HI300 Unit 5 Implementation Checklist Example

Conversion, Testing and the First Twenty-One Days: A Unit 5 Implementation Checklist Taking a Labor and Delivery Unit From Paper Flowsheets to a Live Perinatal System

[Student Name]

Purdue University Global

HI300: Information Systems for Health Care

Unit 5 Implementation Checklist

[Instructor Name]

[Date]

The hospital, dates and staffing are composite; the practices described and the sources cited are real.

Phase 1: Build and Conversion, Weeks 1 to 8

The build phase sets up the system to match the unit rather than the vendor's model unit. Owner: the information services analyst, with the unit's nurse educator. Done test: every location on the unit, including the two operating rooms and four recovery bays, exists in both the perinatal system and the main record, and a composite patient can be moved through all of them. Conversion is smaller than in most projects, because the unit charts on paper. The team decided not to scan old flowsheets into the new system. Patients delivered before go-live keep their paper record in the HIM department, and the main record notes where it is. The one exception is prenatal records from the hospital's own clinics, which are already electronic and must flow into the new system before go-live. Owner: the HIM analyst. Done test: prenatal summaries for ten composite patients display correctly on the labor unit.

Phase 2: Testing, Weeks 9 to 12

Testing runs in three layers. Unit testing checks each form and alert as built. Integration testing sends composite patients through every interface flow, including a transfer to the operating room, a newborn birth and a discharge, and checks each against the expected result. Scenario testing has labor nurses chart a full composite labor, from admission to delivery, at the bedside, while a second nurse times the work and records each problem. Owner: the project lead. Done test: no open defect rated severe, and every moderate defect has an owner and a date. Training happens alongside testing. Every nurse, midwife and obstetrician completes four hours of hands-on training within the three weeks before go-live, not earlier, because skills fade quickly when they are not used. Each shift also gets two super users, nurses who receive a further day of hands-on practice and become the first person their colleagues ask. The scenario test is the only one in which a nurse charts a whole labor. It is also the test most often cut when a schedule slips, and that cut is the one this checklist forbids. Training content follows the requirements rather than the vendor's standard course. The scenario that nurses practice is the night shift the analyst observed: three laboring patients, one with a category II tracing, one moved to the operating room and one delivering at the bedside. Physicians train on the same scenario from their side, entering orders and signing the delivery note. Training that rehearses the unit's own hardest night is more useful than a tour of every screen.

Phase 3: Go-Live, Day 0

Go-live is set for 06:00 on a Tuesday, chosen because the scheduled induction list is shortest that morning and the full project team is on site. Two decisions are written down and signed before the day. First, patients already in labor at 06:00 stay on paper until delivery. Moving a laboring patient's chart mid-labor risks losing the sequence of interpretations at the moment it matters most. Every patient admitted after 06:00 is charted electronically. Second, the rollback rule. If the system cannot display tracings at the bedside for more than thirty minutes during the first twenty-four hours, the unit returns to paper and the project team decides within four hours whether to try again. Owner: the chief nursing officer. Done test: the rule is signed and posted at the nurses' station.

Phase 4: The First Twenty-One Days

Days 1 to 7: super users and vendor staff are on the unit around the clock. A command center log records every problem with the time, the room and the fix. The project lead reviews the log twice a day. Days 8 to 14: support moves to the day and evening shifts, with a phone line at night. The educator observes three charted labors each day and records the time to enter an interpretation, compared with the target of three actions set in the requirements. Days 15 to 21: the team reviews the log for patterns, such as the same alert ignored repeatedly or a form bypassed with a free-text note. Workarounds discovered here are the early signs of a design problem rather than a training problem, a distinction the literature on unintended consequences of clinical systems makes clear (Ash et al., 2004).

What Makes the Checklist Work

The checklist reflects three lessons from the literature on large implementations: bring in the staff who will chart in it, test with real work rather than features, and plan for the first weeks of live use as a phase in its own right (Cresswell et al., 2013). It also respects a point from studies of system downtime, that a plan for when the technology fails belongs in the implementation from the start (Larsen et al., 2018). The unit's downtime procedure is written and practiced in Phase 2, not after the first outage.

References

Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104-112. https://doi.org/10.1197/jamia.M1471

Cresswell, K. M., Bates, D. W., & Sheikh, A. (2013). Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association, 20(e1), e9-e13. https://doi.org/10.1136/amiajnl-2013-001684

Larsen, E., Fong, A., Wernz, C., & Ratwani, R. M. (2018). Implications of electronic health record downtime: An analysis of patient safety event reports. Journal of the American Medical Informatics Association, 25(2), 187-191. https://doi.org/10.1093/jamia/ocx057