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Video: EPR implementations – five critical paths and a cutover

Ideal Health helped us to get our first full-length HTN Now event of the year underway by presenting a live webcast on Electronic Patient Record (EPR) implementations.

Hosted by Andi Taylor, EPR Implementation Programme Director and Consultant, the session – entitled ‘five critical paths and a cutover’ – covered a range of areas including ownership readiness.

Andi began by sharing a little bit about Ideal, his own experiences of working with the digital transformation partner and their services around strategic consultancy, project delivery, and specialist resources.

A former Emergency Department nurse, who specialised in disaster management, Andi highlighted how his experiences in healthcare have shaped his approach to EPRs and health tech and explained his five critical paths to a successful EPR implementation.

“It has to be a mirror image”

“This, in a nutshell, is what I consider to be an EPR implementation,” he said, sharing a slide with points on: data migration, testing, technical readiness, operational readiness, and ownership readiness, with each path followed by three action stages, a full dress rehearsal and a go-live.

“Data migration trial loads – it’s taking the data out of one box and putting it into another box. However, the box is moving, and the data inside it is changing on a daily basis as patients go through the organisation. At each point of these trial loads, when you copy the data from one to the other, it has to be a mirror image. That means that there must be clinic freezes throughout the implementation within the hospital, to support those,” Andi explained.

On testing, he stated: “[With] testing we’ve got the test cycles, system testing is testing the functionality within the system individually, with individual elements of the system and any third-party system. Integration testing is testing the system from a patient journey perspective…you want to be running those journeys through the system and all integrated systems (including medical devices), during integration testing. We learn what doesn’t work, fix it, and do it again.”

Andi’s third focus was on technical readiness. On this he said: “Technical readiness is infrastructure – hardware, networking, backups…structure to support the new system. The big driver that’s coming in is integrated medical devices, and now we’re moving to mobile devices. So, what’s the medical device infrastructure and support system that you’ve got in place ready for the change to any medical device integration?”

“The next one we’ve got is operational readiness,” he continued, “what we’re talking about here is the organisation being operationally ready…it’s looking at their current clinic, the patient numbers versus clinic slot availability position, and planning that in advance…so that when they have to have these clinic freezes, the organisation is still able to function.”

“Certainly, around these last stages – readiness delivery, full dress rehearsal, and cutover – those freezes are absolutely critical, because we need that mirror image, so that all the data we copy from your legacy systems into the new system is like for like and landing in the same places,” he said.

On ownership readiness and cutover, he added: “It’s about taking ownership of the new EPR system from day one. We have the cutover and the go-live date, and then the system will be launched to the trust. It’s about the back-office structure, ownership of the next stages of workflow development…all that piece needs to be put in place, and there’s quite a bit of learning to be done.”

“It’s all about planning, planning, planning”

“Then we’ve got cutover – it’s all about planning, planning, planning. People make the mistake of thinking that cutover is about the first two – data migration and testing, the technical cutover. In reality, cutover is about bringing all five of these critical paths together and working to put the technical solution in, but also to ensure that the organisation is still able to run as a hospital while we’re doing [it].”

Andi then moved on to a discussion point about common challenges, pitfalls, pain points and ‘blockages’ to some of these critical paths. For data migration, he highlighted the importance of data quality and understanding the true current state and issues around it, as well as high volume clinic changes breaking the ‘mirror image’, and why data mappings – which current clinical terminology you use and how will it map to the single one in your new EPR – are key.

His three “biggest blockers” for testing were around legacy system changes that cause any existing testing to become “null and void”, EPR change requests during and late on in implementation, and third-party system interfaces causing complications during integration cycles for the first go-live.

On potential technical readiness pathway blocks, Andi cited infrastructure changes, high volume moves requests between wards and departments disrupting elements such as workflows and printing, and resource shortages due to underestimation of the amount of support and work required for implementation.

With operational readiness, meanwhile, the areas Andi suggests being aware of are getting engagement up and running early in the process, planning your processes, and identifying conflicting pressures that could prevent the EPR being successfully delivered.

Finally, on potential blockers to ownership readiness, he commented: “There’s a lot of focus on the go-live date. It’s the day after the go-live date that we need to get people’s focus on because that’s when the organisation takes ownership of the new EPR system…I’ll say this many times and say this as loudly as I can so you can all hear me – please do not underestimate the requirement that getting this set up takes. If you start it too late, you will not be ready for when that system goes live.

“It’s a rebuild of a new team…there’s a lot of training to be done. The planning and the release of the resources to do that is critical,” he said, also highlighting the importance of releasing staff to do the training.

“It really is like managing a disaster”

“Full Dress Rehearal should be, yes, doing the technical bit, but also testing the technical infrastructure, the operational readiness elements that have been put in place, the ownership readiness, and tying all five of these together, so that you practice all of it…this comes back to my disaster management experience. The skillset that I transfer across to this role is in here – because it’s really like managing a disaster. A planned disaster, so it’s much nicer, but it’s pulling these five [paths] together,” he said.

Andi then moved onto discussing additional topics such as scope, programme governance, team structure, functionality, and patient pathways.

Catch up on Andi’s full session below: