Managing the Medico-Legal Risks of System Migration

Liz PriceTraining and Consultancy Manager

Why problems occur

Implementation poorly planned

Poor communication within the team

information, shared planning, listening to feedback

Lack of ongoing flexibility within process

Not considering ALL stakeholders

Lack of training

wrong time, wrong emphasis

People undermine the process

The Role of the Practice Team

Recognise and accept that change is required

Identify barriers to the change - and ways of overcoming

Plan how the change is to be implemented:

internal and external focus (responsibilities, impacts, risks)

Monitor and evaluate how successfully change is

progressing

communication, feedback, early warning signals

Deal with the consequences of change:

additional training, review of systems, awareness of risks

Maintain business as usual

The planning process

Define the scope:

What do you want to achieve? Get to know the new software

especially where it’s different (views/actions/workflows) Identify the key stakeholders

practice team, patients, pharmacies, attached staff etc Identify and plan a timeline for change (GANTT charts)

Review systems of workingdo they need to change?

Develop a ‘Communication Plan’ pre/during/post and internal/external

Identify team and individual training needs Identify potential risks

Training Needs Analysis (TNA)

Risk The system supplier may not identify your real needs: Lack of understanding around the practice current systems of

working Inability to complete a gap-analysis between old and new Lack of knowledge of individual strengths and weaknesses in

relation to IT within the team

Potential Pitfalls Increased incidence of clinical and administrative errors

after implementation, for example:1. Items in the ‘wrong’ place on the page (e.g. appt books)2. Data not matched in new system (e.g. immunisations)3. Incorrect data entered into patient records

Training Needs Analysis (TNA)

Solution Ensure you compete your own TNA

Examine the new system in relation to your current processes (visit practices)

Where are the gaps? Where do things look really different? Who are your problem team members? Where will the language have to change? Which practice processes need to be adapted to fit the new system? What workarounds did you create in the old system – manual

matching? Try to avoid ‘workarounds’ as these can make life difficult later on Supplement training by your supplier with individually tailored add-

ons

Patient Management/Communication

Risks Patient demands outweigh resources during

implementation Patients do not understand that services may be

disrupted

Potential Pitfalls Increased incidence of patient complaints Complaints not being dealt with as empathetically as

normal

Patient Management/Communication

Solution Create a project plan in relation to managing service

delivery including patient communication around the implementation period

Consider reduced service provision during migration and implementation weeks

Identify the key services you must provide, for example: Emergency surgeries only / Acute prescriptions Ask patients to request repeats before the date of change where

possible Postpone coding where possible Ensure patients have positively-framed information well in advance,

during and after (thanks) Remember that some patients will need questions

answered/reassurance

Post migration week: data extraction and re-entry

Risks Data re-entry following migration week

Potential Pitfalls Information is updated incorrectly into the patient

record Consultations are transcribed incorrectly into the

records

Solution Agree a plan in advance and identify mismatches

early

Utilise a recommended data extraction tool Or set up paper templates for record-keeping (labels?) Encourage doctors and nurses to ‘cut and paste’ their own

consultations

Migration week: data extraction and re-entry

General points

Ensure old system data is archived securely and is retrievable

Disc Image + attached functions (e.g. appointment book)

VISION – ‘treatment groups’ (e.g. GP service provision/school nurses)

Planning priorities checklist