"Pilot" may be somewhat of a misnomer for San Mateo Medical Center (SMMC), as we will be phasing in implementation of the EMR portion of eClinicalWorks (eCW) to a new clinic every 2-4 weeks after implementation of the first clinic.
Because this first clinic is to be like the first stride in the 100m sprint (we go live in April), we had to make sure that: 1) this implementation was representative of the environments in the other clinics, 2) the clinic personnel were motivated to work for a successful project, 3) the implementation would have the maximum amount of technical/user support available and 4) it would be a successful implementation.
Our third floor clinic, the lucky recipient of implementation #1, is actually a combination of 3 clinics: pediatrics, ob/gyn and adult. This satisfies our diverse environment criteria. Of course, this also makes the implementation harder, as there are 3 different workflows and 3 different groups of templates. But, we did give an extra 2 weeks (for a total of 4) for us to learn from this implementation before embarking on the EMR journey with the other clinics.
The third floor clinic also possesses many clinical leaders: the adult clinic was the first to use an electronic registry, the lead provider at the ob/gyn clinic is also the Chief of Staff for SMMC and the adult clinic is the site of a complete and radical redesign of clinic workflow for chronic care. With these leaders and personnel used to change and new technology, we thought that they were highly motivated for success.
Our IT support is centralized, and the division that supports the Medical Center is based there. By having the first implementation on the third floor of the Medical Center, instead of one of the satellite clinics, this will guarantee increased availabilty of support personnel and a more rapid response to any problems.
One of the most important aspects of choosing an initial implementation site was to ensure that this first site would be successful enough to create a positive momentum to our aggressively phased approach. We want the first site to go live with as few problems as possible, and although this may be an obvious wish, another perspective would be to choose to initially go live with the most difficult site. In the latter case, one could argue that this would prove to the other sites that if the implementation could work at the difficult site, it could work anywhere; but this is a somewhat risky approach, as the implementation at the difficult site could backfire. We chose to go with the best odds and hope that this would instill confidence for the future implementations.
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2 comments:
Michael - Thanks for sharing this approach with us. You acknowledged the aggressive time frame for implementation/rollout to the clinics and I'm wondering if you've set any evaluation milestones for telling you when you're ready to go to the next site, e.g. providers at pilot site are back up to X% pre implementation productivity, all priority 1 issues are resolved, etc. Or, is the rollout based solely on a time table and resource availability? Is eCW prepared to set up camp in San Mateo for the next 8 months? :)
SA-The rollout is based on a timetable and resource availability. I wish that we could have used the implementation milestones that you suggested, but you wouldn't believe how hard it was just to schedule the Computer Training Room for the next 8 months! Because physical space with several computers is limited throughout the County (really only 2 places with a possible third) and because we had to give eCW dates so that they could plan their training resources for us, we were committed to a somewhat rigid schedule. It turns out that one of the eCW trainers is now living in the area, and as you know, our former eCW implementation manager is now our employee (and member of the implementation team), so eCW has effectively camped out here.
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