All At Once   

NOT FOR THE FAINT OF HEART

In approaching the implementation of a new EHR, adopting the "All at Once" or some call it the "Nuclear" implementation, is not for the faint of heart. It is like putting all your eggs in one basket and then carrying that basket over a log jam in a river. Good luck. That is not to say that some don't accomplish this successfully (and even make it look easy) but there are numerous pitfalls to such approaches. Our advice is, if you haven't already decided on an approach, read the Phased Approach pages. However, if you are bent on implementing all at once, continue on. Below you will find some general pointers and using the links here, can proceed inside this web site (after Registration) to get even more detailed information.

THINGS TO PONDER

If change is good, much change must be very good! Adopting a full blown EHR and making it work with an existing computerized practice management (CPM) system is a real challenge. One way to reduce risk up front is not to interface it at all, but rather to replace both at once. After all, this is the nuclear option - right. Apart from the issue of whether your new CPM component will work well, at least your new EHR should work with your new CPM, right? Well, even that's not a given. Make sure that BOTH of these were written by the same company, using the same, integrated database, using the same language platform and a common, integrated code set. Avoid companies that had one or the other of these two essential components and then acquired the missing component so they could offer you one combined solution. There are options in our Reality EHR Selector tool to identity these companies and differentiate them from others that actually developed both components and offer an integrated solution.

WHO DECIDED WHAT WE BOUGHT? WHY DIDN'T THEY ASK ME?

It's a key question. Who decided what was needed? MSP talked with some doctors in NJ recently who were struggling to get a well-known vendor's EHR working with that same vendor's practice management system. They had dropped a bundle on this system a few years ago, and had brought the CPM online first. Now they were struggling with going live on the EHR piece. The staff frustration level was high. They were in too deep to back out, but clearly not making much headway either. We observed the clinical specialist make notes on paper during a patient interview, while the desktop computer terminal sat quietly. Once the patient departed, we asked her about this. She recounted that one physician (in a group of about a dozen working over three separate offices) had been the "mover" in getting the system and had not involved the rest of the physicians or their support staff in making the decision. Now, the staff was finding it difficult to use the system and finding that it didn't meet their expectations, but had no choice but to proceed because of the investment already made. Placing "blame" accomplishes nothing, but looking at the situation from an outsider's perspective both the vendor and the practice were short-sighted.

The vendor was probably happy for the order initially, but ended up without a happy customer (and probably not a referable one either). Indeed, the system seemed to be working fine, although some features still didn't integrate, however the expectations of those staff members who were not invited to participate in the purchase decision were not set correctly about what would be involved in rolling out the EHR component of the system, and so they were not using it. Often, the implementation plan is as important, if not more so, than the initial purchase investigation, at least if the end result desired is a happy, referable customer. There is nothing unique in this story, we could recount 50 more stories (with different vendors) with the same result. The key is EVERYONE who will be a significant user should be involved to some degree in the purchasing discussions because an EHR represents CHANGE in the way everyone will be doing their job, and change (even good change) is not always perceived as desirable.

Excellent involvement and implementation planning is always important, but becomes even more so as the size of the system (number of users) increases and the phases of implementation are reduced from several to ONE massive change. People can only accommodate change at a certain pace, so in a single "go live" approach, getting the implementation plan right becomes a critical element to the successful roll out of the system.

A CHECK LIST TO AVOID A "BIG BANG"

If you have gotten this far, and are still bent on doing it all at once, this would be a good time to register and browse a more in-depth discussion of the keys to safety in handing the nuclear implementation approach. Register now.