Chapter 5 System Implementation HIM 2211

Planning for Go-Live: Ongoing Support

24/7 intensive support initially There should be a help desk users can call when help is needed Amount of coverage eventually reduced to regular Help desk Length of time depends on magnitude of IS how well implementation is going Only needed for a few days Project team should be prepared to return to old IS if new IS doesn't work.

Information Systems (IS)

A broader term that includes IT as well as the staff and processes needed to operate and manage them.

Adults need to see relevance

Adults do not want to waste their time They want to learn what they need to know for immediate future. Without relevance, there will be no motivation to learn Instructor needs to tie class material to what individuals will be doing Ex: Don't teach nurses what HIM Department will be doing in the future.

Adults are experienced:

Adults go to training with a lot of experience and knowledge Not all adults have same knowledge and experience Instructor and students can learn from each other Varied backgrounds can make for interesting discussion and improved learning experience

Testing Plan

All components of the IS will need to be tested before go-live. This will help to identify any problems with the system so that they can be corrected.

Routine Maintenance and Upgrades

Backing up data, increasing storage capacity, and upgrading hardware/software.

Policies/Procedure Development/Documentation Cover

Backups, downtime policies for routine maintenance, upgrades, testing of upgrades, and disaster planning How IS will be used by various users- coding professionals, admission clerks, other staff HC facility must create training manuals and user guides for reference.

Post-Implementation

Begins after go live Fix problems not identified during implementation period Update software Back-ups Manage system

Customization of Vendor Software:

Can be done by vendor or facility Very carefully if done in-house. Vendor may refuse to work on the system if a problem occurs, may not give HC facility service agreement. Future updates by vendor may not work with added customization.

Communication with Training

Communicating with employees and keeping them informed of changes, impact, and expectations of their position will help prepare them for training.

Interface Testing

Confirm that data from feeder system are transferred to the new system in correct field and right format. Ensures that the interfaces function properly Ex: Data such as patient name, HR number, DOB, other demographic info, lab tests, radiology results, etc are collected

System Selection Process

Continues until the IS is in use and has been evaluated as to whether or not it meets the objectives established at the beginning of the process

User Configuration and Settings: Time

Could take minutes or months to get all specifications and tables updated, depending on complexity of IS and specifications Ex: User table includes user name, initial password, location, type of access, permissions as to what they can perform in IS.

Training Plan

Crucial to implementation process Addresses timing and methods used to train the users Must be properly executed or negative repercussions can occur.

System Design: Input Specifications:

Data needed to accomplish goals and produce the outputs.

SDLC Maintenance Phase:

Day to day operations after implementation System evaluated on a continuing basis Asks if the system meets needs of users

System Evaluation

Determines if system works as expected Were initial goals met? Did System function as expected? What worked, what didn't. How to improve next implementation Learn from mistakes and overall experience Changes may be needed/periodic updates

Planning for Training: Trainer

Developing objectives, developing the training plan, and implementing the training. Attend project team meetings, keep up with status of project, know when training is needed, type of training. Must be superuser (expert) on new IS. Prepare other trainers

Integration Testing

Does all hardware work together as it should? Scanner, barcode readers, printers, computers, etc. Ability to scan documents, print a report, scan barcode.

Required Field

Does not allow the user to proceed until it is completed Not all fields should be required because not all fields apply to all patients. If required fields are inappropriate, users could put in erroneous data to proceed Ex: Obstetrical data is not required for male patients.

Trainer will work with administration and end-users

During training planning and implementation stages Make trainer excellent liaison between two groups. Communicate expectations of administration to users and communicate fears/concerns of users back to administration

Conversion Testing

Ensures able to transfer data from old to new system Usually begins with a small amount of real data that have been copied. After initial test, project team fixes any problems, reruns the test, and continues to add larger amounts of data Testing continues until problems resolved prior to actual data conversion.

Application Testing

Ensures all functions work Ensures IS meets all functional requirements/other required specifications in the Request For Proposal (RFP) or contract Every conceivable situation that computer will address can be handled. Project team tests reports to ensure that the data and statistics contained within are correct.

User Configuration and Settings

Entry of desired behaviors of the IS into tables or setting fields. Provides flexibility in implementation of IS. Ex: Patient type= inpatient, outpatient, emergency department, lab testing, etc and I=Inpatient

Evaluate the Training

Evaluate trainers on delivery, impact, and knowledge of applications Reaction of trainees after training Learning accomplished Behavior of employees, has morale improved? Results Ask if objectives are being met Additional and Ongoing Training will need to continue after go-live

Reengineering Processes

Evaluating the way the healthcare facility does business in order to improve efficiency The question "why" should be asked over and over again Change procedures, update the policy and procedure manual, change workflow, eliminate unnecessary tasks, and add new tasks.

Testing Environment

Exact dupe of system in use, excluding data. Used to test changes and see what happens without endangering main system.

