What are some "go-live" strategies providers might utilize?
While examples of previous implementations illustrate that benefits can be achieved through the use of EHRs, significant effort went into the implementation of these systems. The term "go-live" strategy refers to the process of implementing and fully integrating the EHR system into the practice. These strategies can vary from an incremental approach that occurs in phases or a "big bang" approach that entails a quick implementation of all the functions and components of the EHR at once. The "go-live" strategy may also include a decision whether or not to phase different users into the EHR system at different times or to introduce all users at the time of initial implementation. These decisions will depend on the resources of the practice, the ability to handle different types of implementations, and the need for different functions at specific phases of the implementation. In pediatrics in particular, it is critical that implementers ensure that pediatric content is loaded and tested. For example, providers should check that pediatric functionalities, such as weight-based dosing, are functional and accurate before the EHR is used with patients. Pediatric providers can also customize the EHR to fit their routines and needs, as was the case at Children's Hospital in Pittsburgh.
In all go-live approaches, careful planning is essential for sustained success of the EHR. According to the Washington Health Information Collaborative, some planning procedures identified include establishing an implementation team; finalizing needs, goals, and priorities for the EHR (including identification of the necessary functionalities); establishing the scope of and strategy for implementation; developing the implementation timeline; communicating effectively internally, with patients, and with the vendor; and developing benchmarks to measure success. It is also important to establish plans for resolution of issues that may arise and ensuring that technical support will be available.
When deciding which strategy would be best for a particular practice, the "go-live" strategies applied in the implementation of previous EHRs can serve as models and guidelines of how other pediatricians can also successfully implement EHRs into their practices. These experiences highlight the lessons to be learned from an EHR implementation, namely that great benefits can be achieved from successful EHR implementations involving careful and conscientious planning. Successful implementation of an EHR into a pediatric practice requires planning that includes the development of a "go-live" strategy. Useful tools to refer to develop this strategy include both the past experiences of other practices and resources such as articles and presentations that provide specific details regarding how this strategy can be enacted. While different providers may have unique needs, these tools offer insight into how EHR implementation can be undertaken.
In his application for the HIMSS Davies Award (PDF - 157KB), Dr. Gonzalzles also outlined his EHR implementation. Before incorporating the EHR into the practice, the staff at Riverpoint Pediatrics underwent one week of onsite training. After this, the EHR went live along with a workflow management system, so that the computer networking system was integrated into the workflow of the office. Another Davies Award Winner from 2004 (PDF - 203KB), Old Harding Pediatric Associates of Nashville, TN, also employed similar methods during its go-live phase.
Old Harding Pediatrics Associates, however, is a much larger pediatric practice; therefore its go-live strategy had to account for this difference. Old Harding's strategy to account for these considerations was to segment the go-live process into three phases that were carried out over about 19 months. The first phase focused on staff education, the second on strategic planning, and the third on reviewing the strategy and planning an intensive one year implementation schedule. Six weeks before the actual EHR implementation, Old Harding instituted a practice management system to connect the billing and EHR systems. During the week the EHR went live, the staff received comprehensive training. This enabled a 100% adoption rate by the staff at Old Harding only 4 days after the initial implementation.
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