Up quickly for air...and then down again for another deep dive!

SMMC has now completed enterprise wide implementation of scheduling in the eCW PM component within 11 clinics 6 weeks ago, and is in the second week of go-live implementation of electronic documentation and eprescribing (eRx), along with laboratory, radiology and lifetime clinical record (HIS) interfaces in 3 clinics, supporting a total of approximately 25 part and full time providers. Seven clinicians are documenting about 50% of their cases electronically (OB/GYN), while the rest are documenting 100% in eCW (Pediatrics and Primary Care). The first day of implementation no patients were scheduled, but a few walk-ins were seen, and today is the final day of a 50% schedule. Next week the schedule increases to 75% of pre go-live capacity and the following week will be increased to 90%.

For the magnitude of the challenge that we have undertaken, SMMC has done very well, in my opinion. All levels of staff have taken a positive attitude to the implementation, our IT department has declared that failure is not an option and the implementation team has attempted to provide aggressive, at the elbow support for all end users.

We have run into many problems but are committed to a rapid break fix cycle to avoid disruption in service. We have tried to accomplish this through a command center staffed by in-house eCW experts and an IT engineer, onsite support staff consisting of specially trained SuperUsers and visible executive support. The command center proved very effective to quick answer queries by endusers or support staff in the field and also included on the first day of both go-lives an interface engineer from the HIS vendor. The 15 specially trained SuperUsers were personnel in the regular SuperUsers group who expressed an interest in providing support to clinic sites other than their own and were trained in all aspects of the eCW application. C-suite executives visited most sites on the first go-live day to offer their support and encouragement.

The circus of events included:

1. Data migration of the schedules from the previous scheduling system to eCW occurred the weekend before the scheduling go-live. It was discovered that 1500 appointments didn't migrate and these had to be manually entered by a group of 8 people. Later in the weekend, it was discovered that the incorrect file was migrated; the go-live was delayed for 1 day and then proceeded on the revised schedule.

2. One clinic was found to have not prepared their rendition of the new, standardized workflow based on the eCW application, although it was thought that they had been given instructions and materials to do so months before. This required an all hands briefing for 1/2 of the first EMR go-live day to achieve consensus; the clinic then got to work and embraced the new system.

3. An interface service crashed for 1.5 hours during the first week of the EMR go-live, necessitating downtime procedures. The problem was quickly fixed and service was restored with minimal incident.

4. After the scheduling portion of eCW went live, unanticipated users (for view only purposes) revealed themselves, requiring hasty installations of eCW on workstations and jockeying for training seats at go-live classes.

Of course, the list could go on, but mostly with more minor infractions. We have discovered bugs in the application, bugs in our HIS interfaces and bugs in the in-house pharmacy information system that interfaces with SureScripts, the eRx vendor. But, the clinics are starting to get used to the EMR and are already making suggestions for improvements ("Sorry, that's a development request, so it might be a while!").

We now have to make the transition from the strike support team to the long term support team to allow the strike team to be ready for the next go-live in 2 weeks. Following the next go-live, the cycle frequency increases with only 3 weeks between go-lives. Despite this challenge, the core team is upbeat and looking towards our next task with confidence!