It is important to test software extensively before implementation. Never assume that the software functions in the way you think it should. Set-up a test database for software testing and for staff training. Thoroughly and completely test all areas of the software and utilize the end-users to test their specific functions.
Perform volume testing, if possible. Take a typical day and do a dry run in a test database. This step is often overlooked but can provide important information regarding the time it takes to enter data with typical volume or increased volume.
Ask for a list of known bugs from the vendor for the version you are about to install. If bugs exist, ask the vendor to create work-arounds and identify dates for patch fixes. You do not want to identify a major system flaw or bug during the go-live phase when this could be prevented.
The infrastructure must be prepared. A crucial part of the success of implementation will rely on the success of the hardware infrastructure readiness. (Note: the hardware testing will be much more extensive if a client/server environment exists or is chosen as opposed to a web based or ASP environment where the software and server is hosted by a vendor off-site.) For a client/server environment, the project should be planned in advance to define locations of workstations, printers, kiosks, servers, and/or wireless device access points etc. Existing hardware systems may need to be upgraded and/or reviewed to determine the stability of the system prior to any software installation. In addition, cabling may need to be run to new locations to accommodate access to the network. New systems need to be purchased and delivered well in advance of implementation to allow for testing. Once the infrastructure is in place the testing phase should begin to ensure all aspects of the network and hardware are functioning properly. Phase 2 of testing begins once the EMR software has been installed complete with a dummy database to enable appropriate testing of the applications in the new environment. All testing should be complete before staff-training dates are scheduled. A test environment should be established for future updates as this allows the IT Director to install future software updates/upgrades in a non-production environment for testing prior to updating live units.
Staff and Testing
Test pilot systems before implementation begins. Test pilot workflows, procedures, modules, templates, documentation time etc. in a live environment utilizing a small group of staff long before ‘go-live.’ This is critical to identifying issues that are unforeseen during the planning phase.
Allocate enough time for training. This is a very common error made by most practices. Keep in mind, not only are staff required to learn the EMR but also new workflow and procedures. Training sessions are best in short and scheduled increments. Small groups are more beneficial for more personalized training. Allow staff to practice what they have learned using a hands-on approach before introducing new information. Utilize the vendor’s experience with training time but be willing to alter for your individual practice.
Training should be performed outside of clinical work sessions. Practice administrators, in their concern to not adversely affect productivity, will attempt to train staff as they try to perform their clinical duties. This leads to poor understanding of the software and also causes frustration. Train users right the first time. There are several methods practices can utilize to effectively train staff such as reducing or blocking schedules, hiring temporary employees, training outside of clinical time etc. Staff should also be paid if they are being trained outside of their usual work schedule.
Set-up a designated quiet environment for your staff to train in. This can lead to a comfort level with the software and lessen the apprehension of ‘go-live.’
Designate and train certain users to be “Superusers”. Their role is to provide immediate, first line response to staff with questions and issues during ‘go-live.’ Designate a Superuser for each type of clinical role (MA, nurse, receptionist, provider). Superusers should have a more extensive knowledge of the software and workflows. Being able to provide immediate support to staff during a go-live situation will more likely ensure that productivity is not interrupted.
One concern with ‘Train the Trainer’ method is the potential for miscommunication and/or misunderstanding from one person to another. Trainers supplied by the vendor usually train large groups of users simultaneously and are more experienced with training the software. ‘Train the trainer’ methods can provide a cost savings to the practice however.
Prepare for Takeoff!
Assess staff’s knowledge of the software and workflows. Create mock live situations and walk-through the workflows considering all possible scenarios. Be prepared to delay ‘go-live’ if staff is not sufficiently prepared, otherwise, proceed to the ‘go-live’ phase.