Best Practices: The 'Go Live' and After
"Technology is ruled by two types of people: those who manage what they do not understand, and those who understand what they do not manage." —Mike Trout
Possibly one of the more stressful of life’s events is the launch of any new program, and initiating the use of health information technology (HIT) is no exception. Moving from paper recording to electronic records forever changes how work is done, how care is documented, and how information is exchanged. If not fully prepared and supported, the experience is similar to going from a tricycle to a two-wheeled bike without the benefit of riding that two-wheeler with training wheels. For some, the event is overwhelmingly stressful—not necessarily because of their own skills and abilities, but because of the way in which the process is managed, and perhaps the level of staff preparation that precedes the “go live.” Worst-case scenarios are indelibly imprinted on those who have been involved in the process without adequate training, support, staffing and other resources. But, they don’t need to happen. Watch this very brief video (below) that gives you the first-hand experience of a worst-case scenario experienced by AFT Healthcare members in Vermont.
|AFT healthcare members in Vermont discuss their experiences implementing health information technology.|
There are a range of factors that make the “go-live” event stressful, and that can be anticipated and addressed to make for a much smoother start-up process. Learning from the good and bad experiences of others is invaluable. The key, of course, is having end-users (direct care staff) actively involved in the process long before the “go live” takes place. Everything is affected by a move to HIT, and using your basic right to bargain over anything affecting working conditions is an entry point to a discussion with management. Visit "Bargaining HIT" for more info on how to make certain that your collective bargaining rights in this process are addressed.
So what are some of the best practices that take place during the “go live”? Members who have experienced the process have made some recommendations based on their experience including that the “go live” should be limited to one unit or two units and sufficient time allowed for debriefing, fine-tuning and testing, before HIT is turned on in additional units. Also, they recommend that “super users,” those highly experienced in HIT, should be available to assist staff during the “go live” interval, and on an ongoing basis, to provide expertise and to collect and analyze feedback for improvement. A complete list of best practices can be found in the 2010 AFT resolution "Implementing Technology in the Healthcare Industry." Some of those specific best practices that relate to the “go live” period are included below.
Best practices that address the considerations of the HIT “go-live” process:
- Workers on all shifts should have the same training and the same resources and support available prior to, during and after the system's "go live."
- Additional staff should be provided both when nurses and others are being trained on the new systems and especially during the implementation (and go live) itself so that the health and safety of patients and frontline caregivers are not compromised.
- No systems should be implemented that do not allow manual overrides of the system when necessary. Have an alternate/back-up plan in place. Prior to implementation, clear policies should be developed on downtime documentation.
Ongoing management of Health Information Technology
As with everything else, continuing attention and evaluation is required to address the myriad issues that arise during the use of HIT. Changes in patient care processes, software updates, policy changes and evolving documentation requirements test systems, and those who use them, on an ongoing basis.
Best practices in the AFT resolution that address the ongoing considerations of HIT:
|Hear advice from AFT member, radiology tech and IT expert Dawn Thomas.|
- The redesign and development of electronic health systems continues long after the initial deployment and "go live." The principles of inclusion, continuous training and full explanation of the impact of all changes on the quality of patient care should continue as the system evolves.
- A permanent labor-management committee, work group or other structure should be established in each facility to oversee design and implementation of the technology, to correct problems, to process feedback from end-users, to consider suggestions for improvements and to plan extensions and adaptations of current systems. Where end-users are represented by a union, the union should select the end-user representatives on the committee, work group or other structure.
- Electronic health systems can be valuable tools for reducing medical errors, improving the quality of patient care and providing necessary data for development of evidence-based improvements in patient care. Electronic health systems should not be designed as tools to enable reductions in workforce or promote personal surveillance of the workforce beyond the standard audit and accountability processes.
- If workers are displaced by the new systems, every effort should be made to retrain them for equivalent positions within the institution. When that is not possible, services should be provided to assist them to apply and/or train for new jobs.
Please view the video (above, at right) that contains expert advice on how to prepare for a best-case scenario from an AFT member—dually qualified as care provider and as an IT professional—who is the lynchpin between direct care staff and the IT department at her University Hospital.
For more information on experiences of others, expert recommendations and HIT resources, visit our HIT Resources page.