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System Conversion Preparation and Optimization
10/2/2019
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System Conversion, Preparation & Optimization
Learning Objectives
• Identify and prioritize project management goals to effectively and efficiently manage a system transition while continuing to meet patient needs
• Outline preparation strategies for an optimal system conversion
• Identify key performance indicators to focus on during the stages of Go-Live
• Describe the opportunities and strategies for post-conversion assessment and sustained optimization
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System Conversion, Preparation & Optimization
Stage 1
Stage 1
Assessment Selection Decision
Stage 2
Stage 2
Initiation Planning & Setup Execution
Stage 3
Stage 3
Go-Live
Stage 4
Stage 4
Adopt Monitor Evaluate
Stage 5
Stage 5
Re-evaluate Optimize Eye on the future
Stage 1: PlanPrinciple: “I didn’t survive, I prepared” – Nelson Mandela
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System Conversion, Preparation & Optimization
Stage 1: Plan
CURRENT STATE
#1 Create a climate for
change
Change Management
- People
-Process
-Technology
#2 Engage & enable the
organization
FUTURE STATE
#3 Implement & sustain changes
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Stage 1: Plan
Governance• CEO• CFO• CIO• CNO• COO
Steering Committee
• Clinical/Operational Managers &
VPs• Outside Counsel• Subject Matter
Experts
Selection Team
Stage 1: Plan
Step 1: Assessment
• Assess industry climate• Evaluate current state
• Identify organizational needs and opportunity• Harvest baseline performance data
• Forecast your EMR implementation system, induced, and opportunity costs• Complete a cost-benefit analysis
• Set SMART Goals
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Stage 1: PlanAssess Industry Climate
Stage 1: PlanAssess Industry Climate
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Stage 1: PlanEvaluate Current State
Cost-Benefit Analysis
Operational Inefficiencies
EMR Deficiencies
Financial Solvency
Stage 1: PlanSet SMART Goals
Quality of Care
Operational Efficiencies
Financial Strength
Patient Satisfaction
Competitive Productivity Standards
Continuum of Care
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Stage 1: Plan
Step 2: Selection
• Establish and prioritize organizational requirements to be met by new software• Industry edge and
organizational agility• Identify deal-breakers• Issue RFIs & RFPs
Stage 1: PlanPrioritize EMR Requirements
Interoperability Organizational Agility Ease of Use
Patient Communication
Competitive Edge
Continuum of Care
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Stage 1: PlanIdentify Deal-breakers
Interoperability Organizational Agility Ease of Use
Patient Communication
Competitive Edge
Continuum of Care
Stage 1: PlanRFIs & RFPs
1. Internally compile organizational EMR requirements2. Issue RFIs & RFPs3. Evaluate & shortlist vendors
• Do not accept a “vanilla” installation• Demand automation and efficiency-driven design • Do not accept workarounds just to meet your installation timeline• Streamline clinical documentation rather than standardized vendor
implementation plans• Develop a customized system based on your EMR needs• Protect against cash flow interruptions and clinician revolt
4. Vendor demos
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Stage 1: Plan
Step 3: Decision
• Consult your network• Build your EMR
implementation roadmap• Think optimization • Finalize contract with
vendor
Stage 2: Pre-Go LivePrinciple: Welcome Failure
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Stage 2: Pre Go-LiveMethod of Implementation
PIL
OT • Pros
• Reduce Go-Live learning curve
• Greater opportunity for customization
• Cons• Potential to hinder
change climate• Poor participation• Limited sense of
urgency
BIG
BA
NG • Pros
• Faster ROI • All functionality
available• Streamlined and
standardized• Cons• High-volume of change• Significant initial
downturn• High learning curve
MU
LTI-
PH
AS
E • Pros• Manageable change• Reduce Go-Live
learning curve• Checks & balances• Mitigated financial and
productivity downturn• Cons• Increased expenses• Elongated timeline• Delayed ROI• Hindered change
climate• Dual workflows
Stage 2: Pre Go-Live
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Stage 2: Pre Go-Live
Multi-disciplinary Implementation Team
*Focus: govern organizational decisions attentive to organizational agility
Implementation TeamGovernance
Steering Committee
Project Manager
Champions of Change
Subject Matter Experts Outside
Counsel
Selected EMR Team
Marketing
Applicable Line
Managers
Stage 2: Pre Go-Live
• Kick-offs• Discovery• System
Understanding
Initiation
• Training Schedule
• Learning Proficiencies
Planning & Setup • Feedback
Point #1• System
Customization
Execution
30-45 Day Timeline
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Stage 2: Pre Go-LiveInitiation
• Comprehensive workflow analysis
– All functions and departments
– Understand current state and future state
• Reconciling processes in Legacy vs. New system
– Same, new, and changing processes
• Staffing structure analysis
Stage 2: Pre Go-LivePlanning & Setup
• Establish learning proficiencies
– Staff development and trainings
– Answer what & why• Training schedule
– Method and timing of training
– 2x – Pre go-live and post go-live• Resources and logistics
– Location, space, and technology for training
– Support staff – clinical and non-clinical
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Stage 2: Pre Go-LiveExecution
• Staffing & process adjustments
• Testing of new EMR features
• Feedback Point #1
– Early feedback from trainings
– Tracking of issues and change recommendations
• System customization requests
– Based on testing and Feedback Point #1
• Transitioning the data from your old EMR
Stage 2: Pre Go-LiveDeveloping the Transition
Dual-systems
• Migrating legacy system data
– Including patient history for quality of care purposes and auditing safeguarding
• Transitioning current and new patients
Challenges
• Transferring clean data
• Dual-systems
– Managing productivity
