By Barbara C. Robbins, RN, MBA
Alpha, Beta, Pilot and Production describe phases of software
development, availability and delivery avenues. It is helpful to
understand these phases when implementing new technology,
particularly electronic medical records (EMRs) to impact the
greatest change, or Delta. Today’s health information management
(HIM) professionals seeking to implement EMRs can leverage
additional functionality and greater acceptance of the application
by further understanding the unique aspects of each of these
development phases.
The approach to applying the right phase of EMR technology and
requirement enhancements may delay the project, but it can also
establish increased clinician buy-in and problem solving in the
work process. And when implemented in a deliberate process, an
integrated EMR with a single patient database can turn short-term
benefits into a process for achieving the long-term goals of
increasing productivity, process efficiency and positioning the
health care business and clinical practice with competitive
advantage.
All technology frontrunners agree on the value of implementing an
EMR. What do health care providers experience in working toward
contributing to enhancements in production technology and
implementing the technology? Should decision-makers consider alpha
software or apply beta software; or wait for pilot and do nothing
about working toward Delta in the interim? Maybe the Production
delivery is best for your health care facility? The answer: It
depends.
Guidelines for Implementing an
EMR
Before examining the phases of development more closely, it is
helpful to learn more about approaching EMR implementation with a
rigorous process. The following illustrates an anecdotal approach
in EMR implementation to achieve Delta in work process:
1. Identify the need and benefit of an EMR.
2. Accept and agree on requirements for an integrated system and
establish a sense of expedience that change must occur.
3. Coordinate with administration to solve recognized challenges
or there will be no buy-in to adopt EMR.
4. Include clinicians that must adopt the EMR in the
problem-solving process.
5. Communicate the strategic imperative to implement an EMR.
Without full compliance, the benefits of an EMR cannot be fully
recognized.
6. Realize that the process of change will involve some
discomfort.
7. Understand that the development of technology is fast and the
absorption rate and adoption rate can be slow.
8. Continue to make progress. Achieving Delta is never the Omega
(or end), but rather is the first step in continual improvement to
work process.
Alpha Development
Alpha technology is applied specifically in the health care
facility for two reasons. The first and most common reason is that
the software needs further development before the quality-testing
phase begins. Aspects of the EMR may not be fully developed to
apply in the patient treatment process in a considered “clinically
safe” manner. Additionally, applied use in the “real world” and
other input must be gathered. The EMR will have specific
components that need “field testing” to provide additional
feedback to the software engineers. Involving different levels of
clinicians in the process of applying the EMR with a practice
database of sample treatments yields significant feedback and
requirements for development that subsequently result in quality
testing.
The second reason to apply alpha technology is that staff with
production software may want to become familiar with
soon-to-be-released enhancements before applying the upgraded
version facility-wide. Alpha testing of an EMR application is
usually very limited because resources are drained from the
developer to educate, communicate, support and work conjointly
with the clinicians. There often is no added monetary
responsibility by the customer other than to provide a separate
server and abide by system requirements in which the alpha EMR
“lives.” The clinicians and HIM professionals provide the needed
additional requirements to achieve the next phase in the EMR
development. Alpha software becomes Beta software when it can be
fully tested in-house and the requirements have approached the end
of the development process and have passed quality control
standards.
Beta Implementation
The Beta EMR can be applied in a clinical environment with the
technology carrying out patient treatments and documentation. A
health care facility with Beta software is usually a long-term
customer that needs the enhanced version as opposed to continuing
with “work arounds.” Some Beta customers applying the software may
be new to the application, but in so much “pain” with their work
process that expectations of the beta software application are a
welcome relief. Beta software is best described as a solution that
delivers clinically safe treatments with software, but that may
present challenges or “hiccups.” This type of facility has a goal
to implement a new and enhanced solution, but may not always have
confidence in their decision to work through Beta to achieve their
absolute Delta. Achieving Delta signals the ultimate change in
managing patient information and delivering patient treatments.
While implementing Beta software brings significant rewards,
challenges may also arise. Some administrators and clinicians may
be uncomfortable with the uncertainty associated with Beta
software, however most facilities frequently volunteer and prefer
Beta software. Why would they favor Beta software? These
facilities are the technology “front runners”—early adaptors and
involved leaders—that drive application use and enhancements
forward to significantly improve the software for Pilot and
Production releases.
Implementing Beta Software
Each facility must develop a unique action plan and methodical
approach to implementing a Beta EMR. The goal is to overcome
challenges to benefit from the successes in applying EMR. Going
back to the process steps outlined previously, the first step in a
successful implementation is the consideration of what needs to
change in the current system. If no change is needed, no change
will occur. One must identify what is good in the change process,
what is bad, and realistically, what is ugly.
The action plan must also include a system configuration to align
with the desired process. If the facility has a previous system(s),
the data will need to be converted. Before implementation takes
place, thorough training must occur, including an education of how
the software applies to the process flow. After implementation,
evaluate and perform problem-solving analyses to determine
effectiveness; often, reconfiguration of the system and retraining
must take place. A plan should always include additional time and
resources than originally projected to ensure implementation
occurs with the highest possible degree of success.
Pilot and Production in
Facilities
Pilot and Production are readily identified terms that signal
release for rollout and widespread distribution of a new product.
The complex arena of patient treatment delivery and information
systems accentuates the need (and capability) to streamline
process efficiencies, comply with regulations, and enhance
treatment delivery and information management accuracies. An
information system that captures treatment delivery and patient
documentation technology is able to provide truly integrated
clinical and administrative patient management information
solutions through a single patient database, leading to a total
solution and process change.
Achieving Delta
The world of technology developers and health care providers
working together to streamline the patient treatment aspects and
documentation with efficiency and accuracy is still evolving. One
may wonder why health care software, in use for more than 30
years, still must evolve. The reason is that health care practices
are always changing, striving for better ways to deliver patient
care, contain costs and work more effectively and efficiently.
Unequivocally, the development of technology is fast, but the
adoption rate is slow in comparison. Nevertheless, the sum of the
parts will always be greater than the whole—and implementing Beta
software is the first step in affecting diligent changes to impact
the practice. For HIM professionals, Delta is not the end. Each
incremental change can help forward the practice toward the end
goals.
Barbara Robbins works with health care facilities to increase
clinician productivity and enhance patient treatment delivery
through applied electronic patient record technology. She
currently works as the manager of market development at IMPAC
Medical Systems Inc., Mountain View, CA, and can be reached at
brobbins@impac.com.
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Julie DeSantis
Public Relations Manager
IMPAC Medical Systems, Inc.
650-623-8883
pr@impac.com
http://www.impac.com
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