Electronic Health Records

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What makes a health IT go-live command center effective?

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- Go-live is the major milestone for an health information system implementation. Months of planning, system build, testing, and training are exerted in preparation for this momentous event. No matter how thorough prior efforts are, a well-coordinated command center is essential for launching a new computer system. Between the triage area that initially receives, documents, and routes calls to the appropriate application area — and the applications area staffed with specialized analysts, certain best practices should be followed to ensure a smooth, successful go-live.

A command center has a single, well-publicized telephone number available to the end-user community. Incoming calls are triaged and recorded into a software program designed for tracking requests for assistance. Ideally, calls come from supervisors or managers rather than directly from staff members.

The benefit of having supervisors or managers report system issues is two-fold. For one thing, it keeps management in the loop as to how the system is performing for their staff. Secondly, when several end-users from the same area are experiencing the same issue, then a single problem ticket is reported and assigned to a single support staff. Multiple requests reporting the same issue could be assigned to different support staff resulting in an inefficient utilization of support.

Each application area has its own direct telephone number for receiving triaged calls, transferring calls to/from other applications, and calling end-users for additional information. It is best not giving out direct phone numbers of applications to end-users. These unpublicized phone numbers get informally circulated, and end-users call with the expectation of a quick answer rather than taking their turn in line with folks who called the triage phone number. Resolving undocumented calls, calls not captured in the tracking software program, hides the actual volume of help calls received and completed. Understating the actual call volume prematurely affects reducing and ending command center support.

Command center location is important, not for the end-user’s benefit but rather for those working in the command center. A single large room is optimal, although conversations can become loud during peak caller volumes, so adjacent rooms are also effective. Each application sits at its designated table with signage identifying its application and phone number. This seating area promotes each application functioning as a team and also lets members of other applications know where to seek assistance. Application analysts working in close proximity promotes troubleshooting requests crossing multiple applications, resulting in timely resolutions.

READ MORE: Smart EHR Implementation Decisions Key to Usability Improvements

Minor system changes to resolve end-user requests are built in a test instance and then migrated to production. Either the application was not built to support their workflows or end-users have inadequate system access. Tickets (i.e., end-user requests) in the tracking software are assigned degrees of urgency from low to critical. Critical tickets affect immediate patient care.  These tickets have automatic numbers assigned so end-users may reference for status follow-up. System enhancement/optimization requests should be encouraged to be taken after go-live is concluded.

Master file changes and other major system changes to resolve requests are reviewed and approved by a system change review board. These change management reviews are conducted at designated times throughout the day, but there is a process to address immediate major system changes that cannot wait until the next scheduled review. Major system changes often require representation from application analysts providing information regarding the need and impact of the system change.

Go-live command center support can be a stressful experience. End-users contacting the triage area are not calling to thank you for the new computer system but because they are frustrated. These end-users are unable to perform their duties effectively as they did as experts in the legacy system.

Command center dress codes, lighting, and temperature should be designed to promote a comfortable work environment, considering the longer hours, off-shift hours, and weekend support provided. Offering meals, snacks, and/or refreshments for command center support helps reduce stress and demonstrate appreciation for the support staff’s efforts.

There is no absolute as to how long a go-live command center operates before transitioning to a routine maintenance mode. They typically average two to three weeks, but support hours are gradually reduced during this period. The comprehensiveness of your information system build and testing that support your new workflows, system access templates, and end-user training efforts determines the need duration of your go-live command center.

READ MORE: Strategies to Better Understand EHR Implementation Barriers

No matter the length of time required, the best practices outlined here will help the command center run efficiently and effectively, providing better support to the end-user, and ultimately, improved patient care.

David King serves as Epic Consultant at Innovative Consulting Group.

 

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