My husband is a family doc who works for a large medical group owned by a hospital system.  The system is rolling out a new Electronic Medical Records system and my beloved, who as medical director is the divisional advocate for physicians, will be among the first in his division to get it.

I’ve been watching the process with interest, because well, I do training, and I do software rollouts, and I’m always nosy about how other people meet these challenges.  My observation is that this implementation is something of a poster child for having a training program integrated with the rollout process, and project management with strong ties to IT, management, and employee relations.

Consider, for a moment, the pool of new users. They are office managers, nurses, nurse practitioners and physicians, who have been using paper and dictaphones for the charting process for decades.  These people have widely varying exposures to computer systems – like senior executives, some are tech aficionados, and others have arranged for their staff to insulate them completely from computer-based tasks. Consider, too, the extra level of challenge posed by the reality that a computer is being inserted into what is otherwise the original “high-touch” workflow!  Patients want to see the doctor’s eyes on THEM, not a computer screen, which means that developing a proficiency with the system which makes it possible to continue to maintain that eye contact is very important to these learners.

A well-designed rollout would carefully interweave training and practice opportunities with the provisioning of hardware and software supporting the new system. This has not been such a rollout, in part because the software company is providing the training,  IT is providing the infrastructure, and there is nobody central within the organization coordinating the two.  As a result, the administrative assistant to the divisional operating officer is being run ragged trying to get the various parties to get the various pieces in place.  The software in question lives on the web, so I guess people didn’t think there was all that much coordination needed, but so far, the timeline I’ve been able to observe looks like this:

T-minus 6 days to rollout:

Provider and office staff are trained in an all-day session, which required closing the office on a Monday.  Trainer for provider is clearly a star former employee of the software company who now works free-lance as a contractor. She’s very smart, very experienced, can answer most of the questions with authority. When she answers “what about docs who can’t type?” (he can type, but is accustomed to dictating his notes) with “oh, we support Dragon Medical!”  The doc responds “hmm. I do not see that software on my machine.” The admin who is auditing starts a fascinating email chain re: equipping docs with dictation software.  When she answers “can I practice with this on my own?” with “there will be a sandbox provided to you after you complete training.” Admin engages in a new round of emails on the “what’s the deal with the sandbox?” issue.  Provider hears for first time that a “mock go-live” is planned for T-minus 1 day.  He is asked to cancel patient appointments which have already been scheduled to enable this, and to close the office for 6 hours. He talks them down to 3, because it’s just not going to work to dump so many patients on short notice. He also talks them into moving it out a day, because closing a busy family practice office on a Monday is possibly the worst possible timing, and he’s already had to do that for this week.  So now it’s T-minus 7 days

T-minus 6 days

A microphone for use with dictation software arrives at the provider’s office. Along with an email string in which IT is asking for the proper authorization form in order to be able to install it.

T-minus 5 days

IT comes out to install dictation software. Unfortunately, the software version only supports Windows XP, and the new laptops which have been issued for this initiative are all running Windows 7.

T-minus 4 days

It is announced that the practice sandbox (to be prepared by the software company)  is not yet ready, and will not be until “late next week”.  Would the provider like to spend his weekend shadowing somebody who is already using the software, instead?  Clearly, watching somebody use it is NOT as helpful a learning experience as is attempting to try a range of scenarios oneself.  Just as clearly, attempting to do this experimentation after full days of jamming people who have been cancelled out of Tuesday  and attempting to use the software with live patient encounters will not be as effective as using the relative peace of the weekend before launch for the same purpose!

T-minus 3 days

Still no dictation software, it’s not clear where the licensing information is and how the upgrade can be obtained by IT for installation!

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Most of us have it considerably easier. We arrange training under the aegis of learning organizations with ties to the various operating entities which must be coordinated to pull off a smooth learning experience. And this, my friends, is why we have such structures – because without them, high-value, high-profile initiatives founder!

Who is in charge of having all the ducks in a row for your next high-profile, high-value initiative?