Lecture 3b -- Acquisition and Implementationx

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2 Δεκ 2013 (πριν από 3 χρόνια και 7 μήνες)

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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

Planning &
Analysis

Design

Implementation

Support &
Evaluation


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


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 (
ch

6), the second two
implementation (
ch

7)


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


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


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.


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



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


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


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


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



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



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?



Conversion


Data should be complete, accurate, and current before being
converted


T
esting


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


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




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?)




American
College of Physicians and
AmericanEHR

Partners


The
following are 10 mistakes that physicians commonly
make with EHRs
:

1.
Thinking
a site visit to a practice that is using the same EHR
product isn't worth the effort
.

2.
Signing
an
unvetted

contract with a vendor.


3.
Neglecting
to perform a workflow analysis before implementing
EHRs
.

4.
Undertraining
other physicians and staff on EHR use
.

5.
Refusing
to purchase a laboratory or device interface
.

6.
Entering
too much data into the EHR
.

7.
Doing
EHR
-
related work staffers should be doing
.

8.
Using
shortcuts and workarounds while using EHRs
.

9.
Creating
"shadow" paper documents and believing they are more
accurate than EHR information
.

10.
Accepting
inefficiency as the new status quo.

1.
Speed is Everything


this is what users value most

2.
Anticipate needs and deliver in real time


deliver
information when needed (anti
-
lock brakes)

3.
Fit into user’s work flow


integrate suggestions

4.
Little things can make a big difference


improve
usability to “do the right thing”

5.
Recognize that physicians will resist stopping


offer alternatives rather than insist on stopping an
action

6.
Changing direction is easier than stopping


changing defaults for dose, route, or frequency of a
medication can change behavior

7.
Simple Interventions work best

8.
Ask for additional information only when you
really need it

9.
Monitor impact, get feedback and respond

10.
Manage and maintain your knowledge
-
based
systems


track users response to decision support
and update to coincide with changes in medical
knowledge