Section2.1 Utilize – Implement

Section 2.1 Utilize – Implement – Rollout and Turnover Strategies-1

Rollout and Turnover Strategies

Organizations can roll out health information technology (HIT), including clinical information system applications, in a number of ways. Some processes are slow and painful; others, often described as big bang rollouts, can include greater pain but are carried out in a shorter period of time. This tooldescribesa turnover strategy─how an application may be rolled out by staging user adoption over time and transitioning users.

Instructions for Use

  1. Review the various strategies described below and decide which apply to the application you are implementing. Certain strategies may apply to different applications or different parts of the organization.
  2. Plan the rollout when you are planning for the implementation. Users can become concerned about how a new application will be rolled out. Determine the order in which components of the organization will implementthe HIT.
  3. Recognize that the turnover strategy differs from chart conversion and pre-loadstrategy (1.2 Chart Conversion Planning), which describes how previous records will be used with and integrated into a new electronic health record (EHR). Any chart conversion strategy can be used with any ofthe rollout and turnover strategies described.

Rollout Strategy

Rollout strategy generally refers to how an application will be implemented throughout an organization.

Type of Rollout / Consider Using if Organization is:
Big bang
  • Everyone goes live at once
  • Paper processes cease shortly after go live
/ Very small
Confident in computerization
Assured of adoption by all users
Implementing a departmental application that has limited interface with other departments
Phased
  • One or a few organizational units or groups of users at a time
  • Plan exists to follow on with full rollout in same manner
/ Large organization that cannot support all users simultaneously
Organizations with less confidence in computerization or adoption by all users
If a phased rollout will negatively impact overall operations but big bang is too much, apply one or more of the turnover strategies in a big bang manner

When using a phased rollout, determinethe order in whichdifferent groups of chiropractors or different sites will be rolled out. Groups with the most interest in HIT and EHRshould implement first.Select a small number of individuals with good computer skills, who may have past experience with the type of HIT being implemented, and who have a lot of patience to be the first users. Those who areleast interested should become involved during the middle of the process. This will insure that they will not be left out of the process and that they receive the most attention.

Various strategies may be used for transitioning. These strategies are not mutually exclusive:

  • Trade– chiropractors take turns covering for one another to allow extra time during transition.
  • Ease– chiropractors use the EHR each day until it becomes too much for them and they go back to paper. Ensure that they increase time on the EHR each day.
  • Slow–plan the transition for the slowest time of the year.
  • Decrease- reduce the number of patients scheduled during transition. Revenue may suffer initially, but it may be the quickest way to transition, with revenue made up later.
  • Extend –increase the length of the day by one or two hours, lengthening each appointment time. Chiropractors who normally workfour days, can work five days during transition.

Monitor adoption rates for each component to assure adoption is occurring.

What
Component / Who / Strategy:
-Trade
-Ease
-Slow
-Decrease
-Extend / Adoption Rates
Site / Chiropractors / 1 week / 2 weeks / 1 month / 3 months

Turnover Strategy

Regardless of the rolloutstrategy, you may need to transition individual users from the paper they are used to, to full adoption of all components of the new system. This is especially important for a large organization where a phased rollout will disrupt internal operations of at least some part of the HIT application. Various strategies may be used for transitioning. These strategies are not mutually exclusive:

  • Retrieve data.Setting up the system so users can retrieve information from it prior to having to enter data can help reinforce newly learned computer skills and generate interest in using the system for other purposes. For example, they could retrieve referral information that has been electronically fed or scanned into the system.Doing this may be feasible for two or three months while the rest of the system is being customized.
  • Enter limited data. If the application includes several modules, identify one module that will be used first and have new users enter data only into that module. This module should be as stand alone as possible, without other data, with as little difference from the paper process as possible, andthat demonstrates value to staff. For example, the module may be similar to a form you are already using or be used to generate reminders. When everyone is comfortable with this functionality, other functionality can be added as feasible until all components are being used.
  • Parallel processing. Parallel processing is the entry of information into both the automated system and the paper chart. Some think this dual system is a quality check and is reassuring to staff that they are using the system correctly. Unfortunately, the time burden of duplicate entry ends up causing errors. Staff members forget what they have entered into the EHR and what they have recorded on paper. They may end up not recording in either or making duplicate entries. They may skip parts of entries because they don’t have time to be complete.

Copyright © 2011 Stratis Health. Funded by Chiropractic Care of Minnesota, Inc. (ChiroCare),

Adapted from Stratis Health’s Doctor’s Office Quality – Information Technology Toolkit, © 2005, developed by Margret\A Consulting, LLC. and produced under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.

For support using the toolkit

Stratis Health Health Information Technology Services

952-854-3306 

Section 2.1 Utilize – Implement – Roll Out and Turnover Strategies - 1