Lessons Learned at Go-Live

This past week I’ve learned so much from being an outsider at an inpatient go-live.   Some of my lessons learned are:

Workflows are key.  From a project team perspective, know the different workflows of the institution, especially the ancillary workflows.   A completed workflow analysis  – before the EMR and after the EMR is needed and available to everyone.

Share the workflows with the trainers.  The trainers are in contact with the end users.  End users know when trainers are not clinical.  The end users know when the trainers do not understand their workflow or the system.  This results in end users not trusting the trainers and not asking enough questions.  And this results in end users documenting in places where they should not be documenting.

Share the workflows with the clinicians. Who knows the workflow better than the clinician?  Before implementing a system, meet with your end users and get an idea of what their workflow is. I find it unacceptable to call the command center and have one of the analysts tell me they do not know the particular department’s workflow.  Some of the common questions I was receiving were “Where do I document this?”  I looked in the system and the fields are missing.  This is why getting to know the department’s workflows are important.  In addition, taking the documentation and workflows from one institution and making another institution use it will not work.  The electronic medical record is supporting the hospital workflow and not the other way around.  You can’t make clinicians workflow change with the system. The system changes to meet clinicians workflows.

Communication is key.  The project team needs to communicate what is in scope with their end users and what is not in scope.  For example, the blood administration workflow confused many people and it was not clear if it was on paper or in the system.  The system had a flowsheet template on blood administration.  The end users were about to use the one in the system because all week leadership kept repeating, “Document in the system and not on paper.”

Explanation of what is in Scope is important.  I found many clinicians double documenting.  If the clinicians are documenting on paper, then they should not be documenting the same items on the computer.   Explain to all clinicians that the electronic medical record is one record, one chart where all disciplines document.

Know how to troubleshoot. The go-live support staff identifies the issues and the project team resolves them.  Being in this go-live helped me with my troubleshooting skills and learn how to identify and problem solve those issues.  I was so happy when nurses were proactive in troubleshooting and stopped relying on me. The clinicians knew I was not going to be there next week so they collectively as a nursing team troubleshoot the computer issues.

I think the clinicians did a great job on their first week of go-live.  Yes, there were issues and there will always be issues at every go-live. Nothing is perfect:  workflows will be missed and so will documentation, users will be missed with their security or provider records. It’s about how you can handle the situation.

This experience was so invaluable for me as it made me a stronger analyst and clinicians. I know where my strengths are and know how to develop my weaknesses.  My strengths are my patience, training, and interacting with the users.  If they are flustered, I help them get focused. If they are angry, I let them be angry and walk away. If they need help, I help them but I let them think for themselves. These are the qualities of a true nurse, teacher, and informaticist.   I went home with a sense of confidence in me and the clinical staff and will cherish my first inpatient go-live experience.

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