| Overcoming problematic training before go-live |
| Creating own training programs in the live/simulated environment before go-live |
We spent a large amount of time developing training scenarios and helping faculty and staff run through them. I believe having our entire faculty and staff run through training together in a live but simulated environment together was invaluable.(family medicine) Our clinic admin… created her own training program… Far superior to what we got from the official training program because she knew our unit, our needs and our flow patterns. She organized a field trip to the Cleveland Clinic where they have used EPIC for about 10 years. This allowed us to actually see a working clinic—and it was a real eye-opener….(surgery) Ran personalization sessions for our department prior to go live, really was just another pseudo training but was well received.(family medicine)
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| Adapting and customizing the system to their own workflow before and after go-live |
Doing the workflows at a round table before go-live was most helpful at ferretting out the issues and educating our local users about those issues and workflows. I think the education we provided regarding the adaptation of our workflow (eg, how letters to referring physicians can be created in this system) might have been helpful.
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| Obtaining more at-the-elbow support after go-live |
| Looking for additional help |
Our nurse coordinators who served as superusers… really knew the system and were adept at helping their colleagues and physicians.(surgery) Finding a tech savvy “teenager” who needed a part time job, who problem solved and sat with the nurses and physicians one on one and coached them through.(surgery)
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| Physicians volunteering to provide timely and inclusive help |
I spent a week in the clinics helping individuals optimize our approach and ultimately formulated a standardized way for our clinic to utilize MiChart that would be consistent among residents and attendants.(surgery) Biggest success was my department clearing time for me to walk around to clinics and help people in clinic as they were getting used to using it. People knew they could call me and I'd talk them through things.(internal medicine) Being there as we went live. I worked a lot of extra hours but it showed support…. Establishing a routine of answering any emailed questions by the end of the half day (allowing for decreased disruption of clinical activities): responses went to the entire clinical staff in an attempt to give as many as possible the information, rather than only the questioning individual. Timeliness of response went a long way in getting “buy in” to the system.(pediatrics)
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| Facilitating peer support |
The team work within our clinic with every one trying to help each other out.(anesthesiology) We make the best of things and try to help each other out. Units which have greater cohesiveness—they get along well, know each other, and work well BEFORE implementation probably did the best because the implementation process stressed the social links of the units. Stronger groups would usually do better.(surgery) We did several sessions with multiple types of providers, and were able to identify several crucial problem areas that we were able to define some kind of work-around.(internal medicine)
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| Adapting sociotechnical context to make the system work better |
| Changing practices/workflow after go-live |
A critical component of this approach was to accept changes in our practice and work flow to allow the new system to work efficiently for us, rather than rigidly holding on to our old practices and “force feeding” it through Epic.(dermatology) We held 3-4 dry runs with the MA's, PA's, nurses, and faculty so everyone had a better idea of the workflow. Everyone's had to adjust to MiChart to some degree, but I think it's working well in most aspects.(surgery)
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| Optimizing the system before and after go-live |
I think having a smartset and smartphrases that I helped generate has provided templates for new patient notes, and progress notes for different types of [clinical activities].(internal medicine) It was important to have myself and [Administrator Name] familiar with the system beforehand and to have many of our templates, smart sets, and preference lists in the system before Go Live.(surgery) My familiarity with the system was helpful to troubleshoot problems, know when something ‘isn’t working as built' or ‘not working as desired’, when to submit tickets and general moral support.(internal medicine)
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| Creating a positive and honest atmosphere after go-live |
Positive responsiveness to clinical staff (when making suggestions for design of SmartPhrases, etc. for information capture) enables the staff to feel they are improving the system!(pediatrics) People sometimes complain for good reasons. It may be important to keep a positive attitude, but we should not try to silence dissenters as they may have the right outlook to prevent problems. Physician Champions are important, but credibility will be lost when people are championing something that doesn't deserve as much merit as it deserves. Honest appraisals of what to expect will be better received and will garner more support in the long run.(pediatrics) Trying to stay calm so that others stay calm.(area withheld)
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