HMT Think Tank
Software conversions: Who's on first?
By Rick Dana Barlow, Editor-at-large, August 2014
So what's the first step healthcare information technology professionals must take when they embark on a software conversion effort? A group of provider and supplier IT executives share their perspectives with Health Management Technology.
Director, Data Management
& Business Intelligence, CHRISTUS Health
Zimmerman: The first step for the IT professional is to learn the basics about the project: who, what, when and why. The IT professional must know who is making the request, who is impacted, who are the resources involved, who are the sponsors and who are the detractors. They must also know what systems are impacted and what the scope of the project is. They also need to know the expected time frame when the new system will be stood up so they know how to appropriate resources.
Finally, they must know why the software conversion is necessary. Is it because existing software is outdated? Is it a regulatory issue that is requiring the change? Perhaps it is a strategic realignment that creates synergies that otherwise wouldn't exist. These things are very important to know, not only for understanding the potential risks and rewards but also to help with the "story" told to stakeholders and executive sponsors that will help establish high-level buy-in and secure needed resources in the future.
Erich Schatzlein, Senior Practice Consultant, Massachusetts eHealth Collaborative (MAeHC)
Schatzlein: Information technology professionals should establish a clear understanding of the desire for an EHR vendor change and list the specific reasons why a change is being investigated. Defining the reasons for change will allow IT professionals to examine and measure the potential benefits of a vendor change, while making research more targeted and meaningful. Failure to clearly define the specific "pain points" of the existing software system can potentially lead IT professionals to become sidetracked by the superficial appeal of a new EHR and lose focus of the primary objective(s) while getting caught up.
Ashley Wagner, DC, CACCP, A L Wagner Family Chiropractic, Synergy Health Group
Wagner: Regardless of the department (IT, accounting, providers, etc.), I believe every person who will be involved in the conversion should watch any introduction/training videos provided by the new software vendor, as they are the experts who know the software inside and out.
Regional Vice President, Professional Services, Orion Health
Maennling: As with any IT project, it is important to understand the rationale for moving from a current to future state, taking into consideration the improvement advantages of the change and the business drivers that motivate it. Assuming this is well defined and understood, and the business and IT operations fully support the change, the next steps for IT professionals are:
- Identify the changes, gaps and their impacts, asking questions
- Do we have the right skills to support and maintain the new software package? What training do we need?
- Do we know well the features of the new software? Do they address all the processes we have? Are there any gaps? Do we need to plan for compensatory adjustments if a process is not supported? Are any features not relevant to our business? Are there any dependencies on third-party software or hardware?
- How does the change impact our operations and processes? What changes are needed?
- How does the change impact end users? What training do they need? What else do we need to do to support end users?
- Engage user groups and business owners as appropriate in these reviews and ensure the organization overall understands the change and the organizational impacts.
- Engage the vendor and understand how gaps could be addressed.
- Understand the need for access to data in legacy systems, and discuss with business owners and vendors any requirements for making that data accessible (either through data migration, portal views or read-only access to legacy systems).
- Ensure you create a plan for the conversion prior to getting started. Ensure you include in your plan change-management processes and that you engage the appropriate business stakeholders to support the organizational change.
Vice President, Professional Services N.A., BridgeHead Software
Giangregorio: Proper communication of the objectives, the benefits and the timelines. There are countless examples of software conversion projects that are performed in IT vacuums or only those that need to know. The more you engage your community of users (and users can include those that don't actively interact with the software, but just benefit from it), you build acceptance and start to alleviate the fear of change early in the process, so the community has time to react and understand what will change.
Jennings, Director, Implementation Services, Capsule Tech
Jennings: IT professionals should first make sure they understand all of the touchpoints of the system being converted – all of the interfaces that are dependent upon that system. Start with an architectural diagram so you can see the full footprint of what could be impacted by the system you're converting.
For integrating medical devices, this can be complex because data is flowing in from a wide range of devices hospital-wide. Medical device integration (MDI) implementations are often first-time installations rather than replacements. However, if it is a replacement or expansion project, a large number of additional devices could be added. In either case, the number of devices being connected to an information system can be large, and you should not underestimate the time required to understand and coordinate all this.
Client Services Executive,
CTG Health Solutions
Anderson: A software conversion of any size, complexity and duration takes careful planning, coordination and consideration to determine the overall goals. Will it improve performance? Increase revenue? Decrease wait times? Increase customer and end-user satisfaction? Developing detailed key performance indicators (KPIs) identified as part of the strategic planning and project charter process can assist not only in selecting the right vendor, but also in managing the overall project, especially scope creep that is all too prevalent in the majority of system conversions today. Rating a request against the approved project goals and KPIs can assist in managing those 23rd-hour requests.
Christine Morgan, Executive
Vice President, Professional Services, e-MDs
Morgan: The first step IT professionals must take when they embark on a software conversion is to thoroughly discuss and review what the providers and office staff require from their EHR software. This involves looking at workflows as well as features and functionality. They should also recruit some internal champions for the cause and get them involved in the decision making, purchase and planning. This will help ensure adoption of the EHR into the everyday workflow of the practice.
Next, they should review the hardware, software, licensing and network requirements and determine the initial cost as well as what it will take to maintain that standard. They will also want to inquire about the type of database the HHR software uses and what it will take to maintain and secure it.
Healthcare Strategist, Infor
Rydbeck: Early this summer, I met with the CIO and his direct reports at a regional hospital system in Ohio. Something excited several team members: The CIO paused the conversation to say, "Write it down, we need to understand if this is a challenge for our customers." I meet weekly with CIOs at hospitals throughout North and South America, and rest assured, I don't often hear CIOs speak of the greater organization as "customers."
My encouragement is to first and foremost recognize who the true customer is. It can be easy for IT teams to feel like customers themselves with the many vendors catering to them. The reality is that IT is serving a customer themselves, and those customer needs are the priority.
Tom Giannulli, M.D., M.S., CMIO, Kareo
Giannulli: Pick a new system that has the capability for data migration. Identify what data is valuable to the practice and needs to be migrated, then decide on the data that is considered "nice to have." This will help focus your resources on the essential data for the data conversion process. Be aware that with respect to data migration, "It takes two to tango," thus the legacy system must export data in a structure that can be parsed by the new system or via a third-party conversion tool. Bad data out means bad data or no data in.
Vice President, Viztek
Deaton: IT professionals need to first identify the needs of the new software product. It is important to understand the needs of the incoming solution, to identify what infrastructure components will need to change from the historical deployment. Many items may need to be changed, both with regards to workflow and IT. One example is the elimination of VPN requirements when transitioning from a client-server deployment to a Web-based deployment.
Vice President, Stoltenberg Consulting
Pilcher: The first step that needs to be taken is a thorough assessment of the organization's current state. This current state covers the application that is being converted and how the end users interact with that system. It also covers a complete assessment of process flows. Over time, end users change their day-to-day process flows due to many reasons. Some changes are in response to limitations within the software application. Other changes just occur over time as bad habits form or corners are cut. Prior to implementing any new software, you must make sure that your process flows are effective and efficient. Only then should you start wrapping new technology around them. Wrapping new technology around old and inefficient process flows will only exacerbate the inefficiencies.
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