EHR Implementation: Go-Live Week

I recently wrote about my experiences during training to use the EHR to be implemented at the hospital where I practice. That training has been put to practical use this week after Go-Live started in the early hours of Tuesday. Here are some thoughts about my early experiences. Admittedly, I am just one physician in a large organization and my use of the system to date has primarily been in an orthopedic outpatient clinic.


I want to start out with positive comments because I am wired to be critical rather than complimentary. We have had on site-support by engineers and other experts from the vendor, in addition to the local implementation team members. These folks were flown out to Yuma to help us over the "speed bumps" of early implementation, as it was couched by our CEO. The few vendor experts I have encountered have been quite impressive. They are knowledgeable about the software and seem to have efficiently connected with the local team to help solve problems. To their credit, they have been able to fix the majority of issues that have been raised in a most expeditious fashion. Although they were not experts in all modules of the enterprise software, they seemed to have sufficient breadth of knowledge to address almost every issue I had or knew who to go to for appropriate help. Also, their priority has clearly been to provide the one-on-one support that is so valuable at this point in an implementation. None of the pre-go-live activities was able to adequately simulate the daily record keeping needs of a busy clinician.


Now for my usual negative, critical, (?constructive) comments. Even though I have been told that every Go-Live is chaotic, I think many of the problems I have had this week were preventable. Stephen Covey in his The 7 Habits of Highly Effective People advises us to start with the end in mind. So in my opinion "the start" was not completed very effectively. One lesson learned from prior EHR implementations has shown that needs assessment is a very important step. In talking with the clinic staff, I have come to the conclusion that this assessment was carried out in a superficial fashion. Secondly, perhaps the biggest challenge in implementing EHRs is adapting the software to local clinical workflows. This requires in-depth understanding of current workflows and a clear concept of how this will change with EHR adoption. The workflow assessment for our clinic was too simplistic and in many was did not depend on actual, in-person, observation of existing workflows. You might refer to a couple of my previous posts in which I discussed workflow. Finally, I don't think the timeline for implementation allowed enough time for pre-go-live testing of the production environment. I am guessing that a lot of the glitches we have seen this week probably could have been discovered and corrected by following checklists developed based on lessons learned from prior implementations of this vendor's software.


Overall, I think that Go-Live week went about as well as could be expected. I have been impressed with the professionalism of the support team and their ability to rapidly resolve issues that have come up without needing to resort to a lot of administrative overhead. I look forward to developing proficiency and optimizing the EHR capabilities to improve my ability to deliver high quality patient care.