System acquisition and implementation
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System Acquisition and Implementation. 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.

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System Acquisition and Implementation

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System Acquisition and Implementation

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

Systems Development Life Cycle

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

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

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

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

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.

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

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

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

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

  • 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

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

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?

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

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

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?)

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.

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