Lecture 10
System Implementation and
Maintenance
(Chapter 10)
http://www.csun.edu/~dn58412/IS531/IS531_SP16.html
Learning Objectives
1. Cultural change in System
Implementation
2. Implementation committee
3. Issues in test, training, and
production environments.
4. The “go-live” process
5. Implementation pitfalls.
6. Maintenance and System Life Cycle
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System Implementation
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Third phase of the life cycle
Begins with purchase of the system
Planning before purchase
Selection of the implementation
committee to oversee the process
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Implementation Committee
• Project leader—needs to be involved in the
entire process
• Technical staff
• Informatics representatives
• Clinical representatives
• Managers who understand day-to-day
operations and how those processes might
be improved
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Implementation Committee
• Steering Committee membership and
organizational issues are as important as
the technology when implementing a new
system.
• The project leader must have strong
leadership and communication skills.
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Committee Tasks
• Develop plan /work breakdown structure
(who is responsible of what, timeframe).
• Schedule tasks for implementation.
• Define the scope of each task.
• Identify timelines and “go-live” date.
• Identify resources and constraints.
• Get to know the system.
• Research what data is needed and how it
is used.
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Getting to Know the System
• “Base” system—supplied by vendor without
any changes
• Training for committee
– On-site training by the vendor
– Vendor training at corporate headquarters
– Consultants may provide training
• Should revisit issues examined during
selection
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Issues to Revisit
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Is technology current? Upgradable?
Financial stability of vendor
Vendor compliance with regulations
Integration with other systems
Support different types of patient accounts
Clinical support (client care)
EMR support
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Cultural Changes in System
Implementation
• “If change does not produce a notable
resistance, then the change is probably not big
[significant] enough”
• New IT always change life (at home/at work)
• People should embrace (buy-in) the reason
for change
• Any change should make people feel
differently (more important/valuable/
effective/efficient …)
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Base System vs. Custom
• System as-is vs. customized
• Workflow Optimization: Gap Analysis to
identify required changes in workflows and
prototype
• Customization requires time and resources.
• Customization may have ripple effects on
other systems and interoperability.
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System Function
• A task performed manually or automated
• Must identify information pertinent to
completion of each function
• Examples
– Order entry
– Results reporting
– Documentation
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System Output
• Material generated by the system
• Examples
– Requisitions produced in other
departments
– Reports
– Diagnostic results
– Work lists
– Charges
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Required Output for
New System
• Analyses of the current and desired
workflows provide this information.
• Specifications must be agreed to, or
“signed off” by, managers in the areas
that will be impacted.
• Constant changes to specifications delay
the project and increase costs.
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Test Environment
• System testing vs. integrated testing
• Use a copy of the information system
software to make changes from the offthe-shelf version
• Programmed changes are tested to ensure
that they work as designed
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Test Plan
• Long-range goals (what for) and test
items (what)
• Test Script provides a series of
transactions from beginning to end for all
associated functions
• Requires input and participation from
users from all areas of the facility
• Evaluate actual vs. desired output
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Hardware Requirements
• Analysis of needs must be done early in the
implementation phase
• Considerations
– Network infrastructure
– Types of workstations and mobile devices
– Workstation locations
– Hardware locations
– Printer needs
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Network Infrastructure
• Should be determined early—later
changes will increase costs
– Network configuration requirements
– Server specifications—memory,
processing power, consider future needs
– Technical standards
– Cabling and power
– Wireless access
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Workstations and Mobile
Devices
• Advantages and disadvantages of each
type of device.
• The number of devices needed.
• Technology and support for access by
PDAs and handheld devices.
• Where devices will be located.
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Procedures and
Documentation
• Determine how the system will be used
before end user training starts.
• Evaluate/revise policies and procedures
for system use and include in training.
• Develop user guides.
• What to do in the case of planned and
unplanned system downtime
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System Documentation
• Develop a “dictionary of terms” and map
terms from one system to another.
• Mapping terms across systems help to
ensure high-quality data.
• Finalize pathways and screens before the
test plan is written and training starts.
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User System Training
• Do not start until changes are complete
• Training environment—separate copy of
the information system software that
works the same way as the actual system
and is populated by fictitious clients
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Go-Live Planning
• Go-live—system running and used to
collect and process actual client data
• Implementation strategies / rollout —
staggered/modular/all at once
• Conversion—bring in old data (backloaded)
• Develop the support schedule
• Develop evaluation procedures
• Develop a procedure to request post golive changes
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Implementation Pitfalls
• Underestimation of time and resources
needed
• Ongoing addition of changes and more
features (“scope creep” and “feature
creep”)
• Failure to consider costs for annual
maintenance and other expenses
• Problems with testing or training
• Lack of system “ownership” by users
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Maintenance
• User support—resource staff available
during go-live on units and via help desk
at all times
• User feedback / requests for changes
analyzed and appropriate changes made
to identify problems
• Must apply updates to all three
environments—testing, training, and
production/live
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Technical Maintenance
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Problem solving and debugging
Backup supply of hardware
File backup procedures
Storage space
Interfaces with other current/new systems
System upgrade
Disaster recovery plan
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Return on Investment (ROI)
• A system having poor performance, dated,
outgrown should be replaced
• Financial justification for changes
– Decrease in costs/expenses
– Increase in profits/benefits (tangible vs.
intangibles)
• Payback /break-even
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The Role of Nursing
• All users should have input into the
systems that they use.
• Nurse informaticists provide “credibility”
for information system projects.
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Nurse Informaticist
Responsibilities
• The Chief Nursing Officer (CNO) must
work with key figures to develop
strategies to transform care, prioritize
system design to maximize the value and
benefits of a clinical information system,
and reallocate time saved in
documentation and other efficiencies to
improve client care services.
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