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EHR Go-Live Support: 5 Steps to Build a Proactive Strategy for Optimization

Posted by The HCI Group on July 23, 2015 at 11:26 AM

The HCI Group Go-Live OptimizationAfter the initial Go-Live phase is over, your project will move into the optimization phase. It might feel easy to let your foot off the gas and slow down, either on issue resolution, communication or a mix of the two, but this is typically not a successful approach. In this post, we look at 5 key elements to consider when planning a proactive strategy for optimization.

The communication between all departments and the project teams (with a focus on analytics and change management) should continue in order to facilitate both the efficient resolution of existing issues and also to add new pieces to the optimization strategy. If an issue can’t be addressed quickly, or at all, that must be explained to end users – failure to do so can damage the trust that’s so crucial to success. Even though your organization is live, the project truly never ends. This is important to remember – if you’re as serious and proactive to growing your EHR post-live as you are before you Go-Live, you’ll be in a great position to be a leader not only in your area, but in the industry as well.

Unfortunately, many organizations have assumed a reactive approach to optimization and struggle to support it while consecutively implementing new technologies. They spend vast amounts of time and expend great effort evaluating and prioritizing customer requests and complaints, only to be limited by lacking the resources and experienced personnel needed to resolve these issues. As a result, customers lose confidence in the IT department’s ability to meet their needs. This viral response carries through to subsequent initiatives, making it harder to achieve true adoption. In addition, lack of an effective methodology that shows measurable improvement impedes the ability to realize the value of both the immediate optimization efforts and the overall investment.

It is time to start realizing the potential of the EHR and impacting the health of the population, and it all starts with effective and efficient utilization. Putting a proactive strategy in place allows you better manage your staff, to improve customer satisfaction and earn the true value of EHR.

So, what does a proactive strategy for optimization look like?

1)   Optimization is a planned phase of every project. 

Rarely does an initiative produce the anticipated results on the first pass. Initial training often results in many end users learning how to “get by” in their day-to-day activities. Adoption occurs at a varying pace; therefore, it is important to have a plan in place to address the late adopters. At the same time, if optimization occurs too late, users will have already adopted new sub-optimal workflows, making it more difficult to achieve maximum proficiency. Adding an optimization phase to the project plan following implementation allows facilities to have the resources needed, monitor how they are utilizing the technology and intervene when behaviors can be most impacted.

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2)  Needs are identified before customers complain. 

Many end users who need additional support do not vocalize concerns. Feedback should be sought from a representative sample, not just from those voicing concerns. Users will actively engage if they know there is a dedicated team who anticipates and supports their needs and there is a culture of optimization.     

3)  Optimization is built into the IT roadmap. 

The need for optimization is ongoing and should not be considered a one-time event. Building it into the roadmap as a continuous project and reserving a cross-functional team will allow organizations to respond to new issues in a timely fashion, while implementing additional planned projects.     

4)  A methodology utilizing data is used. 

Data uncovers discoveries not apparent in periodic observations or subjective reports. Developing and reporting metrics shows the value of optimization efforts and helps support staffing for them moving forward. It also illustrates the overall value gained. A well-planned metrics strategy aligns and integrates with other organizational initiatives and goals.     

5)  There is a consistent method for prioritization.

It may not be possible to meet all of the requests of end users, so managing their expectations is equally important. An effective multidisciplinary governance committee driven by the end users will validate the high-priority needs and alleviate time spent analyzing low-value requests. High-priority items that require a major work effort should be balanced with low-hanging fruit. Once priorities are set, they should be communicated so that all staff are working toward a few common goals rather than working on multiple competing initiatives. 

Change Management Plan

Not all aspects of a project can be determined in advance. Consequently, changes to the project scope, schedule, budget, quality, requirements, and deliverables may need to be accommodated throughout the life of the project. The purpose of this plan is to establish and maintain a policy and approach to control project changes as they arise.


The objectives of the Change Management Plan are to:

  •          Establish project change standards, policies, and procedures.
  •          Effectively manage and coordinate all changes across EHR program.
  •          Monitor and influence impacts on program’s delivery dates and costs.
  •          Coordinate all work activities associated with change requests.
  •          Effectively manage the approved baseline dates and deliverables.
  •          Eliminate or reduce scope creep.

Change Management controls any additions, deletions, or modifications to the scope, cost, or the project schedule. Investigating a proposed change will allow the EHR Change Control Board (ECCB) to evaluate the effects of a change on budget dollars, schedule, and resources. All requests for change for review must be entered into a Change Request Management Tracking tool.

Approval Process

The steps and timing of the impact analysis for each normal CR is as follows:

  1. Once the status of a CR is promoted to “Approved for Analysis” by the ECCB it will proceed to the next process step below.
  2. Once all assessments have been completed, the Financial Office (FO) conducts its analysis to determine financial implications both to cost and revenue integrity.
  3. If the FMO does not approve a CR for any reason, the FO communicates directly with the Functional Area to which analysis it questions or objects to obtain the clarification the FO requires to complete successfully its impact analysis for that CR. Once the FO approves the CR, the FO flips the Ready for ECCB flag on that CR from “No” to “Yes”.

Ideally, a typical CR lifecycle is two weeks; however, a three-week lifecycle is also acceptable for average CRs.

Emergency Approvals

To process emergency CRs, Submitter will request CR approval from impacted Service Line Area Director . Guidelines must be in place to identify submissions that meet identified criteria to be considered “Emergency” i.e. Patient Safety, Financial/Revenue/Billing Integrity considerations, and Regulatory Requirements are most common.

Topics: EHR Implementation, Optimization & Adoption, Go-Live Support

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