When it's time to replace the health IT system and how to do it

On the one hand, the IT system is crucial, while on the other, it is often disliked. It does not work as it should, crashes a lot, is hard to work with, is user-unfriendly, and lacks the features physicians, nurses, receptionists, or executives need. When requests for modifications, upgrades, or updates fall on deaf ears, the IT system becomes a burden instead of the promised assistant supporting the administrative and clinical processes. So what needs to be done?

Honest internal audit

The first signal that the system needs changing are common crashes. The emphasis is on "common," as IT programs for healthcare facilities are "living beings" which require constant development to follow the legal framework and generate documents following the new standards. Every upgrade involves the risk that something may go wrong. However, large IT companies react quickly by preparing patches to remove bugs. This is not a reason to change the system, but it is instead a common issue among IT providers. But some situations frustrate and drag on forever: the IT provider says everything works at their end, while the employees say otherwise; new administrative requirements are introduced with an unjustifiable delay; and tech support cannot be reached. Or the facility may have reached the limit of the program's capabilities, meaning it cannot keep up with technological and organizational progress. Here a decision has to be made: should the system be fixed or replaced? One thing is sure: something has to be done. Otherwise, the workers will quickly become annoyed and overburdened, dangerous crashes may occur, and an atmosphere of chronic frustration may develop, affecting the entire organizational culture.

Create a task force team and be ready that things won't go well in the beginning

Here is a typical list of questions to help conduct an IT audit that will help to make a final decision:

• What exactly is the problem? Avoid generalizations, e.g., "The system does not work," "There are missing functions," "The system is not up to date," or "The system is too slow."
• Have the employees been adequately trained?
• Are the issues reported by the entire team or by individuals?
• Has the system been configured properly?
• Are updates released on time?
• How are questions regarding critical functionalities resolved?
• Are the work procedures the bottleneck?
• Do the on-site IT team and the provider's tech support help the users enough?
• Does the IT provider offer webinars and instructions when new features roll out?
• Is the system functionality competitive with rival solutions'?

An honest investigation must be conducted with the IT provider's representative. It may be beneficial for the users to confront the IT workers and implementation department personnel if needed. Sometimes, the mistake occurs at the IT provider's end, while other times – at the facility. For example, the system may feature an outdated user interface (responsibility on the provider's sited), or the need for specific functions resulting from development plans was forgotten when choosing the IT system (facility). Regardless of the causes, the decision to change the system has to be well thought out and rational. Otherwise, it is likely to mean wasting the already-invested money. Cold financial calculations matter rather than emotions. If sticking to the present system means further costs and organizational inefficiencies, there is no reason to wait longer. Implementing an IT system is often compared to a marriage – being in an unhappy relationship is unhealthy.

Check what is critical to succeed

The decision is made, and the budget is there – what now? Firstly, a project schedule needs to be written up. Depending on the facility size, this project may take months. Secondly, a list of all IT resources must be made, and the old system must be thoroughly documented. This will help recreate the already well-oiled processes and fix those that work poorly. Thirdly, the list of required functions must be verified, emphasizing the elements missing from the previous system. Finally, create a task force team with IT workers, representatives of healthcare professionals, and provider IT experts. The first and the most challenging is a smooth database transfer from the old to the new IT system. But this is something the IT provider should do.

Reality verifies even the best of plans         

That is it for the theory. In practice, anything may happen. Digitization relies less on the system itself and more on IT project management. Thus, several non-IT elements of digitization should be looked into:

• Allocate plenty of time for training. The training schedule should match the reality so it does not collide with employees' responsibilities and does not require them to train during overtime at home.

The breaks between training sessions should not be too long; otherwise, the employees may forget some of what they learned. Although the training schedule should be planned several weeks in advance, there should be a degree of flexibility shortly before launching the system – when it is clear who still has problems with using the system. Organize training sessions until every user feels confident when interacting with the system. Ask the provider's consultant for honest and regular feedback regarding your team's skills.

• Prepare plan B and announce potential problems at the start. Within the first few days after launching the new system, it is almost certain that some people will say: "Why did we ever move away from the old system" or "It's even worse now."

The CEOs should organize regular meetings with the team and repeat that it will feel worse before it gets better. However, backup plans should be ready, as you can't justify long waiting times and other disruptions with IT system upgrades.

• Create a change management center. Do not leave your employees all alone when a problem appears. To manage the implementation of the new program, create a team of the IT provider's consultants (on-site and online), board representatives, implementation leaders in the facility and IT technicians. Everyone should be available during the healthcare facility's working hours – it is best to create a list with responsibilities matched to individual people and telephone numbers. Create a financial cushion in the budget if the training needs to be prolonged – this should help avoid unnecessary arguments with the IT provider.

• Monitor the state of the implementation thoroughly. Ahead of time, create a list of the most relevant KPIs (key performance indicators) that can serve as a basis for assessing the implementation progress. This may be a regular employee survey, data quality checks etc.

Validate the progress weekly in the first three months and once a month afterward (depending on the progress). Using an anonymous survey, ask your employees how confident they feel when using the new system and which functionalities are still problematic. Organize summary meetings to discuss progress in the areas which led to moving away from the old system in the first place. Do not sweep anything under the rug – if the team trusts the board, a sincere dialogue can only aid in managing the change. Create an atmosphere of support – all the workers must know they can share their concerns. These are only a few elements of replacing the IT system in an organization. Moving onto a new IT infrastructure is not easy, as the team may get used to even poorly implemented software. Such "digital apathy" can slowly break down the organizational culture and weaken the facility's potential to improve service quality and reinforce employee satisfaction. This is where more problems begin, so be sure to avoid sticking to somehow working but frustrating software.