Test Environment

Exact duplication of the IS in use excluding data. Changes can be made to the IS and then tested to see what happens

Additional Training

Existing employees may need additional training to learn advanced capabilities, reinforce what they have learned, acquire new skills if they transfer or job changes

Go-Live: Big Bang/Cut-Over

Facility stops old system all together and starts new system. No safety net/backup provided by old system if problems occur. Most risky!

Trouble Ticket:

Form used to report problems encountered during testing. Must be as detailed as possible so project team can replicate problem Trouble ticket is logged into tracking system, assigned a tracking number, and assigned to project team member to solve.

Go-Live: Straight Turnover

Former system and processes cease with implementation of new system. Higher risk if new IS has to be aborted More cost effective and reduces the work load because there is no duplication of efforts

System Design: Database Design:

From where data will come, how it will be stored, size of db, etc.

Computers May Have Limitations

HC facility may not allow printing of lab results in nursing unit to protect confidentiality, forcing the user to look up most current results available.

Resources for Training

Handouts at every session Training materials to remind users how to do a task they have forgotten Objectives should be clearly outlined Agenda should be sent to the scheduled attendees ahead of time, subject to change, but keeps trainers on track Providing info on IS prior to training is useful preview

Volume Testing

How is system able to handle multiple users and tasks simultaneously. Confirms that the IS and network can handle large volumes of users and data. User task force and other users in facility can be brought in Project team needs to recruit as many users as possible to use IS at same time

Training Manuals/User Guides

How to use system How to incorporate it into their jobs How to identify how their jobs changed

Adults need to know why

Instructors should tell adults why they need to do something, why they need to learn what they are being taught They need to know why something is as important as they need to know how to do it.

User Preparation

Involves providing the users with enough information about the IS being implemented so that they are prepared both psychologically and through training to use it Letting users know what to expect from system Address fear of change, change in roles, job descriptions, expectations, downsizing. Realistic expectations through training, facility newsletters, updates at department meetings.

Testing Plan "Laundry List" Includes

Is a document that will cover: What is to be tested, who will be involved in the testing, dates of testing, documentation of testing results, test environment, and types of testing. Must continue until all problems are fixed Includes documentation created for use with the IS as well.

Screen Design: Graphical User Interface (GUI)

Is a term used to describe the interaction of users and the computer whereby the user clicks on icons, menus, and other tools to assist in the use of the IS. Located on toolbar.

Information Technology (IT)

Is the field that includes hardware, software, and databases.

Learning and Training

Learning ability is impacted by age, maturity level, and experience Learning styles: auditory, visual, and so forth Instructors should use a variety of methods that accommodate learning styles

Report Writers

Many IS have Report Writers built into them to allow data to be exported into various reporting design systems.

Screen Design:

May design computer views for different levels/types of users. Logical flow to facilitate data entry -Left to right and top to bottom• Standardized look and feel Same look and feel across screens so each progressive screen is user friendly Instructions on using system Use of color, blinking and reverse video to draw attention to specific areas

Programming and Customization

May or may not have any programming required Depends on type of system, complexity and whether in-house or vendor software. If IS interfaces with other IS to share info, such as demographics, interfaces will have to be programmed.

Site Preparations

Modifying physical location to accommodate hardware (computers, printers, workstations) May include building of new buildings or renovation of an existing space Installation of outlets, network cabling, cooling, etc.

Computer Assisted Instruction (CAI)

Multimedia and interactive technology used to teach Uses audio, video, simulation, multiple learning styles, other tools Increases learning Work at their own pace Self-quizzes Immediate feedback Standardizes training

Training Schedule

Must cover all shifts Must accommodate the different classes required by various users As close as possible to go live Short sessions One on one physician training

HIM Professional

Must work with information technology professionals to ensure the screen in the IS are designed to support quality data entry.

Parallel Testing

Occurs after go-live Running the old system and the new simultaneously to validate performance and synchronization. Not required, but operational Benefit: If new IS is not working and needs to be shut down, then the existing IS is current, thus not impacting the operations of HC facility.

Acceptance Testing

Occurs after go-live to verify working as expected in a live environment. Gives HC facility time to confirm that the new IS meets response time, functional requirements, and other standards guaranteed in the contract.

Installing Hardware

Once the hardware arrives, it will need to be set up and installed in the data center. Install computers, printers, network, scanners, and other hardware installed in nursing units, training rooms, other locations according to project plan.

Go-Live: Pilot Method

One group in a department is changed over at a time. Ex: The 3W nursing unit starts ordering everything using the new system but no one else uses it (yet) Helps lessen the impact on staff

Train the Trainer

One or a few users are selected to be trained directly by the vendor on how to use the system "Superusers" The superusers return to the facility to train other trainers who will help conduct training sessions. This visibility will make the trainer a go-to resource and a key player in the days following go-live. Help allay fears and answer questions.

