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Roll Out Strategies
Organizations might roll out clinical information system applications in a number of ways. Some are
slow and painful; others are often described as big bang, potentially have greater pain. The
information below describes how an application may be rolled out if you have multiple locations,
such as all nursing units, where it will be used (frequently called turnover strategy), as well as ways
to transition individual users (frequently called transition strategy).
Instructions for Use
1. Review the different strategies and decide which apply to the application you are implementing.
Different strategies may apply to different applications or different parts of the organization.
2. Plan the roll out when you are planning for the implementation, because many users will be very
concerned about how a new application will be rolled out.
3. Recognize that the turnover strategy differs from chart conversion strategy, which describes how
previous records will be used with/integrated into a new electronic health record (EHR). For care
transitions, the turnover strategy will guide the implementation strategy for the use of a
standardized patient assessment and medication management tools via health information
exchange (HIE).
Turnover Strategy – Multiple Locations/Units
Type of Turnover
Consider Using if Organization is:
Straight turnover
 Everyone goes live at once in a big
bang approach
 Paper processes cease shortly after go
live




Very small
Confident in computerization
Assured of adoption by all users
Implementing a departmental application that has
limited interface with other departments
Parallel processing
 Everyone goes live at once
 Paper processes continue until system
works as planned




Small
New to computerization
Implementing a product new to market
Implementing a patient accounting or other system
where there is a need to compare results between
old and new system
Phased turnover
 Application of straight turnover or
parallel processing to one or a few
organizational units at a time
 Plan exists to follow on with full roll out
in same manner
 Multi-floor
 Multi-wing
 Multi-unit
When using a phased roll out, you need to determine in what order the different nursing units or different
departments (e.g., a standard nursing unit vs. a hospice unit, rehab unit, or high risk unit) will have the
health information technology (HIT) rolled out to them.
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Transition Strategy – Individual Users
Irrespective of the turnover strategy, you may need to transition individual users from the paper they
are used to, to full adoption of all components of the new information system application. Various
strategies may be deployed for transitioning. These strategies are not mutually exclusive:

Retrieve data. If the system is set up so you can have users retrieve information from it prior to
them being expected to enter data, this can help users who are new to computers to reinforce their
newly learned computer skills and will generate interest in using the system for other purposes.
This may apply to retrieving documents that have been electronically fed or scanned into the
system, such as transfer documents from a hospital. Doing this may be feasible for two or three
months while the rest of the system is being customized for the organization.

Enter limited data. If the application includes several modules, you may want to identify one
module that will be used first and have new users enter data only into that one module initially.
This module should be as stand alone as possible, where not having other data will not cause a
burden or pose a safety risk; has as little difference from the paper as possible (e.g., already using
a flow sheet); and demonstrates value for the staff (e.g., provided reminders). For instance, you
might start with a medication administration record (MAR) module where staff are reminded
when to administer medications and can record in a fashion similar to their existing MAR.

More sophisticated data entry. The final phase is to have staff enter all other data, including
using templates that must be followed including branching to alternative screens or where
narrative notes must accompany some of the structured data entry.
This toolkit was prepared by Stratis Health, the Minnesota Medicare Quality Improvement Organization, under contract with the Centers for
Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily
reflect CMS policy. 10SOW-MN-SIP-HIT-13-06 031313
For support using the toolkit
Stratis Health  Health Information Technology
Services
952-854-3306  info@stratishealth.org
www.stratishealth.org
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