1. business and industrial
2. business operations
3. management
4. project management

BIG BANG EMR
IMPLEMENTATION:
UNDERSTANDING NEW IMPLEMENTATION – BEGINNING & MIDDLE PHASES
From large clinical organizations to small offices, implementation of electronic medical records generally follows one of
two overall methodologies: the phased implementation or the big bang approach. The major difference between the two
methods is timing and how disparate processes and departments are rolled into the new system. In phased implementation,
the new system is developed and rolled out over years, with each area becoming fully enmeshed and proven before a new
department or function is added to the system. Big bang implementations can take months to around a year, and usually
involve an all-in approach for an organization.
Benefits of a Big Bang EMR Implementation
Implementing electronic medical records via a big bang approach is faster, which often means cost savings associated with
labor, training, and technical resources. Project management needs, continual software upgrades, and the chance that an
organization becomes trapped in a perpetual implementation cycle are all reduced with a big bang model. Rapid deployment
also reduces reliance on legacy systems and functions, keeping the organization on the same page and mitigating compliance
risks from disparate systems.
Central Maine Healthcare, an organization spanning 250 physicians, three hospitals, a trauma center, and dozens of clinics,
benefited from a big bang approach during a massive transition of all its systems. The organization converted to nine vendor
functions as part of a new EMR to manage clinical, administrative, and financial functions, and it did so in approximately
1.5 years, from January 2012 through July 2013. In the early part of 2012, the organization worked on beginning stages
– planning and developing. Later, it rolled out three major solutions with target completion dates between April and July of
2013. In effect, the majority of the organization successfully made the change to a new EMR in about three months, thanks to
strong planning and a big bang approach.
Where Is Your Organization in the EMR Implementation Process?
The name big bang gives the impression that things happen all at once, but with any software implementation, there are
stages. Understanding where your organization is in the EMR implementation stage is critical for optimal management
of the project.
Beginning or Middle of a New Implementation
The beginning and middle stages of an implementation are critical to success, particularly in a big bang approach, when
things move quickly in later stages. With a big bang approach, the earlier phases are where planning and triage are done
– if you need to make a change to your scope, expectations, or needs, it’s easiest to do in these stages. During the beginning
stage, your organization should enter into internal discussions about why you need a new EMR and what that product must
do to meet your needs. After mapping such needs, a project team begins to evaluate vendors and products and enters into
contract negotiations with a selected vendor. You might also develop a statement of work with the vendor and begin assessing
internal resources, such as staffing and governance structures. As you work with the vendor and assess internal needs and
resources, you enter the middle phase of an EMR implementation, which involves creating new policies and governance,
communicating an upcoming EMR change to staff, and beginning to make changes to hardware and software.
Involved in an Ongoing Implementation
Once you start to make changes to hardware, software, and policies, the organization becomes involved with an ongoing
implementation – a stage that both overlaps with the middle stage and can take months to complete.
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During this part of a big bang implementation, all staff that is impacted by the new system should have been migrated – or be
migrating – from legacy systems. Troubleshooting may occur on a daily basis as new resource draws are placed on the system,
and both technical and vendor resources are likely to be heavily utilized. This stage is often referred to in the technical world
as the go-live phase, and is usually the most compressed and intense phase of any implementation. During the Central Maine
Healthcare implementation, for example, more than 6,000 tickets were opened, reviewed, and resolved, allowing technical
resources to create a top ten list of challenges to work on.
Post Go-Live of an EMR Implementation
Following the go-live phase of an EMR implementation is a post phase that usually involves evaluating the outcome of the
project, identifying lessons learned, and putting planned daily monitoring in place to ensure the system continues to perform.
Troubleshooting and support needs have likely leveled off at this point; while technical and vendor support is still necessary,
it is utilized in a maintenance fashion rather than the intense need of the go-live days.
Pros and Cons of Each Stage
Each stage in a big bang EMR implementation comes with benefits and disadvantages that must be faced by an
organization. Understanding advantages and drawbacks going into the project lets CIOs and teams maximize positives
while mitigating risks.
Beginning Stage
The beginning stage lets you participate in a critical review of the current organization and begin brainstorming redesigns
that are more efficient in meeting patient, clinical staff, and administrative needs. Project teams can review data about
similar projects in like organizations, such as the EMR implementation completed by Central Maine Healthcare, to learn from
challenges and successes experienced by others. Beginning stages also bring leadership and key staff from all departments
together to create or update governance structures for appropriate review and approval of new policies, new technology,
and new workflows.
The beginning stage of a big bang implementation can be lengthy, which means project fatigue is a risk. CIOs and leadership
must keep project teams and vendors engaged throughout the process, as early planning is critical to success through go-live.
Some challenges at this stage include developing appropriate budget management, risk identification, and issue tracking that
will help manage the project in later stages. Identifying resource needs and securing resources to fill any gaps can also cause
delays and headaches at this stage.
