  Poor communication within the team information, shared planning, listening to feedback  Lack of ongoing flexibility within process  Not considering ALL stakeholders  Lack of training wrong time, wrong emphasis  People undermine the process

The Role of the Practice Team  Recognise and accept that change is required  Identify barriers to the change - and ways of overcoming  Plan how the change is to be implemented: internal and external focus (responsibilities, impacts, risks)  Monitor and evaluate how successfully change is progressing communication, feedback, early warning signals  Deal with the consequences of change: additional training, review of systems, awareness of risks  Maintain business as usual

The planning process  Define the scope:  What do you want to achieve?  Get to know the new software especially where it’s different (views/actions/workflows)  Identify the key stakeholders practice team, patients, pharmacies, attached staff etc  Identify and plan a timeline for change (GANTT charts)  Review systems of working do they need to change?  Develop a ‘Communication Plan’ pre/during/post and internal/external  Identify team and individual training needs  Identify potential risks

Training Needs Analysis (TNA) Risk  The system supplier may not identify your real needs:  Lack of understanding around the practice current systems of working  Inability to complete a gap-analysis between old and new  Lack of knowledge of individual strengths and weaknesses in relation to IT within the team Potential Pitfalls  Increased incidence of clinical and administrative errors after implementation, for example: 1.Items in the ‘wrong’ place on the page (e.g. appt books) 2.Data not matched in new system (e.g. immunisations) 3.Incorrect data entered into patient records

Training Needs Analysis (TNA) Solution  Ensure you compete your own TNA Examine the new system in relation to your current processes (visit practices) Where are the gaps? Where do things look really different? Who are your problem team members? Where will the language have to change? Which practice processes need to be adapted to fit the new system? What workarounds did you create in the old system – manual matching? Try to avoid ‘workarounds’ as these can make life difficult later on Supplement training by your supplier with individually tailored add-ons

Patient Management/Communication Risks  Patient demands outweigh resources during implementation  Patients do not understand that services may be disrupted Potential Pitfalls  Increased incidence of patient complaints  Complaints not being dealt with as empathetically as normal

Patient Management/Communication Solution  Create a project plan in relation to managing service delivery including patient communication around the implementation period Consider reduced service provision during migration and implementation weeks Identify the key services you must provide, for example: Emergency surgeries only / Acute prescriptions Ask patients to request repeats before the date of change where possible Postpone coding where possible Ensure patients have positively-framed information well in advance, during and after (thanks) Remember that some patients will need questions answered/reassurance

Post migration week: data extraction and re-entry Risks  Data re-entry following migration week Potential Pitfalls  Information is updated incorrectly into the patient record  Consultations are transcribed incorrectly into the records

Solution  Agree a plan in advance and identify mismatches early Utilise a recommended data extraction tool Or set up paper templates for record-keeping (labels?) Encourage doctors and nurses to ‘cut and paste’ their own consultations Migration week: data extraction and re-entry

General points  Ensure old system data is archived securely and is retrievable  Disc Image + attached functions (e.g. appointment book)  VISION – ‘treatment groups’ (e.g. GP service provision/school nurses)

Planning priorities checklist