Giangregorio: These key tenets serve any project well and help to eliminate frustration, unplanned costs and additional expenses in the future that could have been addressed now:
- Communicate effectively. Don't hoard information. Share it. Explain what will change.
- Plan for a proper amount of testing, and think about the edge cases. They will burn you more than the obvious ones.
- Assemble a team that understands their obligations and how their responsibilities impact the project as a whole. Make sure they are bought into the overall project's success.
- Don't forget about soft costs. They add up quickly and are often as important as the hard costs.
- Consider how your decisions today will impact future ability to upgrade or replace the system you are now moving towards. You don't want to lock yourself in now and find it very difficult to move or change in the future. Additionally, consider what might be good decisions today, might also save you significant long-term expenses.
- A comprehensive plan is absolutely essential – make sure you have a complete conversion plan going forward and backward – and work closely with your vendor who should be able to draw on successful use cases to help.
- Perform a dry run – each step will offer lessons learned that will help the actual conversion go that much more smoothly.
- Always complete and validate a backup before beginning.
- Be clear on staff availability and commitment. Know all essential contact numbers, and make sure all team members know their roles and responsibilities.
- Communication, as in many situations, is key in a software conversion. Many hospitals set up a bridge line so team members on standby can dial in to be informed of the progress.
- Ensure executives fully support the conversion.
- Ensure you have the right team to carry out the conversion.
- Ensure business owners and their staff are committed to dedicating enough time to the conversion to make it successful.
- Ensure you reengineer processes to use the software as it is designed.
- Be sure to keep the scope of the project narrow enough to deliver what is required and minimize scope creep.
- While a process may be arduous to develop, embrace the charter TCO and ROI process. Having the framework designed early around how the project's success will be demonstrated will give executives peace of mind that it is being managed appropriately.
- Understand who are your stakeholders and the need for communication. Keep in mind people's individual perceptions are different. Therefore, develop a communication and change-management strategy that allows for messages to be delivered via different methods. Research indicates folks need to hear things multiple times before they “hear it,” so tailor messages to particular audiences to truly elicit the “what's in it for me” message.
- Outmoded information documented in the paper record or other source doesn't necessarily mean it should be part of the designated new record set. Determine its clinical value first on and before decisions are made concerning the quantity of information to convert. For example, does an entire medical record need to be scanned into a patient's electronic medical record as part of the conversion? Chances are that six-year-old urgent care visit's dictated note won't support a clinical decision next year; however, there are other examples where information may need to be abstracted. Engage your physician champions in developing an abstraction policy to avoid conflict at go live.
- Don't skimp on training. An unexplained phenomenon occurs during a system conversion where staff forget basics such as how to answer the phone. In attending many training classes and many go lives, staff unfailingly question, “What did you do before?” Training should be workflow based so end users can compare their work pre and post conversion. This starts in the classroom, and having adequate shoulder-to-shoulder support at go live will help make those first few days manageable.
- Communicate, communicate, communicate. Expect issues at go live as well as huge accomplishments, and communicate openly about both. Users will respect the project more if challenges are addressed proactively supported by explanations. Not everything that happens at go live is the result of the conversion. If given no clear communication, end users' tendency will be to blame the new EHR, when in reality the two are not connected.
Ashley Wagner, DC, CACCP, A L Wagner Family Chiropractic, Synergy Health Group
- Do your research and make sure you choose a software that works well for your needs.
- Complete the recommended training/implementation period.
- Make sure to budget properly for the expenses involved with the transition.
- Be sure to train all members of the staff who will have anything to do with the software.
- Use the help website, online chat, as well as the phone support. These people are experts, so don't waste hours trying to figure something out that you could get an answer to in minutes!
- Understand the value and the stakeholders.
- Get buy-in from all the stakeholders.
- Design and invest in the bigger solution – usability, flexible loose integration coupling.
- Break it up – try not to do a big bang, instead look for incremental paths (possibly longer) that will get you there.
- Recognize early wins – this will help everyone see progress and value early in the game.
Tom Giannulli, M.D., M.S., CMIO, Kareo
- Understand and pretest data conversion capabilities and costs.
- Spreadsheet all operations related to the new system, including infrastructure upgrades, cloud/data storage fees, conversion costs, training costs.
- Reduce clinic hours for the two weeks around go live.
- Secure all mobile devices.
- Have a back-up plan that is paper based or low tech.
- Set realistic timelines. Implementation timelines are often aligned with other organizational goals, objectives or needs. While it is important to incorporate other organizational activities into timelines, this should not be the sole driver to a go-live date. Allow enough time to complete the conversion, workflow assessments and staff training to ensure a smooth transition.
