1. SYSTEM IMPLEMENTATION AND SUPPORT Lecture 6

2. System Development Life Cycle (SDLC) Diagram

3. Do Not Underestimate User Resistance During the implementation process it is important to analyze current workflow and make appropriate changes as needed. With CPOE, physicians are now doing things that were not asked of them before—they are checking for drug interactions, responding to reminders and alerts, evaluating whether evidence-based clinical guidelines apply to the patient, again the list goes on. All these activities take time, but in the long run they will improve the quality of patient care. Therefore it is important for physicians to be actively involved in designing the process and in seeing its value to the patient care process.

4. Do Not Underestimate User Resistance Getting physicians, nurses, and other clinicians to accept and use clinical information systems such as CPOE or EMR can be challenging even when they are involved in the implementation. At times the incentives for using the system may not be aligned with their individual needs and goals. Physician resistance: if the physician is expected to see a certain number of patients per day and is evaluated on patient load and if writing orders used to take thirty minutes a day with the old system and now takes sixty to ninety minutes with the new CPOE system, the physician can either see fewer patients or work more hours. if the physician’s performance and income is related to adherence to clinical practice guidelines, using the CPOE system might improve his or her income, creating a greater chance of acceptance.

5. Do Not Underestimate User Resistance Key staff in participating hospitals recommended starting with a strong commitment to CPOE, delivering a consistent message that CPOE is the right thing to do, and working within the culture of the medical staff toward the goal of universal adoption. This goal might take years to achieve. Readiness for universal adoption occurred when 1. A significant number of physician CPOE adopters showed their peers what was possible. 2. Sufficient progress was made toward achieving patient safety objectives. 3. The medical staff came together with one voice to champion CPOE as the right thing to do.

6. Do Not Underestimate User Resistance Experience has shown that a mandate should not be imposed until the organization has achieved a certain level of system use and medical staff overall have confidence in the system’s functionality and have bought into the system. However, that point in time should be clearly communicated, all efforts should be made to ensure users are trained and ready to make the change, and backup procedures should be in place when the day arrives. System champions, when they are also physicians, can be extremely helpful in preparing for the day of universal adoption. User acceptance occurs when users see or realize the value the health care information system brings to their work and the patients they serve. This value takes different forms. Some people may realize increased efficiency, less stress, greater organization, and improved quality of information, whereas others may find that the system enables them to provide better care, avoid medical mistakes, and make better decisions.

7. Tactics used for inducing or encouraging physician adoption 1. Providing one-on-one training anywhere and anytime. 2. Making it easy to establish remote access from home and office. 3. Assigning high priority to enhancements that benefited ease of order completion. 4. Empowering nurses to serve as super-users and to encourage physician direct entry. 5. Investing in order sets and helping physicians build a personal favorites list and removing all paper order sheets from the floor.

8. Allocate Sufficient Resources Sufficient resources are needed both during and after the new system has been implemented. Individuals want to know that the system works properly, is stable, and is secure and that someone is available to help them when they have questions, problems, or concerns. At a minimum, adequate technical staff expertise should be available as well as sufficient IT infrastructure. Some methods of supporting the team are to make available release time, additional staff, and development funds.

9. Allocate Sufficient Resources Senior managers might allocate travel funds so team members can view the system in use in other facilities. They might decide that all implementation team members or super-users will receive 50 percent release time for the next six months to devote to the project. It is critical to achieving the organization’s strategic goals.

10. Allocate Sufficient Resources 1. Devoting a significant portion of an employee’s time to training so that he or she may assume a support role. 2. Partnering with a neighboring organization that uses the same system to share technical support staff. 3. Contracting with a local computer firm to provide the needed assistance. 4. The vendor may be able to assist the organization in identifying and securing local technical support.

11. Allocate Sufficient Resources In addition to arranging for local technical support, the organization will also need to invest resources in building and maintaining a reliable, secure IT infrastructure (servers, operating systems, and networks) to support the information system, particularly if it is a mission-critical system. Health care professionals rely on having access to timely, accurate, and complete information in caring for their patents. An IT infrastructure’s lifetime may be relatively short. It is reasonable to expect that within three to ten years, the hardware, software, and network will likely need to be replaced as advances are made in technology, the organization’s goals and needs change, and the health care environment changes.

12. Provide Adequate Training Having a training program suited to the needs of the various user groups is very important during the implementation process. People who will use the system should be relatively comfortable with it, have had ample opportunities to use it in a safe environment, and know where to turn should they have questions or need additional assistance. It is equally important to provide ongoing training months and even years after the system has been implemented.

13. SYSTEM SUPPORT AND EVALUATION Information systems evolve as an organization continues to grow and change. No matter how well the system was designed and tested, errors and problems will be detected and changes will need to be made. IT staff assume a major role in maintaining and supporting the information systems in the health care organization. When errors or problems are detected, IT staff correct the problem or work with the vendor to see that the problem is fixed.

14. SYSTEM SUPPORT AND EVALUATION Moreover, the vendor may detect glitches and develop upgrades or patches that will need to be installed. Many opportunities for enhancing and improving the system’s performance and functionality will occur well after the go-live date. The organization will want to ensure that the system is adequately maintained, supported, and further developed over time.

15. SYSTEM SUPPORT AND EVALUATION Like any other device, information systems have a life cycle and eventually need to be replaced. Health care organizations typically go through a process whereby they plan, design, implement, and evaluate their health care information systems. Evaluating or accessing the value of the health care information system is increasingly important. Evaluations must be viewed as an integral component of every major health information system project and not an afterthought.

16. References “Health Care Information Systems: A Practical Approach for Health Care Management” By Karen A. Wager, Frances W. Lee, John P. Glaser “Information Systems and Healthcare Enterprises” By Roy Rada

17. End of Lecture 6