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Review EHR readiness with five steps

HIM Connection, April 5, 2005

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Because it is so important to ensure that work goes smoothly once your electronic health record (EHR) system goes live and is "turned on," many organizations develop a final checklist to make sure everything is truly ready. Go-live is not just flipping a switch but carefully constructing a plan in which each function of the new system is turned on and runs in parallel with the old system.

Some organizations use a highly detailed checklist at the point of pre-live. Others use the project plan and go over every detail on it. Still other organizations use a high-level checklist and return to the more detailed project plan only as necessary. Five readiness review steps include the following:

Step one: Make sure that all modules of the applications are fully built out, workflow process and redesigns complete and working, and backup and downtime procedures are in place.

You'll also want to ensure that all users received training, were assigned access privileges, and have changed their default passwords. Although you might assume that these steps were completed prior to pre-live activities, checking actual against project plan ensures that assumptions are accurate.

Step two: Verify that all human-computer interface and other peripheral devices are installed, placed in the proper location, and in working order. Check, for example, that there is sufficient paper in printers, cables are connected to work stations, handheld and portable devices secured, cabinets built or installed to hold devices, carts acquired and set up for "computer on wheels" (often referred to as COW), and wireless devices have fully charged batteries.

Step three: Make sure all modules are set to produce data validation reports, backup lists, and perform other processes needed for parallel runs. Even if the EHR is phased in per unit and the intent is not normally to produce paper backups, it is important that these be run during the go-live conversion. They serve as backup in the event you need them, and they serve to validate that the EHR is functioning properly. For example, if you implement CPOE as one of the EHR applications, you should print the orders entered into the system and validate them against those received in each department.

Step four: Ensure that existing applications are either not affected or affected only as intended by the EHR. An EHR is a clinical system, but many of the functions performed generate charges, work orders, task lists, and other pass-offs that additional, existing systems must receive and process. Even though you should have tested each thoroughly during formal testing, you need to validate them during the actual go-live.

Step five: Ensure that all functions set to cease after go-live actually are ready to stop and, if so, that they ceased properly. Although you will need to find some parallel processing for a short time, it is not appropriate to run dual systems for very long. It is important to know when they are ready to be turned off and that they have been turned off properly.

This excerpt is adapted from Electronic Health Records: Strategies for Implementation.

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