- Migrate as little data as possible. Data conversions are never one to one, and the process can cause more pain than gain. Understand what data
will map to structured, reportable fields and assess if information can be put in by staff through manual chart abstraction.
- Manage the vendor. Hire a consulting team with vendor and conversion experience to assist with the implementation process and help set realistic expectations. The vendor can often promise functionality in a demo that does not truly exist in the system today. The organization and consulting team should ensure the vendor delivers for agreed-upon timelines. When there is any slip in the project plan, escalate issues immediately, clearly explain the expectations for performance, and document requests and responses. Good communication and a positive working relationship with the chosen vendor is extremely important.
- Understand this is not the same system. Implementation staff will often use phrases such as, “My old system does it this way” or “My old system can do that, why can't the new one?” There will be many differences in the systems, such as functionalities that are available and workflows needed to document in the EMR. The practice should be aware they are not trying to recreate their old system, rather work to make the new system as functional as possible for the end user.
- Manage the gossip. Project leadership and IT professionals should maintain a positive outlook and project this outlook to other staff, clinicians and end users. Change is difficult and can cause a lot of anxiety, causing negativity to spread quickly through an organization. Not everyone will be happy with the choice to change EMRs or the vendor selected. By mitigating the spread of any negativity about the system, you can ensure end users are not tainted about the project or new system before even touching the system.
Erich Schatzlein, Senior Practice Consultant, Massachusetts eHealth Collaborative (MAeHC)
- Don't rush the conversion. The project is a significant investment in the future of the organization, and ample time and funds should be allocated. If barriers or issues are experienced at any time during the project phases, don't be afraid to delay the project if necessary. Rushing through obstacles to meet a timeline does not always translate into effective and efficient implementation.
- Allocate additional time and resources after the go live on the new system. Far too often, organizations assume that workflow and production will return to the previous state of “normal” after only a few weeks. Although preparation and configuration of the new system before the go-live date is crucial for ensuring timely integration, full adoption and anticipated benefits of a new system will take more time to be realized. Organizations should continue to have on-site support available with software experts and “super users” for many months following the conversion.
- Engage a third-party consulting organization with vendor experience. Having an outside party involved in a software conversion will provide the huge benefit of knowing the experience of other organizations with the same vendor. A consultant can provide insight into issues that are common with a particular software product or vendor during conversion, and can help the organization stay mindful of the ultimate goals and timelines.
- Identify and leverage strong project leads. Each software conversion will have a high-level project director or directors. However, with so many moving parts and separate working groups, the project director should have a team of managers that oversee and track the many operations during the conversion. Not only will the extra managers alleviate some of the workload from the project director(s), but it allows more individuals to gain important experience with the new software from the initial phases. More people with experience at the beginning of the project will produce a greater depth of knowledge during the go-live and support phases.
- Keep vendor communications clear and documented at all times. A conversion project, like any other major undertaking, will have a multitude of risk areas that can impact the ultimate success of the project. At the beginning of the project, all parties involved should agree to a communication plan that includes documenting all correspondence and meetings. Documentation provides a clear historical representation of project events and can be critical in solving areas of disagreement between parties. Unfortunately, if the conversion project runs into an impasse such as a failure to meet expectations or promises by a vendor or a major staff turnover during the project, documentation of events can be relied upon heavily to resolve disputes or bring new members up to speed on the project.
- Spend time on requirements and make sure they satisfy all stakeholders, drop legacy workflows and retire obsolete data.
- Get your finance, change-management and legal teams involved early. Ensure stakeholders are notified early about upcoming changes; review and finalize all agreements, policies and contracts well in advance of go live; and, above all, make sure everyone who uses the new system has proper training, support and mentorship.
- Don't ruin end-users' experience with new software by asking them to use old hardware or obsolete browsers to access your solution. The total cost of ownership must include the proper desktop IT enablement, otherwise users will not enjoy the benefits and efficiency of the new system and satisfaction will suffer.
- Do your due diligence, and do not be satisfied just with vendor information. Talk to peers, and experience the software prior to any decision.
- Secure appropriate support from executives, clinical champions and other business stakeholders to carry out the change; vendors to resolve technical issues and support the IT operations; and users to drive better adoption and use.
- Plan more time than you think for the rollout.
- Invest in your staff, financially and with extra training, beyond what you initially expect. Remember that salespersons will want to show a good price, but you need trained people.
- Identify changes required for IT, and don't be afraid to include an outside consultant. Their experiences elsewhere will benefit everyone.
- Step through all items to be converted. Make sure you understand every piece of data that is capable of being moved. Migration is too broad of a term.
- Look for flexible vendors, because even after you extensively audit the conversion process, new items will pop up that weren't noted during the sales cycle. You need a vendor who is willing to be flexible and help you overcome these surprises.