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Other Key Considerations: The level of risk tolerance of your organization as well as leadership engagement are key organizational factors to consider around whether you chose a big-bang, pilot, or phased geographic approach as well as the amount of functionality you chose to bring live at once. There are some important considerations related to your physician and patient population related to the readiness of the M.D. constituents as well as the acuity level of the patients in various locations of the hospital that also should be explored.
THE LEVEL OF RISK TOLERANCE OF YOUR ORGANIZATION AS WELL AS LEADERSHIP ENGAGEMENT ARE KEY ORGANIZATIONAL FACTORS TO CONSIDER AROUND WHETHER YOU CHOSE A BIG-BANG, PILOT, OR PHASED GEOGRAPHIC APPROACH AS WELL AS THE AMOUNT OF FUNCTIONALITY YOU CHOSE TO BRING LIVE AT ONCE.
The design, build, testing, training, and activation support needs of your implementation will all be impacted by the choices you make related to your activation approach. The more units and the more functionality you bring live together, the greater the implementation effort will be. There are also technology needs to investigate based on the needs of the areas you activate in addition to the functionality you bring live. Specialty areas may require larger monitors and stationary devices versus computers on wheels versus the need for hand-held devices should be weighed.
MULTI-HOSPITAL SURVEY
In the summer of 2008 we conducted a survey related to activation strategies. Twenty hospitals responded to the survey all of whom had activated CPOE and documentation representing four major vendors. Questions were asked about the approach taken to EMR activation within their organization. The results of the survey showed that each organization activated CPOE and clinical documentation using different approaches. However 73 percent said they would use the same activation approach if they were to do it again.
Based on all the information gathered during our intensive due diligence process related to determining our activation strategy, we developed an “acuity-based” strategy which consisted of a phased geographic and a big-bang functionality activation. In our phased geographic approach we activated more than 90 percent of our inpatient beds and then activated our highest acuity pediatric intensive care unit and cardiovascular intensive care unit at a later time. In terms of the functionality that we activated, we decided that due to the integrated nature of our CPOE and clinical documentation build, we would activate them together using a big-bang approach.
From the data collected and evaluated plus our own EMR activation experiences we have determined that there is no one right way to implement CPOE and clinical documentation, however there is a right way to activate it for your organization. Through the application of a thorough and thoughtful decision making process which studies the factors outlined in this article, you can position your organization for a successful EMR implementation. Good luck!
Lisa M. Grisim, R.N., M.S.N., is director of operations, Department of Information Services; and Christopher A. Longhurst, M.D., M.S., is chief medical information officer, Department of Clinical Informatics, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, Calif. Healthcare Informatics 2011 December;28(12):47-50
