How to improve information system installations

Healthcare Financial Management, June, 1990 by Vince Ciotti, Karl Sydor

Since hospital information systems (HIS) first were introduced in the mid-1960s, tremendous advances have occurred in computer hardware and software. In hardware alone, today's personal computers that cost only a few thousand dollars offer the same raw computing power and storage capacities as old room-sized mainframe systems that required investments of several million dollars.

HIS applications also far outpace early uses and now can serve every ancillary department in a hospital. Some facilities also have chosen automated bedside systems.

Despite these advances, the process of installing new information systems has seen far less progress. Poor conversions still occur with alarming frequency, resulting in unhappy buyers, disgruntled users, and even unemployed hospital executives.

With growing strains on hospital finances, few institutions can afford expensive implementation errors. Hospitals considering information system purchases should review a list of practical tips on what to pursue and what to avoid during installation stages. What to pursue

Use a project management system. One of the latest developments in computer systems, PC-based programs manage the tasks, people, and deadlines of a complex computer conversion. These products cost only a few hundred dollars and produce elaborate charts that can help manage resources needed to complete a conversion on time and under budget.

Of equal importance, project management systems give hospital staff members more involvement in assigning responsibilities and setting agendas for periodic review meetings, rather than leaving the vendor to manage the project. Even if a hospital cannot afford this software, it should automate "to-do" lists, tracking who is assigned to certain tasks and the corresponding deadlines, so slippages can be detected early, reminder notices sent out in a timely fashion, and extra resources allocated to problem areas.

Involve all management levels. Because an HIS effects all levels of a hospital, executives and managers need to be involved in the implementation process. Exhibit 1 illustrates how multiple levels of an institution should be involved in various committees: he The chief executive officer (CEO)

or chief operating officer (COO)

should lead or attend monthly

steering committee meetings that

include the chief financial officer,

management information system

(MIS) director, and vice presidents

who oversee ancillary departments

and nursing; * The MIS director should lead biweekly

application committee

meetings with managers of departments

effected by modules

being installed; and * Task forces of working supervisors

should meet weekly to

jointly complete system master

files and code tables, as well as

draft policy recommendations

and procedures for management

approval.

Several levels of vendor personnel also should be involved in these committees: the regional or area manager at steering committee meetings and the installer at application committee and task force meetings.

Develop a detailed work plan. Ideally, during contract negotiations for the new system, a detailed work plan should be drawn up and agreed on by both parties. The plan should include the number of days that are required to perform each step and an idea of what should result when each task is complete.

Most vendors supply a "boilerplate" that lists steps required for conversion. As might be expected, however, most of the work in their plans is assigned to hospital employees, and a hospital should carefully ascertain how often vendor installers will be on site and what they will do. Such a plan can reveal hidden charges the vendor will make for "extra" days on site by their staff, enabling the hospital to negotiate the price.

The plan should be managed through regularly scheduled status meetings to check off tasks as completed or get them back on track.

Set priorities for system applications by the hospital's needs. In what order should various applications, such as patient accounting, order entry, and laboratory, be installed? Vendors would be wise to implement procedures that maximize cash flow first, to collect -acceptance" money as early as possible.

Hospitals' priorities are different: First install applications that have current contracts expiring or offer the greatest benefits in terms of full-time equivalent reductions or cost avoidance. It is often wise to start with a relatively "safe" application-such as accounts payable to test the hardware, operating system, and basic application software while only risking a hospital's cash outflow rather than inflow.

Lower user expectations. If the vendor selection process is done wisely, user departments should have ample time to learn the system's weaknesses as well as its strengths. By talking with other users of a vendor's products, reading user manuals, and making site visits, users soon understand that buying a new system is only the start of their work, not the solution to their problems.

Test and retest. Many information systems managers have been in the field for 10 or 20 years, leading them to think that their "hard knocks" experience alone will protect them from common pitfalls. But the increasing complexity of HIS applications can be deceiving, and only a full system test can reveal unpleasant surprises in advance.