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I Want my Vanilla Install with Chocolate Syrup!

October 20, 2015
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Oh the honeymoon phase! After months of review and request for proposal submissions you made your decision and selected a software vendor. The committee is happy with the selection and everyone is giving each other high fives. Now the work really begins. You’re confident in the selection and the personalities of the new vendor. You may have even established a friendship with them. You trust that they can do what they promised during all those PowerPoint sales presentations. You also agreed to do a “vanilla” or non-custom software install to reduce costs.

You’re now weeks from go-live and the shiny new product is losing its luster. Apparently some of the workflows and policies that you worked years on, is not working for the software. Information technology is telling you that there are screen functionalities and software rules that require input from the staff and you will have to change your workflow. All of a sudden the vanilla tastes a little sour.

During electronic medical record (EMR) installations and other health information systems, I’ve seen plenty organizations change the workflow in order to conform to the functionality of the software. Somehow software vendors convince CEOs, CMIO’s, and CNO’s that their software screen flows are best practice. All their customers are using it and achieving high financial benchmarks. So you get convinced to throw away years of healthcare operations experience, and information provided by organizations such as ACHE, UHC, and MGMA, to surrender to the vendor.

Often success metrics and end of year leadership bonuses are tied to these type projects. They touch every aspect of the organization and has the potential of severely impacting operations. So people tend to differ their opinion and adopt the wait-and-see perspective. Maybe it is time to change your workflow, maybe it is time to move equipment around, and maybe it is time to start new…maybe.

However if this was the case, it should have been identified early on as part of the strategy. We tend to get derailed from our clear vision that was carved out during hours of strategic planning and retreats. At the end of the day you know what’s best for your organization. You know the capabilities of your employees. You know the strong points and the weak areas. Every organization is unique. So why do software vendors think we are all the same flavor, vanilla?

The rationale is simple. Get all software customers using their system in the same identical way with the same screens and the same input and you keep software maintenance and support cost low. Keep in mind that your software license is often contingent on you maintaining current versions and abiding with their support agreement. On the other hand there might be an expectation for support and maintenance, including timely resolution. If every one of their customers were to customize the application the way they really wanted, it would create a software support nightmare.

I believe every organization should approach a software purchase with a big sign in their conference room stating: “Caveat Emptor.” In order to stay true to yourself and your organization, and most importantly to your mission and vision; start with the following:

  1. Have your requirements for the software up front of the sales process and make it part of the scope document for the installation.
  2. Make sure the requirements are tied to your strategic plan and therefore has buy in from the staff.
  3. As part of the project scoping phase make sure that the vendor identifies each potential workflow change:
    1. Identify the gap between current and future state.
    2. Identify what information needs to be captured and why it needs to be captured at that point of the patient encounter.
    3. The downstream effect of not capturing that information at that time.
    4. Options for capturing the information in other ways.
  4. Have the project success scorecard include metrics that identify the key requirements that you started off with.

Part of the ROI for a new system includes the reduction of rework and workarounds. Make sure that after the initial software training, you budget for the vendor to provide a follow-on (advanced) training 6-8 months after go-live. This will help users with issues not discovered until after they start using the system. It helps them learn keyboard shortcuts and other functionality that was not covered during the initial “software 101 course.”

The software go-live should be a consistent and expected outcome. If you like vanilla, that’s fine. But make sure that it is not at the expense of your workflow. I always take my vanilla with chocolate syrup, fruit, sprinkles……