By Dan O’Connor, vice president of client relations, Stoltenberg Consulting
Only 29 percent of today’s hospitals have fully staffed IT departments even though EHR optimizations or new implementations remain the second-highest priority for these organizations for the next 12 months, according to the latest HIMSS leadership survey.
Considering that more than 80 percent of healthcare leaders expressed difficulty finding qualified healthcare IT staff and support, making high-priority EHR projects come to fruition may pose a challenge. However, even short-staffed organizations of all sizes can experience EHR implementation and go-live success with the right planning, stakeholder involvement and third-party support. Here are four best practices to follow:
1. Explore different go-live strategies
The go-live approach is a crucial decision that needs to come from a project steering committee comprised of cross-disciplinary stakeholders who determine the project scope. When deciding the go-live approach, it’s not one size fits all. Your route should be based on your organization, its culture and any external pressures. Study what implementation rollout path your selected EHR typically follows and its resource constraints, such as staffing, cost and risk for your organization and the vendor.
Across the industry in the past, small to medium-sized providers with one to two facilities typically followed a big-bang approach where the entire organization would switch to the new EHR at the same time. Large, more complex organizations tended to adopt a phased approach, which carries a higher cost, but lower risk for the organization.
In recent years, however, a hybrid big-bang approach has emerged due to staffing constraints as well as industry pressures with value-based care. A hybrid approach uses big bang at one or a subset of facilities, which is then rolled out across the remainder of the organization within a three-month span. This approach allows short-staffed organizations to conserve IT resources while still aggressively moving forward with the implementation.
2. Start go-live planning early
Planning ahead sounds pretty straightforward, yet many project teams don’t start go-live planning until much too late into the project. If the go-live is botched, the whole implementation project, including optimization work, can be perceived as a failure, draining cross-organizational buy-in for IT initiatives in the future.
Instead, go-live planning should commence during the planning and developmental stages of an implementation, as soon as the IT team decides to move forward with either a phased, big-bang or hybrid approach.
Once an approach is decided, organizations can make the go-live a more tangible event by selecting a location for the go-live command center. Reserve this space early, keeping in mind that it is better to have too much space than not enough.
Prior to go-live, develop a progress-reporting strategy early on in the process, outlining necessary reports and specific dashboards with benchmarks to measure improvements and address deficiencies. This type of documentation ensures that even short-staffed organizations will be able to stay on track and not lose sight of the progress between numerous other IT projects and duties.
3. Select a team of dedicated experts
Select a realistic go-live team early on, consisting of staff who can commit to the significant event, meet regularly, provide detailed reporting, handle implementation pressure and effectively communicate with end users. In a short-staffed environment, this may be a challenge, but early planning and goal-setting should help meetings and project steps move more efficiently.
The team is nothing without a leader, so make sure the project manager understands organizational culture with the ability to effectively motivate, lead and proactively address project obstacles, such as lack of IT support.
Beyond the designated go-live team, Subject Matter Expert (SME) super users are the foundation for effective transition and organizational support. Organizations should identify and utilize SMEs not only for traditional super user roles such as training and go-live support, but also key decision making, including financial and administrative staff as well as clinicians. Engaging such expertise gives respective areas a stake in the success of the project, encouraging buy-in throughout the process.
In coordination with the SME group and go-live team, plan a two- to three-hour team building session to design a visual support map covering all facilities, applications and tools impacted by the go-live.
4. Staffing support gaps
Visual mapping will help identify staffing gaps to proactively anticipate go-live event issues. From here, your organization can create plans to minimize those gaps. For example, offer incentives for internal staff to help with the go-live event. Look to local sources for potential help, such as area colleges. Depending on the project, utilize students in IT, healthcare administration, education, nursing or healthcare-related programs to creatively source staffing.
Also consider supplementing with third-party consultants who can share industry best practices, project key performance metrics and expertise. When working with such a partner, obtain multiple bids and check references. Insist on an on-site coordinator that will work through onboarding and logistics as a single point of contact for issues. The on-site coordinator needs to be a good fit, so interviews are necessary to gauge how he or she aligns with your organizational structure and to set measureable expectations.
An EHR implementation extends beyond the go-live event with continuous optimization focused on end-user ease of use, customization and improved workflow. In a short-staffed environment, however, optimizations need to be done strategically to minimize the amount of time required from IT staff. Here again is where outside expertise can work proactively toward reimbursement program measures and industry certification mandates to maximize long-term clinical quality and organizational efficiency.