Keys to a Successful System Implementation

Friday, June 5, 2015
Pat Stricker, RN, MEd
Senior Vice President
TCS Healthcare Technologies

This article is the last in a four part series on factors to consider when looking for a new case management or medical management software. The previous issues dealt with:

As noted in earlier articles, before you begin to look for a new medical management software, it is essential to determine exactly what you need the software to do. Before sending out an RFI or RFP, spend time listing the "must have" features required for each functional area of your organization—the key elements needed from an operational perspective to automate and streamline all workflows and processes in order to make programs successful.

Once the system and vendor have been chose, it’s time to implement the software. The first step is usually to have a kick-off meeting that is done by conference call to introduce the client and vendor management and implementation teams. The vendor should present an overview of the implementation process and review a draft implementation plan explaining: all key steps, expected time frames, training schedules, and expected responsibilities and time commitments for implementation team members. An initial on-site visit and initial training session should also be scheduled during this meeting.

Immediately after this meeting, the two technical teams should begin to install the system, so it is ready for the initial client visit that should include a high level demo of the system, an initial overview training for the implementation team, and an in-depth assessment of workflow processes.The high level demo is important at this point in the process in order to provide the implementation team, senior management, and other staff at the client site an overview of the system, since many of them may not have been part of the selection committee. It is also a good time for members of the selection committee to review the system, since it has probably been months since the initial demo took place. The initial high level training for the implementation team should focus on reviewing the features of the system and provide them with "hands-on" practice in navigating the system.

In addition, a technical and clinical member of the vendor’s implementation team should conduct a detailed assessment of the client’s planned workflows and processes. Meetings should be scheduled with all functional areas to determine exactly what their unique workflows and processes need to do. This is an essential step that drives how the system will be configured to meet their unique needs; it also helps the vendor finalize the implementation project plan with realistic tasks and time frames.

It is now time for more in-depth training for each of the client’s implementation groups: technical, clinical, and reporting. These sessions focus on specifics related to their key responsibilities.

  • The technical team will install the system, set-up network connections, create processes for data loads and exports, build interfaces, etc.
  • A sub-group consisting of an analyst, a report writer and operational staff will develop letters and reports.
  • The clinical team will set up workflow processes and configure the system.

These trainings can be done on-site or in online sessions. Due to the cost of on-site visits, more implementations are now being done using online conference sessions in which the 

individual groups work with the vendor at least twice a week. These sessions, which will continue throughout the implementation process, are part training and part "hands-on" work, with tasks assigned between meetings. Intermittent on-site work sessions may also be scheduled, depending on the needs and the complexity of the implementation.

Depending on how the contract is written, the vendor may actually configure the system for the client and then provide the in-depth training after the system is configured, when the client is more familiar with the overall system. This option reduces the number of hours the client needs to spend on configuration, shortens the overall configuration process, and reduces the hours needed to train the client. For example, there is no need to train the client to do some things that are only done during the implementation process.

Regardless of whether the client or the vendor configures the system, the process of re-designing streamlined and automated processes in the new system will take a good deal of time. However it is imperative that "old, convoluted processes" and "workarounds" are not brought over into the new system. As noted in last month’s newsletter, an article in HealthLeaders magazine by Scott Mace stressed the importance of process redesign. The health care leaders who were interviewed agreed that it is the way the processes are implemented that allows the system to provide value and efficiencies. One even joked that "if you don’t (redesign workflows first), you’re just moving garbage at the speed of light and magnifying inefficiency." Another said, "When we redesigned the system around (a workflow process)...it streamlined so much, and from a quality point of view it also took out a huge number of errors and potential errors." A third expert noted, "Our IT projects are really only 20% technical, and the other 80% is adaptive change and integrating the operational systems with the technology." Clearly, process redesign is a critical step that requires time and attention!

The vendor’s project manager oversees the implementation project, working in conjunction with the client’s project manager. Weekly status meetings should be scheduled for the implementation team, as well as monthly or bi-monthly governance meetings with senior leadership, if needed, to discuss any outstanding issues.

During the implementation process, each team needs to have access to a practice system to test out the data loads, configuration, reports, etc. The vendor should offer a process that allows each team their own system that can be used by them and not interfere with the other groups. For example a vendor may offer to set up three databases: one for technical group to use for data loads, interfaces, etc.; one for configuring the workflows and processes; and one for training and practice used by all groups. Prior to the final training, the data load and configuration databases can be combined to produce a database for User Acceptance testing. Once the team has tested the system with realistic workflows and processes and made any needed changes, the database can become the End-User Training database and, eventually, the actual Go-Live Production database.

The End-User Training is usually conducted within one to two weeks before Go-Live. The timing will be determined based on the number of staff to be trained and the availability of training facilities. Ideally, each trainee should have their own computer, so they can get the "hands on" practice they need. Try to avoid sharing computers, if possible. The class should be taught by the vendor and the client, with the vendor providing basic features and navigation and the client teaching client-specific workflows and processes. The vendor should provide training materials either in hard copy and/or digitally.

Providing additional time for the staff to practice entering "real" cases into the system immediately after the End-User training is beneficial. This can be done by defining scenarios to test the various workflow processes that are included in a normal workday or by having the staff replicate actual work that they performed the previous day. The staff will not only learn the functionality of the system, but also be able to practice the newly designed 

workflows and system configuration before Go-Live. This process also provides additional testing of the configuration and workflows.

Now, it is time for Go-Live! The implementation team and vendor should be available for the staff during the first week to offer assistance and keep logs depicting all issues, suggestions and requests for changes. At the end of each day, the implementation team should review what went well and what needs revising or fixing. This quality process is critical, so that issues are identified and addressed on a timely basis.

Notice that I didn’t say that Go-Live was the last step; that’s because it isn’t. Weekly team status meetings should continue for the next three to four weeks or until all issues and revisions are completed. About four to six weeks after Go-Live, the vendor should schedule a meeting with the client’s leadership and implementation teams to get input on the overall implementation project: what worked, what could have gone better, etc. This information should be used by the vendor to improve their implementation processes.

Lastly, about six to nine months after Go-Live, the vendor should conduct another on-site visit to determine how the system is working, reassess the client’s needs, review ongoing configuring needs, provide suggestions for improvements, provide additional tips and hints for better use of the systems and assist the client in determining how to add additional programs or processes, if needed.

I hope this series of articles has provided some insight into the most important factors to consider, if you are looking for a new system. Knowing how to choose the "right system and vendor" is extremely important, which then makes the actual implementation much easier. Any implementation takes a great deal of time and resources, but it is definitely worth it, because of the improved effectiveness, efficiency, productivity and clinical outcomes that it provides. Taking the time to choose the "right system and vendor" and re-designing workflow processes are the keys to a successful implementation.

Orginally published in the May 2015 edition of CMSA Today.