Ad hoc Reports

One time reports that can be created as needed

Policy and Procedure Development and Documentation

Policy and Procedure manual must be updated to reflect the new way of doing business Policies and Procedures should blend together the manual processes and decision making processes MGMT and Maintenance of system itself should be clearly outlined

Report Design

Process of creating and formatting report

System Implementation

Process of preparing and launching the information system (IS) that has been selected for use Some steps linear, some steps concurrent Hardware/Software: Order Early

Data Conversion

Process where data is copied from the old system, manipulated in the format required by the new system and entered into the new system. Mapping from old format to new is critical. Ex: HR number was 10 digits, new IS requires 12 digits, two additional zeroes will need to be added.

System Design: Prototyping:

Programmers quickly develop a system and show it to those people who will ultimately use the system. Gather feedback, make revisions, show, gather feedback, revise. One option for design but most system designs are much more formal and detailed.

User Configuration and Settings: Project Team

Project Team sets up specifications by filling in tables and other fields with the desired set up. Update tables that provide reimbursement rates, tax identification number, national provider identifier (NPI).

Icons

Provide shortcuts to functionality within the system, along with buttons and menus, allowing the user to command the software to perform specific tasks.

System Design: Output Specifications

Reports and screens

Trouble Ticket Resolved

Resolution is recorded, IS testing begins again. Must test entire IS once problem identified, because the changed part of IS could break another

Go-Live:Phased Approach

Roll out begins with one module of the new system and then gradually new modules are added. Advantage: Impact on staff is lessened Disadvantage: Start-up process is extended

Go-Live

Roll-Out Strategies: How an application will be implemented throughout the HC Facility

Go-Live:Parallel Processing

Safety net because old and new system both running. Can be labor and cost intensive. Similar to Parallel Testing Least amount of risk involved

Instructors and Trainers

Should have a basic understanding of adult learning principles and practice them in the development and implementation of training

Planning for Go-Live: Initial Support

Should have a member of implementation team with users in every department Should be visible - perhaps matching shirts Answer questions and ensure smooth start-up

Documentation of Training

Sign in sheets for proof of attendees for employee and employer benefit Competency tests- documentation of results should be maintained Copies of all training materials should be maintained List of attendees, absentees List of objectives

Software Loading

Software will need to be loaded onto the file server, mainframe, individual user computer, or other computer in the data center. Installed on all authorized computers prior to implementation if on individual computers for development and testing. Any failures identified in this stage.

Learner has to be motivated to learn

Some HC facilities motivate learners with a competency test at the end of the training Sometimes HC facilities tie employment to successfully completing test Users given second or third chance before they are terminated Termination is not the best motivation, learning must come from within but competency with IS is vital to HC facility

Downsides to CAI

Start-up costs Time required to develop Should not be used when content changes frequently, CAI requires updating with every change

Testing Plan = Cyclical Process

Team will test the IS identify problems, fix problems, and test the system again. Rinse, wash, repeat

Training Testing

Testing employees after training See how well training materials, agenda, format of training, time allotted for training, and other attributes work. Changes are made to the training process as needed before real training begins.

Trouble Tickets Detail:

The screen where/when problem occurred Task being performed Error message received Data entered Report with incorrect data

Testing Plan Should Create a Realistic Test Environment:

The settings in the test system should be the same as the ones that the facility will use. Test to see how the system handles real-life situations

Basics of System Implementation

The system is built or purchased and tested Training is implemented for end users A technical support plan is put into place Use by end users is evaluated.

System May Come with Standard Reports

These may or may not meet the needs of the facility. New reports or edits to existing reports will likely be necessary.

Adults like being responsible for their own decisions

They resent not having control, instructors should let them have say in program by helping to set the agenda, deciding which two or three activities to do, strategies to use, and so on.

Report Characteristics

Title Date/time run Time period report covers Page number Column headings Data

Ongoing Training

Training needs to be reassessed to determine frequency and specific needs. May be reorganized in conjunction with Human Resources new employee orientation program May be required before employee is issues identification and password Training doesn't end after go-live Training ensues after updates are made

Adults need to be ready to learn

Training sessions may be mandatory, learners show up physically, but they cannot be forced to learn Instructor must engage learner and encourage their desire to learn

Go-Live: Turnover Strategies:

Transitioning individual users to the system.

Documentation Testing

User guides, policies, procedures should all be checked and created. Followed during testing process to ensure that the instructions in the document are accurate Testers follow the IS documentation that will be provided to the users Errors in documentation will be identified and corrected so that the user will have the proper instructions

Scenario or "Use-Case" Testing

Users bring real-life situations to be addressed by the IS Scenarios documented in the plan Allows user to think through how a situation will be handled by actually using the IS Addresses entries in the IS, tasks, and output

Training Problems:

Users may feel like they are being reverted back to a novice employee after being an expert in their position. Job security may be another concern Those with little experience with computers are the most concerned with new IS's Learning curve is different with every employee

Trainer will also work with training staff from vendor

Vendor staff know product well and offer project team suggestions on different teaching methods Vendor should provide customized resources for HC facility

System Design: System Objective

What facility is wanting to achieve