Middle Stage
The middle stage of a big bang implementation lets you put key resources in place, establish governance over both project
and system management, and ensure IT resources are trained on the new system. Disadvantages you’ll likely identify during
this time include keeping staff informed and motivated about the changes and addressing insecurities about an upcoming
software change. Some staff, particularly in the technical departments, may not have the appropriate skills to lead or
participate in the project or ongoing system support, which leaves CIOs and managers with hard decisions about staff turnover
and hiring. Other challenges that begin to crop up as you move out of beginning stages are the recognition that necessary
policies have not been developed or that milestones are in jeopardy due to hardware needs or delays in development of
resources such as training materials.
Though each stage of your implementation presents challenges, many CIOs are opting for a big bang approach for EMR
projects. With a faster approach, organizations can identify and address challenges before they become problems, and most
experience faster time to value from their EMR changes.
Checklist for Beginning and Middle Big Bang EMR Stages
For success in later stages, big bang EMR implementation requires strong prerequisite planning at the beginning and middle
stages. In identifying successes during the Central Maine Healthcare implementation, the team pointed to a build-it-once
mentality – planning had to keep the entire patient existence in mind, reduce impact to the business, and integrate the
importance of both current and future workflow needs.
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Take Ample Time to Evaluate and Negotiate with Vendors
During vendor selection, CIOs and other executive resources should work to understand vendor implementation capabilities.
• How much leadership and management will be provided by the vendor, and how much of the burden will fall
on in-house technical resources? Optimal success usually requires a fine line between vendor management and
in-house oversight.
•
Will the vendor provide resources to supplement your staff during an implementation – how many resources,
what type, and how long will they be available? These are critical data points in calculating organizational
productivity during an implementation, so you know if you can continue meeting patient needs throughout
the process.
• Does the vendor simply provide a software package and implementation, or do they offer expertise with
process improvement and workflow design? Depending on your in-house project management resources,
this may be a critical need.
• Does the vendor understand the current technical and workflow environment, including integration and interface
needs, and are they willing to put in time mapping these requirements with you to effect a strong
EMR replacement?
Review and Upgrade Governance Structures
Most healthcare organizations have governance structures in place, so you aren’t starting from scratch. Any implementation
project is a good time to review those structures and put new or updated policies in place to ensure compliance and efficiency
across the entire organization, as well as solid project management. Some structures to address include:
• Oversight of the implementation project, which should always include final review and approval from an
executive level before various project phases move forward.
• Clinical build, which includes orders, order sets, alerts, and other clinical documentation and workflow needs.
• Revenue cycle management, including insurance verification, claims billing, and patient collections procedures.
While RCM is considered a backend function, teams should keep in mind that data gathered during admissions
and clinical procedures fuels the revenue cycle.
• Metrics and key performance indicators, which should be viewable in a variety of formats and easily accessed
by management.
• Training curriculum development and training plans, which must be scaled to bring current employees on board
with the new system quickly and train new employees in the future.
• Organization communications, both during and following the implementation process.
Assess Current Staff and Vendor Resources to Determine Skill Gaps and Needs
Skills we provide for your EMR implementation include:
• Project management
• Integration and interfacing with legacy systems
• Process and workflow design
• Training and education
• Systems analysis
• Technical and user-end testing
• Reviews and input from both clinical
and revenue cycle sides
• Support during go-live and post implementation
• Infrastructure support for networks and hardware
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Other Beginning and Middle Stage Considerations
Organizations should also review current policies and procedures to determine whether updates or additions are required
to align functions with new technology. Teams must review implementation plans regularly as well, and ensure that the plan
identifies critical milestones for scheduling and allows alternative strategies to keep the project on pace and within scope if
necessary. CIOs and teams must also monitor vendor performance against contract requirements and service level agreements
to ensure adherence – a responsibility that begins in early stages and continues long after the implementation is complete if
vendor support is a permanent function.
The Huntzinger Overview
Why choose Huntzinger for your staffing and sourcing needs? Huntzinger offers our clients:
• A unique philosophy and approach to managing staff augmentation projects, while recognizing and balancing
the client’s and consultant’s needs to ensure quality services.
• A robust pool of resources with demonstrated experience to support already installed and functioning systems,
as well as new implementations.
• An equally robust pool of resources to support other vendor products and non-vendor specific initiatives.
• Project directors, project managers, and consultants are some of the most experienced in the industry and are
adept at working with executives and departmental users.
• Consultant resources with clinical operational experience.
• Proven experience working with healthcare systems (academic and non-academic) and physician practices.
• Executive leadership that is committed, and stays engaged, with our clients, making sure strategic and tactical
objectives are met and priorities are addressed.
Executive leadership has “walked in” our clients’ and consultants’ shoes (having held positions of healthcare and business
leadership, management consultant, etc.).
The Huntzinger Management Group, Inc.
670 North River Street, Suite 401
Plains, PA 18705
Phone: 570.824.4721
Fax: 570.824.4731
[email protected]
www.huntzingergroup.com