1. Special Topics in Vendor- Specific Systems EHR Go-Live Strategies This material (Comp14_Unit8) 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 1U24OC000003.

2. EHR Go-Live Strategies Learning Objectives 2 By the end of this unit, learners will be able to: 1. Describe characteristics of training and go-live strategies that would facilitate implementation of a new Electronic Health Record (EHR) system 2. Compare the advantages and disadvantages of a big- bang roll-out versus a phased roll-out and vice-versa 3. Identify staffing, command center and on-site consultant considerations 4. Compare strategies for monitoring system usage and change management Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies

3. Big-Bang vs. Phased Roll-Out 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies All modules in selected locations All modules in all locations Typically used when replacing a legacy system Big-Bang Selected modules Selected locations Combinationof both Phased or incremental roll- out

4. Big-Bang 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies Pros: Short-term disruption No need for linking old and new Only one system to support Cons: Much higher risk to organization Requires comprehensive planning Mass training required

5. Phased Roll-Out 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies Pros: progressively adjust implementation strategy Focused planningDisruptions are isolated Smaller groups of users affected Cons: Need to maintain two systems Risk of stagnation Need to correlate information from both systems

6. Staffing Greatly dependent on: –Product being implemented –Location, e.g. hospital or physician office –Implementation performed by vendor or consultants –Big-bang vs. phased roll-out –Hosted locally or remotely –Temporary staffing or permanent staffing 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies

7. Physician Champion Project Director Project Manager Enterprise Master Patient Index Cleanup Application Coordinator RN Application Coordinator MD Application Coordinator analysts Health Information Management Director Reporting Applications Coordinator Reports/Designer/Analyst Database Extract and Load Administrator 3rd Party Reporting Tool Administrator Programmer/Analyst Hardware/OS support Storage Support Enterprise Data Backup support Network Support Security Coordinator Workstation Management Workstation/Printer Systems Support Database administrator Principal Trainer Supplemental trainers Go live support Helpdesk support Risk Manager Chief Privacy Officer Staffing Example EHR implementation team: 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies

8. Command Center Special location during implementation –Typically setup in a big-bang rollout –All project communications go through this center –Usually serves as project help desk and receives all user calls –Field staff meet at center at least 2 times per day –Project executives meet at center each day 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies

9. On-site Consultants 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies EHR Selection EHR Implementation Meaningful Use EHR VendorsIT ConsultingEHR Review EHR Training EHR Certification

10. Monitoring System Usage System performance monitoring Application usage monitoring Documents created Orders written Orders completed Prescriptions written Monitor calls to Help Desk System issues Application questions 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies

11. Change Management 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies Typically, organizations undertake organization-wide change to evolve to a different level in their life cycle e.g., going from a highly reactive, entrepreneurial organization to more stable and planned development http://www.managementhelp.org/mgmnt/orgchnge.htm Organizational Change Typically refers to IT systems or other process changes in an organization This is the context that we will use in the following slides. System Change

12. System Change Management 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies Typically instituted after go-live A structured approach to transitioning individuals, teams, & organizations from a current state to a desired future state The process during which the changes of a system are implemented in a controlled manner by following a pre-defined framework/model with, to some extent, reasonable modifications http://en.wikipedia.org/wiki/Change_management Definition:

13. System Change Management (cont.) 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies A formal process used to ensure that changes to a product or system are introduced in a controlled & coordinated manner Reduces the possibility that unnecessary changes will be introduced to a system without forethought, introducing faults into the system or undoing changes made by other users of software Goals of a change control procedure usually include minimal disruption to services, reduction in back-out activities, and cost-effective utilization of resources involved in implementing change http://en.wikipedia.org/wiki/Change_Control Change Control

14. System Change Management: Set of 6 Steps 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies 6. Close / Gain Acceptance 5. Implement 4. Build / Test 3. Plan 2. Assess 1. Record / Classify

15. EHR Go-Live Strategies Summary We have covered a few of the most important go-live strategies Reviewed staffing, command centers, use of consultants and change management These are just a few of the very important aspects of go-live strategies that have to be considered during implementation 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies

16. EHR Go-Live Strategies References References: 1.McNamara, C. (n.d.). Organizational Change and Development (Managing Change and Change Management). Free Management Library. Retrieved from http://www.managementhelp.org/mgmnt/orgchnge.htmhttp://www.managementhelp.org/mgmnt/orgchnge.htm 2.Wikipedia. (2011). Change management. Retrieved from http://en.wikipedia.org/wiki/Change_managementhttp://en.wikipedia.org/wiki/Change_management 3.Wikipedia. (2011). Change control. Retrieved from http://en.wikipedia.org/wiki/Change_controlhttp://en.wikipedia.org/wiki/Change_control 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Special Topics in Vendor- Specific Systems EHR Go-Live Strategies