Cerner has changed its implementation project methodology from a waterfall to a more agile method known as TIP. As a Program Manager for a beta TIP project, some of the lessons learned with this change are these:
TIP methodology-outlining a project plan, with tasks and hours is much more challenging.
- The TIP implementation project methodology or The Iterative Process was created as a series of workshops, to discuss design, then Cerner does the build and comes back with the build from the data it collected, as a current state which is your future state with Cerner. Often model content is used and aligns with standardized data and processes.
- The older framework is no longer used which did an excellent job of outlining the number of hours or time that was needed to truly do an accurate current state review, to be certain all workflows were accounted for and documented.
- This makes outlining a project plan difficult if you are now a seasoned PM, and have not provided Cerner implementation project services in the past, as you have no guideline on the total hours your team will spend. This is definitely something Cerner is working toward, so that small or large-scale implementation hrs. are not underestimated when looking at the workshops.
- Be certain to spend time as a part of each workshop assignment to take the time to account for each workflow.
- This more condensed version of project assignments includes utilizing a model design. Review the assignment information with your SMEs again, once your data is collected.
Core applications which include Organizations/Facilities/Locations and access security should stay in Core. These were separated as part of TIP, and this created miss-matches in locations, and not all teams assisting in decision making were using actual legal names. This created some rebuild to align them with CLIA, CAP agencies which require the information to be exactly as approved by the governing agency. This is something that Cerner agreed would be done, as it impacts the hospital and the ambulatory locations, and can have a ripple effect on Faxing/Referrals/Consults/Message Center to name a few of the tools.
Do not underestimate:
A Key decision process-use of documenting decisions and why the group agreed to the decision.
- Often when everyone starts to use the new electronic health record, as soon as there is a dis-satisfier, the first request is to immediately change the design, rather than look at the workflow that was used which caused the dissatisfaction, and ask if the correct workflow was used-Y or N.
- Use the Key decision documents to align with workflow, be certain workflow is followed, and make certain that the build is in line with the decisions.
Mapping out current state workflows-do this with your working staff. Often time’s managers are SMEs, and what they perceive is the workflow is often different than those that carry out the tasks each day. If possible have lunch in the breakroom and have the staff walk thru the processes, you will be amazed at what the staff is doing to get processes complete. Listen to what they are doing, and talk about what would make their workflow easier, write down those ideas to be discussed at the workshops.
Applications with no Test or Build domain, and building and validating processes would occur in the production domain. Ex: Clairvia-the organization can and should request a test or build domain. This can be made available, and the organization has to require it. This will allow you to have a separate domain to validate the new build or changes requested. This is needed to be certain there are no concerns, as changes occur because they will change in the non-prod domain, and can be thoroughly tested.
Nursing/Patient Ratio tools, like Clairvia, should have workshops that should start earlier in the process, as it takes time to gather the information associated with this tool a long time. As you need time and attendance numbers, as you will need to utilize HR tools, rev. cycle tools and scheduling tools.
Please come back to review more lessons learned in our next Cerner blog, with regard to future state.