1. Installation and Maintenance of Health IT Systems
Unit 11
Pilot Testing and Full Scale Deployment
Topic 8-11: Pilot Testing and Full Scale Deployment
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

2. Health IT Workforce Curriculum Version 1.0 Fall 2010
What We’ll Cover…
Identifying a Pilot Group for Testing
Installation, Training of Users
Gathering and Prioritizing Feedback, Revising Project Plan as Needed
Planning for and Deployment to End Users
Big Bang vs. Phased Rollout
Communications
Technical Support Resources During Rollout Phase
Re-evaluating Usage and Capacity of System resources Under Production Environment Conditions
In this lesson we will touch on identifying, training and installation of pilot program users, soliciting feedback from those users to tweak the system and beginning full deployment. We will look at the two most common deployment strategies as well as the importance of training end users prior to final rollout dates.
Lastly, we will close the loop by highlighting some tips for successful deployment and some post-deployment initiatives to undertake.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

3. Identifying a Pilot Group
Pilot Testing – A trial run of procedures, instruments and software that you plan to fully deploy in an environment.
Trial Group –
Dependent upon organization’s size and structure
Should be assessed to determine staff’s technical capabilities and the ability of the practice’s existing practice management technology to meet its needs
Larger organizations should consider a steering committee to help with the selection process
Ensure you have an adequate cross section of users testing the product
As the rollout date approaches and internal testing winds down, at some point real users must be allowed to interface with the new system, take it through its paces, and provide feedback. We call this process pilot testing.
Pilot testing is designed to catch and correct costly errors before they are magnified through full deployment.
Defining a pilot testing group is largely dependent or the organization’s size and structure and priorities. In larger organizations, consider creating a steering committee comprised of clinical, administrative and information technology leaders deeply involved in the selection process to assist with identifying pilot practices or departments. Use a readiness assessment to identify the technical capabilities of the practice’s staff and the ability of the practice’s existing practice management technology to meet its needs. The readiness assessment can also help devise a final rollout strategy by identifying which department are more willing and capable of more ambitious rollout schedules and which departments will need addition readiness efforts prior to implementation.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

4. Staff Education and Training
Schedule enough time PRIOR to implementation (2 weeks or more) to ensure adequate training and to build confidence and familiarity with the system
Training for end users is best done within two weeks of going live so that new skills aren't quickly forgotten. One initial training session may not be enough. Teaching complex skills, like efficient note documentation for physicians, can be started with the initial training and then advanced with briefer updates.
While some EHR skills apply to all users, distinct user groups, such as receptionists, records personnel, medical assistants/nurses and physicians, will benefit from customized training relevant to them
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

5. Staff Education and Training
Adequate training is crucial to the success of your implementation!
There are many training strategies. Choose a combination of styles that works for your organization:
Train the Trainer
Classroom Style
Web
Hands on
Many implementations use a train-the-trainer approach, in which a core group of people are trained directly by the vendor. This group in turn trains the rest of the users at their site(s). Training can be done classroom style, via the Web or one-on-one, depending on your resources and inclinations. Initial training time will vary depending on your software and implementation plan. Typically initial training commitment ranged from four hours for receptionists to 16 hours for physicians.
Workflows and preimplementation training should enable the staff to use the EHR without intense support from the implementation team after the initial implementation has been completed.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

6. Pilot Group Training and Implementation
Treat it as a Mini-Rollout of the project
Training is EVERYTHING!
Pilot sites should understand that being a pilot site requires flexibility on timelines and functionality.
Devise a contingency plan
IT support and available resources must be ready for implementation day
In most ways, you should consider the roll out of your EHR as a mini-trial run of the final rollout strategy. Begin with setting your pilot implantation dates and begin with setting up training session with your project users. Here are some important tips about your pilot installations:
Pilot sites should understand that being a pilot site requires flexibility on timelines and functionality.
Because the transition to the EHR may not run as smoothly as hoped, a detailed plan for addressing anything from minor glitches to the worst-case scenario should be developed prior to the start of implementation and communicated to all providers and staff at the implementation site. At North Garland, the use of an established downtime policy when the system failed was instrumental in the clinic's remaining operational on the first day of implementation.
Adequate technical support must be available during the transition period, and providers and staff should know how to access it when needed. Likewise, resources need to be committed and available at a moment's notice when the system goes live.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

