System Acquisition and Implementation

1. System Acquisition and Implementation

2. System Acquisition • System acquisition refers to the process that occurs from the time the decision is made to select a new system until the time a contract has been negotiated and signed. • System implementation begins once the organization has acquired the system and continues through the early stages following the go-live date

3. Systems Development Life Cycle

4. Systems Development Life Cycle • Panning & Analysis • Examine current systems and problems to identify opportunities for improvement (independent of technology) • If new IS is needed, what are the information needs of the users and what are the functional requirements? • Design • In-house, outside developer? Or purchase from a vendor or contract with an Application Service Provider (ASP) “the cloud” • All the alternatives are considered, cost-benefit is done and a system is selected

5. Systems Development Life Cycle • Implementation • Workflow and process analyses • Installing new system • Training, converting data • Support & Evaluation • Longest phase in the life cycle • The first two states are referred to as the acquisition process the second two implementation

6. Prior to System Acquisition • Health care executive team should • Engage in strategic information systems planning • Identify goals and strategies and how IT will be employed to aid the organization in achieving them • Establish IT priorities • Gain budgetary approval and institutional support

7. System Acquisition • Establish Project Steering Committee • Primary function is to plan, organize, coordinate, and manage all aspects of the acquisition process. • Project manager Is critical • Often clinicians with training in informatics • Chief medical informatics officers or nursing informatics officers • Size of the committee

8. System Acquisition • Define Project Objectives and Scope of Analysis • What does the committee expect to achieve? • What process will be used to ensure success? • How will milestones be acknowledged? • How will committee communicate progress? • What resources are needed? • Screen the Marketplace and review Vendor Profiles • Determine System Goals • The system goals should be aligned with the strategic goals of the organization and should serve as measures of success throughout the system acquisition process.

9. System Acquisition • Determine and Prioritize System Requirements • Focus groups/interviews/written surveys/product demonstrations • Software • Technical infrastructure • Training and support • Develop and Distribute RFP or RFI • RFP tend to be highly detailed and are costly and time consuming to develop • RFI is considerably shorter • Some may send RFI and then RFP to screened vendors

10. System Acquisition • Explore Other Acquisition Options • Contract with an ASP • On a subscription basis to deliver an application and provide the support. Buy vs. lease • Benefits • Requires less IT staff • Fewer up-front costs and less capital • Rapid deployment • Disadvantages • Off the shelf • Technical support will not be site specific • Data ownership, security and privacy worries

11. System Acquisition • Explore Other Acquisition Options • Contract with a system developer or build in-house • Evaluate Vendor Proposals • Develop evaluation criteria • Vendor demonstrations • Make Site visits/check references • Conduct Cost-Benefit Analysis • Prepare Summary Report and Recommendations • Conduct Contract Negotiations

12. CH 7: System Implementation and Support • Organize the Implementation Team and Identify a Champion • May contain some of the members of the selection team, but also others • System champion is someone who is well respected in the organization, sees the new system as necessary to the organization and is passionate about implementing it. • EG: • Physician (system champion), nurse manager, lab manager, radiology director, CIO, IT analysis, business manager

13. Determine Project Scope and Expectations • Should be consistent with the system goals established in the system selection process • Establish and Institute a Project Plan • Major tasks and milestones • Estimated duration of each task • Dependencies among tasks • Resources and budget • Individuals responsible for completing each task • Target dates • Measures for evaluating completion and success

14. Typical Components of an Implementation Plan • Workflow and Process Analysis • Analyze current process and procedures • Identify opportunities for improvement • Identify sources of data • Determine location and number of workstations • Redesign physical location as needed • Involving users at this stage is critical • System installation • Determine system configuration • Order and install hardware • Upgrade or implement IT infrastructure • Install software and interfaces • Test, rest, and test again

15. Typical Components of an Implementation Plan • Staff training and procedure manuals • How much training? Do different groups have different training needs? • Who should conduct the training? • When should the training occur? What intervals of training are ideal? • What training format is best (classroom, one-on-one, small group, computer-based?) • What is the role of the vendor? • Who in the organization will manage or oversee the training? How is it documented? • What criteria and methods will be used to monitor training and ensured that staff are adequately trained? Will staff be tested?

16. Typical Components of an Implementation Plan (continued) • Conversion • Data should be complete, accurate, and current before being converted • Testing • Communications • Establish communication mechanisms for identifying and addressing problems and concerns • Communicate regularly with various constituent groups • Preparation for Go-Live Date • Select date when patient volume is relatively low • Ensure sufficient staff are on hand • Set up mechanism for reporting and correcting problems and issues • Review and effect process reengineering

17. Managing the Organizational Aspects • Create an appropriate environment • Expectations are defined, met and managed • CFO – financial return • CMO – physician’s time/quality of care • Nursing staff – workload, patient satisfaction • IT staff – help desk calls • Do not underestimate user resistance • One of the biggest managerial challenges • Allocate sufficient resources • Provide adequate training

18. Managing the Organizational Aspects • Manage unintended consequences • More work or new work • Workflow (workarounds) • System demands • Opportunity cost of time • Communication • Emotions • New kinds of errors • Upcoding • Juxtaposition errors • Power shifts • Dependence on the system (what happens when the system is down?)

19. Common Implementation Mistakes • American College of Physicians and AmericanEHRPartners • The following are 10 mistakes that physicians commonly make with EHRs: • Thinking a site visit to a practice that is using the same EHR product isn't worth the effort. • Signing an unvetted contract with a vendor.  • Neglecting to perform a workflow analysis before implementing EHRs. • Undertraining other physicians and staff on EHR use. • Refusing to purchase a laboratory or device interface. • Entering too much data into the EHR. • Doing EHR-related work staffers should be doing. • Using shortcuts and workarounds while using EHRs. • Creating "shadow" paper documents and believing they are more accurate than EHR information. • Accepting inefficiency as the new status quo.