– Reporting KPIs
– Responsibility alignment
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Stage 2: Pre Go-Live Change Management
Focus: Reduce resistance and incubate influencers
Create a climate of change
- Define & embed organizational mission & vision
Build a guiding coalition
- Live it
- Address the “naysayers”
Establish a sense of urgency
- Communicate clearly, effectively and with consistency
- Provide incentives and rewards
Stage 2: Pre Go-Live
Focus on process & skill changes
• …Not just new technology
• 95% of staff attend trainings
Create effective learning & proficiency
techniques
• Staff scores 80% or higher on e-learning trainings
• Certified super-users by Go-Live date
Communicate change using
meaningful metrics
• Adherence to conversion and communication timeline
• 30% of staff involved in feedback loops
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Stage 2: Pre Go-LiveCommunication Plan & Pathways
• Communication plan aligned to project milestones
• Methods not Method
– Storyboard outlining organizational vision
– Town hall meetings
– Written and verbal communication
– Relative information for end-users
• What & WHY
• Two-way feedback pathways
– Employee surveys & check-ins
– Issues log designed to circle back to steering committee
– Feedback point #1
• GOAL: Employee empowerment & increased engagement
Stage 3: Go-Live
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Stage 3: Go-Live
Stage 3: Go-Live
Go-Live Checklist
Overcommunicate the plan & timeline
Documented changes to work responsibilities and structure
Metrics to monitor through process
Go-Live Support Team & Command Center activated
Super-usersTrainersHelp desk & device setup
Legacy system information transfer
System of feedback/ check-ins
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Stage 4: Post Go-LivePrinciple: An EMR is a business process, not just a piece of software
Stage 4: Post Go-Live
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Stage 4: Post Go-Live
• Management & Leadership Roles
• Feedback Point #2
Adopt
• Support System• Data
Infrastructure
Monitor• Optimization &
Continuing Education Strategy
Evaluate
Up to 90 Days Post Go-Live
Stage 4: Post Go-LiveAdopt
• Leadership and Managements Role: Transparency and Accountability
– Executive Leadership Role
• Clear lines of accountability for the optimization team
• Allocation of resources
• Goal oriented
– Managements Role
• Understand new processes
• Employee accountability
• Regaining productivity standards
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Stage 4: Post Go-LiveAdopt
• The first 90 days is key to ensure adoption
– Manager adoption
– Leadership adoption
– Staff adoption
• Monitor resistance
• Continue the communication plan
• Expect an increase in support requests
– In times of decreased workload – be proactive in identifying issues
Stage 4: Post Go-LiveMonitor
Issue Identified
Support Requested
Solution
Implement
Problems by type data point
Solutions & Root Causes by type data point
• Focus areas for Optimization• Additional training topics
User Feedback
Manager Feedback
Superuser Feedback
Importance of a Support System
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Stage 4: Post Go-LiveMonitor
• Development of a Data Infrastructure
• EMR system setup tables
– Sales
– Clinical
– Financial & Revenue Cycle
– Volumetric
– Time
– Operational
• Data rich processes
Stage 4: Post Go-LiveEvaluate
• Maintain the training & momentum
– Training round 2
– Highlight opportunities for improvement
– Document workflow efficiencies or ways to improve
• Super-users & training staff
– Ramp-down timeline
– Full-time position need
• Optimization & Continuing Education Strategy
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Stage 5: OptimizePrinciple: Losers Have Goals, Winners Have Systems
Stage 5: Optimize
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Stage 5: Optimize
Multi-disciplinary Optimization Team
*Focus: Identify and implement system efficiencies
• Implementation team evolves into the optimization team
• Re-examine key stakeholders on this team
Optimization TeamGovernance
Steering Committee
Project Manager
Champions of Change
Subject Matter Experts Superusers
IT and Help Desk
Marketing
Applicable Line
Managers
Stage 5: Optimize
• Assess operations based on feedback and KPIs
• Workplan
Re-evaluate
• Use data to make decisions
• Optimize –People, Process, Technology
Optimize• Ancillary Systems• Address upcoming
changes
Eye on the Future
90 Days+ Post Go-Live
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Stage 5: OptimizeRe-evaluate
• Incorporate Optimization Stage in project plan
• Assessment strategies
– Goals
– Obtain feedback from users via meetings, chair-siding, and feedback loops
– Data to make decisions
• KPIs and goals
• Dashboards
• Ticket system reports
– Workplan development
• Steering Committee’s role in prioritization
• Initiative approval
Stage 5: OptimizeOptimization Approach
• Build a system of ongoing optimization not just a one-time goal
• Optimization should occur in:
– People – staffing needs, training, structure
– Process – how to effectively complete work
– Technology – effective use of the tools
• Data gathering system
– Maintain solid data infrastructure
– Develop data rich processes
– Avoid garbage in, garbage out
– Act on data
– Data transparency
People
Process
Data
Tools
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Stage 5: OptimizeOptimization Approach
• Expect challenges related to:
– Human nature:
• Unwillingness to change or participate
• Reverting to prior bad habits
• Misunderstanding of the process
• “Click-through” mentality
Stage 5: OptimizeEye on the Future
• When working through your optimization plan consider short/long-term organizational changes
– Ancillary system use or introduction
– Internal changes & organizational goals
– External changes
• Payor shifts
• Regulatory changes
• Market demands
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Questions?
• Stavros Katsifis, Consulting Manager
Contact McBee: 610.964.9680 | Visit McBee: McBeeAssociates.com
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