6 Things Your Medical Practice Can Learn From Our Recent Computer Upgrade

During the month of June, we upgraded our entire computer system (hardware and software) here at InHealth – the culmination of two years of planning, testing and hard work.

Although everything seems to have worked out fine in the end (we successfully made it through “Go Live”; two month-end closes and a fiscal year-end close), there were definitely times when we all turned to each other and said “What were we thinking and why did we decide to do this?” As we worked our way through this process, I realized it was not unlike what some of you are facing as you make decisions regarding EHR/EMR implementation.

Here are 6 things we learned (sometimes the hard way), which may help you as you consider your options and make your choices as they relate to technology in your medical practice.

  1. We didn’t necessarily want to upgrade; but, we felt as if we had no choice. InHealth installed its first computer system in the late 80s/early 90s. It was a Unix-based accounting/manufacturing/order entry system that we customized to include a sales and customer-tracking program. Over time, though, while the software itself continued to work and did what we needed for it to do, it became more and more difficult to find the hardware on which it ran and technicians who knew how to support it. We made the decision to move forward with an upgrade because we were at an ever-increasing risk of the system crashing without the ability to be able to get it back up and functioning in a timely and efficient manner. We simply could not risk being down or losing data. Perhaps you’re in the same position – your practice management system is a Unix-based system running on obsolete hardware – and you’re worried about what might happen if your system were to crash?
  2. We decided to UPGRADE our existing software system as opposed to implementing a brand new software package. I’m not 100 percent sure we made the right decision. We decided to do so for the following reasons: we thought the conversion of data would be easier and more accurate; we thought the training of our 300+ associates would be easier if they were learning an upgraded version of what they already knew; and we thought it would be more cost-effective. When all was said and done, we upgraded our system through 13 different versions. The conversion was difficult (maybe even more so than if we had started fresh with a new system); the training was just as intense due to the sheer number of changes to the software; and it wasn’t more cost-effective because we ended up having to customize the existing software to meet our needs. When you begin your search for the right system for your practice – be open-minded. Don’t assume that your only option is to upgrade your current practice management system. There are many options available to you. Explore them and do your due diligence on all of them without giving your existing system a higher ranking than it earns.
  3. When the vendor says “Our system does that,” ask to SEE it. Don’t simply take the vendor’s word for it. We ended up spending a great deal more than originally budgeted for customizations because we didn’t ask to see it. While their system did indeed do it; it didn’t do it the way we needed it to do it. And once you’ve signed the paperwork and you’re well into the implementation plan, you don’t have any choice but to pay it. Had we done our homework in advance, we could have made some if not all of the customizations part of our negotiations with the vendor.
  4. Acknowledge that technology has changed and yours probably needs to be upgraded. While we knew we would be changing out all of our existing main hardware (servers, monitors, PCs, etc.), we did not pay as close attention as we should have to the cabling/wiring throughout our building. We experienced a delay when we went to install some of the hardware as we had to stop and have someone come in and run cabling. We also experienced problems as part of our Go-Live process due to a few wiring issues in the server room which were the cause of some data corruption errors we experienced during the first week. If I had to do it all over again, I would have paid an expert to come in and check our cabling/wiring from one end of the building to the other. It doesn’t make much sense to install brand new hardware throughout the building but to connect it with inadequate cabling/wiring.
  5. Don’t scrimp on ancillary hardware. Each of our associates is connected to the main server via a thin client device. We had used thin client devices previously and decided to save some money by using those instead of buying new ones – after all a thin client is a thin client is a thin client. Right? Wrong! Once we went live, we realized that we were sending a lot more data back and forth from the thin client to the server – and our existing thin clients simply could not handle the work load. The result? The system was crawling (and frustrations were running high).  We ended up purchasing new ones and installing them during the hectic Go-Live week. If I had to do it over again, I would not have assumed the existing hardware would work with the new system. And, once I determined it would not, I would have purchased all new thin clients in advance and saved everyone a lot of stress and frustration. It’s amazing how one little piece of equipment can slow down an entire system.
  6. No matter what anyone tells you, plan for a loss of productivity during the weeks after Go-Live. We did everything possible to plan for the training of InHealth associates on the new system: we limited staff vacations the week before and the week of Go-Live; we staggered training times so we always had associates available to assist customers; we trained some of our outside sales associates after hours so that they could still be in the field visiting clients during the day; we provided customized training manuals and cheat sheets and we had a team of implementation people roaming the office during the week of Go-Live answering questions and helping staff remember how to do it “in the new system.”  Bottom line, though, the new system slowed us down significantly and our productivity was severely impacted during the month of June. As a matter of fact, we didn’t reach peak productivity again until the latter part of July. While I anticipated some loss of productivity, I was not prepared for the reality of the situation and its impact on revenues, invoicing and cash flow. My advice to you – prepare for the worst in terms of loss productivity.

Hindsight is always 20/20 – but I hope seeing our upgrade through our eyes might help you avoid some of the same mistakes or, at the very least, give you food for thought. In our next article, we will discuss more in depth some of the technology requirements of a new system and what you should be doing now to make sure you are ready.



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