For a while big-bang rollouts of health IT projects were popular. But many organizations realized that rushing in could lead to mistakes—and that it’s difficult to make corrections after go-live. With computerized physician order entry in particular, many organizations rolled out order sets only to find that physicians were unhappy with them, that data was missing, or that there were so many sets that physicians were tuning them out. Some organizations eliminated all but the most crucial order sets … and then started the process all over again. Perhaps the most vivid example of big bang gone bust occurred at Cedars-Sinai Medical Center in Los Angeles, which, in 2002, pulled the plug on its multimillion-dollar CPOE system after hundreds of physicians complained that it was endangering patient safety and required too much work. The lesson: Better to get it right the first time.
On the heels of this and other cautionary tales, organizations slowed down, first taking pains to make sure every single stakeholder had a hand in developing the programs, conducting small tests and pilot programs before go-live, then performing gradual rollouts hospital by hospital, department by department, and even unit by unit. But that method has its drawbacks as well. Some argue it’s not safe. And it takes a long time. With CPOE a key component of meaningful use requirements, organizations can’t afford to dally over endless tests and consensus-building.
At the 386-staffed-bed North York General Hospital in Toronto, Canada, leaders were nervous about going big bang. They considered conducting a small pilot program; spending a month or two in a semi-live environment to make sure everything ran smoothly.
But they quickly realized that a pilot wouldn’t get them much further ahead in the process of implementing CPOE. On top of that, they believed it would complicate patient flow and cause confusion over which records were paper and which were electronic.