Loretta Gallagher On ‘The Cutover’
The process of transitioning from an old system to a new system.
Loretta Gallagher is the owner of Gallagher Associates, a professional EMR company located in Wayne, New Jersey that provides developmental services to hospitals and corporations across the country. The Cutover is a process of moving from your current state to your new EMR.
Gallagher says there are two main parts to this process. First is the technical items; turning off interfaces to your current system and redirecting them to the new system is a good example of the technical cutover. This happens right before you go live. Technical cutover will likely happen in your command center with your technical team and vendors on-hand. Next is the manual piece of cutover, items that cannot be imported into the new system and need to be manually entered. This will likely be your current patients “head in a bed” demographics (ADT) which consist of height, weight, allergies and all current orders. Clinical leadership will need to weigh in on other items that might be needed for patients. Loretta Gallagher mentions seeing ICU patient’s cutover last four (4) hours of vital signs as an example.
According to Gallagher and her team at Gallagher Associates, manual cutover process traditionally starts 16–24 hours prior to your go-live. The objective is to enter the pertinent information needed at go-live for all patients, head in a bed. Keep in mind, says Gallagher, your old system does not disappear. The data is normally available to clinicians on a read-only basis for some time. Entering all of the information your clinical leadership has determined is necessary will require a large number of clinically licensed staff, a space equipped with all the correct infrastructure, support at the elbow for the end users entering information, and a detailed process to ensure accuracy.
For a large number of clinically licensed staff, Loretta Gallagher has seen success with nursing entering height, weight, allergies and all non-medication (i.e. chest x-ray). It is important to backup data prior to entering new data. Every patient needs to be registered and placed in the correct bed and in the correct unit. ADT (Admission, Discharge, Transfer) has a significant role before anyone can get started. Once all patients are in the new system and it mirrors the old system, nursing can begin entering data. Many drugs are weight-based, and all drugs require an allergy check. This means that no medication orders can be entered until these prerequisite items are complete. Once nursing has finished entering these items, the medication orders can now be entered. A decision needs to be made if providers or pharmacists will enter these orders. Keep in mind that if providers enter the orders, you will likely need a step for pharmacy to verify orders also. Gallagher has seen cutover staffing of 150 clinical staff working 20 hours prior to go-live and recommends to keep up with the current patients and changes throughout the day.
The next major consideration, says Gallagher and her team, is the space to complete cutover. A good strategy is to use your training rooms. Training should be complete by cutover day, and the rooms should be already equipped with the proper infrastructure. This space should be able to handle the large number of staffing needed, and also have enough space for support staff.
Loretta Gallagher: Going Live With Cutover
Going live does not happen if cutover is not complete, so practicing this process and timing is very important. Three dry runs is highly recommended, and all staff should be required to partake in a dry run if they will partake in cutover. The cutover day is a robust busy day, and training staff of what needs to be completed is not the day to do this. Practice is essential to success. Loretta Gallagher and her team at Gallagher Associates in Wayne, New Jersey have been helping companies attain a successful cutover process for over 18 years.