Your EHR Go-Live should be the culmination of months of research, evaluation and planning by a multidisciplinary team comprised of a cross representation of business, clinical and provider management and end-user representatives. But sheer effort alone does not ensure success.
The lack of a comprehensive and coordinated approach to preparing for Go-Live such as above could result in negative satisfaction, adoption and sustainment—as well as perhaps harmful financial outcomes. You do not need to be in the industry long to know that hospitals sometimes experience revenue challenges soon after implementing EHR systems. See Revenue Cycle Series here. In this article we look at EHR readiness through the prism of two key questions.
1) How many users will you have? And where will they be?
Accurately assessing the number of users you will have and their accessibility to at-the-elbow support during Go-Live is vital in determining the outcome of your overall plan.
Identify your needs based on ratios and models that are compatible with vendor standards. Design a justifiable support ratio for every site across your organization by walking it, recording volumes and staffing levels by modality.
For example, the vendor-recommended support ratio may call for four support professionals to cover a department with 12 users. But you may need five professionals if those users are dispersed across a sprawling space, thus making it difficult for your at-the-elbow support resources to stay close to each user.
Or, you may know that you have 100 employees in your radiology department. But did you account for the fact that you are adding 30 users spread across 10 rooms?
Similarly, your IT leadership may not know that part of another department is undergoing construction, and that you will have 25 rooms for it at Go-Live instead of 15 rooms as you do now. Uncovering small departments hidden inside a clinic or identifying needs for staff who require limited support can be large contributors to your Go-Live's success.
2) How proficient are your users?
Numbers alone do not account for how adept your users are at learning new technologies. Identify what internal resources you currently have trained and committed to work in each department. Know what classes your resources have taken to identify exactly where your support gaps exist by department.
Your initial assessment may be that you need three support professionals for a department with nine users, based purely on recommended support ratios. However, if most of the department’s members are experienced technology users then you may be able to reduce their support team to two professionals.
If you can trim the department’s support team, you could assign one of the previously allocated at-the-elbow resources to a unit that could use additional help. You could also pocket the savings of reducing your support team without compromising training. Or, you could maintain the original support team of three at-the-elbow resources, allowing them to collectively give more time to users who are not as adept with technology.
When formulating your response to these key questions, focus on data elements, recording facts as they are, not as you wish they would be, and apply the following principles.
- Consider the "facts." Compile numbers objectively, without accounting for how they may affect your budget or whether they will please upper management. Or, demand that your Go-Live consultants do so. You can inform leadership of the need as you perceive it based on your analysis, but it is ultimately up to them to determine the size of the support team.
- Budget conservatively. Some hospitals have disbursed practically unlimited budgets so that their team does not lack for assistance at Go-Live, perhaps hoping to overwhelm physicians in particular so that they do not complain. Other facilities have literally not provided any budget at all, essentially leaving clinicians and non-clinicians to learn among the challenges that inevitably arise during Go-Live, like printer issues. Optimally, you should fall in between, by providing enough support professionals to speed adoption and accelerate learning—without blowing out your budget.
- Be inclusive. Do not rely on any one party to set your staffing levels. Include your internal team, EHR vendor and any other third-party participants in your planning to ensure that you account for all perspectives. Your vendors know their products, your consultants bring best practices and your internal team knows the inner workings of your organization. Together, they can provide the most complete picture and comprehensive solution.
Adequate support at Go-Live lowers operational risks, improves patient care and increases physician buy-in (end-user adoption). Build your activation support schedule-—down to the specific names, dates and staff who will be working throughout your activation—so that you know exactly where gaps exist in every unit.
The outcomes will justify the expense by allowing you to properly budget and plan for your activation and implementation. If your C-Suite is keen on risk mitigation, they are more likely to commit to hiring more external resources if you demonstrate that adequate at-the-elbow support will increase end-user adoption and facilitate learning. Then you could build a comprehensive staffing and support schedule based around your internal super users and credentialed trainers.
Properly assessing your readiness for Go-Live from the onset will help make your eventual Go-Live successful, thus ensuring that your hard work does indeed pay off.
Related EHR Go-Live Posts:
- Big Bang EHR Go-Lives: ‘Best’ Practices to Avoid
- EHR Activations - Achieving End User Buy-In
- Physician Adoption and Satisfaction Before & During Go-Live | A CMIO Perspective
- At the Elbow Support – Go-Live Lessons from the Hospital Frontlines