One very important decision when considering an electronic medical record (EMR) implementation is whether or not to use a third party system integrator to run the project. The decision to use a system integrator can add as much as 20 percent to the overall implementation costs. I have been involved in leadership roles with a system integrator at a major academic medical center and ‘going alone’ at a regionalhealth care system. There are many benefits of using a system integrator under certain situation. One size does not fit all.
"When selecting system integration vendor it is important to know and understand the experience level of that service"
There are several factors that must be in place in order to have a successful ‘go alone’ strategy. They include:
• Strong C-Level management support engagement
• Good employee engagement prior to the project implementation
• A stable workforce
• A capable and experienced internal project director
• Strong IT leadership and processes
• A commitment to hire a mostly internal project team and pull them completely out of operations
• A commitment to training
• Tools for project management, status, testing, and many others
• A commitment to the vendor's project methodology
• Strong clinical engagement, participation, and leadership
• Ability to slow or freeze the pace of changes to the existing EMR and other applications services
• A very strong infrastructure and Integration team
• Testing resources and methodologies exist in the current organization
• Ability to internally execute a change management plan
• Governance should not be a new experience as many difficult decisions need to be made in the course of the project.
In thinking about my prior experience at the major academic medical center implementation, the above are success factors even when hiring a system integrator. The distinction is that many times the IT footprint at larger health systems in inherently more complex with many more customizations and a high degree of vertical integration.
When to bring in a system integrator:
• Decision making in the organization is decentralized • The requirement for more complex workflows and order-sets compared to out-of-the-box • There exist many different IT divisions in the organization • The desire to optimize current applications (compared to soft and hard freezes) • Systems are behind on upgrade schedules for applications that will be maintained • Low capability maturity levels inIT service management
Other considerations that may merit a system integrator:
• Strength and experience of EMR vendor's implementation practice • CIO and IT leadership stability (especially strength of CMIO) • Low credibility or missing skill sets in IT • Little to no governance for IT/Business related decision making • Low consumer perception or perceived low credibility of IT support services • Competitive staffing market where high turnover exists or has the potential to disrupt the project
When selecting system integration vendor it is important to know and understand the experience level of that service. Validation of the experience is required. The vendor should agree to provide a list of people who will be on the project. It is important to understand if the vendor team will be involved in multiple projects or focused on your implementation. Juggling multiple healthcare implementations by the same team is a red flag. Expertise in bringing in experienced individual contributors is also important. Many times the speed in which the integrator can bring resources to bear allows the organization to cut off problems early.
When going alone, one of the major challenges is identifying trouble areas early and having the ability to mitigate issues, first with internal staff, then with contract services. When using contract services, we have experienced some hit and miss resources. Making sure contract vendors are willing and able to respond quickly to needs and concerns is paramount. A good knowledge turnover plan is important as disengaging with the system integrator is important after the project is complete.
Another really important action for independent implementation is periodic independent audits of the project. The report should go to key board members, C-level and experienced contributors. We have been lucky enough to have three CIOs and one CFO from other hospitals participate in this advisory committee.