August 2014

10 Ways to Reduce Go-Live Stress
By Free Correa and Tamarah Alexander
For The Record
Vol. 26 No. 8 P. 8

New system installations take a considerable amount of time and effort to analyze, build, test, rebuild, train users on, and optimize. IT teams often work around the clock to implement seemingly impossible guidelines so organizations can meet meaningful use requirements and ensure appropriate documentation and successful billing.

When tackling 10 common challenges related to these installations, health care consultants should implement the following steps to ensure a successful and low-stress go-live:

1. Perform a functionality gap analysis. Early in the process, identify functionality gaps between the legacy and new systems. Demonstrate to users the functionality differences between the two systems.

2. Mitigate fear of the unknown. In general, people fear the unknown, especially when it comes to the prospect of some newfangled technology changing their workflow or sending them to the unemployment line. When a new EMR disrupts a practice’s smooth-running process, end users may feel threatened.

Additionally, workflow analysis may reveal flaws such as inconsistent processes or poor data governance. Therefore, it’s important for IT analysts to make staff members feel valuable and important during the interview processes. Take time to interview management and IT staff on site as much as possible.

Additional tips for easing staff anxiety include the following:

• Establish an initial meet and greet with IT staff, management, subject matter experts, and superusers to discuss high-level topics such as process owners, government structures, and dates and deadlines.

• Ensure that staff and management thoroughly and accurately complete and return all questionnaires prior to the initial meeting and provide specific deliverables that will impact the build.

• Determine whether IT trainers can observe staff and work processes.

• Set up meetings to discuss department-specific scheduling, registration, and billing workflows. Schedule follow-up meetings to validate the build.

• The IT build should reflect the health care organization’s needs, which should leave little to question during go-live.

3. Educate and train users. Weeks or months before go-live, end users often are sent to training sessions to learn about the new system. Many leave confused, frustrated, and worried about not knowing how to apply what they just learned. IT trainers must understand both the client’s legacy system and how the new EMR’s functions compare.

Additional training tips include the following:

• As much as possible, work elbow to elbow with IT staff, subject matter experts, and end users.

• It’s one thing to learn material in a classroom, but actually applying it is another matter. Therefore, set aside time for staff to experience workflow in a practice system and prepare demonstrations and learning labs.

4. Identify new workflows. The motivation for implementing a new EMR often stems from a desire to meet federal requirements such as meaningful use. Therefore, end users may not have been exposed to processes that address data collection. A new system will undoubtedly displace and replace workflows, leaving end users feeling disoriented. It’s important to identify these components during analysis and address them in training and during support. For example, an organization may decide not to customize fields and workflows for each department, resulting in surprises such as the following:

• asking for the patient’s employer in a pediatrics office;

• Medicare secondary payer questionnaire hard stops;

• collecting e-mail addresses for patient portals used by other practices in the organization; or

• gathering claim information for accidents and injuries during registration.

IT consultants must understand and identify areas that fall outside of an organization’s typical processes. Questionnaires and interviews can be used to delineate such information.

Nevertheless, workflow design may need to include unfamiliar or unnecessary processes, forcing staff to deal with foreign items.

5. Don’t get caught in analysis paralysis. While workflow details are important, build decisions are as well. Often, build becomes a hurry-up-and-wait game while workflows are being determined. Indecision can put the build on hold until IT teams ultimately have to make a mad dash to the finish line to meet deadlines. In some extreme situations, a build can be placed on hold until after go-live. Reduce the risk of falling behind by following these steps:

• Track the incomplete build items and document their impact.

• Weigh issues based on their impact. For example, will the problem produce patient and/or financial risk? Will it create end user or build needs?

• Determine whether the issue has a workaround.

• Share concerns with the project manager.

• Stay on top of undecided workflows and build.

• Include communication in the work plan, especially if deadlines and training dates have expired.

6. Thoroughly test security. Prior to implementation, it’s crucial to assess user workflows in terms of who does what and how these tasks are performed to ensure that security and access issues aren’t overlooked. Every layer of security must be thoroughly tested based on actual workflows. Also, end users, subject matter experts, and superusers must attend the testing sessions.

A firm organizational decision combined with guided governance should result in a meaningful structure describing security boundaries. Defining what’s permitted is as important as defining what’s not. Such a strategy ensures that staff members who perform the same duties have the same privileges without access to system components they don’t need.

IT and department management should understand the way security works in the EMR to make informed decisions.

7. Communicate. Far too often, end users are left in the dark when it comes to the changes involved with moving from a legacy system to a new install. The following are helpful hints to keep staff in the know:

• Use visuals such as screen shots and cheat sheets to provide staff with a proverbial security blanket.

• Title and draft any communication.

• Identify a documentation library, such as SharePoint, where tip sheets and information can be housed.

• Establish a communications committee to provide consistent updates.

Remember, communication doesn’t stop after the install. IT and other departments must have a clearly documented line of communication to work through issues and optimizations.

8. Don’t ignore reporting. The new EMR may have great reporting tools, but if no one knows how to use them, they have no value. Build in time to educate report writers and those who use the reports.

9. Document. Providing adequate documentation before, during, and after the install is vital to achieving a successful, less stressful implementation. During installation, there will be numerous meetings at various management levels where decisions will be rendered. Create an easily accessible trail to use as a reference tool that can be utilized when the situation warrants. For example, well-crafted documentation can help create an effective governance plan and policy and procedures for many workflow processes.

10. Conduct a day in the life. This concept, which is similar to script testing but with real-life workflows, gives staff an opportunity to experience firsthand what it will be like to work in the new system prior to go-live. It also provides an opportunity to spot problems and issues that may have been overlooked.

To get the most benefit from a dress rehearsal, create a spreadsheet with multiple workflow examples and walk through each scenario.

Every go-live is unique and every department is different, making it imperative for IT analysts, operational leadership, and trainers to understand the specifics of each department prior to an install. By following these 10 suggestions, health care consultants can turn an overwhelming task into a learning experience, and organizations will be on their way toward collecting data to improve performance and patient care.

— Free Correa is an Epic-certified senior health care consultant at Hayes Management Consulting, specializing in revenue cycle leadership and HIT from both operational and technical aspects.

— Tamarah Alexander is an Epic Cadence–certified senior health care consultant at Hayes Management Consulting with expertise in workflow design and analysis, implementations, and professional billing.