7. Pilot Group Training and Implementation
Involve everyone in decision making
Consider rolling out more complex modules later on after confidence is built up and users are more familiar with the EHR.
A formalized orientation process should be developed outlining the policies and procedures that underlie the decisions made at the organizational level
A standardized communication process should be in place for internal departmental communications and feedback centralized around the EHR implementation clinic super user. Having a single person act as a liaison between the EHR team and the clinic undergoing implementation helps these two entities communicate effectively.
Every individual on the project should be aware of the policies and procedures that underlie the decisions made at the organizational level regarding the EHR and its implementation. A formalized orientation process should be developed for new members joining the project.
There is a tradeoff between complexity and additional content in the EHR functionalities, particularly in clinical decision support applications. While it is important that the EHR applications not intimidate a first-time user, it is also important to remember that as users become more familiar with the system, they will learn and come to appreciate the advanced options and functionalities that might have appeared unnecessary at first. Complex modules such as charge capture may be differed until later during the implementation process.
During the decision-making process, at both the organizational and the individual clinic levels, as many people as possible should be involved, representing the views of physicians, nursing staff, administrative/financial staff, and all others who will use various functions in the EHR regularly
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

8. Pilot Group Training and Implementation
Medication dosages and instructions incorporated in the EHR content should be reviewed by independent experts
Even during pilot and beta phases of a project implementation, system stability is essential to gaining user confidence in a system
Medication dosages and instructions incorporated in the EHR content should be reviewed by independent experts to ensure that prescription errors are not programmed into the system. Users are asked to report any potential mistakes
Even during pilot and beta phases of a project implementation, system stability is essential to gaining user confidence in a system. Even
brief periods of instability can leave a negative impression long after the instability has been resolved.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

9. Learning from Your Pilot Test
Develop Surveys incorporating;
Workflow change analysis
Suggestions for interface adjustments and errors
Data errors or failure
Keep a journal of experiences and processes
Conduct a post implementation review
Once the implementation has occurred it is important to listen to your pilot user feedback to isolate and resolve potential glitches in the system or make interface adjustments to resolve severe workflow issues which may have arisen. Try not to get wrapped up in customization in the early stages however as it takes time to adjust to new work patterns.
Listen to your end users and carefully evaluate and respond to their feedback. Actively solicit feedback so you can implement improvements before problems arise. Take nothing for granted. Slow resolution may demoralize users and result in low adoption.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

10. Health IT Workforce Curriculum Version 1.0 Fall 2010
Legacy Data
There are three options for dealing with legacy data at launch:
No pre-loading. In this scenario, paper charts are retained for reference. All visits after the go-live date use the EHR.
Pre-load limited data. With this plan, the EHR is pre-loaded with commonly referenced data like current medications, chronic conditions, immunization history, and allergies. This approach reduces the need to pull paper charts for most visits.
Pre-load all information from the last year. Ideally, your vendor will assist you in this scenario, since the data input volume is high. In this case, older paper charts are retained for reference.
Established practices have mountains of data stored in old charts, but it’s neither practical nor reasonable to transfer all that data to the EHR. Create a clear plan for defining what portions of current charts you’ll transfer and from how far into the past you want to retain records.
Your decisions will be determined by practice preferences, physician needs, and available time and money. The more data loaded into the system at launch — whether by you or your vendor — the sooner you’ll see the benefits of the EHR.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

