The race is on to implement advanced clinical software and get in line for a piece of the HITECH pie. After months of planning, building and testing, much rests on the selection and execution of a live conversion strategy.

Conversion methodology options have changed little over the years.  The usual suspects include:

• Big Bang - an all at once approach in which all departments using an application(s) go live simultaneously
• Incremental roll out -  converting one department at a time until the new software is fully deployed
• Phased -  subdividing a large project into distinct phases by application, department groups or user groups

Once recommended only for small, well contained organizations, Big Bang approaches are paving the road to success in a variety of arenas. Endorsers of the all at once approach appreciate the avoidance of dual systems. During incremental roll outs, some departments are converting to the new software while those awaiting their turn are using paper or legacy systems. Dual business processes are confusing to physicians, staff and customers, typically affecting productivity.

Big Bang, packaged in high risk, is not for the faint of heart. If the new system does not function as planned, crashes or meets heavy resistance from the end users, the business suffers. Incremental schemes find favor with those preferring to play it safe. By carefully selecting the first department for conversion, early success is usually achieved.

Training for any system is best offered as close to the conversion date as possible. This is problematic for Big Bang. Judicious use of e-learning helps, but user adoption improves with use of small group or one-on-one training sessions. It usually is a matter of resources; with a sizeable training staff, sufficient equipment and enough space to offer multiple concurrent training sessions – problem solved. When training one to two months prior to conversion, strategies to reinforce the learning are essential. If training resources are limited, you may find yourself leaning toward an incremental roll out. Using fewer training staff over a longer period of time works well when training is scheduled immediately before each departmental conversion.

The same resource constraint applies to go live support. The rate of deployment directly affects the number of support staff needed. Since individual users require the same amount of support regardless of the roll out plan; the more rapid the deployment, the overall length of the support period is shorter, but the number of support staff needed increases. The actual number of training and support hours are higher for longer roll outs, but less overtime is typically incurred. Cost differences between the two strategies is affected more by the cost of support and training venues than by the number of support hours. When clinical staff provide the training and support, the cost of temporarily backfilling their positions must also be considered.

Morale, technology acceptance and attitudes toward change may be primary factors in selecting a strategy. Incremental plans allow time for staff to adapt to new business processes. However, if the implementation seems to lag, morale decreases.

If Big Bang is a good fit for some, but not all of your HITECH initiatives, consider a phased approach. Phases may be defined by applications, departments, user types or customer types. This option is often selected when changing Health Information System (HIS) vendors or software platforms prior to implementing advanced clinical applications. The HIS implementation phase is carried out Big Bang style, followed by incremental roll outs of clinical documentation, electronic medication administration and provider order entry.

Selecting the right strategy, right-sizing the support resources and executing the conversion can prove demanding. Perhaps it is best summed up by the preferred method of removing a band-aid. If you remove it quickly, the pain is more intense for a shorter period of time then the pain is gone. If you gently peel off the band-aid a millimeter at a time, it still hurts. The pain is less intense but is felt for a longer time.

If you are struggling with what conversion methodology will be the best choice for your organization, Santa Rosa can assist you with this important decision.  To learn more about Santa Rosa Consulting, go to santarosaconsulting.com or email us at contactus@santarosaconsulting.com.

Becky Dawson, BSN, RN-C
Santa Rosa Consulting, Inc.