11. Big Bang vs Phased Implementation
Big Bang - An implementation strategy that cuts over all parts of a planning system at the same time in a company or division, as opposed to a phased implementation module by module.
Phased Implementation - A gradual roll out of functions sequentially to a grouping of departments/ practices.
One of the difficult decisions of an ERP implementation is the implantation strategy: do you take the big bang approach and get it done with quickly, or do you slowly phase in new processes and technology over time?
Should all physicians go on the system at once? Should you start all functions at once? Ideally, all physicians in one office should go on the EHR together. Otherwise, the office staff will need to run at least two different sets of processes for paper-based physicians vs. EHR physicians. Not only is that confusing, but it also is inefficient.
However, if your practice has more than one office, there is no overriding reason that all practices have to go on the EHR at one time. In fact, depending on your practice's resources, you might be wiser to roll out one office at a time.
A few practices have successfully implemented all functions of an EHR at once. This can be called "big bang." The consensus, however, is that success is more likely if you implement functions sequentially in what is known as "phased implementation." This is especially true in larger organizations where big bang implantations have, despite careful planning led to practice chaos where clerical staff, nurses, and providers’ work nearly ceased, resulting in substantial productivity losses and inability to retain training.
When applying the phased implementation approach, typically you start by introducing less interactive functions first, like scanning and result reviewing, and then move on to more interactive functions, like interoffice messaging, prescription writing and note documentation. A lot of variability exists in this area, partly perhaps due to variation in EHR software. With regard to specific phased implementation strategies, you should pay close attention to your EHR vendor's recommendations.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

12. Tips on a Successful Implementation
Train, evaluate and support your users throughout the implementation process. This is essential for optimizing user efficiency, effectiveness and system adoptability and for building user confidence.
Test your system thoroughly before and after the final roll-out, and resolve any issues, problems or bugs as quickly as possible.
Keys to a successful Implementation:
Train, evaluate and support your users throughout the implementation process. This is essential for optimizing user efficiency, effectiveness and system adoptability and for building user confidence.
Test your system thoroughly before and after the final roll-out, and resolve any issues, problems or bugs as quickly as possible.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

13. Tips on a Successful Implementation
Remember end users determine the success of your implementation. Support them from the beginning of implementation and throughout training and into post-implementation support.
Realize that implementing health IT is not the ultimate goal. The objective should be to maximize the efficiency, quality and effectiveness of your care delivery processes.
Support the implementation through proactive organizational policy. Facilitating user adoption through training and continued support can help you achieve optimum results.
Remember end users determine the success of your implementation. Support them from the beginning of implementation and throughout training and post-implementation support.
Realize that implementing health IT is not the ultimate goal. The objective should be to maximize the efficiency, quality and effectiveness of your care delivery processes.
Support the implementation through proactive organizational policy. Facilitating user adoption through training and continued support can help you achieve optimum results.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010

14. Closing the Gap: Post Implementation
Continued support and development is key to ongoing success.
Continue to solicit user feedback. Resolve issues promptly and consider improvement suggestions
Hold a Project review Meeting
Hold a Customer Acceptance Meeting
Just because the roll-out has been completed and your IT teams are beginning to settle into a normalized routine, the job is only beginning. Now your plan has officially entered the maintenance and update phase of the product lifecycle. There are some tasks you should do to close the gap:
Now is the time to run another baseline test to determine any shortfalls associated with increased system usage. Based on these new baseline projections, decide where do you stand for further growth. Are your system resources holding within projected margins?
Solicit user feedback as soon as you feel they have become acclimated to the system. Examine the feedback for common workflow and technical issues that need resolving. Continue to provide an avenue for users to submit feedback and suggestions for improvements.
Hold a project review meeting with all the key stakeholders and implementation players. Discuss what went smoothly and where things went wrong.
Lastly, hold a customer acceptance meeting with the vendor. Sometimes called a close out meting, use this opportunity to summarize your User Acceptance testing and finalize customer service agreements.
Component 8/Unit 11
Health IT Workforce Curriculum Version 1.0 Fall 2010